8-Restrictive Pulmonary Disease (Pleural Effusion) PDF

College of Applied Medical Sciences DEPARTMENT OF RESPIRATORY CARE PATH 301 Mrs.Azza Al-Nabulsi.Msc.Healthcare Sciences  Objectives: At the end you will be able to Identify the following: ​  List the anatomic alterations of th...

College of Applied Medical Sciences DEPARTMENT OF RESPIRATORY CARE PATH 301 Mrs.Azza Al-Nabulsi.Msc.Healthcare Sciences  Objectives: At the end you will be able to Identify the following: ​  List the anatomic alterations of the lungs associated with pleural diseases.  Describe the causes of pleural diseases.  List the cardiopulmonary clinical manifestations associated with pleural diseases.  Describe the general management of pleural diseases.  Outline Anatomic Alteration Pathophysiology Etiology & Epidemiology Clinical Feature Management  Case Scenario A 62-year-old woman who is referred to the chest clinic by her GP with a 6-week history of chest pain and increasing shortness of breath, which is now problematic at rest, particularly when she lies on her right side. Her history is otherwise unremarkable. Respiratory examination shows: Trachea – shifted to the right Expansion – slightly reduced on the left Percussion – normal on right, stony dull on left side to midzone Auscultation – decreased air entry on the left side Vocal resonance – decreased on the left side to the midzone Interpret Her Examination Finding?  Pleural Disorders Pleurisy/Pleuritis Pneumothorax – Acute Inflammation of the parietal and/or Buildup of air or gas in the pleural visceral pleurae space Hemothorax Pleural effusion – Buildup of blood in the pleural Excess fluid in the pleural space space Mesothelioma Pleural Emergencies: Malignant condition of the pleura caused Elevated Pleural Pressure by the inhalation of asbestos - Tension pneumothorax - Massive pleural effusion  Pleural Fluid Normal pleural fluid has the following characteristics: -clear fluid -pH7.60-7.64, -protein content less than 2% (1-2g/dL), -fewer than 1000 WBCs per cubic millimeter, -glucose content similar to that of plasma, -lactate dehydrogenase(LDH)level less than 50% of plasma Pleural Effusion Anatomic Alteration Pathophysiology Etiology & Epidemiology  Etiology & Epidemiology (Transudative Pleural Effusion)  Etiology & Epidemiology (Exudative Pleural Effusion) Diagnosis Diagnosis Diagnosis Diagnosis Diagnosis  Diagnosis If the pleural fluid protein is between 25 and 35 g/L. Light's criteria should be applied to differentiate transudates and exudates accurately. Light's criteria state that the pleural fluid is an exudate if one or more of the following criteria are met:  Pleural fluid protein divided by serum protein >0.5  Pleural fluid LDH divided by serum LDH >0.6  Pleural fluid LDH >2/3 the upper limits of normal serum LDH Diagnosis  SPECIAL TYPES OF PLEURAL EFFUSION Malignant Effusion Hemothorax Chylothorax Criteria of malignant effusion: presence of blood in the pleural space= pleural fluid with Hct > 50% Presence of chyle in the O Usually massive, rapidly blood pleural space. accumulating. Causes : O Rapidly recurrent after aspiration. disruption of the thoracic duct O Bloody or serosanguinous. due to: O Trauma O Associated with central O Tumors: lymphoma, mediastinum, ipsilateral or contralateral mediastinal shift. bronchial cancer , mets. Pleural Effusion - causes, symptoms, diagnosis, treatment, pathology Diagnosis Where is the effusion? ntify each effusion from its appearance… Management Management Management Pleural Effusion Pleural Effusion  Outline Anatomic Alteration Pathophysiology Etiology & Epidemiology Clinical Feature Management  Reference: Chapter 24