Friday, February 20, 2009

Parapneumonic Effusions

When a patient is found to have a pleural effusion, it is important to determine whether this is a transudate or an exudate. You can read more about that here.

When dealing with a parapnumonic effusion, it is important to categorize it into one of three types:
  • Uncomplicated Parapneumonic Effusions: These resolve on their own with antibiotic therapy.
  • Complicated Parapneumonic Effusions: This will require drainage to prevent progression to an empyema.
  • Empyema: pus in the pleural space, with cellular debris and fibrin deposition. This certainly requires drainage.
Below is a table with recommended definitions of parapneumonic effusions:

Managment issues: Complicated parapneumonic effusions should be drained to prevent conversion to an empmyema. A pig-tail catheter may suffice, but sometimes something larger like a chest tube may be necessary. An empyema may be difficult to drain even with chest tubes/empyema tubes in place. Sometimes thrombolytic therapy is given through the tube to help break up the contents and ease drainage. Other times, Video-assisted thoracoscopic surgery is used. In a recent trial published in NEJM , it was found that "intrapleural administration of streptokinase does not improve mortality, the rate of surgery, or the length of the hospital stay among patients with pleural infection".

Here is a link to a good review on the diagnosis and management of parapneumonic effusions from Clinical Infectious Diseases.

Tuesday, February 3, 2009

Some liver related issues

(a Black Howler Monkey aka Alouatta pigra pictured left)

We discussed a number of issues today in morning report around Wilson's disease, the managment of ascites, and bacterial peritonitis.

  • You can read more about the serum-ascites albumin gradient here.
  • We discussed Wilson's disease here.
  • Want to know about the underlying causes of liver disease? Try looking here.
  • Infections in hemochromatosis can be found here.