The Pleurisy: symptoms, treatment of pleurisy of the lungs
medicine online

Pleurisy: symptoms, treatment




Pleurisy is an inflammatory disease of the pulmonary and parietal sheets of the serosa, which surrounds the lung and is called the pleura.

There are two types of pleurisy:

  • exudative pleurisy - accompanied by the accumulation of fluid in the cavity of the pleura
  • dry pleurisy - proceeds with the formation of fibrin protein on the surface of pleural sheets.

Causes of pleurisy

Most often the development of pleurisy is preceded by an infectious disease of the respiratory system, but sometimes pathology can arise as an independent disease. Depending on the causes that provoked inflammation, it is common to divide pleurisy into an infectious and non-infectious pathology.

The causes of infectious pleurisy are:

  • bacterial microflora (staphylococci, pneumococci, streptococci);
  • Fungal infection (fungi of the genus Candida, blastomycosis and others);
  • viruses;
  • parasitic infection;
  • tuberculosis (in 20% of patients, pleurisy is diagnosed with tuberculosis);
  • the transferred surgical operations on the organs of the thorax;
  • syphilis , brucellosis, typhoid.

The causes of non-infectious pleurisies are:

  • breast cancer in women;
  • Malignant neoplasms in the thoracic organs with the formation of metastases in the pleura;
  • myocardial or pulmonary infarction;
  • connective tissue diseases ( systemic lupus erythematosus , rheumatism, vasculitis, rheumatoid arthritis ).

The mechanism of the development of the disease has a certain specificity. Infectious pathogens act directly on the pleural cavity, trying to penetrate it by any means. With such lesions as lung abscess, tuberculosis, pneumonia, bronchoectatic disease, the penetration of pathogenic microflora into the pleural cavity is possible with the flow of blood and lymph. When surgical operations on the organs of the chest, injuries and injuries received, the entry of bacterial flora into the pleural cavity occurs in a direct way.

Pleurisy can develop against a background of increased vascular permeability in systemic blood diseases, a decrease in immunity, the presence of oncological neoplasms, diseases of the pancreas and other pathologies.

A small amount of pleural fluid can be absorbed by the pleura itself, which leads to the formation of a fibrin layer on its surface. Thus, fibrous, or dry pleurisy develops. If the formation of fluid in the pleural cavity occurs faster than its outflow, then exudative pleurisy (with accumulation of effusion in the pleural cavity) develops.

Exudative pleurisy: symptoms

The intensity of clinical symptoms of exudative pleurisy depends on the degree of neglect of the pathological process, the etiology of the development of the disease, the amount of fluid in the pleural cavity, and the nature of the exudate. The main complaints of the patient with this form of the disease are:

  • pain in the chest,
  • the appearance of dyspnea,
  • cough,
  • lethargy,
  • temperature increase,
  • intense sweating.

Pain in the chest is the main symptom of pleurisy. Depending on the degree of lesions of the pleural cavity pain can be acute or moderate. When fluid accumulates in the pleural cavity, the pain intensity in the patient decreases, but dyspnea increases.

Dyspnea with pleurisy is mixed. Its intensity directly depends on the amount of fluid accumulated in the cavity, the rate of its accumulation, the degree of disruption of the physiological ventilation of the lung and the displacement of the mediastinal organs.

Cough is observed at the initial stage of pleurisy. At first it is dry and without phlegm separation, and as the disease progresses it becomes wet and productive. The general condition of the patient is moderate. The patient takes a forced position of the body to reduce pain in the chest - sitting without rest on the hands.

Due to the disruption of the normal functioning of the lung, the patient changes the color of the visible mucous membranes and skin - they become cyanotic. If the fluid accumulates simultaneously in the pleural cavity and mediastinum, then the patient has a marked swelling of the neck and face, as well as a change in the voice.

When examining the chest, the doctor notes the frequent and shallow breathing of a mixed patient. Visually the thorax is asymmetric - the affected side is enlarged and lagging behind in the act of breathing.

During the palpation of the chest, the patient complains of pain. The affected side is strained.

Classification of exudative pleurisy

  • On an etiology distinguish - infectious and not infectious;
  • By the nature of the accumulated fluid in the cavity - serous, purulent-serous, purulent, hemorrhagic;
  • Adrift - acute, subacute and chronic.

