PLEURAL EFFUSION.ppt

JUJUM

1. PLEURAL EFFUSION
BY FRANK.S
PRESENTATION OUTLINE
1. Definition
2. Types of fluids in pleural effusion
3. Types of pleural effusion
4. Pathophysiology
5. Causes of pleural effusion
6. Sign and symptoms
7. Investigations
8. Management
9. Complications

2. Definition
This is the build up /accumulation of pleural fluid
between the layers of tissue that line the lungs
(pleural membranes) and chest cavity.
OR This is the excessive fluid that accumulates btn
the pleural layers (visceral and parietal), the fluid
filled space that surrounds the lungs.
Excessive fluid can impair breathing by limiting
expansion of the lungs during ventilation.
The serous fluid is secreted by parietal pleural and
removed by visceral pleural.

3. Types pleural fluids in pleural effusion
Serous fluid (hydrothorax)
Blood (haemothorax)
Pus (pyothoraxor empyema)
Chyle(chylothorax/fat)
Pathophysiology
Pleural fluid is secreted/produced by parietal pleural
membrane and reabsorbed/removed by visceral pleural
membrane then joins general circulation/blood.
In this case removal/reabsorption is less than secretion
In btnthe pleural is a potential space capable of
expanding depending of fluid amount present.

4. Types of pleural effusion
Transudate and exudate pleural effusions
Transudate pleural effusion
It is produced through pressure filtration without
capillary injury.
Also defined as effusions that are caused by
systemic factors that alter the equilibrium or
starling forces.
Starling forces include; hydrostatic pressure,
capillary permeability and onchotic pressure.
Pressure is altered by the composition of pleural
fluid and blood

5. Types of pleural effusion
Exudative pleural effusion
It is inflammatory fluid leaking btncells
They are caused by alterations of local factors that
influence the formation and absorption of pleural
fluid.
It can be blocked vessels and drug reactions
Causes of Exudative pleural effusion
Pulmonary tuberculosis
Pulmonary embolism (blood clot movtin vessels)
Cancers of lungs, Viral infections

6. Causes of transudate pleural effusion
Left ventricular heart failure/congestive cardiac
failure (L.H.F/CCF)
Renal failure
Hepatic failure
Liver cirrhosis
Bacterial pneumonia, severe PEM/kwashiorkor
In this case there is high BP and low protein in
blood.
Low blood protein>low onchotic pressure>high
hydrostatic>high capillary permeability>oedema

7. MAKE A SPOT
DIAGNOSIS=Cardiomegally

8. MAKE A SPOT DIAGNOSIS

9. MAKE A SPOT DIAGNOSIS

10. Signs and symptoms of pleural effusion
Once accumulated fluid is more than 300ml, there
is detectable clinical signs in a patient.
Decreased/reduced chest mov’t of the affected side
Stony dullness on percussion over the fluid
Reduced/diminished breath sounds on affected side
Decreased vocal resonance and tactile fremitus
Pleural friction rub on cough/deep breathing where
the lung is compressed (severe chest pain)
Bronchial breathing is diminished
Tracheal deviation away from the effusion

11. S/s of pleural effusion cont’d
Pleural effusion will show an area of whiteness on a
standard posteronterior chest x-ray (obliterated
costal phrenic angles and meniscus line)
Chest pain (sharp worse on coughing /deep breath)
Cough, tracheal tagging/pulsation
Fever if infections present
Hiccups due to irritation of diaphragm
Fast breathing
N.B Take medical history, physical examination
and chest x-ray to get the S/S

12. Investigations
Chest X-ray
Fluid aspiration for microscopy to rule out infections
by ZN staining, Gram staining, amount of protein
and histology to rule out cancers
Chest Computerized Tomography scanning (CT scan)
Ultrasound of the abdomen

13. Management of pleural effusion
Thoracocentesis(pleural tapping)
N.B Read & make notes about thoracocentesis
RX of the cause e.gPTB
Treatment aims
Removal of the fluid
Prevent fluid from building up again
Treating the cause
If CCF treat accordingly
If TB use, Anti TBs
If Cancer, chemotherapy, radiotherapy & surgery

14. Complications of pleural effusion
Fibrosis/scar tissue formation of the compressed
part of the lung
Abscess formation (Empyema)
Pneumothorax (air in pleural cavity)

15. Thanks for listening