Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
29 Cards in this Set
- Front
- Back
|
Two structures on pleural surface
|
villi, stoma to drain
(no sensory fibers) |
|
|
Where does pleural fluid come from?
|
pleural capillaries
(parietal: intercostal & int. mam.) (visceral: bronchial & pulm a.) interstitium intrathoracic lymphatics |
|
|
2 changes that can lead to collection in pleural space
|
pressure changes and area changes
|
|
|
causes of pleural effusions
|
inc fluid formation (phys or anatomic)
dec pleural fluid absorption (lymphatics or inc SVPs) |
|
|
What transports fluid across pleural layers?
|
aquaporins
|
|
|
3 most common causes of pleural effusions
|
CHF
parapneumonic malignancy |
|
|
What drives dyspnea in pleural effusions?
|
changes in chest wall pressure-volume curve
|
|
|
PE findings in pleural effusions
|
dullness to percussion
absent fremitus reduced/absent breath sounds |
|
|
What film for pleural effusion evals? Things to look at?
|
upright PA
look at costophrenic angle (blunted) apex of diaphragm could be more shifted contralateral mediastinal shift if effusion is large |
|
|
Dx eval of pleural effusion
|
tap dry, stop based on symptoms
-allows expansion of lung -improves length-tension relationship of chest wall muscles & diaphragm |
|
|
Where is needle inserted for thoracocentesis?
|
top of rib
|
|
|
What should always be sent on pleural fluid?
|
LDH, total protein, albumin
cell ct, glucose, cytology, gram stain |
|
|
What can CHF present as in pleural fluid?
|
exudative process
typically post-diuretic Rx higher protein and LDH ratio |
|
|
3 common causes of transudates
|
CHF, PE, cirrhosis
|
|
|
Where do hepatic hydrothorax occur? (which side)
|
67% are R sided
|
|
|
Empyema tx
|
must drain space (poor circulation)
|
|
|
PMNs indicate what in pleural fluid?
|
acute inflammatory process
|
|
|
Eosinophils indicate what?
|
air & blood etiologies
-also parapneumonic & drugs/asbestos/parasites |
|
|
Lymphocytes indicate what?
|
>50% malignancy or TB
|
|
|
Glucose <40, which 2 things should you think of?
|
empyema and rheumatoid
|
|
|
LDH >1000, think what?
|
complicated parapneumonic
malignancy paragonimiasis (eat crabs) |
|
|
Mesothelial cells are uncommon in what?
|
TB
|
|
|
Parapneumonic effusions
|
inc permeability
dec fluid reabsorption due to fibrin deposition high pleural space oncotic pressure |
|
|
Which classes should be drained?
|
III & IV (pus)
|
|
|
Necessary to be considered empyema
|
bugs or pus
|
|
|
Bloody effusions, think what?
|
trauma
malignancy (>50% lymphocytes too) PE infection |
|
|
Direct causes of malignant pleural effusions
|
inc permeability
obstruct lymphatics |
|
|
What does a malignant effusion mean in lung cancer?
|
stage IV cancer
|
|
|
Clinical presentation of TB effusion
|
acute
<1 mo younger unilaterla mimic bacterial pneumonia |
