Page 1 of 3
Symptoms of a disease. Pleurisy — the inflammation of leaves of a pleura which is characterized by accumulation of exudate in a pleural cavity. Depending on character of exudate distinguish fibrinous (dry), serous, serofibrinous, hemorrhagic pleurisy. Purulent pleurisy is called a pleura empyema.
At dry (fibrinous) pleurisy the acute beginning of a disease is observed. The main symptom of a plastic pleuritis is the pain at breath amplifying at cough, a trunk inclination in the healthy party. At phrenic (basal) pleurisy pain is localized in lower parts of a thorax and an upper half of a stomach, it can irradiate to the supraclavicular area and a neck in connection with damage of a phrenic nerve. Position of the patient forced, lies on a sick side.
The struck party lags behind at breath, at percussion decrease in mobility of bottom edge of lungs is defined. At auscultation on the struck party the breath weakened is listened a pleural rub. At a plastic pleuritis intoxication and fever are expressed poorly.
At a syndrome of a pleural exudate the main complaint of the patient is an asthma. Dull aches, are more often weight in a side, an asthma accrues at accumulation of a large amount of liquid. Position of the patient forced, lies on a sick side. At survey lag in the act of breath of the struck party, increase in volume of a lower part of a thorax, expansion of intercostal spaces is noted.
At percussion the upper bound of the defined dullness goes slantwise from a backbone up to the back axillary line and further kpered slantwise down (Damuazo's line).
Over area of an exudate the stupid percussion sound is defined. At auscultation in a zone of dullness of a percussion sound the weakened vesicular breath is defined or breath is not listened (the last — at large volumes of an exudate), voice trembling is weakened or is absent. Over Damuazo's line breath rigid, can be listened a pleural rub here. Percussion borders of heart will mix up in the party opposite to pleurisy.
At percussion existence of a pleural exudate can be revealed if its volume exceeds 300 — 500 ml; increase of level of obtusion on one edge corresponds to increase in an exudate approximately on 500 ml.
At accumulation of a pleural exudate three "triangles" are formed. The area of a stupid percussion sound limited to the line of Damuazo which goes slantwise from a backbone up to the back axillary line and then slantwise down to a breast is formed by a pleural exudate. Between a backbone and Damuazo's line on the sick party — a triangle of Garland which is formed by the drawn-in lung. Percussion sound here clear, pulmonary, breath rigid.
The displaced mediastinum in the healthy party forms an area of dullness — Grokko-Raukhfus's triangle limited to a backbone, a diaphragm and continuation of the line of Damuazo. In this triangle cardiac sounds are listened.
a) causal treatment taking into account sensitivity of a microorganism to antibiotics;
b) pleurocenteses at exudative pleurisy, if necessary — repeated, with the maximum removal of exudate for a full raspravleniye of a lung and the prevention of an obliteration of a pleural cavity; for prevention of an empyema of a pleura antibacterial agents are entered into a pleural cavity;
c) the symptomatic therapy directed to stopping of pain, cough, asthma (analgetics, anti-inflammatory drugs, etc.);
d) the means increasing reactivity of an organism (a complex of vitamins, plasma transfusion, donor immunoglobulin);
e) disintoxication therapy (intravenous administration of Haemodesum, reopoliglyukin and other solutions);
e) treatment of an empyema of a pleura is carried out in specialized surgical department by drainage and washing of a pleural cavity with continuous active aspiration.
At tumoral pleurisy the system chemotherapy supplemented by administration of antineoplastic drugs vnutriplevralno is carried out.
At recurrent tumoral pleurisy sclerosing therapy by means of inside pleural administration of solution of doxycycline (500 mg in 50 ml of normal saline solution) which can be repeated in 48 h allows to prevent exudate accumulation sometimes. With the anesthetizing purpose add lidocaine (3 mg/kg, at most 150 mg) to sclerosing solution. Skleroziruyushy therapy can be executed also by intrapleural introduction of Bleomycinum or Cyclophosphanum.