Term
| overlying the mesothelium there is |
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Definition
| various layers of CT containing elastin and collagen |
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Term
| only the parietal pleura contains __ and is __ |
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Definition
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Term
| pressure in the pleural cavity |
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Definition
| intrapleural pressure is lower than interstitial pressure of pleural tissues so pleural fluid goes into the pleural space (7-10/15 cc) (effectively a filtrate w low protein and cellular composition, influx of fluid into the pleural space is balanced by lymphatics) |
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Term
| function of the visceral pleura |
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Definition
| mechanical support to lung, reservoir for lung water preventing the development of pulmonary edema, |
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Term
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Definition
| extra fluid in the pleural space due to injury, inflammation or both (local response to a disease or manifestation of systemic disease-CHF, pancreatitis) |
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Term
| how a transudate is formed and what is it |
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Definition
| when you get an inc in hydrostatic pressure due to venous outflow obstruction (CHF) or decrease in colloid pressure (dec protein synthesis, liver disease). a transudate has low protein content and very few cells, just outflow of fluid |
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Term
| what is an exudate and how is it formed |
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Definition
| an exudate has a high protein content and may contain some wbcs, get fluid and protein leakage, inc interedothelial spaces -> cells separate -> leakage out of fluid (fluid and protein leakage due to inflammation) |
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Term
| causes for fluid in the pleural space |
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Definition
| in hydrostatic pressure, dec colloid osmotic pressure, dec in pleural space pressure, inc permeability of the vascular microcirculation, blockage of lymphatic drainage, fluid movement from the peritoneum |
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Term
| transudates result from __ leading to |
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Definition
| alterations of starling's forces across the normal membrane, straw-colored clear odorless fluid |
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Term
| exudates result from __ leading to |
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Definition
| inc in permeability of membrane due to inflammatory process, inc in protein inc in LDH could be cloudy or purulent |
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Term
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Definition
to diagnose something an a transudate or exudate
Exudate- pleural protein to serum protein ratio is greater than 0.5 or pleural LDH to serum LDH is > 0.6 or pleural fluid LDH is >2/3 normal or greater than 200 |
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Term
| radiographic assessment for pleural fluid |
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Definition
| PA or lateral-decubitus film, blunting of either costophrenic angle on film indicates a fluid accumulation of 250-500cc. CXR is initial test. lateral decubitus film allows fluid to shift to differentiate it from a pleural thickening or fibrosis (can pick up an extra 5-10 cc of fluid) |
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Term
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Definition
| if the fluid has been around a long time and has walled itself off, get loculations of fluid in different areas (D shaped), don't always show up well on lateral film, ultrasound can help |
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Term
| helpful to distinguish between lung abscess and empyemas |
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Definition
| CT scan. but not test of choice for pleural fluid, do CXR or ultrasound first |
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Term
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Definition
| fluid in lungs, can't see costophrenic angles (takes 50cc to obscure), can't see diaphragm border, |
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Term
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Definition
| systemic cause- CHF, cirrhosis, pulmonary embolism, nephrotic syndrome. leakage our of fluids |
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Term
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Definition
| local cause- inflammatory, cancer, infection, GI disease (esophageal perforation- destruction of membrane), collagen vascular disease (, rheumatoid arthritis, lupus, drug-induced lupus, Sjogren's), sarcoidosis, asbestos exposure, pulmonary embolism, neosplastic disease, mesothelioma, metastatic disease, bacterial infection, tb, fungal infection, drug-iunduced (Nitrofurantoin, radiation therapy), dec lymph clearance |
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Term
| 3 most common causes of all pleural effusions |
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Definition
| CHF (transudate), pneumonia and malignancy (exudates) |
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Term
| signs/symptoms of pleural effusion |
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Definition
| dyspnea, pleuritic chest pain, cough, rapid shallow breathing, dullness to percussion, dec tactile fremitus, trachial deviation away from effusion, dec breath sounds, pleural rub, but also dependent on underlying issue (pneumonia- fever, CHF- edema, JVD, ascitis), little or no change in oxygenation or vital capacity, tumors may cause chest pain |
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Term
