8/12/2019 Pleural Effusion Cr

1/18

8/12/2019 Pleural Effusion Cr

2/18

ANAMNESIS Taken From :Autoanamnesis Date 26 Maret Time 06.00

WIB

Chief complain : dyspnea

Additional complains : productive cough, chest pain whencough, feel full in right thorax History of the Illness :

Patient came to the hospital with dyspnea since 7 month ago andgot worse in 7 days before she came to the hospital. narrow thisvery troubling activity patients. Patient also have cough withyellowness sputum, but there was no haemoptysis. ,that

productive cough was experienced by patient since a year ago.Chest pain was also expended perceived since 1 month beforecame to the hospital. chest pain is felt excruciating and hot inright chest, so if the chest pain occurs, patients feel shortness ofbreath again, she also complained about decreased appetite andweight continued to decline. She denied about history of OAT.

8/12/2019 Pleural Effusion Cr

3/18

PATIENT IDENTITY Initial Name : Mrs. S Sex : Female Age : 56 years old Nationality : Indonesia Marital status : Married Religion : Islam Occupation : Housewife Educational background : Junior HighSchool Address : Teluk

8/12/2019 Pleural Effusion Cr

4/18

ody Check Up General Check up Height : 155 cm. Weight : 55 kg Blood Pressure : 130/ 90 mmHg Pulse : 80 x/minute Temperature : 36,6 C Breath (frequence&type) : 20 x/m Nutrition condition : Enough Consciousness : Compos mentis Cianotic : (-)

General edema : (-) The way of walk : Normal Mobility (active/pasive) : Pasive The age prediction based on check up : eighties

8/12/2019 Pleural Effusion Cr

5/18

8/12/2019 Pleural Effusion Cr

6/18

Working diagnoseEffusion pleura ec. Ca Paru

asic DiagnoseAnamnesis :

dyspnea, right chest pain, cough which intensified since 7

mounth ago

Clinical checkup : I : Asymmetric, P: vokal Fremitus vocal dantaktil R

8/12/2019 Pleural Effusion Cr

7/18

Treatment Plan1. General Treatment Bed rest Nutrition

2. Special TreatmentMedicamentosa IVFD RL gtt15/ minute Ranitidine 2x1 amp Antibiotik: ceftriaxone 1 gr/12 jam Antalgin : 3 x1 Plan Bronkoscopy

Support Check Up - sputum sps - broncoscopi

Prognose Quo ad vitam : dubia ad malam Quo ad functionam : dubia ad malam Quo ad sanationam : dubia ad malam

8/12/2019 Pleural Effusion Cr

8/18

Accumulation of fluid within the visceraland parietal layers of the pleura when thereis an imbalance between formation andabsorption in various disease states.

Normal amount 8.4 ml per hemithorax witha WBC count of 1700 per c.mm 75% ofwhich are macrophages and 23%

lymphocytes.Protein concentration is lowabout 15% of plasma protein concentration.

8/12/2019 Pleural Effusion Cr

9/18

Origin from systemic circulation of thepleura, absorption is into the lymphaticspaces of the parietal pleura.

Rate of formation equals the rate ofabsorption which is about 0.01 0.02 ml/kgper hr.

8/12/2019 Pleural Effusion Cr

10/18

Lights criteria Pleural fluid protein/serum protein >0.5 Pleural fluid LDH/serum LDH >0.6 Pleural fluid LDH more than two-thirds

normal upper limit for serumPleural fluid cholesterol >60mg/dlSerum albumin and pleural fluid albumin

8/12/2019 Pleural Effusion Cr

11/18

Congestive heart failure Cirrhosis

Pulmonary embolism Nephrotic syndrome Peritoneal dialysis

Superior vena cava obstruction

Myxedema Urinothorax

8/12/2019 Pleural Effusion Cr

12/18

Neoplastic diseasesMetastatic diseaseMesothelioma

Infectious diseasesBacterial infectionsTuberculosisFungal infectionsViral infectionsParasitic infections

8/12/2019 Pleural Effusion Cr

13/18

Pulmonary embolizationGastrointestinal disease

Esophageal perforationPancreatic diseaseIntraabdominal abscessesDiaphragmatic herniaAfter abdominal surgeryEndoscopic variceal sclerotherapyAfter liver transplant

8/12/2019 Pleural Effusion Cr

14/18

Clinical Manifestations Dyspnea Cough

Chest pain

8/12/2019 Pleural Effusion Cr

15/18

Other symptoms in association with pleuraleffusions may suggest the underlying diseaseprocess. Increasing lower extremity edema,orthopnea, and paroxysmal nocturnal dyspnea

may all occur with congestive heart failure.

Night sweats, fever, hemoptysis, and weight lossshould suggest TB. Hemoptysis also raises the

possibility of malignancy, other endotracheal orendobronchial pathology, or pulmonaryinfarction.

8/12/2019 Pleural Effusion Cr

16/18

Radiography

Posteroanterior, upright chest radiograph showsisolated, left-sided pleural effusion and loss ofleft, lateral costophrenic angle. Image courtesy ofAllen R. Thomas, MD

http://refimgshow%289%29/

8/12/2019 Pleural Effusion Cr

17/18

8/12/2019 Pleural Effusion Cr

18/18