Pleural Diseases Flashcards Preview

Foundations II- Pulmonary > Pleural Diseases > Flashcards

Flashcards in Pleural Diseases Deck (56):
1

What is the pleura?

serous membranes, consists of mesothelial cells, CT

Visceral-covers lungs and adjoining structures

Parietal- attached to CW, covers the diaphragm

2

What is pleuritis?

AKA pleurisy

inflammation or irritation of the pleura

the 2 layers rub together which produces pain with inhalation and exhalation

3

What are some causes of pleuritis?

Infection, autoimmune disorder, PE, pneumothorax, lung CA, rib , meds, sick cell disease, post op...

4

Sxs of pleuritis?

Sharp CP worse with breathing, coughing, sneezing. May radiate to shoulders/back


+ other signs and sxs depending on underlying cause: fever, chills, SOB, etc.

5

PE findings of pleuritis?

pleural friction rub

6

Can you see pleuritis on CXR?

NO, it is a clinical dx

7

Work up for pleuritis?

CXR- look for pna, pleural effuse, mass..

CTA chest- r/o PE

Serologic studies

8

Tx of pleuritis?

NSAIDS --> try for 2/3 wks and re-eval

Steroids for refractory pain


treat the underlying cause

9

Lupus Pleuritis

involvement of lung, pleura and pulmonary vasculature is common in SLE

pleurisy can be first sign of disease

10

Serological testing for SLE

ANA if +

anti-dsDNA, anti-Sm, etc.

r/o infection

11

Tx for lupus pleuritis?

NSAIDS

12

Common signs of rheumatoid pleuritis? tx?

pleuritic CP, fever, +/- dyspnea

NSAIDS

13

What is a pleural effusion?

Abnormal fluid collecting in the pleural space as a result of excess fluid production and/or decreased lymphatic absorption

14

How much fluid is normally contained in the pleural cavity?

5-15cc

15

Causes of pleural effusion?

can be caused by lots of disorders.

most caused by: CHF, pna, malignancy, pulmonary embolism

16

What are the 2 different categories of pleural effusions?

1. Transudative effusions

2. Exudative effusions

17

sxs of pleural effusion?

dyspnea, cough, pleuritic CP

18

PE findings in pt with pleural effusion?

dullness to percussion, decrease/absent tactile fremitus, decreased BS, no voice transmission

19

How can you dx pleural effusion?

CXR-pleural fluid may blunt costophrenic angle and form a meniscus laterally (lat decubitus view is most sensitive)

CT chest/ US

Thoracentesis

Pleural biopsy

20

Indications for thoracentesis?

-newly dx pleural effusion (for dx purposes)

- Atypical feat. in CHF

- therapeutic sxs relief

-if imaging suggests complicated effusion: loculated, empyema

21

Contraindications for thoracentesis?

small volume of fluid (risk for pneumothorax), skin infx at needle site, mechanical ventilation, uncooperative pt

22

Potential complications of thoracentesis?

pain at puncture site, int. bleeding, pneumothorax, empyema

23

What is Light's criteria used for?

to differentiate transudate v. exudate

exudate if one of following:
-ratio of pleural fluid protein: serum protein >0.5

-ratio of pleural fluid lactate dehydrogenase: serum LDH >0.6

-pleural fluid LDH level > 2/3 of the upper limit of norm serum LDH

24

What causes transudative effusions?

systemic imbalances in hydrostatic and oncotic forces

i.e HF, atelectasis, nephrotic syndrome, hepatic hydrothorax

25

What causes exudative effusions?

occurs when local factors influencing accumulation of pleural fluid are altered

increased pleural capillary permeability leads to elevated protein/cellular content

i.e. malignancy, infection, PE, post cardiac injury

26

Long term management of pleural effusion?

