Pleurisy

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Pleurisy , also known as pleuritis , is an inflammation of the lining that surrounds the lungs and lining the pleural cavity (pleurae). This can lead to sharp chest pain with breathing. Sometimes the pain can become a constant dull pain. Other symptoms may include shortness of breath, cough, fever or weight loss, depending on the underlying cause.

The most common cause is a viral infection. Other causes include pneumonia, pulmonary embolism, autoimmune disorders, lung cancer, after cardiac surgery, pancreatitis, chest trauma, and asbestosis. Sometimes the cause is still unknown. The underlying mechanism involves rubbing together of the pleurae instead of gliding smoothly. Other conditions that can produce similar symptoms include pericarditis, heart attack, cholecystitis, and pneumothorax. The diagnosis may include chest X-rays, electrocardiogram (ECG), and blood tests.

Treatment depends on the underlying cause. Paracetamol (acetaminophen) and ibuprofen can be used to relieve pain. Spirometry incisions may be encouraged to encourage greater breathing. Approximately one million people are affected in the United States every year. Description of the date of the condition from at least as early as 400 BC by Hippocrates.

Video Pleurisy

Signs and symptoms

Symptoms that define pleuritis are sharp, piercing, burning or blunt pain that is suddenly on the right or left side of the chest during breathing, especially when a person inhaling and exhaling. It feels worse by breathing deeply, coughing, sneezing, or laughing. The pain may remain in one place, or it may spread to the shoulder or back. Sometimes, it becomes a fairly constant dull ache.

Depending on the cause, pleuritic chest pain may be accompanied by other symptoms:

• Cough
• Fever and cold
• Fast, short breath
• Short of breath
• fast heart rate
• A sore throat is followed by pain and swelling in the joints

Maps Pleurisy

Cause

The pleural space can be attacked by fluids, air, and particles from other parts of the body, which is quite complicating the diagnosis. Viral infection (coxsackie B virus, HRSV, CMV, adenovirus, EBV, parainfluenza, influenza) is the most common cause of pleuritis. However, many other different conditions can cause pleuritic chest pain:

• Aortic dissection
• Autoimmune disorders such as systemic lupus erythematosus (or drug induced lupus erythematosus), Autoimmune hepatitis (AIH), rheumatoid arthritis, and BehÃÆ'§et disease.
• Bacterial infections associated with pneumonia and tuberculosis
• Chest injuries (blunt or pierced)
• Familial Mediterranean fever, inherited condition that often causes fever and swelling in the abdomen or lungs
• Fungal or parasitic infections
• Heart surgery, especially coronary artery bypass grafting
• Heart problems (ischaemia, pericarditis)
• Inflammatory bowel disease
• Lung cancer and lymphoma
• Other lung diseases such as cystic fibrosis, sarcoidosis, asbestosis, lymphangioleiomyomatosis, and mesothelioma
• Pneumothorax
• Pulmonary embolism, which is a blood clot that enters the lungs

As the space between the pleura begins to fill with fluid, as in pleural effusion, chest pain may be reduced but shortness of breath may occur, since the lungs need space to expand during breathing. Some cases of pleuritic chest pain are idiopathic, meaning that the exact cause can not be determined.

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Diagnosis

The diagnosis of pleuritis or other pleural conditions is based on medical history, physical examination, and diagnostic tests. The goal is to get rid of sources of other symptoms and find the cause of pleuritis so that the underlying disorder can be treated.

Physical exam

A doctor uses a stethoscope to listen to breathing. This method detects unusual sounds in the lungs. A person with pleurisy may have an inflamed pleural layer that makes a rough and rough sound as they rub against each other while breathing. This is called friction of pleural friction.

Diagnostic test

Depending on the results of the physical examination, diagnostic tests are sometimes performed.

Chest x-rays

Chest X-ray takes pictures of heart and lungs. This may indicate air or fluid in the pleural space. It may also indicate the cause (eg, pneumonia, cracked ribs, or lung tumors) of pleurisy.

Sometimes x-rays are taken while lying on the sick side. This may indicate fluid, as well as a change in the fluid position, which does not appear in a vertical x-ray.

Blood test

Blood tests can detect bacterial or viral infections, pneumonia, rheumatic fever, pulmonary embolism, or lupus.

ECG

Electrocardiographic tests can determine whether the heart condition contributes to the symptoms.

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Ultrasonography uses sound waves to create images. This may indicate where the fluid is located in the chest. It could also show some tumors. Although ultrasound can detect fluid around the lungs, also known as pleural effusion, sound waves spread in the air. Therefore, the true picture of the lungs can not be obtained by ultrasound.

