Module 5 Logbook - Pleural Effusion

Front 1

Definition

Back 1

Fluid collects between the parietal and visceral pleural surfaces of the thorax.

Either too much fluid produced or not enough removed, then fluid accumulates

Front 2

Anatomy

Back 2

Serosal membrane covers any serosal cavity

Outer layer- parietal

Inner layer - visceral

Prevents lung from collapsing by maintaining the –ve pressure needed to draw air into alveoli by creating its cavity

Front 3

Epidemeology

Back 3

Common CHF > Pneumonia > malignancy

Front 4

Aeitology

Back 4

Many! Transudative - disruption of the hydrostatic and oncotic forces operating across the pleural membranes (Heart failure (hydrostatic)/kidney disease (osmotic))

Exudate - protein rich inflammation related (infection and malignancy)

Blood (haemothorax), pus (empyema) or chyle (chylothorax - disruption of thoracic duct) can also accumulate in the pleural space

Front 5

Pathophysiology

Back 5

Imbalance between the fluid production and fluid removal in the pleural space.

Local factors are altered, the fluid is protein- and LDH-rich and is called an exudate

Systemic factors are altered, producing a pleural effusion, the fluid has low protein and LDH levels and is called a transudate

Front 6

Signs and symptoms

Back 6

Dyspnoea, pleuritic chest pain and cough

Dull to percuss, reduced vocal fremitus,

Risk factors: heart failure, pneumonia, malignancy and recent coronary artery surgery

Front 7

Investigations

Back 7

CXR: blunting of the costophrenic angles

Ultrasound: fluid in the pleural space

LDH (lactate dehydrogenase) and protein in pleural fluid: exudate if the ratio of pleural fluid protein to serum protein is >0.5, if the ratio of pleural fluid LDH to serum LDH is >0.6

Cytology: abnormal cells present in malignant pleural effusion

Front 8

DDx

Back 8

Pleural thickening, Pulmonary collapse and consolidation, Elevated hemidiaphragm

Front 9

Treatment

Back 9

Chest drain - No more than 1.5 litres (some say 1 litre) should be removed at a single procedure, as fluid shifts can result in pulmonary oedema

Underlying cause.

Front 10

DALTEPARIN

Back 10

Increases ATIII, reducing Xa and clotting

Front 11

AMLODIPINE

Back 11

Calcium channel blocker. Less calcium >>> smooth muscle relaxation

Front 12

FUROSEMIDE

Back 12

Loop diuretic. Inhibits water reabsorption in nephron acting on sodium-potassium-chloride co transporter

Front 13

BETAHISTINE

Back 13

Histamine agonist for vertigo - stimulates H1 receptors

Front 14

SIMVASTATIN

Back 14

Enzyme inhibitor. Competes with HMG CoA for HMG CoA reductase. Reduced amount of mevalonic acid, needed for cholesterol

Front 15

TAMSULOSIN

Back 15

Alpha blocker in prostate. Relaxation of smooth muscle leads to decreased resistance when passing water

Front 16

PARACETAMOL

Back 16

COX inhibitor. Less prostaglandins >>> increased pain threshold

Front 17

ORAMORPH

Back 17

Acts on mu opioid receptors. Increased pain inhibition pathway

Front 18

ONDANSETRON

Back 18

Antiemtic - selective serotonin antagonist. Inhibits visceral afferent stimulation of vomiting centre.