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12 Cards in this Set
- Front
- Back
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orange: visceral pleura. Pulm capillary bed, has lymphatics, no stomata, no innervation
parietal pleura: systemic capillary bed, lymphatics, stoma, pain innervation |
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what is a pneumothorax philosophically |
uncoupling of visceral and parietal pleura with air |
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how does pleural fluid formation work in healthy pt |
systemic cap in parietal side and visceral pulm cap have same osmotic pressure pulling out, systemic have higher hydrostatic pressure. Hydrostatic puts fluid out.
net result is that parietal pleura producing fluid and visceral pleura is absorbing fluid |
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how does pleural fluid formation go wrong in dz pt |
visceral pleura has limited resorptive capacity, so if increased formation, fluid transported via parietal pleura stomata directly into lymphatics which drain to mediastinum (not molecular size limit)
increased formation is from higher hydrostatic pressure so if CHF, lymph nodes changed or something, lymphatics can increase capacity over time |
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how do you get a pleural effusion |
transudative- disturbed hydrostatic and/or oncotic pressure
exudative: increased capillary permeability
lymph obstruction exacerbates either |
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how does transudate effusion happen |
no pleural inflam no pleuritic pain bilateral
pleura is not the problem
CHF (left or both ventricles) cirrhosis hypoalbuminemia nephrotic syndromee |
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how does exudate effusion happen |
increased capillary permeability so pleura is abnormal
pleural inflam and or neoplasia pleuritic pain may be present u/l or b/l
pneumonia, cancer, PE, autoimmune dz, uremia, TB |
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how do you dx effusion |
thoracentesis
on it test: total protein and lactate dehydrogenase |
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how does the exudate fluid differ from transudate |
can be:
pleural fluid protein/serum protein >.5 pleural fluid LDH/serum LDH >.6 pleural fluid LDH >2/3 upper limit of normal serum
transudates never have any of these, so any signifies you should think exudate (increase sensitivity, decreased specificity) |
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how do you get pneumothorax |
air in through chest wall: thoracic trauma transthoracic needle biopsy
air enters from bronchial tree: ruptured lung bullae surgical lung resection (leaking suture) |
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what do u think about this |
worried tension pneumothorax since trachea is pushed away medical emergency |
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what can asbestos do pleural wise |
mesothelioma: primary pleural tumor, kills you
pleural plaques: fibrous tissue islands in pleural space, esp diaphragmatic plaques |
