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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
Differential diagnosis (8)
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
What is Q fever?
bacterial infection caused by Coxiella burneti which is found in cattle and is passed onto humans
27
Investigations (4)
1. CXray 2. US 3. aspiration - done with US guidance 4. pleural biopsy
28
Treatment
1. drain 2. pleurodesis 3. pleurectomy 4. antibiotics 5. diuretics 6. pleural tap
29
If the cancer is the cause of pleural effusion how would you treat the pleural effusion?
treat the cancer with chemo and radiation
30
What is a pleurodesis?
surgical procedure which artificially obliterates the pleural space by adhering the 2 pleurae
31
What criteria is used to diagnose exudative pleural effusions and what does it state? (1,3)
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
How does transudative pleural effusion affect the lungs (bilaterally, unilaterally, which side?)?
1. right hand side
33
What is the most common cause of exudative pleural effusion?
carcinoma of the bronchus
34
What three components are measured in pleural fluid? (3)
1. LDH 2. dehydrogenase 3. lactate

YEAR 3 CORE CONDITIONS ATS (7 decks)

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