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15 Cards in this Set
- Front
- Back
Pleural Effusion
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Pleural effusion is an abnormal accumulation of fluid and is often detectable on plain chest film
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5 major types of pleural effusion
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- exudate
- empyema - transudate - hemothorax - chylothorax |
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Exudate: formed by an active abnormal protein.
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.5 of pt protein of same pt
.6 LDH of same pt LDH content 2/3the upper limit of normal serum |
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Causes of Exudate
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Various INFX:
TB, Fungus/parasite (Pneumo, bact or viral, Cancer)most common |
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TRANSUDATE
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Passive movement of fluid
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Resulting from:
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- increased vascular hydrotstatic pressure
- decreased plasma oncotic pressure - increased negative intrapleural pressure |
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Causes of Transduate:
1.CHF |
accounts for 90% of transudates and is the most common cause of pleural effusion overall. Left ventricular failure causes pressure to increase in the pulmonary vessels ----->
increased hydrostatic pressure. REMINDER:CHF s a syndrome which results from one or more of the various causes of heart pathology, i.e. cardiomyopathy, valvular disease, infarction |
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2.Nephrotic Syndrome
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decreased plasma oncotic pressure
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3.Constrictive pericarditis
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noncompliant pericardium restricts ventricular filling and mimics CHF
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4.Acute atelectasis
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increased negative intrapleural pressure
- Pulmonary embolism inc’d Pul.Vasc. Resistance inc’d hydro- static pressure transudate |
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EMPYEMA
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a form of exudate. Fluid is turbid or purulent due to infection in the pleural space itself.
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HEMOTHORAX
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gross blood in pleural space. Usually due to chest trauma.
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CHYLOTHORAX
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milky in appearance due to presence of cholesterol complexes.most common in tuberculous pleuritis or rheumatoid
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S&S
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pleuritic chest pain (pain with breathing not due to fractured rib) effusion is usually exudative.
if pleural friction rub -> indicates pleurisy. SMALL EFFUSIONS:usually asymptomatic. LARGE EFFUSIONS: dyspnea, may compress. dullness to percussion lung. dullness to percussion. Massive effusion on one side may push the trachea(and therefore the tracheal air column)to the opposite side. |
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X-RAY FINDINGS:
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blunting of the costophrenic sulcus (or angle ) due to fluid accumulation there.
“Thickening” of interlobal and/or interlobular lung fissures on plain film. Crescentic line or meniscus: When an effusion is large enough, it fills the pleural space from the lung base toward the lung apex, so the affected hemithorax appears as a large white opacification on the Xray |