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RESP > Pleural Effusion > Flashcards

Pleural Effusion Flashcards

1
Q

What are the two types of pleura and what do they correspond to?

A

Visceral- outlines the lungs Parietal- outlines the chest wall Pleural cavity- between these two layers

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2
Q

What is the function of pleural fluid?

A

Provides lubrication for the two pleural layers to slide over one another

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3
Q

Are the hila of the lung covered by pleura?

A

No because the two layers combine around the hila.

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4
Q

The pleural layers combine to form the _ _

A

Pulmonary ligament

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5
Q

What is pleural effusion?

A

Abnormal collection of fluid in the pleural cavity

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6
Q

What are some common causes of pleural effusion?

A
  1. Chest infection/ lung cancer 2. Heart failure causing back flow i.e. oedema 3. Rheumatoid arthritis
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7
Q

What are the symptoms of pleural effusion?

A

Depends on underlying cause 1. Breathlessness 2. Chest pain

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8
Q

What does straw coloured pleural fluid suggest?

A

-Hypoalbuminaemia - cardiac failure

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9
Q

What does bloody pleural fluid indicate?

A
  • Infection - Cancer - Trauma - Infarction
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10
Q

What does turbid/milky fluid indicate?

A

empyema, Chylothorax

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11
Q

Prensence of food substances in the pleural fluid suggests what?

A

Oesophageal rupture

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12
Q

What area some causes of a bilateral effusion?

A
  • LVF - Drugs - Pulmonary-thrombo-embolism
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13
Q

What are transudates and exudates in relation to PE?

A

Transudate- disruption of oncotic/hydrostatic pressures across the pleural membranes Exudate- leaky pulmonary capillaries, as a result of inflammation

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14
Q

What levels of protein are seen in transudate & exudate pleural effusion?

A

Transudate= < 30g/l Exudate = >30g/l

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15
Q

Clinical implications of both types of effusion?

A

Transudate - LVH - Liver cirrhosis - Hypoalbuminaemia Exudate - Infection - Malignancy - Pulmonary infarct Exudative pe- Serious pathology

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16
Q

What does a lower than 7.3 fluid pH suggest?

A

Pleural Inflammation

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17
Q

Glucose levels are low in pleural fluid caused by infection , malignancy, rheumatoid etc. T/F?

A

True

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18
Q

What microbiological tests are carried out in pleural effusion?

A
  1. Gram stain 2. PCR 3. Culture
19
Q

What is thoracentesis?

A

Using a needle to draw the pleural fluid out.

20
Q

What are some tissue biopsy tests that are useful for pleural effusion?

A
  1. Thoracoscopy 2. Blind percutaneous pleural biopsy 3. CT guided needle pleural biopsy
21
Q

What is a mesothelioma?

A

Malignancy of the lining of the lung or the lining of the abdominal cavity

22
Q

Biggest risk factor for mesothelioma?

A

Length and degree exposure to Asbestos

23
Q

Symptoms of mesothelioma?

A
  • Chest pain - Breathlessness - High fever - Malaise - Weight loss - Sweating - Cough
24
Q

Some investigations for mesothelioma?

A
  1. Imaging 2. Fluid aspiration 3. Biopsy
25
Q

Treatment options for mesothelioma?

A
  1. Radiotherapy 2. Chemotherapy 3. Surgery 4. palliative
26
Q

What is pleurodiesis?

A

Using an agent (TalC) into the pleural space to irritate the pleura, causing the two layers to stick together preventing further fluid build up.

27
Q

Common complications of using TalC?

A
  1. Minor pleuritic pain/ fever 2. Pneumonitis 3. Pneumonia 4. Respiratory failure
28
Q

What do pleural catheters do?

A

Long term drains inserted into the pleura to drain fluid. Used mostly in malignant effusions.

29
Q

What scoring system is used to predict survival in malignant pleural effusion?

A

LDH ECOG PS Nuetropil : lymphocyte ratio Tumour type

30
Q

Main form of treatment?

A

To treat underlying cause - Heart failure- diuretics - infection- antibiotics - malignancy- catheter, radiation, chemo If excess fluid- Draining

31
Q

Tall, thin people are more likely to get pneumothorax. T/F?

A

True

32
Q

Some other risk factors for pneumothorax?

A

-Cannabis - smokers - other lung disease

33
Q

What are the two types of pneumothorax

A

Spontaneous- hole in chest wall. lung collapses Traumatic (tension) - hole in the lung wall, causes air to move out of the lungs into the chest cavity. Lung collapses

34
Q

Symptoms of pneumothorax?

A
  • acute pleuritic chest pain - breathlessness - Hypoxic
35
Q

Signs of pneumothorax?

A
  1. Tachycardia 2. Hyper resonant on percussion 3. Reduced expansion 4. Quiet breath sounds
36
Q

What investigations would you do for pneumothorax?

A

Chest X ray sufficient Small= < 2cm rim of air Large= >2cm rim of air

37
Q

Which point of the lungs is the rim of air measured?

A

Hilar not apex

38
Q

Management for pneumothorax?

A
  • Oxygen - Chest drain - Aspiration - Suction - Surgical intervention
39
Q

Is tension pneumothorax an emergency? why?

A

Yes, risk of cardiac arrest

40
Q

What anatomical changes are seen in tension pneumothorax?

A

Increasing pressure of leaked air, Pushes mediastinal organs to opposite side of the pneumothorax Can cause acute respiratory distress

41
Q

Signs of tension pneumothorax?

A
  1. Tracheal deviation to Opp side 2. Hypotension 3. Raised JVP 4. Reduced air entry on affected side
42
Q

Treatment for Tension pneumothorax?

A

Needle decompression. With large bore venflon

43
Q

What anatomical position is the needle inserted in tension pneumothorax?

A

2nd intercostal space anteriorly, Mid clavicular line

RESP (25 decks)

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