Pleuritis symptoms
pleurisy is an inflammatory change in the pleura - a thin two-layered membrane that surrounds the lungs and lining the inside of the chest cavity, with the deposition of fibrin particles( fibrinous, dry pleurisy) or the development of effusion into the pleural cavity( serous, serous-fibrinous, hemorrhagicor purulent pleurisy).
The space between the layers of the pleura( pleural cavity) is usually filled with lubricating fluid, which guarantees uniform expansion and contraction of the lungs during breathing. With pleurisy, part of the pleura inflames and coarsens, resulting in the fact that two layers of membrane begin to rub against each other, causing pain. Pleurisy can develop in people of any age. Most cases of the disease occur due to infections and with appropriate treatment passes in a few days or weeks. However, some cases are caused by more serious diseases, for example, lupus or pulmonary embolism.
Pleurisy can be a manifestation of a variety of diseases that are diagnosed on the basis of characteristic features. However, very often it proceeds as an independent disease without a specific cause;in such cases, one should first of all think of a latent tuberculous process, in which inflammation of the pleura is a peculiar paraspecific reaction of the organism.
Dry pleurisy occurs sometimes after a cold, chest injury, as well as with a lung infarction, lung abscess, uremia, systemic lupus erythematosus, systemic scleroderma, etc.
If the inflammation is severe, fluid can accumulate in the pleural cavity;this disease is called effusion into the pleural cavity. Excess fluid often provides a lubricant that relieves pain, but it can also squeeze the underlying lung and make breathing more difficult. Although effusion to the pleural cavity is often associated with pleurisy, it can also occur in the absence of pleurisy( in particular, in heart failure).Since pleurisy and effusion into the pleural cavity are not diseases, but a manifestation of the underlying disease, it depends on the degree of its severity that the result of treatment depends.
The disease occurs with general malaise, pain in the chest, with fever. Pain associated with pleurisy, worse with breathing, cough, have limited localization. The most characteristic symptom is the noise of friction of the pleura of different intensity. To distinguish the noise of pleural friction from crepitations, it is recommended to listen with deep breathing and pressure with a phonendoscope, while the pleural friction noise amplifies. In the blood there is a small leukocytosis, an increase in ESR.The disease proceeds favorably, ending with recovery after 1-2 weeks, sometimes after it remain pleural adhesions.
Treatment is carried out with anti-inflammatory drugs( acetylsalicylic acid, analgin, indomethacin, etc.).Locally use mustard plasters. With severe pain, codeine is prescribed, promedol. In the absence of a visible cause of the disease and suspicion of tuberculosis, specific antituberculous treatment( ftyvazid, PASK, streptomycin) is carried out. How to use folk remedies for this disease look here.
Exudative pleurisy is more often serous or serous-fibrinous, usually it is a toxic and allergic reaction in tuberculosis, although the primary focus is usually not detected and only occasionally detected later. Actually, tubercular lesions of the pleura are rare. Sometimes exudative pleurisy develops as a result of a tumor, which also can be secretive. Serous-fibrinous pleurisy often develops with croupous pneumonia, lung infarction, systemic lupus erythematosus, rheumatoid arthritis, etc.
Symptoms. The disease begins with the appearance of pain in the side, a general malaise, a decrease in appetite, sometimes with a rise in temperature. With the appearance of exudate, the pain disappears, and with its increase, dyspnea increases, which is associated with compression of the lung and displacement of the mediastinum.
The study finds the lag of the affected side during breathing. Percutally there is dullness, and its upper border descends backward from the scapular line down to the spine. In the area of dullness, breathing is not performed, voice tremor is weakened or absent. The diagnosis is specified by X-ray examination, as well as by pleural puncture( to clarify the nature of the effusion).When puncture, a liquid of lemon yellow color is obtained, in the presence of fibrin, a clot is found in it. In the pleural fluid, the protein content is determined and the precipitate is examined. With pleurisy protein concentration exceeds 3%, and in the sediment are determined leukocytes, mainly lymphocytes. With a lower protein content, one should think about the transudate that develops in patients with a large fluid retention as a result of heart failure and kidney disease.
Hemorrhagic pleurisy of is characterized by the appearance of a large number of erythrocytes in the sweat, which gives the pleural fluid a reddish hue. It occurs in malignant tumors in the lungs, chest trauma, lung infarction, as well as in patients with hemorrhagic diathesis. The clinical picture of hemorrhagic pleurisy basically corresponds to the symptoms of serous-fibrinous pleurisy.