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Definition
| appearance- cloudy/clear/bloody, cell count and differential, gramstain and culture, cytology looking for malignant cells, LDH, protein, dec glucose (infection, tb, malignancy), inc amylase (pancreatitis, esophageal rupture) |
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Term
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Definition
| pus in the pleural space, organisms on gram stain/culture, wbcs, inc in immunocompromised, treatment is drainage the fluid and antibiotics |
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Term
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Definition
| lymphocytes predominant, less than 5% mesothelial cells, do PPD test |
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Term
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Definition
| collection of blood between the visceral and parietal pleura, can be due to pulmonary embolism, infarct, tb, av malformations, torn adhesions, endometiosis, neoplastic (primary or metastasis), melanoma, blood dyscrasias (low plts, hemophilia, if on anticoagulation may be more prone to bleeding), thoracic pathology (ruptured aorta, aortic dissection) |
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Term
| treatment for pleural effusion |
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Definition
transudate- focus on systemic cause/underlying issue
exudate- depends on exact type (chest thoracostomy if gross pus or empyma or pH of fluid is low, malignant, blood in thorax)(place a chest tube to drain the fluids |
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Term
| for a pt who presents w a new effusion |
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Definition
| confirm that it's a new unilateral pleural effusion greater than 10 ml on lateral decubitus, diagnostic thoracentesis (frank pus or hemothorax), if blood or pus put in chest tube |
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Term
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Definition
| where the lung collapses, build up of air in the pleural space, may progress where intrapleural pressure exceeds atmospheric pressure creating a tension pneumothorax scenario- impairing respiratory function and decreasing venous return to the right side of the heart and cardiac output |
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Term
| pathology of a pneumothorax |
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Definition
| have low or negative pressure in pleural space, higher pressure in the alveoli, if there's disruption to the visceral pleura this allows the high pressure in the alveoli to get to the low pressure area causing the high pressure area of the lung to collapse |
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Term
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Definition
| dramatic, increasing the pressure in the lung, air coming in from outside and pushing out against chest cavity and structures on other side, diaphragm drops, trachea can be deviated from midline, eventually dec venous return and then cardiac output, can go into shock |
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Term
| pneumothorax classification |
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Definition
| spontanous- primary/secondary and traumatic (pulmonary source, tracheobronchial source or esophageal source) |
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Term
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Definition
| disease of young adults, 15-35, males more, tall, thin body types, smokers. most common etiology is they already have blebs or pockets in their lungs and one ruptures, collapsing that portion of the lung and when they rupture that leads to primary spontaneous pneumothorax, can be treated outpatient |
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Term
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Definition
| due to underlying pulmonary disease, COPD, asthma, cystic fibrosis, immunocompromised, PCP, pneumocystis, tuberculosis |
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Term
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Definition
| blunt or penetrating damage, iatrogenic (due to endotracheal line placement, central line) or barotrauma, ventilation or blast injuries, or intraoperatively when we cut into their chest |
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Term
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Definition
| no increasing pressure, mediastinum still midline, can be treated outpatient may have to do some drainage |
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Term
| how to determine the percentage of the lung that is collapsed |
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Definition
| take 3 measurements on pneumothroax rim in cm and compare to chart, diff depending of PA or AP film |
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Term
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Definition
| tracheal shift, progressive SOB, tachycardia trying to maintain BP, then hypotensive, inc tympani on side of pneumothorax requiring immediate decompensation to equalize the pressure, diaphragm drops. need to evacuate the air w needle decompression, address the underlying source, promote pleuodesis (get the lung linings to stick together again), usually inpatient |
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Term
| respiratory symptoms in pneumothorax depends on |
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Definition
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Term
| for primary pneumothorax if >2 or breathless |
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Definition
| do an aspiration, chest tube |
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Term
| if <2 and respiratory status fine |
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Definition
| discharge and treat as outpatient |
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Term
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Definition
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