PATHOPHYSIOLOGY: PLEURAL EFFUSION

Non-Modifiable factors: Age Gender Heredity Cardiac Failure Liver Cirrhosis Atelectasis Superior Vena Cava Syndrome Unequal distribution of fluids in different organs of the body Alterations in normal circulation

Modifiable factors: Smoking Diet Lifestyle Nephrotic Syndrome Chronic malnutrition Ascites Tuberculosis

Pleural capillary Hydrostatic Pressure

Capillary oncotic pressure Passage of fluid through openings in the diaphragm due to chest wall and diaphragmatic movements.

Systemic venous pressure

Lymphatic obstruction in the parietal pleura

Leakage of fluid in the pleural space

Excessive Filtration of fluid

Impaired lymphatic drainage

Pleural fluid formation.

Reduction of pleural space reserves

Pleural fluid absorption

PLEURAL EFFUSION

Diagnostic Procedures: Chest Radiograph (x-ray) - Able to distinguish 200cc of H2O. S / SX: Dyspnea Cough, non-productive Pleuritic chest pain Chest pressure Hypoxemia Decreased Breath sounds decreased vibration in chest area dull lung sounds in the lower lung fields. Chest Ultrasound Locates small amounts or isolated loculated pockets of fluids.

Pleural Effusion is the build-up of fluid between a lung and the chest wall. It is caused by the following non-modifiable risk factors: Age, Gender, Heredity, Cardiac Failure, Liver Cirrhosis, Atelectasis, Superior Vena Cava Syndrome; and the following modifiable risk factors: Smoking, Diet, Lifestyle, Nephrotic Syndrome, Chronic malnutrition, Ascites, Tuberculosis. Such factors could lead to alteration in the normal circulation of the blood that can result to unequal distribution of fluids in different organs of the body. The unequal distribution of fluids in the body could lead to an increase pleural capillary hydrostatic pressure and decrease in capillary oncotic pressure leading to leakage of fluid in the pleural space and excessive filtration of fluid, respectively. Passage of fluid through openings in the diaphragm could also manifest due to chest wall and diaphragmatic movements leading to reduction of pleural space pressure. Due to the leakage of fluid in the pleural space and the reduction of pleural space pressure caused by problems in the oncotic pressure, hydrostatic pressure and chest wall movements, an increase in pleural fluid formation can occur. Unequal distribution of fluids in the body can also cause an increase in systemic venous pressure and lymphatic obstruction leading to impaired lymphatic drainage resulting to decrease pleural fluid absorption. The decrease in pleural fluid absorption and increase in pleural fluid formation would then lead to Pleural Effusion. Patients who have pleural effusion manifest the following symptoms: Dyspnea, nonproductive cough, Pleuritic chest pain, Hypoxemia/body weakness, Decreased Breath sounds, decreased vibration in chest area upon performing vocal fremitus and Auscultation of (+) dull lung sounds in the lower lung fields. The procedures performed to diagnose pleural effusion are Chest Radiograph (x-ray) wherein >200 c of water would be distinguished and Chest Ultrasound where small amounts or isolated loculated pockets of fluid will be located