Pleurisy (Pleuritis)

Kamilah Fernandez 10/01/2013 Year 4 Group#1 TSMU

Pleurisy
The pleura is a two layered sac that holds the lungs and separates them from the chest wall, diaphragm, and heart. Pleurisy results from an inflammation of this sac. The pleura that lines the inside of the chest is called the parietal pleura. The pleura that covers the lungs is called the visceral pleura. They are separated by a thin layer of fluid. This lets the lungs expand and contract easily during breathing. The inflammation that occurs with pleurisy can cause pain with breathing and may even cause a large amount of fluid to collect in the pleural sac.

Pleurisy

 Infectious disease cause by virus, bacteria, fungus, tuberculosis or parasites. Cancer such as mesothelioma or spread from other areas Collagen vascular disease such as lupus, rheumatoid arthritis, sarcoid disease, or scleroderma Trauma from bruised or broken ribs Gastrointestinal disease, for example pancreatitis, peritonitis, or a collection of pus under the diaphragm. Reaction to drugs such as methotrexate (Rheumatrex, Trexall) and penicillin Other causes include; uremia, radiation therapy ,HIV, sickle cell etc

Causes and Risk Factors

Symptoms
Chest Pain - sharp, stabbing/dull ache or burning sensation. NB- When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. Cough- dry or productive Shortness of breath Tachypnea Bluish skin color Loss of Appetite- depends on the cause. Fever and Chills- depends on the cause.

Pleural Effusion and Pleurisy

Pleurisy can precede pleural effusion ( accumulation of fluid in the pleura cavity). Pleural fluid accumulates as a result of either increase hydrostatic pressure or decreased osmotic pressure (transudate) or from increased microvascular pressure due to disease of the pleura surface itself or injury in the adjacent lung (exudate) There are two types of effusion; 1. Transudate ( cardiac failure, liver and kidney disease etc) 2. Exudate (cancers, SLE, TB, Pancreatitis etc)

Pleural Effusion and Pleurisy

Pleural Effusion and Pleurisy

Test and Diagnosis

Medical history and physical exam- On auscultation snow crunching (friction rub) sound heard over painful area. This sign is not always present. Blood tests- shows if there is any infections and what type of infection . Other blood tests also may detect an autoimmune disorder, such as rheumatoid arthritis or lupus. Imaging studies- X ray (decubitus) ,computerized tomography scan and ultrasound (effusion)

Test and Diagnosis

Thoracocentesis - fluid is removed for laboratory analysis. A needle is inserted through the chest wall between the ribs and the fluid is taken. If only a small amount of fluid is present, the needle may be insert with the help of ultrasound guidance over the site of the fluid.

Test and Diagnosis

Pleural biopsy- If tuberculosis or lung cancer is a suspected cause , a thoracocentesis with pleural biopsy is done removal of a sample of tissue to be examined . The biopsy needle has a small hook on the end that lifts away a small piece of tissue. Ultrasound guidance is used for this procedure as well. Thoracoscopy. This procedure, preformed under a general anesthetic, allows a surgeon to see inside the chest and obtain a sample of pleural tissue.

Treatment
External splinting of the chest wall and pain medication can reduce the pain of pleurisy. Treatment of the underlying disease, ultimately relieves the pleurisy. Removal of fluid from the chest cavity (thoracentesis) can relieve the pain and shortness of breath. If the pleural fluid shows signs of infection, appropriate treatment involves antibiotics and drainage of the fluid. If there is pus inside the pleural space, a chest drainage tube should be inserted.

Treatment

Complications
Breathing difficulty Collapsed lung due to thoracocentesis Complications from the original illness Bronchopleural fistula Pyopneumothorax Pleural effusion

Prevention
Pleurisy can be prevented, depending on its cause. For example, early intervention in treating pneumonia may prevent the accumulation of pleural fluid. In the case of heart, lung, or kidney disease, management of the underlying disease can help prevent the fluid collection.