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SEMIO CURS 3- SDR PLEURALE Flashcards

1
Q

Factori care influenteaza cantiatea de lichid pleural

6, presiuni

A
  1. pres hidrostatica crescuta in circ sistemica: IC, sdr VCS, HTP
    2.pres oncotica scazuta in circ sistemica: Ciroza hepatica, sdr nefrotic, sdr malabsorbtie
    3.presiune scazuta in spatiul pleural- Atelectazii( pleura viscerala adera de plamanul atelectaziat in timp ce pleura parietala ramane atasata de torace=> se mareste cavitatea pleurala)
    4.creste permeabilitatea: Inflamatii si neoplazii
    5.Drenaj limfatic obstruat : Neoplazii
    6 Drenaj limfatic peritoneo-pleural in ASCITA
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2
Q

Cauze de pleurita uscata

6

A

1.Infectii, de obicei virale
2.reactie inflamatorie de vecinatate= apare o pneumonie/infarct pulmonar=> se inflameaza si pleura
3.boli autoimune
4.neoplasme
5.postoperator
6.posttraumatic

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3
Q

simptome PLEURITA

A

durere toracica-ca un junghi
-accentuata in inspir
-ameliorata de aparitia lichidului
-iradiere specifica( Stenberg, Capp, Mussey)

Tuse iritativa( poate fi productiva daca se asociaza cu patologie parenchim plmn)

Febra-poate lipsi

*sughit-in afect pleura diafr
*astenie, mialgii, inapetenta

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4
Q

Modificari ex clinic in Pleurita

inspectie, auscultatie, RX

A

la Inspectie:pozitie antalgica-semnul Andral
respiratie superf(ptc il doare cand inspira)
Au: m.v insaprit+ frecatura pleurala

Rx: ingrosari pleurale
mobilitate redusa a diafragmului

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5
Q

factori de care depinde Sdr revarsat lichidian

3

A

Cantitatea de lichid
Cat de repede s-a acumulat
etiologia revarsatului

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6
Q

Cauze de revarsat lichidian- cu transudat

A

Hipoalbuminemie
Sdr nefrotic
Ciroza hepatica
Dializati
Urinotorax
ICC
*Tep, mixedem, sarcoidoza si sdr Meigs

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7
Q

Cauze de revarsat lichidian-cu Exudat

A

Pneumonie virala
Pleurezii para/metapneumonice–empiem
TBC
Neoplasme
Boli autoimune
afectiuni subdiafragmatice: pancreatita, abces
postradioterapie
postmedicamente
sdr Dressler
sdr Meigs

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8
Q

descrie Sdr Meigs si Sdr Dressler

A

Sdr Meigs=triada efuziune pleurala
tumora ovariana benigna
ascita

Sdr Dressler=pleuropericardita autoimuna la 2-3 sapt postIMA/interv pe cord deschis

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9
Q

simptome Revarsate lichidiene

A

Durere toracica doar in cele exudative+ ca in pleurita

Tuse iritativa/productiva-asoc cu patologii parenchim plmn

Dispnee- apare brusc in f de etiologie si rapiditatea acumul lichidului

simptome asoc bolii de fond

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10
Q

simptome specifice etiologiei

boli in care apar revarsate si simpt lor specifice

pneumonie, neoplasm, IC, CH, infarct plm, TBC, boli autoimune

A

1.Pneumonie-febra
tuse cu expectoratie
junghi toracic

2.Neoplazii-scadere in G
dispnee progresiva
tuse

3.Insuficienta cardiaca-dispnee
edeme+_ angina
palpitatii
4.Ciroza hepatica-edeme
ascita
icter

  1. Infarctul pulmonar-dispnee
    tuse hemoptoica
    junghi toracic

6.TBC-scadere in G
tuse
hemoptizie
subfebra

7.Boli autoimune-artralgii artrita, lez cutaneo-mucoase

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11
Q

Ex clinic -rev lichidiene mici

A

I:normal
Pa:normal
Pe:submatitate care se sonorizeaza la manevra Hirtz
Au:m.v diminuat bazal ipsilateral

