Download MBBS Pulmonary Medicine Presentations 5 Pleural Disorders Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pulmonary Medicine 5 Pleural Disorders PPT-Powerpoint Presentations and lecture notes


Pleural Disorders

Dept of Pulmonary Medicine

Learning Objectives

? What are various pleural disorders

? When to suspect Pleural effusion

? Symptoms & signs

? Basic Evaluation & Management


Anatomy & Physiology

? The normal pleura is a thin translucent membrane consisting of 1-

mesothelium, 2-thin layer of subendothelial connective tissue rich in

lymphatics, arteries veins and nerves.

? Functions:

? Space for movement &

? protective in volume overload


Types of Pleural Pathology

? Pneumothorax
? Effusion
? Haemothorax
? Pyothorax
? Chylothorax
? Hydro-pneumo
? Malignancies:Mesothelioma & metastasis
? Others
Symptoms

? Chest pain

? Cough

? Dyspnea

? +-Systemic features

Signs

? LN

? Clubbing

? Tachypnea/Tachycardia

? cynosis
Signs:Respiratory

? Inspection

? Palpation

? Persussion:Stony dul

? Auscultation:Rub

? Dec Breath sounds

Approach

? Detailed history and physical examination.

? imaging: CXR; Ultrasound Chest CT.

? Pleural fluid/tissue analysis.
Radiology

? PA view>200

? Lateral 75 ml

? USG 10 ml

? Ct sensitive

Thoracocentesis

? Diagnostic(not always needed)

? Therapeutic


? Transudative Vs Exudative
? Exudative:cells predominate
? Cytology & cultures

TYPES

? Transudative

? Exudative

? Extrapleural:transmigration
Pleural fluid analysis

? Colour/turbid

? Smear

? Smell

? Culture

? Protein

? Cytology

? Sugar

? ADA

? Cells

? HCT

? TLC/DLC

? TG/Cholesterol
? Amylase

LEADING CAUSES OF PLEURAL

EFFUSIONS

Causes

Annual Incidence

Transudate

Exudate

Congestive

heartfailure 50,00 Yes

No

Pneumonia 30,00 No

Yes

Cancer

20,00 No

Yes

Pulmonary

embolus 150,00 Sometimes Sometimes

Viraldisease 10,00 No

Yes

Cornary

arterybypass

surgery

60,00

No

Yes

CirhosiwiLigthht

ascites RW.Pleural5d0is,0ea0ses.4thed.LippincottYeWillsiams&Wilkins,2001 No


Investigations

? CXR


Clinical Scenario

? A 25 yr male:prot 3.5,sugar 55,cells 2000,L-90%

? A 35 yr male:prot 5.5,sugar 25,cells 3000,P-90%

? A 65 male:prot 5.5,sugar 65,cells 1000,L-90%,Hhagic

? A 65 male:prot 1.5,sugar 65,cells 200,L-90%

CASE

Pleural Fluid Analysis

67 yo man with dyspnea and Rt. Pleural effusion

Pleural Fluid

Serum

Nucleated Cell Count

1700; >90%Lymphocytes

Total protein: 4.0 g/dl

Total protein: 6.3 g/dl

LDH: 242 U/L

LDH: 143 U/L

Cytology : negative
Etiology

? Transudative

? Exudative

? CHF

? Pneumonia

? CLD

? Tb

? Renal Failure

? CA

? Anaemia/Hypoproteinemia

? Pulmonary Embolism:Both

? Myxedema

? Trauma

? Gross ascites

? Post surgery
? Inflammatory:RA/SLE

Management

? Tubercular:ATT+-steroids

? Parapneumonic:aspiration & antibiotics to ICD+fibrinolytics or Surgery

? Malignancy:Pleurodesis

? Rest:Treat underlying cause

This post was last modified on 08 April 2022