Pleural Effusions Flashcards
Pancreatitis Pleural effusions are characterized by? Causes, treatments?
In acute and chronic pancreatitis, the development of a pleural effusion is a marker of severity and often portends a poor prognosis. The most likely cause of her effusion is her underlying pancreatitis. Pancreatic effusions are most often left-sided (68%), though they can be right-sided or bilateral as well. They demonstrate elevated lactate dehydrogenase (LDH) and protein and are classified as exudates by Light’s criteria. Additionally, they often contain very high levels of amylase, up to 30x the upper limit of normal.
The two main causes of pancreatic effusions are blockage of the transdiaphragmatic lymphatic channels or pancreaticopleural fistulae secondary to disruption of the pancreatic duct. If ductal disruption causes a leak posteriorly, in the retroperitoneum, the pancreatic fluid often tracks upwards, into the thorax, causing a pleural effusion. If the leak is anterior and the fluid tracks anteriorly, the pancreatic fluid can often enter the peritoneal cavity, causing pancreatic ascites. Pancreatic effusions or ascites often involve significant fluid shifts and can require aggressive treatment with thoracentesis, drains, or the administration of octreotide. Sometimes, if there is a concern for significant damage to the pancreatic ducts, a stent can be placed by gastroenterology. A fistula may need surgical repair.
