| ID | 100 |
|---|---|
| Name | PLEURAL EFFUSION1 |
| Cause | Causes: Common causes -. 1. Tuberculosis of the lung and pleura. 2. Lobar pneumonia. 3. Malignant diseases. 4. Infarction of the lung. 5. Subdiaphragmatic disoder e.g subphrenic abscess, pancreatitis etc. 6. Cardiac failure Others- 1. Trauma. 2. Viral infection. 3. Nephrotic syndrome 4. Advanced cirrhosis of liver 5. Malnutrition 6. Connective tissue diseases 7. Lymphoma 8. Amoebic liver abscess 9. Post rh.i syndrome 10. Rheumatoid disease 11. Acute rheumatic fever 12. Myxoedema 13. Uraemia 14. Meig’s syndrome |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. E.S.R is high when the etiology of the underlying disease is tuberculosis or malignancy. 2. Pleural aspiration is an absolute proof that an effusion is present. Aspirated fluid should be send for bacteriological and cytological examination and Biochemical test. 3. Pleural biopsy may be done when exact etiology cannot be settled. 4. X-ray chest (PA view)- will show a dense homogeneous opacity obliterating the cardio-phrenic and costophrenic angles on the affected side. Trachea and heart may be shifted to the opposite side. 5. Others- sputum for AFB and cytology; tuberculin test. |
| Management | |
| Introduction | It is a condition of exudative or transudative fluid inside the pleural sac. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Symptoms- 1. Symptoms of pleurisy may peresent as - a. Sharp, stabbing and unilateral pleural pain, b. Pain may radiate to tip of the shoulder or anterior abdomen, c. Pain aggravates by cough and relieved by breath holding. 2. Pain may be absent. 3. Pyrexia occurs in most cases and continuous type. 4. Dyspnoea is the principal Symptom. 5. Heaviness, or discomfort feeling due to accumulation of fluid in the pleural sac. 6. Symptoms due to underlying causes i.e P.T. Signs: General examination - Appearance - ill looking. Temperature - Raised. Decubitus - lies on the affected by Cyanosis - Present. Respiration - Rate increased. Systemic examinations (Respiratory System). Inspection - Fullness of the chest. Chest Movement - Restricted on the affected side. Palpation: 1. Trachea and apex beat: - shifted to the opposite side 2. Vocal fremitus - - diminished in the affected part - increased in the upper part (Apex) due to compensatory emphysema. Percussion: Percussion note stony dull on the affected part. Auscultation: 1. Breath sound - Absent or markedly diminished. 2. Volcal resonance - Absent or diminished. above the .effusion breath sound increased (Vesicular) and vocal resonance increased. |
| Preventions | |
| Treatment | Treatment: Treatment should approach both the effusion and its cause. Symptomatic: 1. Rest in bed. and O2 inhalation in proped up position in severe cases. 2. Salicylates or Aspirin in usual dose may be given. 3. Aspiration of pleural fluid may be necessary to relieve breathlessness. To avoid repeated effusion treatment by pleuredesis can be given in malignancy. Specific treatment: Treatment of the underlying cause e.g- 1. Antituberculous chemotherapy for about a year or more in tuberculosis cases. 2. In post pneumonic cases removal of fluid in addition to antimicrobial agent for lung lesion may be given. 3. In malignant effusion cytotoxic agents may be given intrapleurally. Irradiation of the hemi-thorax may also be helpful. |
| Complications | |
| Prognosis | |
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