-tx underlying illness
-PRN thoracentesis
-pleurX catheter (refractor effusions)
-Pleurodesis (obliterates pleural space)

27

What is a pneumothorax?

presence of air/gas in the pleural cavity

usually spontaneous

28

Primary spontaneous pneumothorax? Secondary spontaneous pneumothorax?

occurs w/o precipitating event in person w/o known lung disease

occurs as comp. of an underlying lung disease

29

When does a pt have the highest risk for recurrent pneumothorax?

within the first 30 days

30

risk factors for pneumothorax?

smoking (91%)

familial

marfan syndrome

31

Presentation of spontaneous pneumothorax?

usually in 20s

tall, thin, young men 20-40

sudden onset dyspnea and pleuritic CP

pain is usually unilateral and can be sharp, agonizing and associated with considerable apprehension

32

PE findings in pt with spontaneous pneumothorax?

tachycardia, hypotension

decreased chest expansion on one side


diminished BS, hyperresoinant percussions, labored breathing, subcutaneous emphysema

33

How can you dx spontaneous pneumothorax?

1st line: CXR, CT chest

34

blebs and bullae can...

rupture and cause pneumothorax

they are seen in COPD

35

What US finding would you seen in a pt with a pneumothorax?

absence of "sliding lung sign"

used when dx needed emergently at bedside

36

Tx of spontaneous pneumothorax?

100% oxygen administration

If small (<2-3cm) --> observe if clinically stable

If large (>3cm)--> needle aspiration

Recurrent --> chest tube insertion

Unstable --> chest tube

37

When can you discharge a pt with a pneumothorax?

After observing for at least 6 hrs

CXR must demonstrate NO progression of pneumothorax

38

How do you perform a needle aspiration?

1. needle inserted in 2nd intercostal space in midclavicular line

2. catheter left in place & attached to a 3 way stopcock and large syringe

3. air is aspirated until resistance is met of pt starts coughing

4. repeat CXR to document lung re-expansion

39

Indications for chest tube?

no response to needle aspiration, secondary spontaneous pneumothorax (SSP), recurrent pneumothorax, hemothorax

40

Clinical presentation of SSP?

generally more severe than PSP - have less reserve due to underlying lung disease

41

CXR in pt with SSP?

may be difficult to distinguish from underlying bleb, emphysematous changes

42

Tx for SSP?

admit

almost all will require drainage

tuve thoracostomy > needle aspiration

43

What is a tension pneumothorax?

medical emergency!

occurs in 1-2% of PSP

44

Presentation of tension pneumothorax?

worsening dyspnea, hypotension, diminished BS on affected side, distended neck veins, tracheal deviated away from the affected side

45

Tx of tension pneumothorax?

immediate decompression

needle decompression can be used temporarily until chest tube is placed

46

What is acute respiratory distress syndrome?

acute hypoxemic respiratory failure following a systemic or pulmonary insult w/o evidence of HF

47

Clinical findings in ARDS?

bilateral radiographic opacities and hypoxemia

48

Pathologic findings in ARDS?

diffuse alveolar damage

49

ARDS is a...

dx of exclusion

50

Berlin definition to dx ARDS?

-Acute onset w/in 1 week of a known clinical insult

-B/L radiographic pulmonary infiltrates

-Respiratory failure not fully explained by HF or volume overload

-Moderate-severe oxygenation impairment

51

Pathophys of ARDS?

acute/diffuse inflammatory lung or systemic disease-> damage to pulmonary capillary endothelial cells and alveolar epithelial cells -> increased vascular permeability (and decreased surfactant) -> pulmonary edema and alveolar collapse --> hypoxemia

52

What are some systemic insults? pulmonary insults?

sepsis, shock, trauma, multiple blood transfusions, burns, etc.

diffuse PNA, aspiration, lung contusion, etc.

53

clinical presentation of ARDS?

sig. SOB 6-62 hrs after inciting event, worsen quickly

respiratory distress, accessory muscle use, tachypnea, tachycardia, diaphoresis

hypoxemia that is unresponsive to O2

other signs of multiple organ failure

54

Dx tests for ARDS?

CXR, CT chest

typically see: diffuse/patchy B/L infiltrates, usually spare the costophrenic angels

- pleural effusions, enlarged heart


ABGs: hypoxemia, acute respiratory alkalosis

tests to r/o other conditions: BNP, echo, blood cultures

55

Tx for ARDS?

identify initial systemic/pulmonary insult and tx

Intubation/mechanical ventilation

Prone positioning (turn bed upside)

nutrition support

prompt tx VAP

DVT/GI prophylaxis

56

ARDS prognosis?

high mortality

hypoxemia and infiltrates takes wks-months

survivors will likely be left with significant reduction in QOL