结核性胸膜炎(英文)PPT课件
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
15
Exudate
1. tumorous diseases 2. bacterial infection
empyema – purulent fluid reactive pleural fluid 3. connective tissue diseases 4. parasite infection, paragonimiasis 5. others
Tuberculous nodules
Exudative effusion
3
III. Clinical Features
4
Symptoms
1. Age, often seen in young people, but also in elderly people 2. Fever, typically 37-38C, but can be >39C 3. Chest pain, more severe when there is only little fluid. 4. Breathlessness, when there is a lot of fluid.
11
4. Pleural needle biopsy ---- tub. granuloma 5. Others: Eos. count, liver function, immunoglobulin, ……
12
V. Diagnosis
symptoms + physical signs + fluid exam.
6
IV. Lab. Examinations
1. Chest X-ray FlFra Baidu bibliotekid is not visible when less than
300 ml. CT is needed in a few cases.
7
8
2. Ultrasonic examination More accurate than X-rays. Can provide vital information for thoracentesis.
protein > 3gram/dl.
10
(2) Acid-fast staining for acid-fast bacilli (not sensitive). (3) Culture for tuberculous bacilli (time consuming). (4) Others: culture for bacteria, cytological exam, etc.
9
3. Thoracentesis and fluid examination ---essential (1)Fluid routine ---- exudate
specific gravity > 1.018; WBC > 500/cmm, predominated by polymorphs at early stage and lymphocytes later;
such as
16
VII. Treatment
1. anti-tuberculous chemotherapy in the same way as pul. tuberculosis 2. drainage of pleural fluid 3. corticosteroids ---- controversial
Tuberculous Pleural Effusion
For Grade 2000
1
I. Etiology and Pathogenesis
Etiology : Mycobacterium tuberculosis Discovered by Dr.Koch in 1882 Acid-fast
Pathogenesis :two theories Delayed hypersensitive reaction Pleural infection
5
Physical signs
1. Inspection: fullness of chest in the involved side. 2. Palpation: trachea shifts to the other side, weakness of vocal fremitus . 3. Percussion: dullness in the involved side. 4. Auscultation: disappearance of breathing sound
retrospective, exclusive.
13
VI. Differential diagnosis
See Table 2-13-1 in p136
14
Transudate
1. Heart diseases 2. Kidney diseases 3. Liver diseases 4. Malnutrition 5. Endocrine diseases
2
II. Pathology
Pleural congestion with cell infiltration,
unilateral in most cases.
In the early stage, polymorphs
predominate.
Typically, lymphocytes predominate.
17
VIII. Prognosis
Good in most cases.
18
Home Work
1. Read Chapter 13 (p135~141) carefully. 2. Review Chapter 9 (p84~104)
19
Exudate
1. tumorous diseases 2. bacterial infection
empyema – purulent fluid reactive pleural fluid 3. connective tissue diseases 4. parasite infection, paragonimiasis 5. others
Tuberculous nodules
Exudative effusion
3
III. Clinical Features
4
Symptoms
1. Age, often seen in young people, but also in elderly people 2. Fever, typically 37-38C, but can be >39C 3. Chest pain, more severe when there is only little fluid. 4. Breathlessness, when there is a lot of fluid.
11
4. Pleural needle biopsy ---- tub. granuloma 5. Others: Eos. count, liver function, immunoglobulin, ……
12
V. Diagnosis
symptoms + physical signs + fluid exam.
6
IV. Lab. Examinations
1. Chest X-ray FlFra Baidu bibliotekid is not visible when less than
300 ml. CT is needed in a few cases.
7
8
2. Ultrasonic examination More accurate than X-rays. Can provide vital information for thoracentesis.
protein > 3gram/dl.
10
(2) Acid-fast staining for acid-fast bacilli (not sensitive). (3) Culture for tuberculous bacilli (time consuming). (4) Others: culture for bacteria, cytological exam, etc.
9
3. Thoracentesis and fluid examination ---essential (1)Fluid routine ---- exudate
specific gravity > 1.018; WBC > 500/cmm, predominated by polymorphs at early stage and lymphocytes later;
such as
16
VII. Treatment
1. anti-tuberculous chemotherapy in the same way as pul. tuberculosis 2. drainage of pleural fluid 3. corticosteroids ---- controversial
Tuberculous Pleural Effusion
For Grade 2000
1
I. Etiology and Pathogenesis
Etiology : Mycobacterium tuberculosis Discovered by Dr.Koch in 1882 Acid-fast
Pathogenesis :two theories Delayed hypersensitive reaction Pleural infection
5
Physical signs
1. Inspection: fullness of chest in the involved side. 2. Palpation: trachea shifts to the other side, weakness of vocal fremitus . 3. Percussion: dullness in the involved side. 4. Auscultation: disappearance of breathing sound
retrospective, exclusive.
13
VI. Differential diagnosis
See Table 2-13-1 in p136
14
Transudate
1. Heart diseases 2. Kidney diseases 3. Liver diseases 4. Malnutrition 5. Endocrine diseases
2
II. Pathology
Pleural congestion with cell infiltration,
unilateral in most cases.
In the early stage, polymorphs
predominate.
Typically, lymphocytes predominate.
17
VIII. Prognosis
Good in most cases.
18
Home Work
1. Read Chapter 13 (p135~141) carefully. 2. Review Chapter 9 (p84~104)
19