lecture 59 - Pleural Disease Flashcards

1
Q

what are the two layers of the pleural ?

which has no somatic innervation?

A

Parietal (serosal) and Visceral

Visceral has no somatic innervation

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2
Q

What is a pleural effusion ?

what is a pneumothorax?

A

Abn accumulation of fluid into the pleural space

Abnormal accumulation of air into the pleural space

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3
Q

What are tools for dx of Pleural effusion?

A

H&P

CT / CXR findings

Pleural fluid analysis

Physical exam

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4
Q

what are physical exams findings with an effusion

A

Decreased movement with inspiration of ipsilateral hemithorax
Dull or flat Ipsilateral percussion
Contralateral tracheal shift with large effusions
Decreased breath sounds
Occasional pleural rub
Decreased fremitus

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5
Q

what is seen on imaging?

A

CXR - meniscus opacity

CT – densities indicating fluid in dependent fashion

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6
Q

how are effusions classified?

what is Light’s Criteria ?

A

transudate vs exudate

Total Protein – -Pleural fluid and compare to serum
< .6 indicates transudate

LDH Fluid compared to upper normal limit of serum
- Pleural fluid LDH < 2/3 upper limit of normal of serum indicates a transudate

NEED ALL THREE TO BE TRANSUDATIVE
“HIGH” value of ANY OF THREE VALUES = EXUDATIVE

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7
Q

what are the etiologies of a transudative effusion?

A

Prototype – CHF
Cirrohosis
Renal failure

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8
Q

Treatment of transudative effusion ?

A

Diuretics to decrease Filtration Pressure (Pc) – in CHF
Increase oncotic pressure in settings of low albumin

Thoracentesis – as a therapy

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9
Q

Etiologies of exudative effusion ?

A
Connective tissue disease
				Pulmonary embolism 
				TB
				Malignancy 
				Parapneumonic effusion (or empyema)
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10
Q

Treatment of exudative effusion caused by:
- connective tissue disease

  • pulmonary embolism
  • TB
A

Connective tissue Disease — anti-inflammatory drugs (steroids), for rheumatic disease which cause inflammation

Pulmonary embolism – Treat the embolism (anticoagulaiton)

TB – treat medically; abx

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11
Q

what is the primary malignancy of the pleura called? what causes it? how do you treat it?

A

Mesothelioma
Asbestos
Chemo/surgery

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12
Q

How do you treat vs manage metastatic disease to the pleura ?

A

Treatment of the disease – Systemic Chemotherapy

Management / Symptomatic /Palliative –
Chest tube
Pleurodesis – chemical or mechanical fusion of the visceral and parietal pleura
indwelling pleural catheter – another form drainage

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13
Q

what is a parapneumonic effusion ?

what are the classificaitons?

A

parapneumonic effusion – an effusion which occurs in the setting of a PNA

May be Infectious: aka empyema

May be sterile

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14
Q

How do you treat a sterile parapneumonic effusion ?

How do you treat an empyema (infectious paraneumonic effusion)?

A

Sterile – Give abx for the PNA

Empyema – Chest tube drainage; surgical intervention

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15
Q

What is a Pneumothorax

A

What is it? Abnormal accumulation of air into the pleural space leading to uncoupling of the chest wall and the lung

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16
Q

what are the two ways in which pneumothroax can occur ?

A

Abn communication between Lung and Pleural space (More common in non-trauma)

Abn communication between Atmosphere and pleural space (trauma, stabbin

17
Q

Symptoms of a pneumo thorax

A

Symptoms – Usually have Chest Pain, pleuritic pain (air is an irritant to the pleura)

Usually sudden onset

18
Q

What is seen on imaging for a pneumothroax

A

air in the pleural space

19
Q

Physical exam findings for pneumothroax

A

Decreased BS
Hyperresonant
Chest wall on that side appears large, but decreased movement
Contralateral tracheal/mediastinal shift

20
Q

what helps determine the treatment of the patinet with pneumothorax ?

A

Their clinical condition; the radiograph severity

There may not be a correlation between size and discomfort

21
Q

Treatment for a pneumo thorax

A

Observation -

100% O2

Aspiration

Chest tube with suction

Surgical intervention

22
Q

what is the rationale for providing patient with 100% O2 ?

A

Usually for a small Pneumothorax
Air is 21% oxygen and 80% nitrogen
Have patient breathe in 100% O2
Eventually no more nitrogen in the blood or lung, but still in the pleural space
Therefore the nitrogen will dissipate (due to concentration gradient) into the blood stream and help reduce the pneumothorax

23
Q

What is a tension penumo thorax

A

Cardiovascular Compromise due to continuing accumulation of air into the pleural space which cannot escape (1 way valve)
- Pressure builds, such that it exceeds the Right Atrial Pressure and then start to have CV compromise

24
Q

what is the treatment for a tension pneumo thorax

A

Treatment – Must Urgently decompress –

		Stick needle into the patient -- still left with  pneumothorax, but have relieved the tension 

		Let air out 
		Then put In chest tube