Dry and Vyborny pleurisy of the lungs: what is it and how disease manifests itself
Not everyone knows how dangerous pleurisy of the lungs, what is it and how to treat it. Human lungs are situated in thoracic cavity. Outside they are covered with pleura. The pleura is a serous membrane that lines the inner layer of the thoracic cavity and envelops both the lung. The basis of the amount of pleural mesothelial cells.
Directly between the parietal and visceral leaf is a space in which is located the liquid. The latter makes breathing easier by reducing the friction between the sheets. When inflammation of the pleura is violated, the products of this fluid, which further provokes cough. What is the etiology, clinic and treatment of pleurisy?
Features of pleurisy
Pleurisy is an inflammation of the serous membranes that cover the outside of the lungs. This disease occurs very often. This is the most often diagnosed pathology of the lungs. In the total structure of morbidity of the population the share of pleurisy have 5-15%. The incidence ranges from 300 to 320 cases per 100 thousand people. Men and women suffer from this disease equally often. Pleurisy in children is diagnosed less frequently than in adults.
Interesting is the fact that women often found in so-called malignant pleural effusion. It develops on the background of various tumors of the genital organs and Breasts. As for men, Vyborny pleurisy often occurs when pathology of the pancreas and rheumatoid arthritis. In most cases, bilateral or unilateral pleurisy is secondary.
There are different types of this disease. Distinguish infectious and non-infectious pleurisy. In that case, if the cause of the inflammation of the pleura is unknown, there is a idiopathic pleurisy. Depending on the presence of exudate distinguish exudative and dry pleurisy. In the first case, the exudate may be serous, haemorrhagic, eosinophilic, serous-fibrinous, purulent, putrid, chylous or mixed. The nature of the flow distinguish acute, subacute and chronic inflammation of the pleura. Depending on localization distinguish between diffuse effusion and limited pleurisy. One of the most dangerous is metastatic pleurisy, as it is formed owing to the spread of cancer cells from the hearth in such diseases as lung cancer, breast cancer, ovarian lymphoma.
Acute and chronic pleurisy occur for a variety of reasons. If the disease has an infectious nature, etiological factors can be:
- bacterial disease(streptoccal and staphylococcal infection, tuberculosis, pneumonia);
- fungal infections (candidiasis);
- worm infestation (echinococcosis);
- protozoal infection (amoebiasis);
- typhoid fever.
- infection of the lung and pleura during surgery.
Exudative pleural effusion is commonly observed in tuberculosis. When the infectious form of inflammation of the pleura the patient is contagious as cough, can be pathogenic microorganisms. As for the non-infectious form of the disease, in this situation, the possible causes are:
- the presence of malignant tumors;
- systemic autoimmune diseases (lupus erythematosus, rheumatoid arthritis, vasculitis, scleroderma);
- myocardial infarction;
- blockage of the lumen of the pulmonary artery by a blood clot;
- pulmonary infarction;
- allergic diseases (diathesis);
- traumatic injury;
- chronic renal failure;
- exposure to ionizing radiation;
Lately observed detection carcinomatous pleurisy. The main cause mesothelioma of the pleura and cancer of other organs. Bilateral inflammatory process is rarely diagnosed. In most cases, the cause is tuberculosis infection. The development of left-sided pleural effusion is often due to diseases of the heart (myocardial infarction). How is the causative agent of infectious forms of inflammation of the pleura into the tissue? There are the following ways of penetration of pathogenic microbes:
- through the lymphatic vessels;
- through the blood;
- direct (open chest injury).
Predisposing factors in the development of this disease are: alcohol abuse (may cause pancreatitis and reactive pleuritis, decreased immunity, poor nutrition (which is a triggering factor of atherosclerosis and coronary artery disease, including myocardial infarction), non-Smoking.
The pathogenesis of the disease
It is necessary to know not only what is pleurisy, but the mechanism of its development. In the case of an infectious inflammation in a tissue of the pleura penetrate pathogenic microbes. The last cause inflammation. In the pleural cavity begins to accumulate fluid. This happens on the background of increased vascular permeability. The exudate contains protein fibrin. It accumulates in the pleural layers. If the fluid is backis sucked, is formed by dry pleurisy. Cinnamonkey often diagnosed pleurisy. It develops when inflammation of the lung tissue. The exudate may be haemorrhagic or fibrinous-purulent.
The mechanism of development of inflammation of the pleura of noninfectious origin depends on the underlying disease. Hemorrhagic pleural effusion is formed when damage to small blood vessels (capillaries) of the pleura. This occurs when vasculitis or systemic diseases (lupus erythematosus). Traumatic pleurisy associated directly with the body's reaction in response to hemorrhage. If a person developed kidney failure, blood can accumulate products of metabolism and various toxic substances that lead to inflammation of the pleura. In the case of acute pancreatitis possibly pleural enzymes.
