pleural effusion + atelectasis

Question 1

transudate pleural effusion

Answer 1

<30g/L protein

Question 2

Meigs syndrome

Answer 2

triad of -
- ovarian tumour
- ascites
- pleural effusion

Question 3

exudate pleural effusion

Answer 3

> 30g/L protein

Question 4

causes of transudate pleural effusion

Answer 4

heart failure - commonest

hypoalbuminaemia
– liver disease
– nephrotic syndrome
– malabsorption

hypothyroidism
Meigs syndrome

(<30g/L protein)

Question 5

casues of exudate pleural effusion

Answer 5

infection
- pneumonia = commonest
- tuberculosis
- subphrenic abscess

connective tissue disease
- rhuematoid arthritis
- SLE

malignancy
- lung cancer, mesotheloima
- mets

pancreatitis
PE
Dressler’s syndrome

Question 6

criteria for pleural effusion

Answer 6

Light’s criteria - to help distinguish between trans/exudate

> 30 = ex
<30 = trans

if between 25-35 - Lights criteria applied. Exudate is likely if one of;
- pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than 2/3rds upper limit of normal serum LDH

Question 7

what can low glucose in pleural fluid indicate

Answer 7

rheumatoid arthritis
tuberculosis

Question 8

what can raised amylase in pleural fluid indicate

Answer 8

pancreatitis
oesophageal perforation !!

Question 9

what can low complement (C3, C4) in pleural fluid indicate

Answer 9

SLE

• pleural effusions occur in approx 30-50% of SLE patients, may be presenting feature

Question 10

what can heavy blood staining in pleural fluid indicate

Answer 10

mesothelioma
PE
tuberculosis

Question 11

management of pleural infection (assoc with sepsis or pneumonic illness)

Answer 11

requires diagnostic pleural fluid sampling

if fluid purulent or turbid/cloudy = place chest tube

if fluid clear but pH <7.2 + suspected pleural infection = place chest tube

Question 12

management of recurrent pleural effusion

Answer 12

recurrent aspiration
pleurodesis
indwelling pleural catheter

drug mx to alleviate sx
- opioids to relieve dyspnoea

Question 13

atelectasis

Answer 13

common postoperative complication
basal alveolar callapse leading to respiratory difficulty
–> caused when airways become obstructed by bronchial secretions

Question 14

typical atelectasis hx / presentation

Answer 14

dyspnoea + hypoxaemia around 72hrs postoperatively

Question 15

management of atelectasis

Answer 15

position the patient upright

chest physio - breathing exercises