Lecture 18: Pleural Space Disorders (Specht) - what was covered in class Flashcards Preview

Cardiopulmonary (Estrada-Fall 2014) > Lecture 18: Pleural Space Disorders (Specht) - what was covered in class > Flashcards

Flashcards in Lecture 18: Pleural Space Disorders (Specht) - what was covered in class Deck (22):
1

pleural effusion

accumulation of fluid in pleural sapce

2

hydrostatic and oncotic P effect on pleural fluid***

hydrostatic and oncotic pressures in pulmonary circulation favor form. of pleural fluid at parietal pleural surfaces and absorption at visceral surfaces (conditions that alter this balance result in accum. of fluid)

3

See equation on pleural effusion on 1st slide***

:)

4

CS of pleural effusion

-usually none with mild effusion
-tachypnea, inspiratory dyspnea, orthopnea (shortness of breath when lying flat), open mouth breathing, cyanosis
-dec. lung sounds w/ percussible "fluid line"

5

diagnostic tests for pleural effusion

-rads
-thoracocentesis with cytology +/- culture
-therapeutic thoracocentesis in emergency
-O2, calm patient

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tx of pleural effusion

supportive care:
-intermittent thoracocentesis, chest tubes
-O2
diuretics?
-maintain hydration

7

transudate v. exudate

exudates have higher protein content and/or cell count than transudates

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non-septic exudates usually consist of:

variable cell types including activated macs/lymphs and/or non-activated neuts, eos

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septic exudates

-have extremely elevated cell counts
-degenerate neuts predominate
-bacteria present
-foul odor if anaerobes present
-sulfur granules w/ Nocardia or Actinomyces

10

Aerobic and anaerobic cultures possible in pleural effusion?

Yes

11

Chylous effusion characteristics*

-hallmark: triglyceride conc. higher in chylous effusion than in serum**
-moderate protein and variable cell counts
-grossly white/turbid

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predominant cell type in ACUTE chylous effusions

lymphocytes

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predominant cell type in CHRONIC chylous effusions

neuts and macs, +/- plasma cells

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causes of chylous effusion (chylothorax)

-results from leakage of lymph from thoracic duct
-usually idiopathic, but can occur with trauma, neoplasia, cardiac disease, HW, lung torsion, diaphragmatic hernia

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chylothorax tx

-resolve cause of lymphatic obstruction if possible
-idiopathic: intermittent thoracocentesis, rutin, sx

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chylothorax prognosis

generally guarded to poor

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only tumor that readily exfoliates into effusions*

lymphoma

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remember: inflammation causes reactive mesothelial cells to appear dysplastic like malignancy. Therefore, there are multiple criteria of malignancy***

:)

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T/F: neoplasia in thorax can result in any type of effusion

T

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if neoplasia is suspected, but definitive dx is not possible with cytology, do a:

biopsy

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cytology of pleural effusion involves:

-measurement of total protein
-total cell count
-assessment of cell morph

22

transudates vs. modified transudates

-transudates have lower protein content and nucleated cell counts.
-transudates have primarily mononuclear cells (macs, lymphos, mesothelial cells)
-neuts may be present in modified transudates