Re: [問題] 有關pulmonary edema及pleural effusion

看板Nurse (護理人員)作者greatfish (內科OHCA請準備!)時間18年前 (2008/01/28 01:37)推噓1(1推 0噓 0→)

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底下說明間單易懂還不行我也沒轍了 ※ 引述《rorowsnow (其實你很愛她)》之銘言： : 因為我老是分不清楚這兩種症狀的不同! : 翻以前的內外沒有提到這兩個(只有兩三個字的關鍵字) : 想問呼照的同學可是他們現在已經放假了 : 所以我上線查了一下 : 可是一些知識家&網路上的資料都是針對"個案"去做分析的用google 阿孩子醫師他們不懂也都是上網查最快阿用知識家緊假吸就歹勢提升自己的level 不要都大專了還跟國中生同等級 : 同學建議我問老師 : 可是我想要先自己找找看在問老師 : 所以我想請問各位大大 : 有人是否有看過可以清楚知道兩樣的網站捏? : 如果有~~請大發慈悲的告訴我吧! : 不然我可能會一直待這一問睡不著 = = : 謝謝!! edema http://images.google.com.tw/images?hl=zh-TW&q=pulmonary+edema&gbv=2&aq=f effusion http://0rz.tw/163zO =========================================================== pulmonary edema Shortness of breath with activity is the most common symptom of heart failure. In many cases of heart failure the left ventricle of the heart, which pumps blood to the body, is rendered unable to properly eject its contents. As the left ventricle's abilities are diminished, blood tends to pool and back-up behind it in the pulmonary (lung) circulation. This back-up is under increased pressure, as the right side of the heart is still pumping into this circulation. The result is fluid leakage into the lungs, a condition called pulmonary edema. Fluid retention in the body by the kidneys can also be a culprit in developing pulmonary edema. This situation translates into shortness of breath. The diagram below illustrates just how apparent this problem can develop in some patients: Individual genetic and other factors may influence how likely this is to occur at any given pressure backed up behind the left ventricle. Pulmonary edema can prevent the individual from breathing properly and comfortably. Furthermore, it can strongly impair one's ability to exercise and lead an active life. A primary way to improve this is the use of diuretics. Diuretics are a family of drugs that reduce the kidney's ability to retain the body's salt and water in favor of excreting it in urine. Shedding body salt and water allows for the reduction of symptoms associated with pulmonary edema as well as reducing the strain of volume overload on the heart. ================================================================== pleural effusion What is pleural effusion? Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs. The pleura are thin membranes that line the lungs and the inside of the chest cavity and act to lubricate and facilitate breathing. Normally, a small amount of fluid is present in the pleura. What causes pleural effusion? Pleural effusions are very common, with approximately 100,000 cases diagnosed in the United States each year, according to the National Cancer Institute. Depending on the cause, the excess fluid may be either protein-poor (transudative) or protein-rich (exudative). These two categories help physicians determine the cause of the pleural effusion. The most common causes of transudative (watery fluid) pleural effusions include: Heart failure Pulmonary embolism Cirrhosis Post open heart surgery Exudative (protein-rich fluid) pleural effusions are most commonly caused by: Pneumonia Cancer Pulmonary embolism Kidney disease Inflammatory disease Other less common causes of pleural effusion include: Tuberculosis Autoimmune disease Bleeding (due to chest trauma) Chylothorax (due to trauma) Rare chest and abdominal infections Asbestos pleural effusion (due to exposure to asbestos) Meig’s syndrome (due to a benign ovarian tumor) Ovarian hyperstimulation syndrome Certain medications, abdominal surgery and radiation therapy may also cause pleural effusions. Pleural effusion may occur with several types of cancer including lung cancer, breast cancer and lymphoma. In some cases, the fluid itself may be malignant (cancerous), or may be a direct result of chemotherapy. Is pleural effusion serious? The seriousness of the condition depends on the primary cause of pleural effusion, whether breathing is affected, and whether it can be treated effectively. Causes of pleural effusion that can be effectively treated or controlled include an infection due to a virus, pneumonia or heart failure. Two factors that must be considered are treatment for associated mechanical problems as well as treatment of the underlying cause of the pleural effusion. What are the symptoms of pleural effusion? Some patients with pleural effusion have no symptoms, with the condition discovered on a chest x-ray that is performed for another reason. The patient may have unrelated symptoms due to the disease or condition that has caused the effusion. Symptoms of pleural effusion include: Chest pain Dry, nonproductive cough Dyspnea (shortness of breath, or difficult, labored breathing) Orthopnea (the inability to breathe easily unless the person is sitting up straight or standing erect) How is pleural effusion diagnosed? The tests most commonly used to diagnose and evaluate pleural effusion include: Chest x-ray Computed tomograpy (CT) scan of the chest Ultrasound of the chest Thoracentesis (a needle is inserted between the ribs to remove a biopsy, or sample of fluid) Pleural fluid analysis (an examination of the fluid removed from the pleura space) When the pleural effusion has remained undiagnosed despite previous, less-invasive tests, thoracoscopy may be performed. Thoracoscopy is a minimally invasive technique, also known as video-assisted thoracoscopic surgery, or VATS, performed under general anesthesia that allows for a visual evaluation of the pleura). Often, treatment of the effusion is combined with diagnosis in these cases. How is pleural effusion treated? Treatment of pleural effusion is based on the underlying condition and whether the effusion is causing severe respiratory symptoms, such as shortness of breath or difficulty breathing. Diuretics and other heart failure medications are used to treat pleural effusion caused by congestive heart failure or other medical causes. A malignant effusion may also require treatment with chemotherapy, radiation therapy or a medication infusion within the chest. A pleural effusion that is causing respiratory symptoms may be drained using therapeutic thoracentesis or through a chest tube (called tube thoracostomy). For patients with pleural effusions that are uncontrollable or recur due to a malignancy despite drainage, a sclerosing agent (a type of drug that deliberately induces scarring) occasionally may be instilled into the pleural cavity through a tube thoracostomy to create a fibrosis (excessive fibrous tissue) of the pleura (pleural sclerosis). Pleural sclerosis performed with sclerosing agents (such as talc, doxycycline, and tetracycline) is 50 percent successful in preventing the recurrence of pleural effusions. Surgery Pleural effusions that cannot be managed through drainage or pleural sclerosis may require surgical treatment. The two types of surgery include: Video-assisted thoracoscopic surgery (VATS) – A minimally-invasive approach that is completed through 1 to 3 small (approximately ½ -inch) incisions in the chest. Also known as thoracoscopic surgery, this procedure is effective in managing pleural effusions that are difficult to drain or recur due to malignancy. Sterile talc or an antibiotic may be inserted at the time of surgery to prevent the recurrence of fluid build-up. Thoracotomy – (Also referred to as traditional, “open” thoracic surgery). A thoracotomy is performed through a 6- to 8-inch incision in the chest and is recommended for pleural effusions when infection is present. A thoracotomy is performed to remove all of the fibrous tissue and aids in evacuating the infection from the pleural space. Patients will require chest tubes for 2 to 2 weeks after surgery to continue draining fluid. Your surgeon will carefully evaluate you to determine the safest treatment option and will discuss the possible risks and benefits of each treatment option. -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 125.230.17.253