Diseases of Pleura Flashcards Preview

MD2 Surgery and Anaesthesia > Diseases of Pleura > Flashcards

Flashcards in Diseases of Pleura Deck (23):
1

When do pleural effusions develop?q

Increased fluid entry
- Increase in microvascular pressure
- Heart failure
- Increase in permeability
- Inflammation
- Malignancy
- Decrease in plasma oncotic pressure
Decreased fluid exit via lymphatics
- Infiltration by
- Tumour
- Injury
- Inflammation

2

What biochemistry is performed on pleural effusions to assist in diagnosis?

Protein
Glucose
LDH
pH

3

How can you tell if a pleural effusion is transudative or exudative via its protein content?

Fluid protein/serum protein
If <0.5 > transudative
If >0.5 > exudative

4

How can you tell if a pleural effusion is transudative or exudative via its LDH content?

Fluid LDH/serum LDH
If <0.6 > transudative
If >0.6 > exudative

5

How can you tell if there is an empyema present by assessing the pleural effusion?

Glucose <5.5
Acidic

6

What are the common causes of transudative pleural effusions?

Chronic liver disease
Heart failure
Renal failure

7

What other investigations help evaluate a pleural effusion?

Imaging
- CXR
- US
- CT chest
Bronchoscopy - not routine unless suspecting TB/cancer
Thoracoscopy

8

What are the signs on plain x-ray of a pleural effusion?

Can't see costophrenic angle
Meniscus sign
Uniform opacification
No air bronchogram
- Unless underlying consolidation/collapse > seen above meniscus

9

What is the meniscus sign in the supine lateral chest x-ray?

Laminar sign

10

What are the symptoms of pleural disease?

Pleuritic chest pain = pleurisy
SOB
Cough

11

What are the signs of pleural disease?

Air in pleural space
- Decreased chest expansion
- Increased percussion note
- Decreased breath sounds
Fluid/solid tissue in pleural space
- Decreased chest expansion
- Stony dull percussion note
- Decreased breath sounds

12

What are the possible causes of bilateral pleural effusion?

Heart failure
Fluid overload
Low serum protein
- Nephrotic syndrome
- Liver disease
Inflammatory
Secondary malignancy

13

What are the possible causes of unilateral pleural effusion?

Infection - including TB
Malignancy
- Primary
- Secondary
- Lymphoma
Inflammatory - including post PE
Heart failure - less common

14

What is a primary pneumothorax?

Just pneumothorax, with no underlying lung disease

15

What is a secondary pneumothorax?

Pneumothorax with underlying lung disease

16

Why do pneumothoraces occur?

Spontaneous
Trauma
Underlying lung disease
- COPD
- Lung bullae

17

What are the risk factors for a spontaneous pneumothorax?

Smoking
FHx
Marfan's syndrome

18

What is the initial management of air in the pleural space?

Observation
Drainage
- Aspiration
- ICC with underwater seal
Pain relief
O2

19

What is the management of a possible empyema?

Sample fluid
- Protein
- Glucose
- pH
- Culture
- Cytology
Start Abx
Analgesia
Fluids
O2
Drain fluid

20

What might cause pleural plaques?

Asbestos exposure
Previous empyema/blood in pleural space

21

What are some asbestos-related lung diseases?

Pleural plaques
Pleural thickening/pleural effusions
Pulmonary fibrosis
Mesothelioma
Bronchogenic lung carcinoma

22

What is the management for malignant pleural effusion?

Depends on symptoms and prognosis
Drainage with inter-costal catheter
- Very good for symptom relief
Treat underlying malignancy
Pleurodesis
Intrapleural catheter

23

What is pleurodesis?

Obliterate pleural space to prevent pleural effusion or pneumothorax, or to treat persistent pneumothorax