Ipapburke Pulm Test 2- Pleural Wall

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PLEURITIS

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PAIN DUE TO ACUTE PLEURAL INFLAMMATION

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DESCRIBE PAIN OF PLEURITIS

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LOCALIZED, SHARP, FLEETING, AND MADE WORSE BY COUGH, SNEEZING, DEEP BREATH, OR MOVEMENT (KNOWN AS PLEURITIC PAIN)

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WITH THIS CONDITION, YOU MAY HEAR A FRICTION RUB ON PHYSICAL EXAM

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PLEURITIS

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WHAT DOES A FRICTION RUB SOUND LIKE?

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SOUND OF LEATHER RUBBING TOGETHER OR SOUND OF THUMB AND FINGER RUBBING TOGETHER ON INSPIRATION

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HOW DOES INFLAMMATION OF THE PLEURA AFFECT THE LUBRICANT BETWEEN THEM?

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IT CAUSES LOSS OF THE LUBRICANT, RESULTING IN A FRICTION RUB WHEN THEY RUB TOGETHER

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TREATMENT FOR PLEURITIS

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TREAT THE UNDERLYING CONDITION (HISTORY IS VERY IMPORTANT) AND GIVE ANALGESICS AND ANTI-INFLAMMATORY DRUGS FOR PAIN RELIEF

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WHAT TYPE OF PAIN DOES A RIB FRACTURE CAUSE?

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PLEURITIC PAIN

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WITHOUT HISTORY OF TRAUMA IN A RIB FRACTURE, CONSIDER WHAT?

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A PATHOLOGICAL FRACTURE

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WHAT ARE POSSIBLE CAUSES OF PATHOLOGICAL RIB FRACTURES

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CANCER AND ENDOCRINE DISORDERS; SEVERE OSTEOPOROSIS

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TREATMENT FOR RIB FRACTURE

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PAIN MANAGEMENT AND ADEQUATE VENTILATION TO PREVENT ATELECTASIS (DO NOT USE CONSTRICTIVE BRACE); NSAIDS AND CODEINE

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WHAT WILL BE THE CHANGES ON PE WITH A PLEURAL EFFUSION>

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MAY BE PLEURITIC PAIN OR DYSPNEA (ALSO MAY HAVE NO SYMPTOMS); DECREASED TACTILE FREMITUS, DULLNESS TO PERCUSSION, DISTANT BREATH SOUNDS, AND EGOPHONY IF EFFUSION IS LARGE

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WHAT DO WE DO TO DETERMINE ETIOLOGY OF PLEURAL EFFUSION?

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THORACENTESIS

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MOST COMMON CAUSE OF PLEURAL EFFUSION

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CHF (ACCOUNTS FOR MOST TRANSUDATES ALSO)

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MOST COMMON CAUSE OF TRANSUDATE PLEURAL EFFUSION

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CHF

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MOST COMMON CAUSE OF EXUDATE PLEURAL EFFUSION

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BACTERIAL PNEUMONIA AND CANCER

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TREATMENT OF PLEURAL EFFUSION

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AIMED AT THE DISEASE THAT CAUSES THE EFFUSION AND THE EFFUSION ITSELF; IN CHF AND MOST OTHER TRANSUDATES TREATING THE UNDERLYING CONDITION NORMALLY SOLVES THE PROBLEM

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TREATMENT OPTION FOR PLEURAL EFFUSION SECONDARY TO CANCER

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DONE ON A CASE BY CASE BASIS; CHEMICAL PLEURODESIS IS AN OPTION FOR PAIN CONTROL

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TREATMENT FOR EFFUSION SECONDARY TO PNEUMONIA

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AIMED AT PREVENTING THE EXUDATIVE FLUID FROM TURNING INTO FRANK PUS; ANTIBIOTIC TX OF THE PNEUMONIA USUALLY RESOLVES THE EFFUSION IF THE FLUID HASN'T TURNED TO PUS; IF FRANK PUS IS PRESENT, MUST DO TUBE THORACOSTOMY

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PLEURODESIS

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Pleurodesis is the adherence of the outer surface of a lung to the membrane surrounding that lung, which is performed to treat the buildup of fluid around the lung.

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EMPYEMA

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PUS

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PROGNOSIS FOR PLEURAL EFFUSION

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DEPENDS ON UNDERLYING CONDITION; POOR FOR MALIGNANCY CAUSING

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WHAT POP. IS MOST AFFECTED BY SPONTANEOUS PNEUMOTHORAX?

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TALL THIN MEN B/W 20 AND 40; USUALLY SMOKERS OR FAMILY HX

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PATIENTS WITH MARFAN'S ALSO SOMETIMES GET WHAT?

