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Pleural Effusion Flashcards

1
Q

What is a pleural effusion?

A

Fluid in the pleural space

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2
Q

What can make up the fluid?

A

Blood
Pus
Fluid
Chyle

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3
Q

What is blood in the pleural space called?

A

Haemothorax

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4
Q

What is pus in the pleural space called?

A

Empyema

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5
Q

What is chyle in the pleural space called?

A

Chylothorax

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6
Q

What is chyle?

A

Fluid made of fat and lymph suspended in chylomicrons

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7
Q

What causes chylothorax?

A

Fistula formation between lymphatic system and pleural space cause by inflammation

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8
Q

What are the classifications of pleural effusions?

A

Transdate

Exudate

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9
Q

What is a transudate?

A

Extravascular fluid with low protein content

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10
Q

What causes production of a transudate?

A

Disruption of oncotic forces

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11
Q

What is the pattern of a transudate pleural effusion?

A

Usually bilateral

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12
Q

What can cause a transudate pleural effusion?

A 
Heart failure 
Cirrhosis 
Hypoalbuminaemia
Renal failure 
SVC obstruction 
PE
Meig's syndrome
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13
Q

What is Meig’s syndrome?

A

Triad of pleural effusion, ascites and an ovarian fibroma

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14
Q

What is an exudate?

A

Extravascular fluid with high protein content

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15
Q

What causes production of an exudate?

A

Increased permeability secondary to inflammation

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16
Q

What is the pattern of an exudate pleural effusion?

A

Usually unilateral

17
Q

What can cause an exudate pleural effusion?

A 
Pneumonia 
TB 
Malignancy 
Autoimmune 
Dressler's syndrome
18
Q

What is Dressler’s syndrome?

A

Pericarditis occurring 2 weeks after an MI

19
Q

How do you differentiate between a transudate and exudate?

A

Look at protein content of aspirate

Exudate = >35 g/L
Transudate = <25g/L

25-35 use Light’s criteria

20
Q

What is Light’s criteria?

A

Uses serum protein and LDH

Exudate if

  • effusion:serum protein >0.5
  • effusion:serum LDH >0.6
  • effusion LDh > 2/3 upper limit of normal
21
Q

How do you investigate a pleural effusion?

A

ECG
Sputum culture
Urine dip

Bloods

  • FBC
  • U+Es
  • CRP
  • LFTs
  • D-dimer
  • Troponin
  • autoantibody screen

CXR
Chest CT

Aspirate

22
Q

What do you look for in the aspirate?

A

pH
Glucose
Cytology (RBCs, WBCs, malignancy)
Proteins

23
Q

How do you manage a pleural effusion?

A

Treat underlying cause

Drain

Pleurodesis

24
Q

What is pleurodesis?

A

Irritation of visceral and parietal pleura so they stick together

Use

  • tetracycline
  • talc
  • bleomycin

Respiratory Medicine (18 decks)

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