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Medicine I Exam 3 Pleural Space Disease

Terms in this set (62)

What is the pleural space?
space between parietal and visceral pleura
What is Hydrostatic Effusion?
Increased Capillary Pressure
What can cause Hydrostatic Effusion?
High pressure from heart failure or venous obstruction
What is Oncotic Effusion?
Decreased plasma proteins, like Albumin, so fluid cannot be held in
What can cause Oncotic Effusions?
Liver Disease
Protein Loss
Cutaneous Loss
Severe Malnutrition
Trauma/Burns
What is Leakage Effusion?
Increased capillary permeability due to weak integrity of the vessels
What is obstruction effusion?
Blockage of lymph return
What are the two types of pleural space disease?
Pneumothorax and Pleural Effusion
What is a tension pneumothorax?
The "hole" acts as a one-way valve, allowing air to enter on inspiration but not leave on expiration
What is a Pneumothorax/Pleural Effusion?
Air/Fluid in the pleural space causing the lung to collapse (atelectasis) which causes increased pressure in the pleural space resulting in decreased venous return to the heart
What are the C/S of Pneumothorax?
Respiratory distress
Decreased lung sounds (initially in dorsal fields and eventually everywhere)
Pneumothorax Radiograph
What is a Bulla/Bullae?
Air-filled spaces in the lung parenchyma due to rupture of alveolar walls
What is the most common signalment for Bulla/Bullae?
Large deep chested dogs
How do you treat a pneumothorax?
#1: Oxygen and Low Stress
Then Thoracocentesis to get the air out
When should you consider a chest tube for a pneumothorax?
Recurrent air buildup after 3 thoracocentesis (chest taps)
Why are Thoracocentesis performed?
Diagnostic
Therapeutic -- to ease breathing
When performing a Thoracocentesis for a suspected pneumothorax (air), where do you insert the needle?
Between 6-8th intercostal space on dorsal aspect (air rises)
When performing a thoracocentresis for a suspected pleural effusion (fluid), where do you insert the needle?
Between 6-8th intercostal space on the ventral aspect (Fluid sinks)
Why is it important to insert your needle cranial to the rib and not direct it for a thoracocentesis?
Increase incidence of laceration of lung and pneumothorax
When do you know to remove a chest tube from your patient?
<2-3 ml/kg fluid in 24 hours
If you have a chest tube in your patient for a pneumothorax, but your patient continues to get air in pleural space after a few days, what do you do next?
Lung Lobectomy
Pleural Effusion
What are the different types of Effusions?
Exudative
Chylus
Transudate
Hemorrhagic
True or False: If there is fluid in the pleural space, neoplasia should never be on your differential.
False -- Opposite, should ALWAYS be on differential
Describe Exudative Effusion.
Cloudy
High cellularity (mostly neutrophils and macrophages)
What is Exudative Effusion caused by?
Infection
Neoplasia
Describe Chylus Effusion.
Milkly color
Moderate cellularity
Many small lymphocytes
Trigflycerides in Fluid:Serum is 2-3:1
What is Chylus Effusion caused by?
Cardiomyopathy
Lymphatic Obstruction
Heartworm Disease
Idiopathic
True or False: Patients that present with a Chylus Effusions should always be tested for heartworms and get a full cardiac work up.
True
Describe a Pure Transudate Effusion.
Clear/Straw-colored
Low cellularity
What is Pure Transudate Effusion caused by?
Liver failure, Renal or GI loss of Albumin (Hypoalbuminemia) as a result of low oncotic pressure
Describe Modified Transudate Effusion.
Moderate cellularity
What causes Modified Transudate Effusion?
Right Congestive Heart Failure, Neoplasia or Vasculitis due to a high hydrostatic pressure.
True or False: Modified Transudate Effusion has normal albumin levels, unlike Pure Transudate Effusion.
True
Describe Hemorrhagic Effusion.
Hemorrhagic: Bloody but low PCV
Hemothorax: High PCV (same as peripheral blood)
What is Hemorrhagic Effusion caused by?
Coaguloapathies
Neoplasia
Trauma
Lung Lobe Torsion
You have a patient present to your clinic with shallow breathing and decreased lung sounds ventrally. What is your top ddx?
Pleural Effusion
How does bacteria get into the pleural space?
Perforated respiratory tract or esophagus
What is the most common ways to get a Pyothorax?
Inhaled grass awn or foreign body
True or False: Inflammation of a Pyothroax increases vascular permeability allowing proteins to leak out of vessels and increases the oncotic pull in the pleural space which fluid follows, so the pleura thickens and clogs.
True
How do you medically treat a Pyothorax?
Chest Tube
IV Fluids
Antibiotics
How do you surgically manage Pyothorax?
Exploratory Thoracotomy when you suspect a foreign body and there has been no improvement with medical management for 2-3 days
How long are patients with a Pyothorax treated with antibiotics?
4-6 weeks
A 1-year-old MN DSH presents to the clinic with distended abdomen, dyspnea, hyperglobulinemia, and no presence of bacteria. What is your top DDX?
FIP
Describe the exudate of an FIP feline patient.
Non-septic
High protein
Low cellularity
A cat presents with a decreased compressibility of the cranial thorax on examination. What are your top DDX?
Mediastinal Lymphoma
Effusion
How do you treat Neoplastic Effusions?
Chemotherapy +/- Surgery
What breeds of animals are predisposed to Chylothorax?
Dogs: Afghans and Shiba Inus
Cats: Siamese and Himalayans
What are the C/S of Chylothorax?
Coughing
Dyspnea
Slowly progressive over months
How do you diagnose Chylothorax?
Fluid Analysis and Cytology via a Chest Tap
Compare trigycersides in fluid:serum -- it will have 2-3x more triglycerides than serum
True or False: Heartworm will not be a differential for a Chylothorax.
False
True or False: Idiopathic Chylothorax typically requires a chest tube for treatment.
False --- Usually NOT needed due to slow progression causing compensation
True or False: If Albumin concentration is normal, you suspect an oncotic problem.
False -- Opposite, it is NOT an oncotic problem
If a transudate is not hydrostatic or oncotic, we think it could be due to vasculitis. What are some DDX for vasculitis derived transudates?
Infectious or Immune diseases
A 1-year old MI Doberman patient presents to the clinic with increased RR and effort, decreased lung sounds ventrally, and ecchymosis. What do you suspect?
Pleural Effusion and Coagulopathy specifically von Willebrands
True or False: You should always utilize a jug stick for a blood sample when a patient presents with a possible coagulopathy.
False -- NEVER use a Jug Stick
True or False: A low hematocrit and prolongs PT and PTT with a normal Buccal Mucosal Bleeding Time on a Doberman confirms Von Willebrands.
False
How do you diagnose Anticoagulant Rodenticide Toxicity?
History of exposure
Increased coagulation times (PT will be elevated first)
How do you treat Anticoagulant Rodenticide Toxicity?
Induce emesis
Vitamind K1 supplementation
True or False: You should avoid thoracocentesis for a Hemothorax/Hemorrhagic Effusion if you suspect a coagulopathy.
True
How do you treat a Hemothorax/Hemorrhagic Effusion?
Mild bleeding will reabsorb

Severe cases: Thoracocentsis and transfusion

Ongoing bleeding: Exploratory Surgery
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