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Pathophys II - Block 1 > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

Where is the pleural space?

A

between the parietal and visceral pleura

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2
Q

How much fluid does the pleural space hold?

A

holds up to 15 mL of fluid

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3
Q

What kind of fluid is contained in the pleural space?

A

lubricating, serous pleural fluid

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4
Q

accumulation of excess pleural fluid

A

pleural effusion

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5
Q

What can pleural effusions be caused by? (5)

A
  1. increased pulmonary capillary hydrostatic pressure
  2. increased pulmonary capillary vascular permeability
  3. decreased osmotic pressure
  4. increased negative pressure in the pleural space
  5. lymphatic obstruction
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6
Q

What kind of processes can pleural effusions be caused by?

A

inflammatory or non-inflammatory

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7
Q

results in transudate/exudate being produced and the accumulation of that non-purulent exudate (effusion) in the pleural space, with various amounts of fibrin formation

A

inflammatory causes of pleural effusion

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8
Q

What type of transudate/exudate is associated with inflammatory causes of pleural effusion?

A

May be serous, serofibrinous, or fibrinous transudate/exudate

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9
Q

What are 2 common signs/symptoms of the inflammatory causes of pleural effusion?

A
  • pleuritic pain

- pulmonary friction rub

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10
Q

What is pleuritic pain?

A

sharp, stabbing pain worsening with deep respiration

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11
Q

What kind of diseases are associated with inflammatory causes of pleural effusion?

A

Generally associated with infectious diseases, especially when they affect the peripheral aspects of the lungs

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12
Q

What are some examples of these infectious disease associated with inflammatory causes of pleural effusion?

A
  • TB
  • pneumonia
  • lung infarcts
  • lung abscess
  • bronchiectasis
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13
Q

What are some examples inflammatory disease that can result in pleuritis and subsequent inflammatory pleural effusion?

A
  • RA
  • DLE (disseminated lupus erythematosus)
  • uremia
  • diffuse systemic infections,
  • metastatic involvement of pleura
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14
Q

occurs when the effusion contains purulent fluid indicating infection in the fluid (containing WBC)

A

empyema

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15
Q

Is an empyema usually unilateral or bilateral?

A

usually unilateral

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16
Q

What is an empyema usually a result from?

A

Usually results from bacterial or fungal seeding of the pleural space

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17
Q

What is the most common way that seeding occurs?

A

Seeding usually occurs by contiguous spread of organisms from intrapulmonary infection

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18
Q

What are some other ways that seeding occurs?

A

may also occur via:

  • the lymphatic or hematogenous routes
  • through the diaphragm
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19
Q

What are some characteristics of empyema?

A
  • loculations

- yellow-green, creamy pus

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20
Q

What is the pus in an empyema composed of?

A

composed of masses of neutrophils mixed with other leukocytes

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21
Q

What volume is an empyema usually?

A

often the volume is SMALL, but can accumulate in large volumes up to 500-1000mL

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22
Q

Is an empyema usually diffuse or localized?

A

localized

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23
Q

What frequently forms the walls of loculations?

A

Fibrin forms dense, tough fibrous adhesions that frequently form walls of loculations

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24
Q

What do the loculations attach?

A

attach the visceral to the parietal pleura

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25
Q

What signs/symptoms can loculations cause?

A
  • pain with respiration

- restricting pulmonary expansion

26
Q

manifested by blood (sanguinous) with/without inflammatory exudate accumulating in the pleural space

A

hemorrhagic pleural effusion

27
Q

What is it called if both blood with inflammatory exudate are present in hemorrhagic pleural effusion?

A

serosanguinous

28
Q

What are hemorrhagic pleural effusions associated with?

A
  • hemorrhagic disorders
  • some infections
  • cancer within pleural cavity
29
Q

What must a hemorrhagic pleural effusion be differentiated from?

A

hemothorax

30
Q

collection of noninflammatory, straw colored serous fluid within the pleural cavities

A

hydrothorax

31
Q

Is a hydrothorax usually bilateral or unilateral?

A

it can be either bilateral or unilateral

32
Q

What is the most common cause of a hydrothorax? What is this accompanied by?

