Lec 22 Pleural Diseases Flashcards Preview

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Flashcards in Lec 22 Pleural Diseases Deck (40):
1

What is blood supply to pleura?

parietal = intercostal arteries
visceral = bronchial arteires

2

WHat is drainage of parietal pleura?

systemic veins

3

What is drainage of visceral pleura?

pulmonary veins

4

WHat is lymphatic drainage of parietal pleura?

internal mammary chain and internal intercostal chain

5

What is lymphatic drainage of visceral pleura?

hilar and middle mediastinal lymph nodes

6

Which part of pleura is normally responsible for pleural fluid formation and absorption?

parietal pleura!

7

What is starling equation for pleura?

fluid movement = L [(Pcap - Ppleura) - o(oncoticPcap - oncoticPpleura)]

8

What are pleural stomata?

big holes in parietal pleura = look liek microvilli in intestine

designed for moving fluid around + can take up large particles

9

What are the 2 causes of pleural effusion?

altered permeability of pleural membranes = EXUDATE

altered driving P = TRANSUDATE

10

What things typically cause exudative pleural effusion?

inflammation or tissue disruption

11

WHat things typically cause transudative pleural effusion?

fluid avid states --> CHF, cirrhosis, nephrotic syndrome

== not the lung's fault

12

How do you detect effusions on physical exam?

decreased breath sounds and fremitus; dullness to percussion

13

How do you detect effusions on chest radiograph?

200-500 mL of fluid needed to blunt lateral costophrenic angle

14

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

15

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]

16

What is light's criteria?

if any criteria met = exudate
if none met = transudate

1. pleural fluid/serum protein ration > 0.5
2. pleural fluid/serum LDH ratio > 0.6
3. pleural fluid LDH > 2/3 upper limit of normal

17

What are some things that cause transudative effusions?

- CHF
- nephrotic syndrome
- hypoalbuminemia

18

What are some findings in transudative pleural effusion?

- increased hydrostatic P
- decreased plasma oncotic P
- movement of transudative abdominal fluid [ascites]

19

How does pleural effusion form in CHF?

high PCWP --> fluid leaks into interstitium of lung and subsequently pleural space

20

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

21

How do you treat hepatic hydrothorax?

treat the ascites --> diuretics, reduced portal pressure

22

What are some causes of exudative effusions?

- infectious
- malifnant
- PE
- asbestos
- chylothorax

23

What is a parapneumonic effusion?

effusion around the time of pneumonia

24

What are 3 types of parapneumonic effuson?

- simple
- complicated
- empyema

25

What is complicated parapneumonic effusion?

loculated
pH < 7.2
LDH > 1000

26

What is empyema?

parapneumonic effusion that contains organisms or has gross appearance of pus

27

What is possible complication of empyema/complicated parapnuemonic effusions if left undrained?

- fibrothorax
- septic shock

28

What is TB pleuritis?

- subpleural focus of TB ruptures into pleural space 6-12 wks after primary infection or reactivation

TB antigens in pleural space --> acute hypersensitivity rxn w/ exudative pleural effusion

29

If not treated what happens in TB pleuritis?

- generally resolves over wks
- 65% go on to develop active pulm TB

30

What causes malignant pleural effusion?

- tumor implanted on pleural surface from embolus or direct extension lung/breast

- lymphatic obstruction by tumor prevents fluid reabsorption

31

What are symptoms/signs of pleural effusion?

- dyspnea
- pleuritic chest pain
- fever
- dull to percussion
- decreased breath sounds
- pleural friction rub

32

What do you see on xray in pt with pleural effusion?

- blunted costophrenic angle

33

What is a loculated pleural effusion?

effusion that is not really moving around = can see thick visceral pleura on inside

34

What defines hemothorax?

pleural fluid with Hct > 50% of serum Hct

35

What is a pneumothorax?

air in pleural space

36

What are two types of pleural effusion? etiologies?

entry from parietal pleura = trauama or iatrogenic

entry from visceral pleura = rupture lung cyst; complication of mechanical ventilation; necrosis due to tumor, infection

37

WHat is a spontaneous pneumothorax?

sudden onset pleuritic chest pain w/ dyspnea

38

Who gets primary pneumothorax?

tall, male, thin smoker
w/ asymptomatic subpleural blebs

39

What are some diseases associated w/ spontaneous pneumothorax?

emphysema, PCP, CF, abscess

40

What is effect of tension pneumothorax?

- collapsed lung
- decrease venous return
- displaced mediastinum to opposite side of chest
- cardiovascular collapase