Computed tomography (CT) scan

A CT scan provides a computer-generated lung image that can show a fluid bag. It may also show signs of pneumonia, lung abscess, or tumor. Arterial blood gas

In blood-gas-collecting arteries, a small amount of blood is drawn from the arteries, usually on the wrist. Blood is then checked for oxygen and carbon dioxide levels. This test shows how well the lungs take oxygen.

Thoracentesis

After the presence of excess fluid in the pleural cavity, or pleural effusion, is suspected and the location of the fluid confirmed, fluid samples may be removed for testing. The procedure for removing fluid in the chest is called diagnostic thoracentesis. The doctor inserts a small needle or a hollow thin plastic tube on the chest wall and draws fluid.

Thoracentesis can be performed at a doctor's office or in a hospital. Ultrasound is used to guide the needle into the fluid trapped in small pockets around the lungs.

Thoracentesis usually does not cause serious complications. Generally, chest x-ray is performed after a procedure to evaluate the lungs. Possible complications of thoracentesis include the following:

• Bleeding and bruising where the needle comes in. In rare cases, bleeding can occur in or around the lungs. Doctors can use a chest tube to drain blood. In some cases, surgery is required.
• Incoming needle infection
• Liver or liver injury (in rare cases)
• Pain.
• Pneumothorax, or air buildup in the pleural space, with collapsed or partially collapsed lungs. Sometimes air entering through a needle or needle makes a hole in the lungs. Usually, the seal hole itself - but sometimes the air accumulates around the lungs and makes it collapse. A chest tube lifted the air and let the lungs expand again.

Pulmonary fluids are examined under a microscope and evaluated for the presence of chemicals and for their color and texture. Clarity is an indicator of infection, cancer, or other conditions that may cause fluid or blood buildup in the pleural space.

Biopsy

If tuberculosis or cancer is suspected, a small piece of pleura can be examined under a microscope to make a definitive diagnosis. This is called a biopsy.

Several approaches to network sampling are available

1. Insert a needle through the skin on the chest to take a small sample of the pleural outer layer
2. Insert a small tube with light at the end (endoscope) to a small wound on the chest wall to visualize the pleura, and biopsy small pieces of tissue through the endoscope
3. Eliminating pleural samples through small cuts in the chest wall (open pleural biopsy), usually done if the sample from the needle biopsy is too small for an accurate diagnosis

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Treatment

Treatment has several goals:

• Relieve symptoms
• Eliminates fluid, air, or blood from the pleural space
• Treatment of the underlying conditions

Procedures

If large amounts of fluid, air, or blood are not removed from the pleural space, they can cause the lung to collapse.

Surgical procedures used to drain fluid, air, or blood from the pleural space are as follows:

• During thoracentesis, a thin hollow plastic needle or tube is inserted through the ribs behind the chest to the chest wall. The injection is installed to pull the fluid out of the chest. This procedure can remove more than 6 cups (1.5 liters) of liquid at a time.
• When larger amounts of fluid must be removed, the chest tube can be inserted through the chest wall. The doctor injects local painkillers into the area of ​​the chest wall outside where the fluid is. A plastic tube is inserted into the chest between two ribs. The tube is connected to the box that releases the exit liquid. A chest X-ray is taken to check the position of the tube.
• A chest tube is also used to drain blood and air from the pleural space. This can take several days. The tube is left in place, and the patient usually stays in the hospital during this time.
• Sometimes the liquid contains a thick pus or blood clot, or it may have formed a hard skin or exfoliation. This makes it harder to drain the fluid. To help break up pus or blood clots, your doctor may use a chest tube to insert certain medications into the pleural cavity. These drugs are called fibrinolytics. If pus or blood clot is still not out, surgery may be needed.

Drugs

Some medications are used to relieve symptoms of pleurisy:

• Paracetamol (acetaminophen) or anti-inflammatory agent to control pain and reduce inflammation. Only indometacin (brand name Indocin) has been studied in relation to pleurisy relief.
• codine cough syrup to control cough

There may be roles for the use of corticosteroids (for TB pleuritis), tacrolimus (Prograf) and methotrexate (Trexall, Rheumatrex) in the treatment of pleuritis. More research is needed.

Lifestyle changes

The following may be helpful in management of meningitis:

• Lying on the painful side may be more comfortable
• Breathe deeply and cough to clear mucus as the pain subsides. Otherwise, pneumonia may occur.
• Rest

Treat causes

Ideally, pleuritis treatment is aimed at eliminating the cause of the disease.

