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YEAR 3 CORE CONDITIONS ATS > UNILATERAL PLEURAL EFFUSION > Flashcards

UNILATERAL PLEURAL EFFUSION Flashcards

1
Q

What is a pleural effusion?

A
  • build up of fluid in the pleural space
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2
Q

Is a pleural effusion bilateral or unilateral?

A

unilateral usually

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3
Q

What are pleural effusions divided/categorised by?

A

protein concentrations

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4
Q

What 2 categories are pleural effusions divided into? (2)

A
  1. transudates

2. exudates

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5
Q

What are transudates and what is characteristic of it? (1,3)

A
  • extravascular fluid
  • with decreased protein content
  • decreased specific gravity
  • decreased nucleated cell count

HIGH PRESSURE

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6
Q

What primary cell types are involved in transudative pleural effusion? (3)

A
  • macrophages
  • lymphocytes
  • mesothelial cells
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7
Q

What are exudates?

A

any fluid that filters from the circulatory system into lesions or areas of inflammation

  • lots of protein
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8
Q

What is the fluid like in exudative pleural effusion?

A

clear or pus like

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9
Q

What is the fluid composed of in exudative pleural effusion? (3)

A
  • serum
  • fibrin
  • wbcs
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10
Q

What is a haemothorax?

A

blood in pleura

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11
Q

What is an empyema?

A

pus in pleura

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12
Q

What is a chylothorax?

A

lymphactics in pleural space

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13
Q

what is haemopneumothorax?

A

blood and air in the pleura space

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14
Q

What is the risk factors/causes for transudative pleural effusion? (8)

A
  1. cardiac failure
  2. constrictive pericarditis
  3. fluid overload
  4. cirrhosis
  5. nephrotic syndrome
  6. malabsorption
  7. hypothyroidism
  8. Meig’s syndrome
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15
Q

How does cardiac failure, constrictive pericarditis and fluid overload cause transudative pleural effusion?

A

due to increased venous pressure

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16
Q

How does cirrhosis, nephrotic syndrome and malabsorption cause transudative pleural effusion?

A

hypoproteinaemia

17
Q

What is a typical presentation in Meig’s syndrome? (2)

A
  • right pleural effusion and ovarian fibroma
18
Q

What causes/is a risk factor for exudative pleural effusion? (13)

A
  1. infection
  2. malignancy
  3. inflammation
  4. pneumonia
  5. TB
  6. pulmonary infarction
  7. RA
  8. SLE
  9. bronchogenic carcinoma
  10. malignant metastases
  11. lymphoma
  12. mesothelioma
  13. lymphangitis carcinomatosis
19
Q

How does infection, inflammation and malignancy cause exudative pleural effusions?

A

increase the leakiness of pleural capillaries

20
Q

What is mesothelioma?

A

a rare, aggressive form of cancer of the mesothelial cells caused by asbestos

21
Q

What is lymphangitis carcinomatosis?

A

diffuse infiltration and obstruction of pulmonary parenchyma and lymphactic channels by a tumour

22
Q

What are the symptoms of pleural effusion? (2)

A
  • shortness of breath

- pleuritic pain

23
Q

What are the signs? (7)

A
  1. decreased expansion
  2. dull percussion
  3. diminished breath sounds on affected side
  4. decreased tactile fremitus
  5. decreased vocal resonance
  6. bronchial breathing
  7. tracheal deviation
24
Q

In which direction is the trachea deviated in a pleural effusion?

A

away from the effusion

25
Q

Differential diagnosis (8)

A
  1. congestive heart failure
  2. pulmoanry oedema
  3. diaphragmatic injuries
  4. oesophageal ruptures and tears
  5. lung neoplasms
  6. pancreatitis
  7. Q fever
  8. RA
26
Q

What is Q fever?

A

bacterial infection caused by Coxiella burneti which is found in cattle and is passed onto humans

27
Q

Investigations (4)

A
  1. CXray
  2. US
  3. aspiration - done with US guidance
  4. pleural biopsy
28
Q

Treatment

A
  1. drain
  2. pleurodesis
  3. pleurectomy
  4. antibiotics
  5. diuretics
  6. pleural tap
29
Q

If the cancer is the cause of pleural effusion how would you treat the pleural effusion?

A

treat the cancer with chemo and radiation

30
Q

What is a pleurodesis?

A

surgical procedure which artificially obliterates the pleural space by adhering the 2 pleurae

31
Q

What criteria is used to diagnose exudative pleural effusions and what does it state? (1,3)

A
  1. Light’s criteria
    - Pleural fluid protein:serum protein > 0.5
    - pleural fluid LDH: serum LDH > 0.6
    - pleural fluid LDH > 2/3 of upper limit of normal for serum (105-333 IU/L)
32
Q

How does transudative pleural effusion affect the lungs (bilaterally, unilaterally, which side?)?

A
  1. right hand side
33
Q

What is the most common cause of exudative pleural effusion?

A

carcinoma of the bronchus

34
Q

What three components are measured in pleural fluid? (3)

A
  1. LDH
  2. dehydrogenase
  3. lactate

YEAR 3 CORE CONDITIONS ATS (7 decks)

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