Pleurisy : Symptoms , causes and treatment of pulmonary pleurisy

What it is - is called pleurisy development of the inflammatory process in the serous membrane covering the lung.

This disease rarely exists as a separate process, most often it develops as a complication of other - not only lung inflammation and not only - pathologies.

Pleurisy may be accompanied by an accumulation of fluid between the two layers of the pleura (pleural effusion), but can occur simply by deposition of fibrin (blood clotting product) within the pleural cavity.

Causes of pleurisy


There are two main groups of reasons, depending on which pleurisy can be infectious and noninfectious.

1) Infectious pleurisy caused by:

  • nonspecific bacteria: Staphylococcus aureus, Pseudomonas aeruginosa, Streptococcus pneumoniae and other streptococci, mycoplasma, Proteus and other Gram-negative flora;
  • specific bacteria: Mycobacterium tuberculosis, syphilis, brucellosis, typhoid and typhus typhus, tularemia;
  • viruses;
  • parasites: Amoeba, Echinococcus;
  • fungi: Candida, Blastomyces, actinomycetes
    , coccidia.
2) Microorganisms penetrate to the pleura:

  • by contact: with the patient's lung (with abscess, pneumonia, festering cyst lung) or underlying organs (pancreas, liver), as well as the injury of the chest or on their operations;
  • through blood - any source of infection in the body (osteomyelitis, sinuses, cerebral meningitis, etc.);
  • through the lymph system - from the organs of the chest cavity.
3) The reasons for non-infectious pleurisy are:

  • most tumor of the pleura;
  • metastases in the pleura;
  • connective tissue diseases (scleroderma, rheumatoid arthritis, systemic lupus erythematosus, vasculitis);
  • infarction (death of a certain area) of light;
  • myocardial infarction;
  • pulmonary embolism;
  • pancreatitis;
  • leukemias;
  • coagulation disorders;
  • chronic renal failure.

Classification


pleurisy can be:

  • effusion (exudative);
  • empyema - accumulation of pus in the pleural cavity;
  • dry (fibrinous).
Under the influence of etiological factors (microbes, toxins, enzymes) develops or infiltration of inflammatory or non-inflammatory fluid in the pleural cavity.

first effusion called exudate, the second - transudate.To distinguish one from the other, as well as by the purulent pleurisy is possible only as a result of a puncture.If that is not absorbed vessels effusion pleural effusion called exudative.If he is drawn on sheets of pleura settles fibrin.This is called fibrinous pleurisy.

Symptoms of pleurisy


exudative and exudative pleurisy differ in their clinical manifestations.

first symptoms of dry pleurisy can be suspected by the following features:

1) Pain in one (at least - two) half of the chest when breathing, worse:

  • cough;
  • a deep breath;
  • tilted in the other direction.
Because of this, a man tries to take a forced situation on his side, his breathing becomes frequent and superficial.

2) Body temperature - not above 38 degrees, raised mainly in the evening.

3) Fatigue.

4) Night sweats.

main symptoms of pleurisy effusion:

  • dyspnea.
  • cough.
  • feeling of heaviness in the side of the chest.
  • skin, especially in the area of ​​nasolabial triangle, becomes bluish tint.
  • noticeable lag of one half of the chest in breathing, with the gaps between the skin edges can act beyond the bone (bulging).
  • there is an increase in body temperature, weakness, headache.
  • person is forced to always be in such a position that it was easier to breathe.
empyema - in this case, the body temperature rises to 39-40 degrees, accompanied by chills, a person spends most of his time motionless in a forced position.His skin is bluish shade, cool and covered in sweat.It also marked a cough, shortness of breath, marked weakness, headache and muscle pain.

diagnosis of pleurisy


Diagnosis is based on:

  • complaints of human;
  • inspection data, tapping the chest and auscultation of the lungs;
  • radiography of the chest;
  • CT scan of the chest cavity - a small and encysted (ie restricted shell) exudative pleurisy;
  • lung ultrasound.
nature of exudate - exudate or transudate - can be determined by the results of pleural puncture.This is a procedure in which a local anesthetic is performed puncture the skin and underlying layers in the lateral region of the thorax.

The contents of the cavity is sent to the laboratory (including bacteriological seeding with definition of sensitivity to antibiotics) study.In the pleural cavity with drainage can be installed.

In cases of suspected tumor of the pleura own or metastasis requires biopsy of the pleura.This is an invasive procedure, which is performed under local anesthesia.

To diagnose the causes of pleurisy, can also be performed:

  • bronchoscopy;
  • angiography;
  • ultrasound or CT scan of the abdomen organs.

pleurisy Treatment of pleurisy


Cure engaged pulmonologist, oncologist and thoracic surgeon.Last, if necessary establishes the pleural cavity by draining Bulan, Hautes-Pyrénées particular, at the outer end of its make-way valve, and it is dipped in a sterile solution.

this drainage antiseptic solution may be administered with pleural empyema.Also this specialist surgery is performed if necessary.

drainage of fluid is indicated for:

  • if effusion compressed surrounding organs;
  • if the level of effusion on chest X-ray II comes to ribs;
  • if there is a likelihood of exudate festering.
at a time can be removed no more than 1 liter of fluid, to avoid abrupt displacement muffled before the aorta and heart.

Medication pleurisy


Conservative treatment of pleurisy includes the appointment of such medicines:

  1. 1) Antibacterials, appointed before the results of bacteriological research.This broad-spectrum drugs "Ceftriaxone" "Cefepime", "Levofloxacin", "Bigaflon" "Sumamed".Further, the drug was changed to a more appropriate for this microflora.
  2. 2) Anti-inflammatory and pain medications, "Indomethacin", "Nurofen", "mefenamic acid" and others.
  3. 3) If a fungal nature of pleurisy, or the appointment of a massive antibiotic therapy (but on the 5th day) appointed modern antifungals.
  4. 4) When the nature of the tumor pleurisy patient administered anti-cancer drugs, glucocorticoid hormones.
  5. 5) Diuretic drugs are needed to treat effusion pleurisy.
  6. 6) are appointed by the cardiovascular drugs if necessary.
Therapy fibrinous pleurisy supplemented:

  • warming therapies: mustard, banks, physiotherapy thermal methods;
  • tight bandaging of the chest;
  • drugs that suppress the cough, "dionin", "Codeine".

complications of pleurisy


These include:

  • adhesions in the pleural cavity;
  • cardiovascular failure due to compression of the heart and aorta exudate;
  • respiratory failure due to compression of the lungs;
  • thickening of the pleura;
  • imperforate gaps between the lobes of the lung;
  • pleural effusion may be complicated by the development of pleural empyema.

Prevention


pleurisy can be prevented by such measures:

  • smoking cessation;
  • hypothermia prevention;
  • when working in hazardous work do not neglect the methods of individual protection;
  • timely treatment of pneumonia;
  • treatment of chronic diseases of the heart, kidney and lung, the observation by a doctor, a serious attitude to the slightest change in his condition.


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