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12
Q

Ex clinic revarsate lichidiene masive

A

I:trahee deviata contralateral (si mediastinul-trigonul Grocco Rauchfuss)
Bombare hemitorace afectat semn Pitres
trepopnee/ortopnee

Pa:Ampliatii, amplexatii absente
v.v absente in matitate

Pe:Matitate in tot hemitoracele(de sus pana jos)
Au:M.v absent pe tot hemitoracele

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13
Q

ex clinic in revarsate lichidiene medii

A

I:Trepopnee/Ortopnee
Pa:Ampliatii/Amplexatii reduse bazal ipsilateral
V.v diminuate/absente
Pe:matitate linia Damoisseau
superior de matitate:aria de pseudocondensare:trigonul Garland
Au: M.v. diminuat/absent in aria de matitate
suflu pleuretic deasupra matitatii
egofonie deasupra matitatii
frecatura pleurala

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14
Q

Hidropneumotorax-Rx

A

matitate cu limita superioara orizontala

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15
Q

Revarsat inchistat-Rx

A

matitate lenticulara suspendata

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16
Q

Examene paraclinice efectuate pt revarsate lichidiene

A

1.Rx- daca e >200 ml
2.Eco plmn- pt diagnostic si cuantificare
3.Ex lichid pleural-etiologie
4.alte investig pt etiologie

17
Q

Toracocenteza

unde se efectueaza cel mai frecvent, riscuri, contraindicatii

A

sp 9-10 icost, la 5-10 cm de col vert
risc de pneumotorax, sincopa vagala
contraindic: sdr hemoragipar

18
Q

Glucoza scazuta in lich pleural

A

Empiem
TBC
PAR
Neoplasm

19
Q

ph<7,2

l. pleural

20
Q

ph>7,4

l.pl

A

Chilotorax

21
Q

TGL>100mg/dl

A

Chilotorax

22
Q

Amilaza crescuta

l. pl

A

Pancreatita
Ruptura de esofag
neoplazii

23
Q

ANA

antinuclear antibodies

24
Q

ADA

Adenozindezaminaza

25
Ac hialuronic
mezoteliom
26
Hematii>100.000/mmc | cauze
Traumatism neoplazie TEP
27
Hematii>10.000/mmc
Revarsate transformate hemoragic
28
PMN
Empiem Pleurezii parapneumonice pancreatita TEP
29
Ce patologie asociaza in l.pleural hematii>100.000/mmc si PMN si eozinofile?
TEP
30
In ce patologii gasim limfocite in l.pleural?
TBC--tipic pleurezii virale boli hematologice maligne
31
Eozinofile
paraziti fungi Sdr Loeffler **Limfom Hodgkin, Pleurezii hemoragice:neoplasm/TEP**
32
Pleurezie parapneumonica ## Footnote simpt, Rx, Citologie, Frotiu si culturi
1.simpt:apare dupa debutul unei pneumoniiicu *tuse, durere toracica si febra* 2.Rx: (insoteste proces de condensare) Condensare bronsica+revarsat lichidian 3.Citologie: PMN 4.culturi negative (e abacteriana)
33
Empiem pleural | Pleurezie metapneumonica ## Footnote cand apare, simptome, citologie, culturi
1.la cateva sapt(2-3) de pneumonie, dupa perioade de afebrilitate 2.simptome:febra si **edem si hiperestezie cutanata** la nivelul toracelui afectat 3.matitate lemnoasa 4.Citologie:PMN 5.Culturi pozitive
34
Pleurezie tuberculoasa ## Footnote Simptome, cum e exudatul(glc, LDH, ADA, Lizozim), Citologie, Frotiuri
* Subfebra, scadere in G, hemoptizie, tuse iritativa * sero citrin, tulbure, glc < 60%, LDH crescut,** ADA+, lizozim pleural/plasmatic>2** * Limfocite(pot fi PMN la debut) * Culturi frecvent negative * alte investigatii:PCR, biopsie pleurala, culturi din sputa
35
pleurezie maligna
Scadere in G, subfebra, tuse, hemoptizie, revarsat lichidian care se reface rapid, **disfonie, disfagie** Rx;Rev pl se reface rapid, moderata cantitatea Citologie: Cel maligne, hematii eozinofile dg: biopsie, citologie, imagistica

parazitologie (8 decks)

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