Flashcards in Diseases of Pleura Deck (26):
1
intraalveolar greater or less pressure than intrapleural?
intrapleural pressure is always greater
2
what causes increased fluid entry?
increase microvascular pressure
increase permeability
decrease oncotic (pull) pressure
blockage of lymphatics
3
protein serum vs. protein in effusion fluid to determine transudate vs. exudate?
Light's criteria
4
what else to look for in effusion fluid samples?
pH (anaerobic metabolism)
white cells
blood
LDH
glucose
micro
cytology
TB
5
other investigations for pleural effusion?
bloods
CXR/CT chest
ultrasound
brochoscopy
6
pleuritic chest pain just pleura?
nope, all organs around it, including muscles
7
breath sounds in air or fluid are?
reduced
8
what can mimic a pleural effusion?
raised hemi diaphragm
9
unilateral effusion cause?
pneumonia
primary lung cancers
Trauma
TB
post-PE
heart failure but less common
10
bilateral effusion cause?
heart failure
low-pressure states (low oncotic pressure)
malignancy d
11
what is a chylothorax?
lymph with chylomicrons effusions into
12
why do you get air in pleural space?
spontaneous (smoking, FHx, Marfan's)
trauma
underlying lung disease (COPD, lung bullae)
13
how to manage air in pleural space?
could resolve spontaneously
-drainage: aspiration, ICC with underwater seal (one way valve)
-pain relief, O2
14
why O2 speed up resolution of pneumothorax?
concentration gradient to push nitrogen out and O2 into tissues
15
chest tube has stopped swinging, why?
blocked lumen
kinked tube
Tube slipped into subcut or was never in the right space
Tube tap is in wrong spot.
16
when take out the tube?
no air leaks
recurrent
17
what is fluid in a CT pleural effusion that doesn't change with gravity?
loculated pleural fluid
18
what could cause loculated pleural fluid?
empyema
19
what to do with empyema?
drain it
20
when to intervene with tube? re: pH?
pH
21
chest tube size matter for empyema?
not really, but with loculated, use DNA-ase, tPA to break it down.
22
how pleuradhesive?
talc: active inflammation to stick
strip pleura
23
what causes pleural plaques?
asbestos exposure
previous empyema,
TB or blood in pleural space
24
mesothelioma uni or bilateral usually?
usu. unilateral?
25
pleural plaques turns into mesothelioma?
Nope, just increased risk
26