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25 Cards in this Set
- Front
- Back
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Which is greater in the normal lung: hydrostatic pressure gradient or the oncotic pressure gradient?
Net movement? Is the pleural fluid normally cellular or acellular? Composition? It is bicarbonate rich? Protein high or low? Pleural fluid is cleared by what? What is normally higher, the rate of efflux or the rate of clearance? |
Hydrostatic
Efflux into the pleural space. very acellular - mesothelial cells, mononuclear cells, lymphocytes Yes, pH > 7.5 Low. The lymphatic channels. Clearance. |
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What are some potential causes of pleural effusion from increased fluid formation?
Decreased pleural fluid abs? |
^ hydrostatic pressure
^permeability \oncotic pressure gradient obstr. lymphatics elevation of systemic venous pressure |
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What is the difference between transudate effusion and exudate effusion (they differ in causes and composition)?
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Transudate:
- non-inflammatory fluid w/ a low protein count + ^hydroS P + decrease in Plas COP - inflammatory proteinaceous fl. + ^capil. permeability + obstruction of lymph ducts |
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Absent tactile fremitius
dull percussion reduced breath sounds dyspnea cough... ... all are sx of..? |
pleural effusion
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What is primarily affected by plerual effusion?
1st step when we suspect a pleural effusion? |
diaphram --> loss of lung volume.
CXR |
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What is the point of a lateral decubitus CXR?
Dx Thoracentesis should not be attempted unless the thickness of pleural fluid is >___mm. |
see if the fluid flows, and evalutate the thickness of the pleural fluid.
10mm. |
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Is a throacentesis helpful diagnostically or therapeutically?
Do we insert the needle above or below the rib? What can help in visualization? Most common complication? |
Can be both, depending on Sx.
above, b/c we want to avoid the nerve. CT or ultrasound Pneumothrorax |
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What are 3 key things to order on any pleural fluid sample that will help differentiate b/t transudate and exudate?
What are the characteristics of the different types on these three tests? Are these criterion sensitive/specific? |
LDH, total protein, and albumin
- pleural fluid protein / serum protein > 0.5 - LDF (pf) / LDH (s) > 0.6 - LDH (pf) >2/3 upper limit of normal for serum, or just >163 IU/L --> any of the 3 = exudate. sensitive, but not very specific (it can misclassify transudates) |
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What is the most common cause of pleural efffusions in the US?
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CHF --> transudate; mostly bilateral
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what causes a hepatic hydrothorax?
Usually rt or left side? Especially a problem in pts with what dz? Tx? |
decreased plasma oncotic pressure
mvment of ascitic fluid from peritoneal cavity into the pleural cavity via pores in the diaphragm Right, most often. cirrhosis Tx of choice: liver transplant might be managed with recurrent thoracentesis. |
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Malignancy, Trauma, infections, chylothroax (lymph accumulation), TB
all cause transudates or exudative effusions? Bloody effusions make you think of what Turbid? |
exudative effusions.
Cancer, Pulmonary infarct, trauma, recent surgery Puss --> infection Milky --> lymph/chylothorax |
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>50% Neutrophil predominance in exudate?
>10% Eosionphils in the pleural exudates suggest what? >50% Lymphocyte predomination? >5% Mesothelial cells? >10% basophils? |
acute process
Air/blood Malignancy or TB **TB UNLIKELY** leukemic infiltration |
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Low glucose (<___mg/DL) in pleural fluid is suggestive of what? (4)
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60mg/DL
Parapneumonic effusion malignant effusion rheumatoid effusion TB effusion |
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When a person presents with an acute exudative effusion?
What is am empyema? Failure to recognize this leads to...(2) Tx? |
Well, it could be uncomplicated, and resolve w/ antiB
complicated --> often fails to resolve with just antiB active bact infection w/i the pleural space - unresolving and worseining infection - fibrothorax and loss of volume Tube thoracostomy |
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Something is "borderline complicated" if the pH is between...
Tx? |
7.1 --> 7.2
repeat thoracentesis |
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Pus in the pleural space
positive gram stain / culture Glucose < 40 ph <7.0 LDH > 3x the ULN Loculated pleural field. ...all indicate... |
...the need for pleural fluid drainage as a component of txt.
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What does serosanguinous mean?
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bloody
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Pleural adenosine deaminase lvl > 40 is dx of what?
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TB effusion.
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Are PPD tests often positive in TB effusions?
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no, often negative b/c of sequestration of reactive cells in pleural space.
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What is the most common reason for someone to have a malignant effusion?
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lung cancer.
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Most malignant effusions are ____(transudative/exudative) in nature.
The ___ the pH and glucose, the higher the tumor burden. Is cytology helpful? Tumor markers? Tx? |
exudative
lower. yes, it can be. No, not really. Therapeutic thoracentesis for palliation chest tube drainage Small bore catheter |
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Asbestos related pleural disease results in 3 types of pleural dz:
Which is a dx of exclusion? which is dx'ed by VATS? Which appears 30-40 years post-exposure? |
1. benign pleural plaque - just a marker of previous exposure
2. Benign asbestos pleural effusion (BAPE) - dx of exclusion 3. mesothelioma - appears 30-40 years post exposure |
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How do you dx a chylothroax?
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Check pleural fluid triGs.
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What is pleurisy?
Pleuritis? |
inflammation of the pleura, can be caused by a wide variety of things
any inflammatory process that involves the parietal pleura. --> contains main pain fibers, hence pleurisy ***significance depends of clinical setting*** |
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What is the "deep sulcus sign" indicative of on supince CXR?
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pneumothorax.
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