Purulent pleurisy( empyema of the pleura) is more often associated with pneumonia, lung abscess, septicopyemia, and less often with tuberculosis. The disease is characterized by severe course, accompanied by persistent high fever, large swings of temperature during the day, chills, sweats. Usually there is shortness of breath, leukocytosis in the blood, an increase in ESR.With prolonged flow, the purulent effusion is confined to the shvarts, changes of the fingers appear in the form of tympanic sticks, amyloidosis can develop.
Treatment. With pleural effusion, in any case, hospitalization is necessary, temporary adherence to bed rest, full nutrition, rich in proteins and vitamins. Apply anti-inflammatory drugs( acetylsalicylic acid to 3 g / day), with serous-fibrinous pleurisy in more severe cases, prednisone is prescribed up to 20-30 mg / day. Since the frequent cause of pleurisy is tuberculosis, treatment with prednisolone with an unknown etiology of the disease is combined with anti-tuberculosis drugs: streptomycin, ftivazi-house. With considerable exhalation, pleural puncture is indicated with removal of fluid and 200 mg of hydrocortisone administered to the pleural cavity. With a certain etiology of the disease, treatment of the underlying disease is necessary. Treatment of pleural empyema is possible only surgically.
Tuberculous pleurisy of may occur as a contact( from affected areas of the lung or lymph nodes), lymphogenous or hematogenous. The inflammatory process in the pleura can develop against a background of hypersensitivity of the body in patients with primary, infiltrative or disseminated tuberculosis.
Pleurisy is often the first manifestation of tuberculosis, when there is no other localization of the disease in the body. It can be dry or exudative.
With acutely developing pleurisy, pain syndrome usually comes to the fore. On examination, the lag of the affected side of the chest during respiration is determined. Palpation reveals soreness and muscle tension. The percussion sound over the inflamed pleura is shortened, the breathing is weakened. With dry pleurisy, the pleural friction noise is heard. When a large amount of exudate percutaneously determines the characteristic upper oblique boundary of blunting, the intercostal spaces are smoothed or bulged. Breathing over the effusion is not audible. Increased shortness of breath, symptoms of intoxication, body temperature can be high or low-grade. Patients prefer a position on the affected side. There are more frequent heartbeats, deaf heart sounds, a displacement of the heart beat in the opposite direction from the exudate.
Radiographically, with fibrinous pleurisy of different localization, a diffuse decrease in the transparency of the corresponding sections is revealed, with exudative - an intense shadow with oblique upper border. With the interlobar pleurisy, lateral projection reveals characteristic lenticular shadows along the course of pleural clefts. An important diagnostic feature is the character of the exudate obtained by pleural cavity puncture. Tuberculous pleurisy is characterized by serous exudate with a relative density up to 1022 and protein content from 3 to 6%.In the cellular composition, lymphocytes predominate. By method of inoculation, less often by flotation, BC can be detected.
The course and outcome of pleurisy depend on the nature of the underlying tuberculosis process. Perifocal, "reactive" pleurisies that are not accompanied by the development of a specific inflammation of the pleura flow more easily. With disseminated tuberculosis, they can recur, exudate can be hemorrhagic, long-term non-absorbable.
When breaking into the pleural cavity of caseous masses from the melted focus or cavity, severe complications can develop in the form of purulent pleurisy - empyema and spontaneous pneumothorax. Purulent pleurisies often begin to acutely, flow with chills, pain, dyspnea, body temperature can be hectic, the symptoms of intoxication are sharply expressed. Purulent tuberculous pleurisy can occur at normal temperature.
Treatment of tuberculous pleurisy is carried out according to generally accepted principles. With large effusions, medical punctures are made with the removal of exudate and the introduction of tuberculostatic agents into the pleural cavity. With severe hypersensitivity, hormonal therapy, large doses of ascorbic acid are necessary.
Antibacterial therapy is carried out for a long time by the combination of several drugs depending on the main process. For the first time patients begin treatment with the appointment of three drugs of the I series. After the elimination of acute phenomena, physiotherapy and physiotherapy are necessary, which contribute to better resorption of pleural fusion and cure with the least residual changes.
Treatment of purulent pleurisy is carried out by systematic aspiration of pus. In those cases where the pus is thick, the pleural cavity is washed with an isotonic solution of sodium chloride and tuberculostatic preparations are injected intrapleurally. General therapy should include specific and anti-inflammatory drugs of a wide variety, since in cases of a break in the visceral pleura, there is a mixed infection. Persistent cure is possible only with obliteration of the pleural cavity. With the ineffectiveness of conservative therapy, surgical treatment is indicated - pleurectomy, and in severe pulmonary process and pulmonary-pleural fistula formation - pleuropulmonectomy.