PLEURAL EFFUSION: PLEURAL EFFUSION Conducted by: Ms.Monika Clinical instructor Army college of nursing Definition : 5/2/2011 2 Definition The body produces pleural fluid in small amounts to lubricate the surfaces of the pleura, it lines the chest cavity and surrounds the lungs. The pleural cavity contains a relatively small amount of fluid, approximately 10 mL on each side A pleural effusion is an abnormal, excessive collection of this fluid . Excessive amounts of such fluid can impair breathing by limiting the expansion of the lungs during respiration Types Of Effusions: 5/2/2011 3 Types Of Effusions TRANSUDATIVE PLEURAL EFFUSIONS EXUDATIVE EFFUSIONS a) TRANSUDATIVE PLEURAL EFFUSIONS: 5/2/2011 4 a) TRANSUDATIVE PLEURAL EFFUSIONS a fluid substance that has passed through a membrane or has been extruded from a tissue it is of high fluidity and has a low content of protein, cells, or solid materials derived from cells. It caused by fluid leaking into the pleural space. This is caused by increased pressure in, or low protein content in, the blood vessels . A transudate is a clear fluid, similar to blood serum . It reflect a systemic disturbance of body Causes of Transudates: 5/2/2011 5 Causes of Transudates Atelectasis (early)Cirrhosis Congestive heart failure Hypoalbuminemia Nephrotic syndrome Peritoneal dialysis EXUDATIVE EFFUSIONS:: 5/2/2011 6 EXUDATIVE EFFUSIONS : A fluid rich in protein and cellular elements that oozes out of blood vessels due to inflammation . It is caused by blocked blood vessels, inflammation, lung injury, and drug reactions. An exudate—which often is a cloudy fluid, containing cells and much protein . signify underlying local (pleuropulmonary) disease. Causes of Exudates: 5/2/2011 7 Causes of Exudates Asbestos exposure Atelectasis Hemothorax Infection (bacteria, viruses, fungi, tuberculosis, or parasites) Pulmonary embolism Uremia Types of fluids: 5/2/2011 8 Types of fluids Four types of fluids can accumulate in the pleural space: Serous fluid (hydrothorax) : A hydrothorax is a condition that results from serous fluid accumulating in the pleural cavity. This specific condition can be related to cirrhosis with ascites in which ascitic fluid leaks into the pleural cavity Blood (haemothorax): is a condition that results from blood accumulating in the pleural cavity Slide 9: 5/2/2011 9 C ) Chyle (chylothorax): chyle is a milky bodily fluid consisting of lymph and emulsified fats, or free fatty acids (FFAs). It is formed in the small intestine during digestion of fatty foods . - is a type of pleural effusion . It results from lymphatic fluid (chyle) accumulating in the pleural cavity. d) Pus (pyothorax or empyema) : is an accumulation of pus in the pleural cavity Pathophysiology : 5/2/2011 10 Pathophysiology It is explained by increased pleural fluid formation or decreased pleural fluid absorption. Increased pleural fluid formation can result from elevation of hydrostatic pressure & decreased osmotic pressure. It leads to increased capillary permeability & passage of fluid is through openings in the diaphragm Hence production increases & absorption is decreases lymphatic obstruction Pleural effusions produce a restrictive ventilatory defect and also decrease the total lung capacity and vital capacity CLINICAL MANIFESTATION: 5/2/2011 11 CLINICAL MANIFESTATION Pleuritic chest pain indicates inflammation of the parietal pleura Physical examination findings that can reveal the presence of an effusion dull or flat note on percussion diminished or absent breath sounds on auscultation. Chest pain, usually a sharp pain that is worse with cough or deep breaths Cough Fever Rapid breathing Shortness of breath DIAGNOSTIC EVALUATION : 5/2/2011 12 DIAGNOSTIC EVALUATION During a physical examination, the doctor will listen to the sound of your breathing with a stethoscope and may tap on your chest to listen for dullness. The following tests may help to confirm a diagnosis : Chest CT scan Chest x-ray Pleural fluid analysis (examining the fluid under a microscope to look for bacteria, amount of protein, and presence of cancer cells) Thoracentesis (a sample of fluid is removed with a needle inserted between the ribs) Ultrasound of the chest a) Chest Radiography : 5/2/2011 13 a) Chest Radiography The posteroanterior and lateral chest radiographs are still the most important initial tools in diagnosing a pleural effusion. Ultrasound: 5/2/2011 14 Ultrasound Ultrasound is useful both as a diagnostic tool and as an aid in performing thoracentesis. It assist in identifying pleural fluid loculations. Computed Tomography: 5/2/2011 15 Computed Tomography Cross-sectional computed tomography (CT) It helps distinguish anatomic compartments more clearly This modality is useful as well in distinguishing empyema Treatment: 5/2/2011 16 Treatment Treatment aims to: Remove the fluid Prevent fluid from building up again Treating the cause of the fluid buildup Cont…………..d: 5/2/2011 17 Cont…………..d Therapeutic thoracentesis may be done if the fluid collection is large and causing chest pressure, shortness of breath, or other breathing problems, such as low oxygen levels. Removing the fluid allows the lung to expand, making breathing easier. Cont………….d: 5/2/2011 18 Cont………….d pleural effusions caused by congestive heart failure are treated with diuretics (water pills) and other medications that treat heart failure. Pleural effusions caused by infection are treated with appropriate antibiotics. In people with cancer or infections. the effusion is often treated by using a chest tube for several days to drain the fluid. small tubes can be left in the pleural cavity for a long time to drain the fluid. In some cases, the following may be done: Surgery Thoracentasis: 5/2/2011 19 Thoracentasis Pleural fluid is drawn out of the pleural space in a process called thoracentesis. A needle is inserted through the back of the chest wall in the sixth, seventh, or eighth intercostal space into the pleural space. The fluid may then be evaluated for the following: Chemical composition including protein, lactate dehydrogenase (LDH), albumin, amylase, pH, and glucose Cont……………..d: 5/2/2011 20 Cont……………..d Gram stain and culture to identify possible bacterial infections Cytopathology to identify cancer cells, but may also identify some infective organisms Possible Complications : 5/2/2011 21 Possible Complications A lung that is surrounded by excess fluid for a long time may be damaged. Pleural fluid that becomes infected may turn into an abscess, called an empyema, which will need to be drained with a chest tube. Pneumothorax (air in the chest cavity) can be a complication of the thoracentesis procedure.