Term
| what is the blood supply to the parietal pleura? |
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Definition
| systemic capillaries such as intercostal arteries and the superior phrenic artery |
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Term
| what is the blood supply to the visceral pleura? |
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Definition
| probably systemic capillaries such as the bronchial artery |
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Term
| what is the lymphatic supply to the parietal pleura? |
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Definition
| lymphatic vessels in communication w/the pleural space by means of stomas |
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Term
| what is the lymphatic supply to the visceral pleura? |
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Definition
| there are abundant lymphatic vessels BUT pleural fluids do not enter the lymphatics in the visceral pleura |
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Term
| does the visceral pleura have pain fibers? |
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Definition
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Term
| what is the innervation to the parietal pleura? |
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Definition
| *costal pleura: *intercostal nerves (when stimulated, pain is perceived in the adjacent chest wall). *diaphragmatic pleura: *phrenic nerve (when stimulated, pain is perceived in the ipsilateral shoulder (which is why after laproscopy, gas needs to be cleared out of pts abdomens, b/c the irritation from it can refer to the shoulder) |
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Term
| what structures contribute to the pleural fluid? |
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Definition
| CLIP: capillaries, lymphatics, interstitial, peritoneal cavity |
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Term
| what is the general direction of fluid movement across the parietal pleura? |
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Definition
| an interplay of hydrostatic and oncotic pressure gradients favor fluid migration from the parietal pleura *into the pleural space |
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Term
| what is the net fluid movement across the visceral pleura? |
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Definition
| close to zero (driving force is parietal pleura) |
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Term
| what can cause thoracic duct interruption? |
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Definition
| trauma and malignancies (esp w/breast+lung lymphomas) |
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Term
| how strong is the barrier to movement of fluid across the visceral pleura to the pleural space? |
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Definition
| the barrier is weak, therefore when the *subpleural interstitial pressure increases, fluid will transverse the visceral pleura into the pleural space |
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Term
| what are causes of fluid formation in the peritoneal cavity? |
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Definition
| peritoneal dialysis and ascities |
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Term
| what are reasons for increased pleural fluid accumulation? |
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Definition
| increased interstitial fluid (LV failure, pneumonia, PE), increased intravascular pressures (RV or LV failure, SVC syndrome), decreased pleural pressure (atelectasis - collapse = negative pressure), increased peritoneal fluid (ascites, peritoneal dialysis), disruption of the thoracic duct, and increased pleural protein level (caused by increased capillary permeability) |
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Term
| what are some causes of decreased fluid absorption that lead to pleural fluid accumulation? |
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Definition
| lymphatic obstruction and elevation of systemic vascular pressures (RV failure or SVC syndrome) |
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Term
| what is one way of differentiating pleural effusion and pneumonia? |
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Definition
| pleural effusions have more of a meniscus shape to them |
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Term
| how can you determine if there is loculated pleural effusion w/x ray? |
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Definition
| lay the pt down in the lateral decubitus position |
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Term
| can unilateral pleural effusion cause a mediastinal shift? |
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Definition
| yes, pleural effusions can push the mediastinum to one side |
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Term
| what can fix the mediastinum in place when it should be shifting due to pleural effusion pressure? |
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Definition
| cancer, inflammation, some fungal diseases (histo can cause scarring) |
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Term
| what is subpulmonic effusion? |
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Definition
| NOT subdiaphragmatic, subpulmonic effusion is between the lungs and the diaphragm. it usually will cause a lateral displacement of the diaphragm. it is more visible w/a gastric air bubble |
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Term
| what is a loculated effusion? |
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Definition
| a pocket of fluid trapped in the lungs |
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Term
| should there ever be a straight line in the chest? |
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Definition
| no, this is indicative of free air in the lungs - as seen w/a hydropneumothorax |
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Term
| how do pts w/pleural effusion present? |
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Definition
| pain (if in *chest wall, suggests *localized parietal pleural involvement, if *shoulder involved, suggests ipsilateral *diaphragmatic area of parietal pleural), non productive cough (secondary to lung compression), and dyspnea |
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Term
| if fluid is removed from the lungs, does the equivalent level of air volume return back? |
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Definition
| no - thoracentesis of a large volume of fluid results in a much smaller than anticipated improvement in lung volume (b/c the body modifies V/Q matching w/compression) |
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Term
| can ventricular filling be decreased w/large effusions? |
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Definition
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Term
| how will pts with pneumothorax appear on physical examination? |
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Definition
| the affected hemithorax will be larger, the intercostal spaces may be convex, percussion may be dull (not as reliable as fremitus), and tactile fremitus will be attenuated/absent (due to separation of the lung from the chest wall bu fluid) *consolidation (pneumonia) will increase fremitus* |
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Term
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Definition
| long e to a short a sound over the effusion |
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Term
| what causes transudative effusions? exudative? |
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Definition
| CHF, cirrhosis, myxedema, and nephrotic syndrome (4 major organ systems). exudative effusions are caused by everything else. |
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Term
| what is light's criteria? |
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Definition
a pleural effusion is likely transudative if at least one of the following exists:
1. the ratio of pleural fluid protein to serum protein is less than 0.5
2. the ratio of pleural fluid LDH and serum LDH is less than 0.6
3. pleural fluid LDH is less than 0.7 times the normal upper limit for serum |
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Term
| when is a RBC count higher than 100,000 seen? |
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Definition
| tumor, infarction, trauma (TIT) |
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Term
| neutrophils reflect what? lymphocytes? |
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Definition
| neutrophils reflect acuteness, lymphocytes reflect chronicity |
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Term
| what should you think of with an eosinophilic pleural effusion in an older shipyard worker? |
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Definition
| asbestos related effusions |
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Term
| can air (pneumothorax) alone cause eosinophilia in the lungs? |
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Definition
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Term
| what test will differentiate pneumonias that require a chest tube asap? |
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Definition
| pneumonias with a low pH (called a complicated pneumonia) |
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