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Flashcards in Pleural Disease Deck (25):
1

What is the compositionof parietal and visveral pleura?

layers of collagen and elastin covered by a single cell layer of mesothelium

2

What does peluritic chest pain indicate?

involvement of the parietal pleura because

3

How much fluid is usually in the pleural space?

3.5 mL

4

What are reasons why there would be excess fluid in the pleural space?

excess fluid in the lungs

cancer blocking drainage system

something disrupting the integrity of the membrane

5

What are the hypothesized roles for the visceral pleura?

provide mechanical support for the lung

function as a "reservoir" for lung water preventing the development of pulmonary edema

6

factors favoring the formation of pleural effusions

increased Pcap

decrease Ppleura

decreased πcap

increased K or decreased R

7

transudates

accumulation of fluid from alterations of Starling forces across a normal membrane

8

exudates

protein-rich contents spilling into the pleural space resulting from alterations in the permeability of the membrane

9

Light's Criteria

1) pleural fluid total protein/serum toal protein > 0.5

2) pleural fluid LDH/serum LDH > 0.6

3) pleural fluid LDH > 2/3 of the upper normal value of serum LDH

an effusion is classified as an exudate if ANY ONE of these criteria are et

10

What are the top five causes of transudates?

congestive heart failure (increase Pcap)

liver cirrhosis (decreased πcap)

nephrotic syndrome (decreased πcap)

atelectasis (decreased Ppleural)

atelectasis (decreased Ppleura)

11

What are the three mechanistic causes of exudates?

altered membrane permeability

grossly altered membrane

decreased lymph clearance

12

What are some common causes of exudates through altered membrane permeability?

pulmonary infections

pleural malignancy

pulmonary embolism

subdiaphragmatic inflammation

collagen vascular diseases

occupational or drug induced pleural diseases

13

What are some common causes of exudates through grossly altered membrane?

esophageal rupture

thoracic duct rupture

bleeding

14

What are some common causes of exudates through decreased lymph clearance?

malignant obstruction of the lymphatics

lymphangioleiomyomatosis (LAM)

primary lymphatic diseases (yellow nail syndrome)

15

common symptoms of pleural effusions

asymptomatic

large effusion can cause:

nonproduct cough

chest discomfort

pleuritic chest pain - indicates inflammation

dyspnea from displacement of respiratory muscles

atelectasis

16

signs of pleural effusions

dullness to percussion

decreased tactile fremitus

tracheal devation away from the effusion

decreased breath sounds

pleural rub

17

What is the treatment for pleural effusion?

require drainage when they are large and symptomatic or when they are infected

if not large, a small aliquot is removed and analyzed in order to help establish a diagnosis of a systemic disease (thoracentesis)

18

causes of low pH effusions

parapneuonic effusions (main cause)

malignancy

esophageal rupture

urinothorax

pH of less than 7.15 is an indication for drainage

19

causes of low glucose effusions

complicated parapneumonic effusions

malignancy wiht extensive pleural involvement

rheumatoid arthritis

empyema

tuberculosis

malignancy

20

causes of high amylase effusions

pancreatitis

esophageal rupture

malignancy

other intrabdominal processes

21

How does cytology help the diagnosis of pleural effusions?

helps identify malignancies

up to 90% sensitivity with 2 thoracenteses

22

How does cell counts help the diagnosis of pleural effusions?

high cell counts with mostly PMNs indicate infection

mostly lymphocytes indicates malignancy, TB, or fungal effusions

presence of >5% mesothelial cells speaks against diagnosis of TB

RBC count of >/= 50% of that in peripheral blood indicates hemothorax

23

tuberculous effusions

lymphocyte predominant

less than 5% mesothelial cells

adenosine deaminase > 47 IU/L

(deaminase < 47 means no TB) high sensitivity

24

causes of pneumothorax

iatrogenic

traumatic

bullous disease

infection

lung hyperinflation

25

signs of tension pneumothorax

tracheal shift

progressive dyspnea

tachycardia/hypotension

increased ypmani of same side

requires immediate decompression