Pleural effusion, pleurisy, pleuritic chest pain

Question 1

where does pleural fluid come from and how does it get drained normally?

Answer 1

pleural fluid is filtrated out of the pulmonary vasculatures…then absorbed by lung lymphatics.

Question 2

what is the basic pathology for why a pleural effusion builds up?

Answer 2

↑filtration or ↓absorption = pleural fluid builds up

Question 3

which pressure keeps fluid in plasma?

Answer 3

oncotic pressure

Question 4

which pressure pushes fluid out of plasma?

Answer 4

hydrostatic pressure

Question 5

what are the two types of effusion in regards to the protein content?

what is the protein content in each?

Answer 5

Transudate effusion (protein <30g/L)

Exudative effusion (protein>30g/L)

Question 6

how does heart failure cause pleural effusion?
(step by step)

what type of effusion is it in regards to the protein content?

Answer 6

HF –> back log pressure into lung vasculature –> ↑microvascular pressure (Pulm HTN) –> fluid pushed out –> pulmonary oedema –> this fluid filters into pleural space.

Transudate

Question 7

how does liver cirrhosis cause pleural effusion?
(step by step)

what type of effusion is it in regards to the protein content?

Answer 7

hypoalbuminemia –> low plasma oncotic pressure (as proteins keeps water) –> fluid leaks out of vasculature.

Transudate

Question 8

how does malignancy cause pleural effusion?
(step by step)

what type of effusion is it in regards to the protein content?

Answer 8

tumour infiltrates pleural capillaries & cytokines increase capillary permeability –> fluid leaks into pleural space

Exudative

Question 9

how does pneumonia cause pleural effusion?
(step by step)

what type of effusion is it in regards to the protein content?

Answer 9

acute lung injury –> inflammation + cytokines –> increased vascular permeability –> fluid leaks into pleural space.

Exudative

Question 10

how does nephrotic syndrome & malabsorption cause pleural effusion?
(step by step)

Answer 10

hypoalbuminemia –> low plasma oncotic pressure (as proteins keeps water) –> fluid leaks out of vasculature.

Question 11

what are some Exudate causes of pleural effusions?

-4

Answer 11

Infection (pneumonia)
PE
Pancreatitis
Dressler’s syndrome

Question 12

which Syndrome causes a transudate or a exudate pleural effusion?

what is the triad for this syndrome?

Answer 12

Meigs Syndrome

benign ovarian tumour, ascites, pleural effusion

Question 13

which thyroid disorder causes pleural effusion?

Answer 13

Hypothyroidism

Question 14

main symptoms of pleural effusion?

-3

Answer 14

SOB
Cough
Pleuritic chest pain

Question 15

you percuss someone with pleural effusion, what do you hear

Answer 15

Stony dull percussion

Question 16

you auscultate someone with pleural effusion, what do you hear?
-3 things

Answer 16

↓breath sounds on affected side
↓vocal fremitus
Pleural friction rub

Question 17

you auscultate someone with pleural effusion.

you hear a grating creaky sound.

what is this sound called?

Answer 17

Pleural friction rub

Question 18

1st line Ix? (initially)

Answer 18

CXR

Question 19

after CXR what is the gold.S Ix?

Answer 19

Pleural aspiration + analyse fluid

Question 20

pleural effusion is yellow in colour.

what does this tell you?

Answer 20

likely transudate pleural effusion.

Question 21

pleural effusion has blood.

what does this tell you about cause?
-4

Answer 21

Malignancy, mesothelioma, PE, TB

Question 22

pleural effusion is milky in colour.

what does this tell you about cause?

Answer 22

Chylothorax

Question 23

pleural effusion has pus.

what is located in the pleural space?

what causes this usually?

Answer 23

Empyema

bacterial infection

Question 24

pleural effusion has food particles on analysis.

what is the cause?

Answer 24

Oesophageal rupture

Question 25

what does visceral mean literally?

Answer 25

inner

Question 26

Parietal pleura is innervated by what nerve?

and what is the pain like?
-3

Answer 26

somatic nerve

sharp, intense, stabbing

Question 27

Visceral pleura is innervated by what nerve supply and what is the pain like?

Answer 27

autonomic nerve supply

slow dull achy

Question 28

which pleural layer makes pleural fluid?

Answer 28

Parietal pleura

Question 29

define Pleurisy

Answer 29

inflamed parietal pleura

Question 30

how does pleurisy cause a pleural rub and pleuritic chest pain?

Answer 30

Parietal pleura inflamed – fluid not made - ↓lubrication & ↓pleural space size – both pleural linings rub together causing pleural rub + pleuritic chest pain

Question 31

what are the three basic mechanisms to cause pleural effusion?

Answer 31

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)

Question 32

how does pleuritic chest pain feel?

Answer 32

sharp and stabbing pain

Question 33

what does a pleural rub sound like?

Answer 33

squeaky grating sound

Question 34

what makes pleuritic chest pain worse?

-3

Answer 34

coughing, sneeze, deep breathing