Pleural Effusion Flashcards

1
Q

How do we seperate exudate and transudate pleural effusions?

A

An Exudate contains >30g/L of protein

A Transudate contains <30g/L of protein

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2
Q

What is an exudate pleural effusion?

A

Fluid leaking out capillaries with an increased permeability, often due to inflammation

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3
Q

What is a transudate pleural effusion?

A

Fluid forced out capillaries due to high venous pressure.

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4
Q

What are the common symptoms/signs of pleural effusion?

A

Symptoms - Chest pain, Dyspnoea
Signs - Reduced chest expansion & vocal resonance, stony dullness to percussion and increased jugular venous pressure (JVP).

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5
Q

What are the common causes for a transudate effusion?

A

Left Ventricular Failure
Liver Cirrhosis (leads to low albumin)
Hypoalbuminaemia
Peritoneal Dialysis

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6
Q

What are the common causes of an exudate effusion?

A
Malignancy
Pneumonia or Abscess
Pulmonary Embolism
Autoimmune
Pancreatitis
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7
Q

What investigation is done to confirm a pleural effusion?

A

A CXR

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8
Q

What investigation is done to determine the type/cause of the effusion/

A

An aspiration. 50ml is removed with a 21G needle and tested.

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9
Q

Waht are the complications of aspirating a pleural effusion?

A

haemothorax
Air embolism
Pulmonary Oedema
Pneumothorax, empyema

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10
Q

What can you tell just from looking at a sample of aspirated pleural effusion?

A

Foul smell - Anaeorbic empyema
Food - Oesophageal Rupture
Milky - Chylothorax
Blood Stained - Malignancy, haemothorax, trauma

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11
Q

What can we test an aspiration sample for in the lab?

A

Increased amylase - Pancreatitis
Protein level - exudate/transudate
Bacterial cultures
Malignant cells, lymphocytes and eosinophils

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12
Q

How do we distinguish between exudate & transudate when its very close to the tipping point?

A

If an of Light’s criteria are met its an exudate:
pleural/serum protein > 0.5
Pleural/Serum LDH > 0.6
Pleural/Serum(upper limit) LDH > 0.66

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13
Q

What tests can be done for a pleural effusion?

A
  • CXR
  • CT
  • Pleural Aspiration
  • Pleural Biopsy
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14
Q

What kind of pleural effusion is unilateral vs bilateral?

A

Exudates are often unilateral

Transufates are oftem bilateral

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15
Q

How do we treat a pleural effusion?

A

The fluid must be drained. Patient’s bed at 45 degrees with arm above head. drain in 4 Intercostal space in mid-axillary line.
Pleurodhesis can be performed if repeat offender. (talc poudrage)

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