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Respiratory Diseases


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pleural effusion
aqueous phase = visceral pleural capillaries

protein phase = parietal pleural lymphatics
pleural effusion

1. exudate
1/2 the protein
6/10 the lactate dehydrogenase
active process
causes: cancer & pneumonia
pleural effusion
2. transudate
passive movement
increased vascular hydrostatic pressure
decreased plasma oncotic pressure
increased neg intrapleural pressure
CHF--90% & most common
nephrotic syndrome
constrictive pericarditis
acute atelectasis
pulmonary embolism
pleural effusion
3. empyema
infection in the pleural space
pleural effusion
4. hemothorax
chest trauma
blood in pleural space
pleural effusion
5. chylothorax
tuberculous pleuritis
signs of pleural effusion
small: less than 200 ml
large: dullness to percussion
massive-pushes to one side
pleural effusion x-rays
more than 200 ml to see effusion on film
blunting of costophrenic sulcus
crescentic line or meniscus
white opacification
treatment for pleural effusion
thoracentesis-below the upper level of effusion & immediately above the rib
tracheal/mediastinal shift
tube thoracostomy-5 or 6 interspace at midaxillary line
fibropurulent & organized stages- "peel"
separation bet visceral & paretial pleurae by air
1. primary spontaneous
often tall thin boys
rupture of subpleural apical blebs
2. secondary spontaneous
lung disease
other lung diseases: TB, cystic fibrosis, asthma/COPD
catamenial: onset of menses & intrathoracic endometriosis
3. traumatic
iatrogenic causes
pulmonary barotrauma
4. tension
positive interpleural pressure
tracheal or mediastinal shift
widespread hyperresonance or tympany

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