• If pleural fluid is infected, treatment involves antibiotics and draining fluids. If the infection is tuberculosis or from the fungus, treatment involves the use of long-term antibiotics or antifungal drugs.
• If the fluid is caused by a tumor in the pleura, the fluid can accumulate quickly after being dried. Sometimes anti-tumor drugs prevent further fluid accumulation. If not, the doctor can close the pleural space. This is called pleurodesis. Pleurodesis involves drainage of all fluid out of the chest through a chest tube. A substance is inserted through the chest tube into the pleural space. This substance irritates the pleural surface. This causes the two layers of the pleura to close it so there is no room for more fluid to accumulate.
• Chemotherapy or radiation treatment can also be used to reduce tumor size.
• If congestive heart failure causes fluid buildup, treatment usually includes diuretics and other medications.

Treatment for pleuritis depends on its origin and is prescribed by physicians on the basis of individual assessment. Paracetamol (acetaminophen) and amoxicillin, or other antibiotics in the case of bacterial infections, are common drugs issued by doctors to relieve early symptoms and chest pain, while viral infection is limited. Non-steroidal anti-inflammatory drugs (NSAIDs), preferably indomethacin, are commonly used as pain control agents.

Alternative care

A number of alternative or complementary medicines are being investigated for their anti-inflammatory properties, and their use in inflammation of the lining of the chest. At this time, no clinical trials of these compounds have been performed.

Extracts from traditional Brazilian medicine Wilbrandia ebracteata ("Taiuia") has been shown to reduce inflammation in the rat pleural space. The extract allegedly inhibits the same enzyme, cyclooxygenase-2 (COX-2), as a non-steroidal anti-inflammatory drug.

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Related matter

Pleurisy is often associated with complications that affect the pleural space.

Pleural effusion

In some cases of pleurisy, excess fluid accumulates in the pleural space. This is called pleural effusion. Liquid buildup usually forces two separate pleural layers so that they do not rub against each other while breathing. This can ease the pain of pleuritis. A large amount of extra fluid can push the pleura into the lungs until the lungs, or part of it, collapse. This can make it difficult to breathe.

In some cases of pleural effusion, extra fluid is infected and turned into an abscess. This is called empyema.

Pleural effusions involving fibrinous exudates in the fluid may be called fibrinous pleuritis. Sometimes it happens as the next stage of pleurisy.

One can develop pleural effusion in the absence of pleuritis. For example, pneumonia, heart failure, cancer, or pulmonary embolism can cause pleural effusion.

Pneumothorax

Air or gas can also accumulate in the pleural space. This is called pneumothorax. Can occur due to acute lung injury or lung disease such as emphysema. Lung procedures, such as surgery, fluid drainage with a needle, examination of the lungs from within with light and camera, or mechanical ventilation, can also cause pneumothorax.

The most common symptoms are sudden pain in one side of the lungs and breathlessness. Pneumothorax can also pressure the lungs and cause them to collapse.

If the pneumothorax is small, it can go away by itself. If large, the chest tube is placed through the skin and chest wall into the pleural space to release air.

Hemothorax

Blood can also be collected in the pleural space. This is called a hemothorax. The most common cause is a chest injury from a blunt force or surgery to the heart or chest. Hemothorax can also occur in people with lung or pleural cancers.

Hemothorax can pressure the lungs and force them to fall. It can also cause shock, hypoperfusion where an inadequate amount of blood can reach the organs.

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Prognosis

Pleuritis and other disorders of the pleura can become serious, depending on what caused it. Generally, the treatment of inflammation of the lining of the chest has a very good prognosis, but if left untreated can cause severe complications. For example, pulmonary coronary pulmonary disease, which manifests itself with inflammation of the arms and legs, can lead to heart failure. If conditions that cause pleuritis or other pleural disorders are adequately diagnosed and treated early, one can expect full recovery. The help of a pulmonologist (British and Australian respiratory physicians) can be registered to address the causes and map post-disease rehabilitation.

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References

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External links

• Tim Kenny; Colin Tidy (2002-2013). "Pleurisy dan Pleuritic Pain". www.patient.info . Diperoleh 2013-06-30 .
• Penjelasan Lung Association of Canada tentang Pleurisy (juga tersedia dalam bahasa Prancis)
• Pleurisy oleh Akademi Dokter Keluarga Amerika

Source of the article : Wikipedia