Unit 3 - Pleural Space Disease Flashcards
What air effusion known as?
pneumothorax
What is lymph effusion known as?
chylothorax
What is pus effusion known as?
pyothorax
Whatis blood effusion known as?
hemothorax
What is ‘water’ (pure transudate) effusion known as?
hydrothorax
What is organ effusion known as?
diaphragmatic hernia
What is the pleura?
thin layer of mesothelial cells
What is visceral pleura?
pleura that covers lung surface
What is parietal pleura?
pleura that lines thoracic wall, diaphragm, and mediastinum
What is pleural fluid volume determined by?
Starling’s forces, lymphatic drainage, and mesothelial cells
What are the different mechanisms that can cause pleural effusion?
Increased venous hydrostatic pressure, decreased oncotic pressure, impairment of lymphatic drainage, and increased vascular permeability
What can cause increased venous hydrostatic pressure?
CHF, HWD, venous thrombosis, and neoplasia
What can cause decreased oncotic pressure?
hypoalbuminemia
What can cause impairment of lymphatic drainage?
increased venous pressure, lymphatic trauma, neoplasia, and lung lobe torsion
What can cause increased vascular permeability?
pancreatitis, FIP, and neoplasia
What is the pattern of dyspnea with pleural effusion (if present)?
restrictive
What do you expect to hear on auscultation of a patient with pleural effusion?
Muffled/absent breath sounds
What physical exam parameters should be noted along with pleural effusion?
Other cardiopulmonary abnormalities, thoracic compression, peripheral lymph nodes, abdominal palpation for masses, pain, and ascites, fever, mucous membranes, cranial nerves, and BCS/muscle condition
If in respiratory distress, what is the first step to treating pleural effusion?
thoracocentesis
What is the first step to treating pleural effusion if the patient is not in respiratory distress?
thoracic imaging and minimum database
What supplies do you need for a thoracocentesis?
needle, over-the-needle or butterfly catheter, syringe, 3-way stopcock, extension tubing, sterile gloves, and bowl
What is the ideal position for a thoracocentesis?
sternal recumbency
Where should your needle be inserted for a thoracocentesis if its to get rid of air?
7th to 9th intercostal space, in front of the rib, about 2/3 of the way up between CCJ and spine
Where should your needle be inserted for a thoracocentesis if its to get rid of fluid?
7th to 9th intercostal space, in front of the rib, closer to the CCJ
What would you use EDTA tube for for effusion?
to preserve cell morphology for cytology
What would you use a red-top tube for for effusion?
various biochemical tests
What is the composition of transudates?
low protein, low cellular pleural fluid
What are transudates caused by?
low oncotic pressure or increased hydrostatic pressure from early heart failure
What are modified transudates?
transudates that have been ‘modified’ by the addition of cells, protein, and/or chyle
What can cause modified transudates?
Right sided heart failure, pericardial disease, neoplasia, chylothorax, lung lobe torsion, and idiopathic
What are exudates composed of?
high protein, high cellular effusions - predominant cell type is dependent on underlying cause
What biochemical tests can you do for pleural effusion?
triglycerides (definitive for chylothorax), glucose (low in septic), and pH (low in septic)
What thoracic imaging can you do for pleural effusion?
radiographs, thoracic ultrasound, and thoracic CT
Neoplasia is a frequent cause of pleural effusion. Where can they locate?
visceral/parietal pleura, lungs, mediastinum, and lymph nodes/lymphatics
What fluid types are associated with pleural fluid due to neoplasia?
modified transudate (or exudate) and chylous
How is pleural fluid and neoplasia diagnosed?
ID cells on fluid cytology - most common with round cell neoplasia
Imaging if abscense of cells
+/- surgery for exploration and biopsy
What is hemothorax?
hemorrhage into the pleural space
What causes hemothorax?
trauma, neoplasia, COAGULOPATHY (rodenticide), and vessel rupture
How do you know if the effusion from hemothorax is actually from the hemothorax and not the heart?
it should not clot
What is the cellular make up of hemothorax?
macrophages +/- erythrophagocytosis, no platelets
You should only tap a hemothorax if necessary to alleviate ______.
dyspnea - you can make it worse if coagulopathy is present
Before tapping a hemothorax, you should assess what?
coagulation status - PT and PTT
If rodenticide toxicity, what is the treatment of choice?
vitamin K and blood products
If there is a bleeding mass, what is the treatment that is indicated?
surgery
