Pleural Diseases Flashcards Preview

Clin Med I - Pulmonary > Pleural Diseases > Flashcards

Flashcards in Pleural Diseases Deck (57):
1

Describe the normal physiology of the pleural space

- fluid enters from capillaries in the visceral pleura
- fluid absorbed via lymphatics in the parietal pleura

2

Define pleural effusion

- abnormal build up of fluid in the pleural space

3

What can cause a pleural effusion?

- pleural fluid formation > absorption
- rate of absorption is decreased
- transport of peritoneal fluid from the abdominal cavity through the diaphragm or via lymphatics from a subdiaphragmatic process

4

Describe the physiology of pleural effusion and the result of each

- increased production of fluid in normal capillaries (abnormal pressure changes) ==> low protein "transudates"
- increased production of fluid d/t abnormal capillary permeability/inflam ==> high-protein "exudates"
- decreased lymphatic clearance ==> high protein "exudates"

5

Define empyema

- infection in pleural space

6

Define hemothorax

- bleeding into the pleural space

7

Define chylothroax

- lymphatic leakage from the thoracic duct or one of the main lymphatic vessels that drains into it

8

What are the types of pleural effusions?

- transudative
- exudative
- pus
- blood
- chyle

9

When do transudative type pleural effusion occur?

- altered systemic factors
- absence of local pleural disease
- leakage of fluid from intact normal capillaries d/t increased hydrostatic or decreased oncotic pressures

10

What are the causes of pleural effusion?

- MC: CHF
- nephrotic syndrome
- atelectasis
- chirrhosis

11

When do exudative pleural effusions occur?

- altered local factors
- presence of pleural disease
- increased production by the capillaries or blocking of lymphatics
- impaired lymphatic drainage/leaky capillaries

12

What are the causes of exudative pleural effusions?

- MC: parpneumonic effusion
- 2nd MC: 2ndary to malignancy
- mesothelioma
- PE
- trauma
- 2ndary to viral infection

13

What are the 3 types of parapneumonic pleural effusions?

- simple/uncomplicated
- complicated
- empyema

14

What causes hemothorax?

- MC: trauma
- surgery
- tumor
- ruptured blood vessel
- spontaneous

15

What is diagnostic of hemothorax?

- pleural fluid hematocrit:peripheral blood hematocrit > 0.5

16

What causes chylothorax?

- MC: lymphoma & surgical trauma

17

What does the cylothorax fluid look like?

- milky, white

18

What are the symptoms of pleural effusion?

- dyspnea
- pleuritic chest pain
- cough

19

What are the signs of pleural effusion?

- hypoxic
- decreased unilateral chest movement on affected side
- decreased breath sounds over area
- dull to percussion
- decreased tactile fremitus
- pleural friction rub
- tracheal deviation to contalateral side if large
- egophony

20

What does a pleural friction rub indicate?

- infarction
- pleuritis

21

What diagnostic tests are ordered for pleural effusion?

- CXR
- CT

22

What amount of fluid is required to see pleural effusion

- 75-100mL on lateral view
- 175-200mL on AP/PA view

23

How is a lateral decubitus CXR view helpful for pleural effusion?

- identifies free flowing vs. loculated effusions

24

What is the treatment of pleural effusion?

- thoracentesis
- tx underlying dz

25

What would purulent fluid from a thoracenteis point towards?

- empyema

26

What would putrid odor from a thoracenteis point towards?

- anaerobic empyema

27

What would milky, white fluid from a thoracenteis point towards?

- chylothorax

28

What would blood from a thoracenteis point towards?

- trauma
- malignancy

29

What is the traditional method to ddx between exudative and trasudative pleural effusions?

- Lights Criteria

30

What would the Lights Criteria yield in exudative pleural effusion?

- meets at least 1 criteria

31

What would the Lights Criteria yield in transudative pleural effusion?

- meets no criteria

32

What is the treatment for malignant effusion?

- pleurodesis
- serial thoracentesis if recurs

33

What is the treatment for empyemas?

- drainage
- long term abx

34

What is the treatment for hemothorax?

- immediate large bore chest tube placement

35

What is the definition of pleuritis/pleurisy?

- pain d/t acute pleural inflam caused by iritation of the parietal pleura

36

What causes pleuritis/pleurisy?

- anything that causes inflam

37

What are S&S of pleuritis/pleurisy?

- sharp, localized chest pain
- worsened by sneezing, deep breathing, or movement

38

What is the treatment for pleuritis/pleurisy?

- tx underlying dz
- anti-inflam
- pain control

39

Define pneumothorax

- collection of gas/air in the pleural space ==> collapsed lung

40

What are the types of Ptx?

- primary spontaneous
- secondary spontaneous
- traumatic
- iatrogenic
- tension

41

What causes a primary spontaneous Ptx?

- absence of underlying lung dz

42

What causes a secondary spontaneous Ptx?

- presence of underlying lung dz

43

What causes a traumatic Ptx?

- penetrating or blunt trauma
- open wound

44

What causes iatrogenic Ptx?

- s/p procedures

45

What causes tension Ptx?

- trauma
- lung infections
- mechanical ventilation
- resucitative efforts

46

What patient population is at highest risk for primary spontaneous Ptx?

- tall, thin, males 10-30 y/o

47

What is the suspected etiology of primary spontaneous Ptx?

- rupture of a subpleural apical bleb

48

For _______ Ptx, air pressure in the _______ _______ exceeds _______ pressure throughout the respiratory cycle

- tension
- pleural space
- ambient

49

What happen to the internal chest organs in tension Ptx?

- pushed to contralateral side

50

What are two events that occur with tension Ptx?

- hypoxia
- CV system collapse

51

What are the S&S of all types of Ptxs?

- chest pain on affected side
- dyspnea
- anxiety
- fatigue
- acute epigastric pain

52

What is seen on PE for Ptx?

- respiratory distress
- tachycardia
- unilateral chest expansion
- decreased breath sounds on affected side
- decreased tactile fremitus
- hyperressonace

53

Which of the common PE findings for Ptx suggest tension Ptx?

- tachycardia
- hypotension
- mediastinal/trachial shift

54

What tests should be ordered for Ptx?

- CXR
- ABG
- EKG
- CT
- US

55

What will be seen on CXR for Ptx?

- ipsilateral lung edge/visceral pleural line parallel to chest wall
- increased lucency
- deep sulcus sign

56

What is the tx for Ptx?

- small ( observation
- supplemental O2 to increase rate of reabsorption
- chest tube
- immediate decompression for tension

57

How can Ptxs be prevented in patients w/ (+) hx of Ptx?

- surgical removal of blebs or broncho-pleural fistulas
- smoking cessation
- minimize high altitude flying
- avoid SCUBA diving