Pleural effusion

Question 1

What is pleural effusion?

Answer 1

Excess fluid accumulates between visceral and parietal pleura layers

Question 2

The fluid is either?

Answer 2

Transudative
Exudative

Question 3

What is transudative fluid?
Protein levels?
due to?
how the liquid looks?
examples of diseases causing that fluid build up?

Answer 3

Low protein <25g/L - due to high hydrostatic pressure or low oncotic pressure
TRANSparent
eg. chf, liver cirrhosis, nephrOtic syndrome

Question 4

What is Exudative fluid?
Protein levels?
due to?
how the liquid looks?
examples of diseases causing that fluid build up?

Answer 4

High protein >35g/L due to INFLAMMATION causing vascular permeability
CLOUDY
eg. cancer, TB, pneumonia

Question 5

Sx of pleural effusion?

Answer 5

general dyspnoea, pleuritic chest pain, cough, low breath sounds,
DULL PERCUSSION (increased fluid) on IPSILATERAL SIDE

Question 6

What is a Ddx diagnosis?

Answer 6

Pneumothorax = hyper resonant

Question 7

Dx
1st line + GS?

Answer 7

1st + GS = chest x ray

Thoracocentesis (aspiration of pleural fluid) = sample fluid - pH, Lactate, WCC, Microscopy = to see if transudative or exudative

Question 8

What would be seen on the chest x ray?

Answer 8

decreased costophrenic angles (‘blunting’), excessive fluid appears WHITE +/- tracheal deviation

Question 9

Tx?

Answer 9

Chest drain
If recurrent = Pleurodosis (surgical fusion of pleural layer to prevent fluid build up)

Question 10

What is Light’s criteria?

Answer 10

used when protein 25-35g/L
‘grey area’