The symptoms of inflammation of the pleura is largely determined by the is dry or exudative pleurisy. Type fibrinous pleurisy (dry) occurs most often in the acute form. Its main characteristics are:
- chest pain;
- dry cough;
- the increase in body temperature.
Pain can be stabbing, intense. Pain syndrome is prone to increased coughing, sneezing or deep breath. Pain syndrome weakens when the person lies on the affected side. The pain in the vast majority of cases is localized on one side. Pain appear due to irritation of the pleural layers fibrin. Acute inflammation caused by an infectious factor that always occurs with increases in body temperature. Often it reaches 38º. Additional symptoms include fever, pain in the hypochondrium or abdomen, excessive sweating. In severe cases, may cause shortness of breath and difficulty breathing. Objective signs of dry pleurisy is the pleural friction RUB, decreased breath sounds when listening to lungs.
Vyborny interlobar pleurisy proceeds differently. Often it occurs in abortive form. Its peculiarity is that it most often emerges in adolescence. In this situation, fluid collects between the lung lobes, not reaching plevralnuu cavity. This form of the disease occurs more easily than mediastinal. Often it is detected only through x-rays. In mediastinal pleurisy, when the fluid accumulates in the pleural cavity, the symptoms may include a dull ache from the affected side, dry cough, shortness of breath, cyanosis of the skin, loss of appetite, sweating. Over time, the pain syndrome is replaced by heaviness in the chest, shortness of breath. At the primary exudative inflammationpain is rare. In the serous type of inflammation on the background of possible lung cancer hemoptysis. In this situation you want to exclude tuberculosis.
To identify a left or a right pleural effusion, requires a thorough examination of the patient. Diagnosis includes:
- a survey of the patient;
- external inspection;
- auscultation of the heart and lungs;
- General and biochemical blood analysis;
- x-ray examination;
- study of the pleural fluid;
- analysis of sputum.
During the inspection possible the following changes: displacement of the trachea, discoloration of the skin, smoothing the gaps between the ribs on the affected side, tilting the trunk to the affected side, uneven chest movement when breathing. Diseases of the lung and pleura can be detected after x-ray examination. Elevation of dome of diaphragm and a decrease in transparency of the lung tissue indicate a dry pleurisy. If the angle is in the region of the diaphragm is flattened, there is a shift of the mediastinum to the side that is not affected, and the blackout is the evidence of exudative pleurisy. If adhesive pleurisy, or any other was a complication of pneumonia or tuberculosis, there are signs of these diseases (shadows of different size). The identification of foci of calcification indicates a tubular type of pleurisy.
Great diagnostic value are the results of a study of the liquid after pleural puncture. Normal pleural fluid is clear, straw-yellow color, odorless, not sticky. The reaction medium is 7.2. Reduction in it of glucose could indicate mesothelioma, tuberculosis, or pneumonia. If it is determined in the blood, then the cause may be hemothorax, trauma, embolism, swelling. The analysis considers the content of formed elements, density, protein and enzymes. In the case of an infectious inflammation requires microbiological examination of the sputum.
Treatment is determined by the form of pleurisy. Treatment of infectious type of inflammation of the pleura involves the use of antibiotics and other antimicrobials, diuretics, painkillers. In the case of exudative inflammation can be used physical therapy and therapeutic exercise, but only after the effusion will resolve. If the cause of inflammation of the pleura was pulmonary tuberculosis, TB is assigned to"Streptomycin", "Rifampicin", "Ethambutol", "Isoniazid"). This therapy should last for several months. The treatment of pleurisy on the background of community-acquired bacterial pneumoniausing protected penicillins, cephalosporins or macrolides.
Treatment involves the use of symptomatic drugs. If you have pleural fibrinous overlay (dry pleurisy), the patient should be provided with complete rest. In case of cough antitussives are assigned. Treatment often includes the production of jars, mustard plasters, the application of anti-inflammatory drugs (Aspirin, "Ibuprofen"), breathing exercises.
If there is accumulation of large volumes of liquid may require thoracentesis.
After the puncture the patient requires immediate attention. Fibrinous pleurisy occurs most favorably and ends with the recovery (with the exception of tuberculosis). Surgical treatment may be required when chronic suppurative pleurisy.
Food, in the pleurisy must be complete and meet the physiological needs. You want to include in the diet of more foods rich in vitamins. Diet in pleurisy involves limiting the consumption of carbohydrates and salt. You also want to reduce the amount of fluid intake to 500-600 ml. with regard to non-infectious pleurisy, the treatment involves addressing the underlying disease. In the case of the tumor may be performed chemotherapy. Rheumatic diseases are shown "Prednisolone". Prevention of pleurisy is aimed at preventing major diseases (tuberculosis, pneumonia, heart attack, systemic diseases). Thus pleurisy in most cases is a complication of other diseases. This condition requires prompt diagnosis and treatment.