Pleural Effusions and Empyemas Chapeter 24, CHApter 27 ILD, CHAPTER 32 Sleep Apnea

Exudative Pleural Effusions

DDevelops when the pleural surfaces are diseased 

• Fluid has a high protein content 

• Has a great deal of cellular debris

• Usually caused by inflammation, infection, or malignancy

Transudative Pleural effucion

• Develops when fluid from the pulmonary capillaries moves into the pleural space

• Fluid is thin and watery

• Contains a few blood cells and little protein

• The pleural surfaces are not involved in producing the transudate

Anatomin Alterations

• Pleural effusion

  • The accumulation of fluid in the pleural space  

• Empyema

  • Infected, accumulated fluid in the pleural space  

• Major pathologic or structural changes 

  • Lung compression

  • Atelectasis  

  • Compression of the great veins and decreased cardiac venous return

Treatment

Oxygen therapy protocol

• Lung expansion therapy protocol

• Mechanical ventilation protocol

• Pleurodesis 

Characteristics of other pathologic fluids

• Chylothorax

  • The presence of chyle in the pleural cavity 

  • Usually caused by trauma to the neck or thorax or by cancer occluding the thoracic duct 

Characteristics of other pathologic fluids

• Hemothorax

  • The presence of blood in the pleural space

Assesment findings Physical

• Vital signs

  • Increased 

    • Respiratory rate (tachypnea)

    • Heart rate (pulse)

    • Blood pressure

• Chest pain/decreased chest expansion

• Cyanosis

• Cough (dry, nonproductive)

Chest Assesment findings

tracheal shift

Decreased tactile and vocal fremitus

dull percussion note

diminished breath sounds

Displaced heart sounds

pleural friction rub SOMETIMES

• Chest radiograph

• Chest radi

  • Blunting of the costophrenic angle

  • Fluid level on the affected side

  • Depressed diaphragm

  • Mediastinal shift (possibly) to unaffected side

  • Atelectasis

  • Meniscus sign

Common Causes of Transudative Pleural Effusion

• Congestive heart failure is the most common cause 

• Hepatic hydrothorax

  • Patients with cirrhosis

  • Result of abdominal ascites  

• Peritoneal dialysis

  • When dialysis stopped, effusion usually disappears rapidly 

Common Causes of Transudative Pleural Effusion

• Parapneumonic pleural effusion

  • Effusions that occur as a result of underlying pulmonary infection 

• Nephrotic syndrome

  • Effusions generally bilateral 

  • A result of the decreased plasma oncotic pressure 

• Pulmonary embolism or infarction

  • 30%–50% of patients with pulmonary arterial emboli develop pleural effusion 

Common Causes of Exudative Pleural Effusion

• Malignant pleural effusions

• Malignant mesotheliomas

• Bacterial pneumonias

• Tuberculosis

• Fungal disease

• Pleural effusion resulting from diseases
  of the gastrointestinal tract

• Pleural effusion resulting from collagen vascular diseases

Anatomic Alterations OF ILD (INTERSTIAL LUNG DISEASE)

• Destruction of the alveoli and adjacent pulmonary capillaries

• Fibrotic thickening of the respiratory bronchioles, alveolar ducts, and alveoli

• Granulomas

• Honeycombing and cavity formation

• Fibrocalcific pleural plaques (particularly in asbestosis)

• Bronchospasm

• Excessive bronchial secretions (caused by inflammation of airways)

RISK FACTORS: occupational Enviromental/ Inorganic Exposures

Asbestosis

Coal dust

Silica

Beryllium

Aluminum

Barium

Clay

Iron

Certain talcs

Ocupation/Enviromental/Medications and illicit drugs

Antibiotics

Antinflammatory agents

cardiovascular agents

Drug induced systemic lupus erythematous

illicit drugs

Radiation therap

Systemic Diseases / connective tissue disease

Scleroderma

Rheumatoid arthritis

Sjogren’s syndrome

polymyositis or dermatomyositis

Systemic lupus erythematosus

SARCOIDOSIS

Idiopathic interstitial pneumonia

Idiopathic pulmonary fibrosis

Nonspecific cryptogenic organizing pneumonia BOOP

Lymphocytic interstitial pneumonia (LIP)

General management medications

Corticosteroids

immunosuppressive agents

Assessment findings VITAL SIGNS

INCREASES

Respiratory rate (TACHYPNEA)

Physical Examination

CYanosis

Digital clubbing

Peripheral edema and venous distension

Distended neck vains

pitting edema

Enlarged and tender liver

Phisical Examination

Non productive cough

Chest assessments findings

Increased tactile and vocal fremitus

Dull percussion note

Bronchial breath sounds

Crackles

pleural friction rub

whispered pector

Hematology

Increased hematocrit and hemoglobin (polycythemia)

Chest radiograph

Bilateral reticulonodular patter

Irregularly shaped opacities

Granulomas

Cavity formstion

Honey combing

pleural effussion

General Management

The management of interstial lung disorders is directed at the inflammation associated with the various disorders

SLEEP APNEA, SIGNS AND SYMPTOMS