27. Pleural Disease Flashcards Preview

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Flashcards in 27. Pleural Disease Deck (29):

visceral pleura on what surface? parietal?

visceral are directly on lung surface, cover parenchyma and interlobar fissures. parietal line the inside of the thoracic cavity.


visceral pleura: blood supply? lymphatics? pain fibers?

blood: systemic circ?
rich network of lymphatics
no pain fibers


parietal pleura: blood supply? lymphatics? pain fibers?

blood: systemic circ.
lymphatics have stoma with varied concentrations in diff areas
innervation from intercostal nerves and phrenic nerve


when is pleural pressure most negative?

during inspiration. usually slightly sub-atmospheric at FRC.


what is the normal situation with pleural fluid?

normally fluid continuously enters and is resprbed from the pleural space. accumulation will be due to disease processes.


what equation/law governs the movement of fluid across the pleural membranes?

Starlings Law


acc Starling's law, the flow of liquid across the pleural surface depents on what 4 things?

1. SA of the membrane, and how easily it allows movement of water
2. hydrostatic pressures in caps and pleural space
3. oncotic pressures in cap and pleural space
4. pore size in membrane (for proteins to pass)


what is produced by the net gradient in the parietal pleura?

net gradient causes fluid filtration, movement from the systemic caps into the pleural space.


what is the net gradient between the visceral pleura and the pleural space?

net is ZERO: no net movement of fluid from viscera into pleural space


what mechanism keeps the pleural space relatively free of liquid?

lymphatic drainage on the parietal size


what are stoma/where are they located?

on the parietal side. lymphatic drainage ducts. remove proteins, cells, fluid from the pleural space


what are some factors leading to pleural effusions?

-incr hydrostatic pressure in either side of the heart
-decr oncotic pressure (hypoalbuminemia)
-incr cap permeablity (pneumonia)
-incr intrapleural pressure (atelactasis)
-impaired lymph drainage (obstruction, tumor)


what is a transudate? what are examples?

accumulated fluid resulitng from changed Starling forces (cap pressure or oncotic pressure). pleura are secondarily affected. fluid will be LOW in protein.
-congestive heart failure
-nephrotic syndrome


what is an exudate? what are examples?

increased permeability allowing for leakage of macromolecules. affects pleural surface directly. fluid will be HIGH in protein.
-inflammatory process below the diaphragm
-CT diseases
-asbestos exposure


symptoms of pleural disease?

-SOB is most common symptom
-cough. mech unclear
-sx due to underlying disease


what will you find on physical exam with a pleural effusion? inspection/palp/percuss/ausc

ins: may be asymmetrical expansion
palp: decr tactile fremitus
percus: dullness
auscultation: decr breath sounds


xray appearance with pleural effusion?

may see blunting of costophrenic angles on sides and posterior. may be hazy appearance on supine film.


Pleural effusion: restrictive or obstructive pattern?



how can you tell if the pleural fluid is a transudate or an exudate?

exudate if:
-pleural fluid/serum PROTEIN >0.5
-pleural fluid/serum LDH >0.5
-pleural fluid LDH > 2/3 upper limit normal serum value

transudate if none of the above


testing the pleural fluid's cell count: high WBC suggests what?



testing the pleural fluid's cell count: high RBC suggests what?

trauma, malignancy, pulm infarction


testing the pleural fluid's glucose level: lowest levels seen in what situations?

lowest glucose seen in infection, CT disease, malignancy


an incr amylase level in pleural fluid could suggest what?

pancreatitis, esophag perf/rupture


what is the usual pH of pleural fluid? what might a low pH indicate?

usually 7.5. low could indicate infection, malignancy


what happens in a pneumothorax? (lung, chest wall, 02 level?)

lung recoils inward, chest recoils outward, hypoxia due to shunt or low VQ


what could cause a spontaneous pneumothorax?

apical blebs, congenital cause, underlying lung disease like emphysema or CF.


sx of pneumothorax?

breathlessness, cough, chest pain.


physical exam with pneumothorax: percussion, auscultation, anatomic, extremities?

perc: hyperresonant
ausc: low breath sounds or absent
tracheal shift away from PTX
tachycardia, hypotension, cyanosis


tx for pneumothorax?

remove air with catheter, chest tube, give 02, may do pleurodesis (glue together pleurae)