Pleural Effusions Flashcards
acute, painful, pleural inflammation caused by parietal pleural irritation
pleuritis
what is the cause of pleuritis in healthy individuals?
viral or bacterial infection
what should be considered to be the cause of pleuritis in an ill patient? (2)
malignancy
effusion
a patient presents with localized, sharp, and fleeting pain that is worse when coughing, sneezing, or deep breathing.
pleuritis
where can pain in pleuritis refer to?
ipsilateral shoulder
what is the treatment for pleuritis?
underlying cause
NSAIDs
cough suppressant
pleural effusion that is caused by increased hydrostatic or decreased oncotic capillary pressure
transudative
pleural effusion caused by increased production of fluid
exudative
infection leading to pus in the pleural space
empyema
what is hydrostatic pressure’s job?
pushes out fluid from vessels
what is oncotic pressure’s job?
keeps in fluid from vessels
what is the pathophysiology of transudative effusions?
low pleural fluid concentration of proteins and other large molecules
what is the most common cause of transudative pleural effusion?
heart failure
what is the pathophysiology of exudative pleural effusion?
increased permeability leads to elevated levels of proteins and other large molecules in the pleural fluid
an exudative free flowing effusion that is small and resolves completely with antibiotics
uncomplicated parapneumonic effusion
an exudative free flowing effusion that requires drainage
complicated parapneumonic effusion
an exudative collection of pus in the pleural space in which the lung adheres to the chest wall as inflammation leads to scarring
empyema
a patient presents with dyspnea, cough, pleural chest pain, dullness to percussion, egophony.
pleural effusion
what would a chest xray look like in pleural effusion? (2)
fluid in gravity-dependent areas
costophrenic blunting
what does an empyema look like in pleural fluid gross exam?
purulent, white and milky
what is done in a pleural effusion for testing and therapeutic benefit?
thoracentesis
what would pH and WBC count be in transudative pleural fluid?
7.4-7.55 (alkaline)
<1000
what is light’s criteria for exudative pleural effusion?
pleural protein/serum protein > 0.5
pleural LDH/serum LDH > 0.6
pleural LDH > 2/3 x serum LDH
what is the most common cause of exudative pleural effusions?
lung and breast cancer
a lack of tumor cells on cytology with presumed malignancy etiology
para-malignant effusion
what is the treatment for transudative and malignancy pleural effusion?
treat underlying cause
therapeutic thoracentesis
what is the treatment for an uncomplicated parapneumonic pleural effusion?
treat infection
what is the treatment for a complicated parapneumonic pleural effusion? (3)
treat infection
drain fluid
peel fibrous adhesions
