, INTERNAL MEDICINE MADE EASY
Table of Contents
Diseases of the pleura
Pleural effusion ---------------------------------------------------- 2
Pleurisy (Pleuritis) ------------------------------------------------- 7
Pleural empyema -------------------------------------------------- 8
Pneumothorax ---------------------------------------------------- 11
Obstructive lung diseases
Asthma --------------------------------------------------------------14
Bronchiectasis ---------------------------------------------------- 19
COPD --------------------------------------------------------------- 21
Interstitial lung diseases -------------------------------------- 29
Respiratory failure ---------------------------------------------- 36
Pulmonary hypertension -------------------------------------- 41
Pulmonary Embolism ------------------------------------------ 47
Pneumonia --------------------------------------------------------- 55
Lung cancer ------------------------------------------------------- 61
1
, INTERNAL MEDICINE MADE EASY
Diseases of the pleura
Pleural effusion
Introduction
The lung is surrounded by two linings (the visceral and parietal pleura) and
between them is called the pleural cavity.
The pleural cavity contains the pleural fluid (10ml) which helps to lubricate
the cavity and facilitates lung movements as in inhalation and exhalation
Based on this simple physiology we can identify various types of pleural
diseases. And in this chapter, we are going to discuss the pleural effusion
Definition
The term effusion means that there is an accumulation of fluid inside a
tissue or cavity so simply when we say pleural effusion it means:
Abnormal accumulation of fluid in the pleural cavity of more than 10 ml
(Remember the normal amount of fluid is 10ml)
Types of Pleural effusion
When we talk about types, we actually mean the type of fluid that is
accumulated inside the cavity and based on that we have two types:
1-Transudative pleural effusion
Meaning that fluid accumulated is mainly water and this can happen if there
A- Increase in hydrostatic pressure (more solvent which is water)
The body will compensate by kicking out the water into the interstitium and
the adjacent cavities including the pleural cavity.
B- decrease in oncotic pressure (less solutes)
The same mechanism the body will try to balance between water and
solute by kicking out the water as well
2
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What are the diseases that cause this type of effusion?
A- Liver cirrhosis
Normally Liver produces the protein albumin and releases it into the plasma
When there is liver cirrhosis there will be less amount of albumin produced
in the plasma making the water more than the solute (Decreased oncotic
pressure)
The body will try to compensate this decrease in oncotic pressure by
kicking out the water leading to pleural effusion
B- Renal disease (Nephrotic syndrome)
Nephrotic syndrome simply means that kidney looses control and starts to
excrete more proteins than usual
This will lead to decrease the solutes in the BVs (Decreased oncotic
pressure)
The body will try to compensate this decrease in oncotic pressure by
kicking out the water leading to pleural effusion
C- Congestive heart failure
CHF Is a condition in which the heart cannot pump blood strongly enough
to meet the body’s needs, causing blood and fluid to back up (“congest”).
This congestion means more and more fluid accumulated (Increased
hydrostatic pressure)
The body will try to compensate this Increase in hydrostatic pressure by
kicking out the excess water leading to pleural effusion
2-Exudative Pleural effusion
Meaning that the fluid accumulated is turbid (water and solutes)
This can happen when there is an inflammation
Inflammation will cause increased capillary permeability leading the escape
of the water and solute outside
3
Table of Contents
Diseases of the pleura
Pleural effusion ---------------------------------------------------- 2
Pleurisy (Pleuritis) ------------------------------------------------- 7
Pleural empyema -------------------------------------------------- 8
Pneumothorax ---------------------------------------------------- 11
Obstructive lung diseases
Asthma --------------------------------------------------------------14
Bronchiectasis ---------------------------------------------------- 19
COPD --------------------------------------------------------------- 21
Interstitial lung diseases -------------------------------------- 29
Respiratory failure ---------------------------------------------- 36
Pulmonary hypertension -------------------------------------- 41
Pulmonary Embolism ------------------------------------------ 47
Pneumonia --------------------------------------------------------- 55
Lung cancer ------------------------------------------------------- 61
1
, INTERNAL MEDICINE MADE EASY
Diseases of the pleura
Pleural effusion
Introduction
The lung is surrounded by two linings (the visceral and parietal pleura) and
between them is called the pleural cavity.
The pleural cavity contains the pleural fluid (10ml) which helps to lubricate
the cavity and facilitates lung movements as in inhalation and exhalation
Based on this simple physiology we can identify various types of pleural
diseases. And in this chapter, we are going to discuss the pleural effusion
Definition
The term effusion means that there is an accumulation of fluid inside a
tissue or cavity so simply when we say pleural effusion it means:
Abnormal accumulation of fluid in the pleural cavity of more than 10 ml
(Remember the normal amount of fluid is 10ml)
Types of Pleural effusion
When we talk about types, we actually mean the type of fluid that is
accumulated inside the cavity and based on that we have two types:
1-Transudative pleural effusion
Meaning that fluid accumulated is mainly water and this can happen if there
A- Increase in hydrostatic pressure (more solvent which is water)
The body will compensate by kicking out the water into the interstitium and
the adjacent cavities including the pleural cavity.
B- decrease in oncotic pressure (less solutes)
The same mechanism the body will try to balance between water and
solute by kicking out the water as well
2
, INTERNAL MEDICINE MADE EASY
What are the diseases that cause this type of effusion?
A- Liver cirrhosis
Normally Liver produces the protein albumin and releases it into the plasma
When there is liver cirrhosis there will be less amount of albumin produced
in the plasma making the water more than the solute (Decreased oncotic
pressure)
The body will try to compensate this decrease in oncotic pressure by
kicking out the water leading to pleural effusion
B- Renal disease (Nephrotic syndrome)
Nephrotic syndrome simply means that kidney looses control and starts to
excrete more proteins than usual
This will lead to decrease the solutes in the BVs (Decreased oncotic
pressure)
The body will try to compensate this decrease in oncotic pressure by
kicking out the water leading to pleural effusion
C- Congestive heart failure
CHF Is a condition in which the heart cannot pump blood strongly enough
to meet the body’s needs, causing blood and fluid to back up (“congest”).
This congestion means more and more fluid accumulated (Increased
hydrostatic pressure)
The body will try to compensate this Increase in hydrostatic pressure by
kicking out the excess water leading to pleural effusion
2-Exudative Pleural effusion
Meaning that the fluid accumulated is turbid (water and solutes)
This can happen when there is an inflammation
Inflammation will cause increased capillary permeability leading the escape
of the water and solute outside
3
