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Respiratory > Pleural effusion > Flashcards

Pleural effusion Flashcards

1
Q

What is a pleural effusion

A

collection of fluid in the pleural space

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2
Q

What is transudate ?

A

Pleural fluid protein < ½ serum
protein
Less than 3G protein

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3
Q

What occurs in transudate pleural effusion

A

Increased hydrostatic pressure or reduced osmotic pressure - causes fluid to move from the capillaries into the pleural sac.

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4
Q

What can cause transudate PE

A
  • HF
  • Cirrhotic liver disease
  • renal failure
  • hypoalbuminemia
  • ascites
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5
Q

What is exudate

A

Pleural fluid protein > ½ serum protein

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6
Q

What occurs in exudative PE

A

Increased capillary permeability and impaired reabsorption

caused by inflammation, infection and malignancy. The inflammation results in protein e.g. LDH leaking out of the tissues and into the pleural space

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7
Q

What can cause exudative PE

A
  • Pneumonia
  • Cancer
  • TB
  • Autoimmune conditions e.g. RA, SLE
  • PE
  • Benign Asbestos related pleural effusion
  • Pancreatitis
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8
Q

signs of PE

A
  • reduced chest wall expansion
  • quiet breath sounds
  • stony dull percussion
  • meditational shift away from affected side
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9
Q

Symptoms of PE

A
  • Shortness of breath
  • Cough
  • Pleuritic chest pain
  • Symptoms of the underlying caus
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10
Q

First line investigation for PE

A

CXR- reveal blunting of the costophrenic angle or white out of one hemifield (if large

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11
Q

What would bloods show for PE

A

FBC- infection
U&E - raised creatitine suggestive of renal impairment ]

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12
Q

Diagnostic ultrasound-guided thoracentesis is required in all patients except…?

A
  • Those with clear evidence of heart failure
  • raised jugular venous pressure
  • pitting ankle oedema
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13
Q

When can lights criteria be applied

A
  • If the protein content is equivocal to 25-35g/l
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14
Q

Management of PE

A
  • TREAT UNDERLYING CAUSE
  • diuretics for HF
  • dialysis for renal failure
    -ABCDE
  • Oxygen therapy
  • intercostal drain : for large pleural effusions
  • for recurrent PE pleurodesis should be considered
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15
Q

If these are present in fluid analysis chest tube drainage is required

A
  • Purulent or turbid/cloudy pleural fluid
  • Positive pleural fluid Gram stain or culture
  • Pleural fluid pH <7.2
  • Loculated pleural collection
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16
Q

Non - malignant treatment

A
  • Treat the underlying cause
  • Thoracentesis for symptomatic effusion
17
Q

Treatment of recurrent effusions

A
  • Pleurodesis:scarring the pleural space by slurry injection or spraying sterile talc, this causes adhesion of the visceral and parietal pleura and prevents recurrence
  • Recurrent aspiration
  • Indwelling pleural catheter:a chest tube tunnelled under the skin used for long-term repeated pleural drainage
18
Q

Criteria that would support a pleural infection

A
  • pH < 7.2
  • Glucose < 3.4mmol/L
  • PF LDH > 1000 IU/L
  • Bacterial growth on culture
  • Macroscopic appearance of pus
19
Q

What is an empyema

A

pus in pleural space

20
Q

Causes of empyema

A

Community acquired
- S milleri/ S pneumo / S aureus
Hospital acquired
- MRSA/ S. Aureus / Enterococci

21
Q

Symptoms of empyema

A
  • patient unwell/ not improving
  • swinging fevers
  • cough
22
Q

Tx for empyema

A
  • Ab
  • chest drain
  • surgery
23
Q

What is a haemothorax

A

Blood in pleural cavity
Haematocrit > 50%

24
Q

Causes of haemothorax

A
  • trauma
  • Post operative
  • bleeding disorders
  • lung cancer
25
Q

management of Haemothorax

A
  • large bore chest drain
  • possible vascular intervention
  • surgical opinion
26
Q

What is a hydropneumothorax

A
  • air and fluid in pleural space
27
Q

What is pleural thickening

A
  • thickening of visceral / parietal pleura
  • related to asbestos
  • follows infection
28
Q

What is Pneumomediastinum

A

air in mediastinum

29
Q

Treatment of recurrent effusions

A
  • Pleurodesis:scarring the pleural space by slurry injection or spraying sterile talc, this causes adhesion of the visceral and parietal pleura and prevents recurrence
  • Recurrent aspiration
  • Indwelling pleural catheter:a chest tube tunnelled under the skin used for long-term repeated pleural drainage

Respiratory (21 decks)

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