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Pleural effusion

Eko Priyanto
Eko Priyanto
Eko PriyantoChairman at Indonesian Natinional Nurses Association in Kuwait

description, pathophysiology and nursing care

Pleural effusion

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PLEURAL EFFUSION
• Pleural effusion, a collection of fluid in the pleural
space, is rarely a primary disease process but is
usually secondary to other diseases. Normally, the
pleural space contains a small amount of fluid (5 to
15 mL), which acts as a lubricant that allows the
pleural surfaces to move without friction.
Physiology
• Normally pleural space contains a thin layer of
fluid.
• Fluid enters the pleural space from the capillaries in
the parietal pleural and is removed by the
lymphatics in the parietal pleura.
• Fluid can also enter the pleural space from the
interstitial spaces of the lung via the visceral pleura
or from the peritoneal cavity through the
diaphragm.
PATHOPHYSIOLOGY
• Pleural fluid accumulates when
Formation increases
Absorption decreases
• Pleural effusion can be
Transudative
Exudative
• Transudative effusion occurs commonly due to
systemic factors which either increase the
hydrostatic pressure or decrease the plasma
oncotic pressure.
• Exudative effusion occurs due to local pathology in
the lung or the pleura.
ETIOLOGY
• Transudative pleural effusion
• Congestive cardiac failure
• Cirrhosis
• Pulmonary embolism
• Nephrotic syndrome
• Peritoneal dialysis
• Myxoedema

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Pleural effusion

  • 2. • Pleural effusion, a collection of fluid in the pleural space, is rarely a primary disease process but is usually secondary to other diseases. Normally, the pleural space contains a small amount of fluid (5 to 15 mL), which acts as a lubricant that allows the pleural surfaces to move without friction.
  • 3. Physiology • Normally pleural space contains a thin layer of fluid. • Fluid enters the pleural space from the capillaries in the parietal pleural and is removed by the lymphatics in the parietal pleura. • Fluid can also enter the pleural space from the interstitial spaces of the lung via the visceral pleura or from the peritoneal cavity through the diaphragm.
  • 4. PATHOPHYSIOLOGY • Pleural fluid accumulates when Formation increases Absorption decreases • Pleural effusion can be Transudative Exudative
  • 5. • Transudative effusion occurs commonly due to systemic factors which either increase the hydrostatic pressure or decrease the plasma oncotic pressure. • Exudative effusion occurs due to local pathology in the lung or the pleura.
  • 6. ETIOLOGY • Transudative pleural effusion • Congestive cardiac failure • Cirrhosis • Pulmonary embolism • Nephrotic syndrome • Peritoneal dialysis • Myxoedema
  • 7. Exudative Pleural Effusion • Neoplastic diseases • Metastatic diseases • Mesothelioma • Infectious diseases • Pneumonia • Tuberculosis • Gastrointestinal diseases • Pancreatic disease • Esophageal perforation • Intraabdominal abscess • Diaphragmatic hernia
  • 8. Exudative Pleural Effusion • Collagen vascular diseases • Rheumatoid arthritis • SLE • Drug-induced lupus • Immunoblastic lymphadenopathy • Sjogrens syndrome • Asbestos exposure • Sarcoidosis
  • 9. Clinical Features Symptoms • Chest pain (pleurisy) • Breathlessness • Symptoms associated with the actual cause of pleural effusion • Pnemonia • Renal disorder, Cardiac and liver disease • TB • Risk for thromboembolism • Exposure to asbestos (occupation)
  • 10. Signs • Trachea shifted to opposite side • Chest movements decreased • Stony dullness • Absent breath sounds. • crackles may be present. • Decreased vocal resonance and fremitus on same side
  • 11. DIAGNOSIS • Chest X ray • CT scan • Thoracentesis • Pleural fluid is analyzed by bacterial culture, Gram stain, acidfast bacillus stain (for TB), red and white blood cell counts, chemistry studies (glucose, amylase, lactic dehydrogenase, protein), cytologic analysis for malignant cells, and pH. • A pleural biopsy also may be performed
  • 12. MANAGEMENT OF PLEURAL EFFUSION Treatment of underlying cause Therapeutic aspiration/thoracentesis is necessary in order to relieve dyspnoea Precautions: Removing more than 1L in one episode in inadvisable Can result in re-expansion pulmonary oedema Should never be aspirated to dryness before the exact etiology is determined
  • 13. COMPLICATIONS OF THORACENTESIS Iatrogenic pneumothorax Infection Dry tap or bloody tap Re-expansion pulmonary oedema Pain and respiratory distress
  • 14. • Other treatments for malignant pleural effusions include • surgical pleurectomy, • insertion of a small catheter attached to a drainage bottle for outpatient management, or • implantation of a pleuroperitoneal shunt.