Pleural effusion, pleurisy, pleuritic chest pain Flashcards
where does pleural fluid come from and how does it get drained normally?
pleural fluid is filtrated out of the pulmonary vasculatures…then absorbed by lung lymphatics.
what is the basic pathology for why a pleural effusion builds up?
↑filtration or ↓absorption = pleural fluid builds up
which pressure keeps fluid in plasma?
oncotic pressure
which pressure pushes fluid out of plasma?
hydrostatic pressure
what are the two types of effusion in regards to the protein content?
what is the protein content in each?
Transudate effusion (protein <30g/L)
Exudative effusion (protein>30g/L)
how does heart failure cause pleural effusion?
(step by step)
what type of effusion is it in regards to the protein content?
HF –> back log pressure into lung vasculature –> ↑microvascular pressure (Pulm HTN) –> fluid pushed out –> pulmonary oedema –> this fluid filters into pleural space.
Transudate
how does liver cirrhosis cause pleural effusion?
(step by step)
what type of effusion is it in regards to the protein content?
hypoalbuminemia –> low plasma oncotic pressure (as proteins keeps water) –> fluid leaks out of vasculature.
Transudate
how does malignancy cause pleural effusion?
(step by step)
what type of effusion is it in regards to the protein content?
tumour infiltrates pleural capillaries & cytokines increase capillary permeability –> fluid leaks into pleural space
Exudative
how does pneumonia cause pleural effusion?
(step by step)
what type of effusion is it in regards to the protein content?
acute lung injury –> inflammation + cytokines –> increased vascular permeability –> fluid leaks into pleural space.
Exudative
how does nephrotic syndrome & malabsorption cause pleural effusion?
(step by step)
hypoalbuminemia –> low plasma oncotic pressure (as proteins keeps water) –> fluid leaks out of vasculature.
what are some Exudate causes of pleural effusions?
-4
Infection (pneumonia)
PE
Pancreatitis
Dressler’s syndrome
which Syndrome causes a transudate or a exudate pleural effusion?
what is the triad for this syndrome?
Meigs Syndrome
benign ovarian tumour, ascites, pleural effusion
which thyroid disorder causes pleural effusion?
Hypothyroidism
main symptoms of pleural effusion?
-3
SOB
Cough
Pleuritic chest pain
you percuss someone with pleural effusion, what do you hear
Stony dull percussion
you auscultate someone with pleural effusion, what do you hear?
-3 things
↓breath sounds on affected side
↓vocal fremitus
Pleural friction rub
you auscultate someone with pleural effusion.
you hear a grating creaky sound.
what is this sound called?
Pleural friction rub
1st line Ix? (initially)
CXR
after CXR what is the gold.S Ix?
Pleural aspiration + analyse fluid
pleural effusion is yellow in colour.
what does this tell you?
likely transudate pleural effusion.
pleural effusion has blood.
what does this tell you about cause?
-4
Malignancy, mesothelioma, PE, TB
pleural effusion is milky in colour.
what does this tell you about cause?
Chylothorax
pleural effusion has pus.
what is located in the pleural space?
what causes this usually?
Empyema
bacterial infection
pleural effusion has food particles on analysis.
what is the cause?
Oesophageal rupture
what does visceral mean literally?
inner
Parietal pleura is innervated by what nerve?
and what is the pain like?
-3
somatic nerve
sharp, intense, stabbing
Visceral pleura is innervated by what nerve supply and what is the pain like?
autonomic nerve supply
slow dull achy
which pleural layer makes pleural fluid?
Parietal pleura
define Pleurisy
inflamed parietal pleura
how does pleurisy cause a pleural rub and pleuritic chest pain?
Parietal pleura inflamed – fluid not made - ↓lubrication & ↓pleural space size – both pleural linings rub together causing pleural rub + pleuritic chest pain
what are the three basic mechanisms to cause pleural effusion?
o Parietal cell in parietal pleura makes too much fluid
o Fluid build-up in pulmonary circulation can leak from alveoli into pleural space
o Parietal lymphatics not draining enough fluid (e.g., blockage somewhere)
how does pleuritic chest pain feel?
sharp and stabbing pain
what does a pleural rub sound like?
squeaky grating sound
what makes pleuritic chest pain worse?
-3
coughing, sneeze, deep breathing
