Exudative pleurisy is a disease of the respiratory organs caused by a neoplasm or infection. The patient has a constant cough, it is difficult for him to breathe, and his body temperature rises. Inflamed pulmonary and parietal pleura sheets. The presented disease is characterized by the accumulation of fluid in the cavity of this shell; therefore, it is considered dangerous not only for health, but also for the life of the patient.
General characteristics of pathology
Exudative pleurisy is an independent disease or complication of an existing inflammatory process that affects the lining of the lungs. When a large amount of fluid accumulates in it that serous cells cannot absorb, an exacerbation of the pathological process occurs. In this case, surgical intervention to remove exudate cannot be dispensed with.
The pleural cavity is an enclosed space created by its inner and outer sheets. Pathology can be aseptic or infectious. It all depends on the type of content. The effusion may be clear and cloudy with bloody or purulent contents.
A large number of inflammatory proteins are present in the fibrous fluid, so scars appear in the pleural tissues.
The disease proceeds in several phases:
- Exudations. It lasts 14-21 days. At this stage, the contents gradually accumulate in the pleural cavity. Its volume can reach 10 liters. There are no atypical symptoms.
- Stabilization. This stage is characterized by the cessation of effusion, however, its absorption by the serous tissue has not yet begun. The clinical picture is somewhat stabilizing. But deposits of fibrin appear on the pleural sheets, the outflow of exudate is difficult.
- Resorption. Depending on the state of the body, this stage lasts from 2 to 12 weeks.
If treatment has not been carried out in a timely manner, tissue scarring occurs. In the future, adhesions will provoke pain that can intensify when the weather changes. These cicatricial fragments will prevent the spread of infection, however, respiratory function will worsen.
Disease classification
Exudative pleurisy can be of different types:
- Depending on the composition of the effusion: serous, purulent, hemorrhagic.
- According to the area of accumulation of contents: osumkovanny (it is present in a strictly limited area of the pleural cavity), diffuse (the fluid spreads without problems in different areas).
- By the nature of the course: subacute, acute and chronic pleurisy.
- By etiological factor:
- Aseptic (it is caused by a lung disease).
- Allergic.
- Post-traumatic.
- Stagnant (due to heart failure).
- Tuberculous. It most often develops in children as well as young people.
So that the doctor can correctly prescribe the treatment of exudative pleurisy, he must not only consider the symptoms called by the patient, but also find out the cause of the development of the pathological process.
Development reasons
So, exudative pleurisy is most often provoked by infectious processes, is their complication. We can distinguish the following causes of the disease:
- Pneumonia.
- Abscess in the diaphragm or respiratory system.
- Pulmonary thromboembolism.
- The lack of vitamins in the human body.
- Blood pathology.
- Pathogenic microorganisms: mycoplasma, fungi, brucella, streptococcus, pneumococcus.
- Allergic reaction.
- Helminthic invasion.
- Chemical or thermal burns to the respiratory system.
- Systemic pathologies of connective tissue: lupus erythematosus, scleroderma.
- Penetrating chest injury in which the pleura was damaged.
- Malignant tumor (metastases are considered especially dangerous).
- Glomerulonephritis or other kidney damage, in which excess fluid accumulates in the body.
- Severe heart failure.
- Surgery on the lungs.
- Myocardial infarction or respiratory organ.
The etiology of exudative pleurisy may be different, but it should be determined as accurately as possible. Only in this case it will be possible to get rid of the problem.
Symptoms and signs of pathology
What signs of exudative pleurisy will appear in the patient depends on how quickly the effusion will accumulate and what it will contain. The following symptoms of pathology can be distinguished:
- Pain in the chest. This symptom is the most basic. Sensations depend on the degree of involvement of the pleural cavity in the pathological process. They are acute or moderate. To reduce the intensity of pain, a person is forced to occupy a certain position.
- Dyspnea. She has a mixed character. The more fluid will accumulate in the pleural cavity, the worse the lungs will be ventilated. Respiratory organs may be compressed or displaced.
- Persistent cough, which eventually exhausts the patient. It indicates the beginning of the development of the pathological process. In the early stages, it is not accompanied by sputum production.
- Change in body temperature.
- Sensation of heaviness in the affected area.
- Feeling of lack of air.
- Vascular swelling in the neck.
- Protrusion of the intercostal space.
- Increased sweat.
- Lethargy, general weakness, decreased ability to work.
- Changing the shade of visible mucous membranes. They become cyanotic.
The intensity of the presented symptoms of exudative pleurisy varies depending on the severity of the disease. There are also visual signs of pathology: tension of the affected part of the chest during palpation, its asymmetry.
With a purulent form of the disease, the symptoms will be pronounced. In addition to high temperature, the patient has signs of intoxication. Respiratory failure progresses. Exudative pleurisy is characterized by the formation of cicatricial tissue changes (if it has a chronic type of course).
Diagnosis of the disease
Before a final diagnosis of exudative pleurisy is made, the patient requires a thorough differential examination, which will distinguish the presented disease from other pathological processes in the respiratory system. This requires such studies:
- Feeling the chest and listening for breathing. At the initial stages, the doctor may hear pleural friction noise. Breathing will be weakened.
