Revision- Resp. Other Flashcards
what is an ‘empyema’?
Purulent fluid collection in the pleural space, most commonly caused by pneumonia
what does ‘primary empyema’ mean?
NOT caused by pneumonia
what are causes of empyema?
aerobic organisms
gram +ves: strep pneumoniae, strep milleri, staph aureus
gram -ves: E.coli, pseudomonas, H. Influenzae. Klebsiella
anaerobes: usually in severe pneumonia/ poor dental hygiene
pH of what differentiates simple/ complicated pleural effusion?
pH of < 7.2
swinging fever
empyema
best investigation for empyema?
ultrasound
empyema management?
- Broad spectrum IV antibiotics initially (amoxicillin and metronidazole (anaerobic))
- Oral antibiotics once cultures come back directed towards cultured bacteria, usually 6 weeks of co-amoxiclav (anaerobic/ aerobic)
- Chest tube drainage - 5th intercostal space, midaxillary line in the safe triangle (anterior border of latissimus dorsi, posterior border of pectoralis major, axial line superior to nipple)
what is bronchiectasis ?
Irreversible and abnormal dilation of the bronchial tree caused by cycles of bronchial inflammation -> excess mucus and bacteria build-up and progressive airway destruction
most common cause(s) of bronchiectasis?
Cystic fibrosis
H. influenzae, pseudomonas aeruginosa
also COPD, ABPA, pneumonia, TB, immunodeficiency, rheumatoid arthritis
recurrent “chest infections”, recurrent antibiotic prescriptions, no response to antibiotics/ short lived response
think bronchiectasis
bronchiectasis investigation?
HRCT
showing thick, dilated airways, ‘signet rings’, tram line shadowing
bronchiectasis management?
- Treat underlying cause
- Physiotherapy - airway clearance techniques
- Antibiotics for acute exacerbations - colymicin
- Consider long-term antibiotics in frequent exacerbators
what is colymicin used for?
first line bronchiectasis antibiotic therapy (acute exacerbations)
what is an intrapulmonary abscess?
Parenchymal necrosis with confined cavitation that results from a pulmonary infection
Typically presents as a pneumonia that worsens despite treatment
intrapulmonary abscess
what is used to differentiate between empyema and abscess?
CT
empyema - ultrasound
intrapulmonary abscess- CXR
intrapulmonary abscess treatment?
- Broad spectrum antibiotics- prolonged courses
- Surgical drainage/resection may be necessary
(drainage is less common)
what is/happens in CF?
Genetic disease which leads to abnormally viscous mucus; mucus blocks many structures including the conducting airways and lungs - results in repeated chest infections and chronic colonisation
what is faulty in CF?
CFTR (ATP regulated chlorine channel)
what causes sticky secretions in CF?
faulty CFTR -> no Cl into lumen -> Cl goes into cell, water follows -> sticky secretions in lumen
most common gene involved in CF?
F508
cystic fibrosis management?
physiotherapy
prophylactic antibiotics
CFTR modulators - kaftrio, ivacaftor, orkambi
lung transplant consider when FV1 <40%
Creon (for exocrine failure)
TIPPS (hepatic ducts become blocked)
what can be given for exocrine pancreas insufficiency?
CREON
(e.g. in CF, chronic pancreatitis, hepatobiliary cancer)
what are causes of transudative pleural effusion?
heart failure
liver cirrhosis
(<30g/L protein)
causes of exudative pleural effusion?
malignancy
infection
causes of straw coloured aspirate?
cardiac failure
hypalbuminaemia
pH of effusion that requires drainage?
pH LESS than 7.2
pleural effusion management?
treat underlying disorder e.g. cardiac failure
> 7.2, antibiotics
<7.2, chest drain, antibiotics
what is lung interstitium?
fluid and connective tissue supporting gas exchange units of lung
causes of pulmonary venous hypertension?
- Left ventricular systolic dysfunction
- Mitral regurgitation/stenosis
- Cardiomyopathy e.g. alcohol, viral
back pressure effect
