Lec 22 Pleural Diseases Flashcards
(40 cards)
What is blood supply to pleura?
parietal = intercostal arteries visceral = bronchial arteires
WHat is drainage of parietal pleura?
systemic veins
What is drainage of visceral pleura?
pulmonary veins
WHat is lymphatic drainage of parietal pleura?
internal mammary chain and internal intercostal chain
What is lymphatic drainage of visceral pleura?
hilar and middle mediastinal lymph nodes
Which part of pleura is normally responsible for pleural fluid formation and absorption?
parietal pleura!
What is starling equation for pleura?
fluid movement = L [(Pcap - Ppleura) - o(oncoticPcap - oncoticPpleura)]
What are pleural stomata?
big holes in parietal pleura = look liek microvilli in intestine
designed for moving fluid around + can take up large particles
What are the 2 causes of pleural effusion?
altered permeability of pleural membranes = EXUDATE
altered driving P = TRANSUDATE
What things typically cause exudative pleural effusion?
inflammation or tissue disruption
WHat things typically cause transudative pleural effusion?
fluid avid states –> CHF, cirrhosis, nephrotic syndrome
== not the lung’s fault
How do you detect effusions on physical exam?
decreased breath sounds and fremitus; dullness to percussion
How do you detect effusions on chest radiograph?
200-500 mL of fluid needed to blunt lateral costophrenic angle
When are two situations when you DONT tap pleural effusion?
- less than 10 mm of free-flowing fluid on lateral decubitus film
- CHF w/ improvement with treatment
What is technique for thoracocentesis?
- insert one interspace below loss of fremitus/dullness to percussion
- pt upright not leanding forward
- insert over rib [b/c vessel/nerve below]
What is light’s criteria?
if any criteria met = exudate
if none met = transudate
- pleural fluid/serum protein ration > 0.5
- pleural fluid/serum LDH ratio > 0.6
- pleural fluid LDH > 2/3 upper limit of normal
What are some things that cause transudative effusions?
- CHF
- nephrotic syndrome
- hypoalbuminemia
What are some findings in transudative pleural effusion?
- increased hydrostatic P
- decreased plasma oncotic P
- movement of transudative abdominal fluid [ascites]
How does pleural effusion form in CHF?
high PCWP –> fluid leaks into interstitium of lung and subsequently pleural space
What is hepatic hydrothorax?
- pressure in abdomen is positive; pleura is negative
fluid may move north if there is a connection
R more than L
fluid is transudate
due to ascites
How do you treat hepatic hydrothorax?
treat the ascites –> diuretics, reduced portal pressure
What are some causes of exudative effusions?
- infectious
- malifnant
- PE
- asbestos
- chylothorax
What is a parapneumonic effusion?
effusion around the time of pneumonia
What are 3 types of parapneumonic effuson?
- simple
- complicated
- empyema