- General and biochemical analysis of blood.
- The study of pleural fluid. It allows not only to establish an accurate diagnosis, but also to understand the nature of the content.
- Roentgenography. Such a diagnosis is informative only if there is a large amount of fluid in the pleura (more than 300 ml). In the picture, the contents are a darkened area (homogeneous), and the chest organs are displaced.
- Ultrasound examination of pleural cavities. It will allow you to detect even minimal accumulation of fluid.
- CT or MRI. These studies will help to determine not only the amount of effusion, but also to assess the condition of the soft tissues in the affected area. Such diagnostics will detect changes in tissues in the early stages of the development of the disease.
Only the correct and timely diagnosis of exudative pleurisy will help create an effective treatment regimen.
Traditional treatment
Treatment of exudative pleurisy largely depends on the reasons that caused it. At the first stages of the development of pathology, the patient is prescribed drug therapy, which involves taking such drugs:
- Antibiotics: Clindamycin. They are prescribed if the inflammatory process is caused by microbes. The cause of pleurisy is tuberculosis, pneumonia.
- Analgesics. They will help eliminate pain.
- Drugs to improve the functioning of the heart and blood vessels.
- Means for the fight against tuberculosis.
- Cytostatics. Medications that suppress the immune system are necessary if pleurisy is provoked by an oncological process.
- Means for increasing the body's resistance to the effects of pathogens.
- NSAIDs: Voltaren. These funds reduce the intensity of the inflammatory process, the rate of exudate production.
After signs of resorption of the exudate appear, additional methods of treatment can be used: oxygen therapy, infusion of complexes replacing the plasma, physiotherapeutic procedures. To facilitate the patient’s breathing, he is given an electrovibration chest massage.
The success of drug therapy depends on how quickly the diagnosis has been made.
Need for puncture
With exudative pleurisy, puncture allows you to get rid of excess fluid. In one procedure, no more than 1.5 liters of effusion can be eliminated, so in some cases it requires repetition. Otherwise, the lungs will straighten out too quickly, which will cause complications from the cardiovascular system.
If the disease is accompanied by a purulent process, then, in addition to pumping out the exudate, additional washing of the pleural cavity with antiseptic agents, antibiotics and even hormonal agents will be required.
To prevent the re-development of pathology, special medications containing talcum powder are introduced into the cavity and prevent the sheets from sticking together. The procedure itself involves the use of a special needle, which is inserted into the pleural cavity. Puncture should be carried out in strict sterility. During surgery, the patient is given local anesthesia.
A puncture is carried out between the 7th and 8th ribs (if it is necessary to eliminate excess air, the tool is inserted into the 2nd or 3rd intercostal space). The liquid that has been removed is sent to the laboratory for a thorough examination.
How to care for the patient
Caring for such a patient also has certain features. For example, he needs to organize a high-calorie diet. It should not be difficult for the digestive system. It is better to eat fractionally. It is also important to monitor the drinking regimen.
The patient is provided with bed rest, a relaxed atmosphere. Exudative pleurisy requires surgical intervention, so a person will have to stay in a hospital. He must follow all the recommendations that the doctor gives. Moreover, this should be done regularly.
If a person has severe pain after removing the effusion, then you should immediately consult a doctor. The specialist will prescribe pain medications that are allowed to the patient. In the period of postoperative recovery, it is necessary to control the heart rate, blood pressure, and respiration.
Pleurisy Complications
In most cases, timely detection, as well as proper therapy, allows you to quickly get rid of the pathology. However, ignoring the recommendations of doctors or later seeking professional help is fraught with complications of exudative pleurisy, among which are:
- Adhesive process.
- Sealing of pleural sheets.
- Pneumosclerosis leading to respiratory failure.
- The development of a purulent process.
Complications may also arise during a fluid removal operation. For example, bleeding, air entering the pleural cavity may develop, in which repeated drainage of this area is required. Non-compliance with the rules of sterility is fraught with the development of infection in the wound. The actions of an inexperienced surgeon can lead to damage to neighboring internal organs or a sharp decrease in blood pressure.
In some cases, getting rid of complications is much more difficult than getting rid of the underlying disease, so you cannot delay a visit to the doctor.
Preventative measures
No one knows how the disease will progress if left untreated. However, it is better to completely prevent its development. To do this, it is important to observe preventive measures:
- In the presence of acute respiratory diseases, it is not necessary to self-medicate, since in this case the development of complications is not excluded. The pathogenic microflora cannot be allowed to enter the pleural cavity. It is better to entrust the treatment of these pathologies to professionals.
- If there is a suspicion of pneumonia, then it is better to immediately take an x-ray.
- Periodically make trips to the sea, especially if a person often recurs colds.
- Strengthen immunity through multivitamin complexes, observing the daily routine, taking walks in the fresh air and proper nutrition.
- Perform breathing exercises.
- Stop smoking. This bad habit often leads to the development of cancer or exudative tuberculous pleurisy.
In most cases, the correct treatment and compliance with medical recommendations is enough to get rid of the pathology. But even after this, you need to carefully monitor your health so that there is no relapse.