A

Most common cause is heart failure, usually accompanied by pulmonary congestion and edema

33
Q

What may a hydrothorax be associated with?

A

May be associated with generalized edema (e.g., renal failure, hepatic cirrhosis)

34
Q

occurs with bleeding into the pleural cavity

A

hemothorax

35
Q

What are some common causes of hemothorax

A
  • ruptured aortic aneurysm
  • vascular trauma
  • post-op
36
Q

accumulation of milky (fat-rich) lymphatic fluid in the pleural cavity

A

chylothorax

37
Q

What are the causes of a chylothorax?

A

Caused by:

  • thoracic duct trauma
  • obstruction or rupture of major lymphatic ducts (malignant conditions)
38
Q

What are the components of evaluation of pleural effusion?

A
  • history and PE
  • thoracentesis
  • CBC
39
Q

What are normal values of a pleural fluid via thoracentesis? (6)

A
  • Pleural fluid is clear
  • pH 7.6-7.64
  • Protein content of less than 1-2 g/dL
  • Fewer than 1000 WBCs per mm3
  • Glucose content ≈ plasma
  • LDH less than 50% of plasma activity
40
Q

What are some reasons to cause a variation from normal values of pleural fluid?

A
  • neoplastic cells
  • microbes
  • RBCs
  • protein
41
Q

partial or total collapse of a lung due to introduction of gas (usually air) into the pleural space

A

pneumothorax

42
Q

Is a pneumothorax only due to air?

A

NO - can be any gas

43
Q

What happens to the pleural space when a gas enters?

A

there is a reduction in pleural space

44
Q

What allows lung compliance to collapse

A

negative pressure

45
Q

may occur with rupture of the lung surface, allowing gas to enter into the pleural cavity

A

spontaneous pneumothorax

46
Q

What are some examples of conditions that can lead to a spontaneous pneumothorax?

A
  • bullous emphysema
  • asthma
  • TB
  • abscess
  • neoplasm
47
Q

probably due to rupture of small, peripheral, usually apical subpleural blebs

A

spontaneous idiopathic pneumothorax

48
Q

What type of people does a spontaneous idiopathic pneumothorax generally occur in?

A

Generally occurs in relatively tall, thin, young people

49
Q

usually caused by perforating injury to the chest wall, and/or to the lung where gas can enter into pleural space

A

traumatic pneumothorax

50
Q

What does lung compression and collapse cause?

A
  • atelectasis

- respiratory distress

51
Q

What happens if the point of air entry acts as a one-way flap valve, permitting air entrance during inspiration but not permitting air escape during expiration?

A

it will act as a pump that progressively increases intrapleural pressure

52
Q

What does a one-way flap valve permitting air entrance during inspiration but not permitting air escape during expiration that acts as a pump that progressively increases intrapleural pressure describe?

A

tension pneumothorax

53
Q

What does a tension pneumothorax compress?

A

Compresses the mediastinum and the contralateral lung

54
Q

What may a tension pneumothorax cause?

A
  • tracheal deviation
  • hyper-expanded chest that moves little with inspiration
  • increased percussion note over affected side
55
Q

If there is tracheal deviation with a tension pneumothorax, which way will it deviate?

A

AWAY from the affected side

56
Q

________ of air in the pleural space air occurs _____ in spontaneous and traumatic pneumothorax, provided that the gas source becomes _____ (defect in lung or chest wall).

A

Resorption of air in the pleural space air occurs slowly in spontaneous and traumatic pneumothorax, provided that the gas source becomes sealed (defect in lung or chest wall).

57
Q

How can a small pneumothorax be treated?

A

time and observation

58
Q

What does a large pneumothorax require for treatment?

A

chest tube insertion (thoracostomy)

59
Q

What type of pleural tumors are possible?

A

primary and secondary/metastatic tumors are possible

60
Q

What type of pleural tumors are most common?

A

metastatic tumors are most common

61
Q

Where do most frequent metastatic malignancies arise from?

A
  • lung
  • breast
  • ovary
  • other
62
Q

What do most metastatic cancers result in? What does this often contain?

A

result in a serous or serosanguineous pleural effusion that often contains neoplastic cells

Pathophys II - Block 1 (8 decks)

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