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PRIMARY SPONTANEOUS PNEUMOTHORAX

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CAUSES OF SECONDARY SPONTANEOUS PNEUMOTHORAX

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COPD, ASTHMA, CYSTIC FIBROSIS, TB, AND MANY INFILTRATIVE DISEASES INCLUDING PNEUMOCYSTIS PNEUMONIAE

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WHAT IS CATAMENIAL PNEUMOTHORAX ASSOCIATED WITH?

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MENSTRUATION

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IS PRIMARY OR SECONDARY PNEUMOTHORAX USUALLY MORE SERIOUS?

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SECONDARY (BUT DEPENDS ON THE UNDERLYING DISEASE)

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CLINICAL FINDINGS IN SPONTANEOUS PNEUMOTHORAX

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SUDDEN ONSET OF ONE SIDED CHEST PAIN AND DYSPNEA; OFTEN BEGINS AT REST OR SLEEP; MAY PRESENT AS LIFE THREATENING RESP. FAILURE IF COPD OR ASTHMA IS UNDERLYING

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WHAT WILL PE ON LARGE PNEUMOTHORAX SHOW?

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DIMINISHED BREATH SOUNDS, DECREASED TACTILE FREMITUS, HYPERRESONANCE ON ONE SIDE

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IF THERE IS SEVERE TACHYCARDIA, HYPOTENSION, AND MEDIASTINAL OR TRACHEAL SHIFT, WHAT TYPE OF PNEUMOTHORAX SHOULD BE SUSPECTED?

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TENSION PNEUMOTHORAX

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WHAT WILL BE PRESENT ON CXR IN PNEUMOTHORAX?

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A VISCERAL PLEURAL LINE; TENSION- WILL SHOW A LARGE AMOUNT OF AIR IN AFFECTED HEMITHORAX AND CONTRALATERAL SHIFT OF MEDIASTINAL STRUCTURES

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WHAT WILL TENSION PNEUMOTHORAX RESULT IN?

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ACUTE RESPIRATORY FAILURE

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POSSIBLE COMPLICATIONS OF PNEUMOTHORAX

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SUBCUTANEOUS EMPHYSEMA MAY OCCUR; PNEUMOMEDIASTINUM CAN CAUSE RUPTURE OF THE ESOPHAGUS OR BRONCHUS

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TREATMENT FOR SPONTANEOUS PNEUMOTHORAX

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DEPENDS ON SEVERITY AND NATURE OF UNDERLYING DISEASE; IF LESS THAN 15%, TREATED W/ BEDREST, SYMPTOMATIC CARE, AND SERIAL X-RAYS; FOR GREATER THAN 15%, A CHEST TUBE IS USUALLY PLACED AND SUCTION APPLIED UNTIL LUNG EXPANDS

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IF A TENSION PNEUMOTHORAX IS SUSPECTED, WHAT IS THE TX?

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A LARGE BORE NEEDLE INSERTED IMMEDIATELY FOR DECOMPRESSION AT THE 2ND ICS MCL; TUBE THORACOSTOMY THEN FOR DEFINITIVE CARE

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A PRIMARY TUMOR ARISING FROM THE SURFACE LINING OF THE PLEURA OR PERITONEUM

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MESOTHELIOMA

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MALIGNANT MESOTHELIOMAS ARE ASSOCIATED WITH WHAT?

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ASBESTOS EXPOSURE

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SYMPTOMS OF MESOTHELIOMA

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INSIDIOUS ONSET OF SOB, NON PLEURITIC CHEST PAIN, AND WEIGHT LOSS

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PHYSICAL FINDINGS- MESOTHELIOMA

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DULLNESS TO PERCUSSION, DIMINISHED BREATH SOUNDS, AND OCCASIONALLY CLUBBING

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CXR- MESOTHELIOMA

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NODULAR, IRREGULAR, UNILATERAL PLEURAL THICKENING, AND SOMETIMES UNILATERAL EFFUSION

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PROGNOSIS FOR MALIGNANT PLEURAL MESOTHELIOMA

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75% DIE WITHIN ONE YEAR, TX IS PALLIATIVE

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WHAT IS TX FOR NON-MALIGNANT MESOTHELIOMA

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TREATED ACCORDING TO SYMPTOMS ANS SIGNS

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FOR FLUID TO BE VISIBLE ON CXR WHEN PLEURAL EFFUSION IS PRESENT, WHAT VIEWS ARE USED?

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FOR FLUID GREATER THAN 250 ML, PA VIEW; FOR LESS THAN 250 ML FLUID, USE LATERAL DECUBITUS POSITION

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TRANS OR EXU- CHF

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TRANSUDATE

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TRANS OR EXU- TRAUMA

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EXUDATE

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TRANS OR EXU- CONSTRICTIVE PERICARDITIS

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TRANSUDATE

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MALIGNANCIES- TRANS OR EXU

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EXUDATE