Internal illnesses. Pleurisy (most important)

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Internal illnesses. Pleurisy (most important)

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42. PLEURITIS

Inflammatory process in the pleura, which develops a second time and is a reflection of an independent disease in the body (tumor, pneumonia, tuberculosis, pancreatitis, trauma, etc.).

Etiology. Etiological factors: exacerbation of the tuberculosis process in the lungs or intrathoracic lymph nodes, non-specific inflammatory processes in the lungs, rheumatism, collagenoses, heart attacks, lung tumors, chest trauma, acute and chronic infectious diseases (dry pleurisy).

Pathogenesis. There is an excessive accumulation of pleural fluid.

Clinic. With dry pleurisy, there is pain in the affected half of the chest, which intensifies with breathing and coughing; In case of phrenic pleurisy, pain radiates to the upper half of the abdomen or along the phrenic nerve (to the neck). The pain is most severe in the initial period. Body temperature is normal or subfebrile. On auscultation: breathing is weakened, a pleural friction noise is heard.

With exudative pleurisy, there is a high body temperature, severe stabbing pain in the chest, intensifying with a deep breath, a painful dry cough, sweating, lack of appetite, shortness of breath, cyanosis, lag of the normal half of the chest when breathing, smoothness of the intercostal spaces. On the diseased side, the formation of the Garland triangle occurs with stimpanitis (between the spine and the ascending line of dullness), on the healthy side - the Rauchfus-Grocco triangle with dullness of percussion sound. During auscultation, weakening of breathing is heard in the affected area, in the area of Garland's triangle - with a bronchial tint, pleural friction noise is heard at the onset of the disease and during resorption of the exudate.

Additional diagnostic study. A general blood test is performed (anemia, leukocytosis, an increase in ESR), a study of the pleural fluid (protein above 3%, relative density above 1,018, positive Rivalt test, many neutrophils in the sediment, straw-yellow color - with exudates, with empyema - pus), x-ray examination: intense darkening with an oblique upper border, shift of the mediastinum to the healthy side - with exudates, limited mobility of the dome of the diaphragm, lowering the transparency of the sinus on the corresponding side.

Treatment. With dry pleurisy, the underlying disease is treated. Analgesics (up to narcotic), non-steroidal anti-inflammatory drugs are introduced.

For pleural effusions, the underlying disease is treated, a diet rich in protein, vitamins, and limited in salt and liquid is prescribed. Antibacterial drugs are administered (taking into account the sensitivity of the flora), detoxification therapy is carried out (plasma replacement solutions, vitamins B, C), pleural punctures are performed with the evacuation of pleural fluid. Desensitizing therapy is prescribed.

Flow. Prolonged, acute, subacute, chronic.

Forecast. Depends on the underlying disease and the nature of the effusion, more often recovery.

Prevention. It is aimed at the prevention and timely treatment of diseases that can be complicated by inflammatory processes in the pleura, early recognition of the presence of pleural effusion, and its evacuation.

Author: Myshkina A.K.

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