Diagnosis of exudative pleurisy

When a large amount of fluid in the pleural cavity accumulates above the lungs, diagnostic zones are determined, according to which it is possible to determine changes in the results of listening and tapping of the affected organ.

During the auscultation (listening) of the lungs at the initial stage of the development of pleurisy, a patch with weakened breathing is detected, and the noise of friction of the pleura is clearly heard.

As a rule, the diagnosis of pleurisy consists of a clinical blood test, an analysis of pleural fluid, and lung radiography.

Dry Pleurisy

Dry pleurisy often develops on the background of tuberculosis, pneumonia, due to hemorrhagic lung infarction or after a violation of diet (scurvy, cachexia).

Dry pleurisy is characterized by a sharp onset. The patient has pain in the side and a feeling of tingling. Most often, all the unpleasant sensations are localized in the area of ​​the armpits. The disease is characterized by severe pain, the intensity of which increases during inspiration, sneezing, coughing, or touching the affected side. Sometimes the pain can radiate to the shoulder, armpit and abdomen. Parallel with the pain, the patient has a dry, painful cough that does not bring relief and causes severe pain. Such a cough patient tries to suppress by any means.

At the initial stage of development of dry pleurisy, the patient may have a fever. As the disease progresses, the thermometer goes up to 39 degrees. This condition of the patient is accompanied by a profuse sweating and an increase in heart rate. Very often dry pleurisy is difficult to diagnose at the very beginning, since the body temperature does not exceed the subfebrile indicators, and the cough is insignificant and does not cause pain.

Upon examination, the doctor may notice that the patient seems to be sparing the affected side: takes the forced position of the body, restricts mobility, intermittently and superficially breathes. With palpation of the chest, there is an increased sensitivity of the skin on the side of the lesion and a friction noise is clearly heard during auscultation of the pleura.

The prognosis for dry pleurisy is favorable, if the treatment is started in a timely manner and the patient complies with all the doctor's instructions. Recovery occurs in 1-2 weeks. If the patient neglects the doctor's recommendations, the dry pleurisy can last a long time with the development of the adhesion process in the pleural cavity and other complications.

Very often dry pleurisy is confused with intercostal neuralgia. The main distinctive feature of dry pleurisy from intercostal neuralgia is that in the first case, the patient has an increase in pain when he tilts to the healthy side of the body, and in neuralgia - on the sore side.

Complications of pleurisy

As a rule, the outcome of the disease is always favorable, however, if patients are ignored medical appointments it is possible:

  • development of adhesions in the pleural cavity,
  • compaction of pleura sheets,
  • education shvart,
  • development of pneumosclerosis and subsequent respiratory failure.

A frequent complication of exudative pleurisy is the suppuration of fluid in the pleural cavity.

Treatment of pleurisy

First of all, the treatment of pleurisy is to eliminate the cause that led to the development of the disease.

If the pleurisy developed against a background of pneumonia, then the patient is required to prescribe antibiotics. With pleurisy against rheumatism, non-steroidal anti-inflammatory drugs are used. In pleuritis in parallel with tuberculosis, the patient is shown consultation with a phthisiatrician and taking antibiotics to kill Koch's rods.

To alleviate the pain syndrome, the patient is prescribed analgesics and drugs to improve the functioning of the cardiovascular system. To dissolve the accumulated fluid - physiotherapy and physical therapy.

With exudative pleuritis with the formation of a large amount of effusion, the question arises of performing a pleural puncture to drain or drain the exudate from the cavity. For one such procedure, it is recommended to pump out not more than 1.5 liters of effusion to avoid sudden spreading of the lung and the development of cardiovascular complications.

With a complicated course of pleurisy with suppuration of exudate, the patient is washed with pleural cavity solutions of an antiseptic with the introduction of an antibiotic or hormone preparations directly into the cavity.

To prevent the recurrence of exudative pleurisy, specialists conduct pleurodesis - the introduction into the cavity of special preparations based on talcum, which prevent the gluing of pleural sheets.

In the treatment of dry pleurisy, the patient is assigned bed rest and rest. To ease the pain syndrome, the setting of mustard plasters, warming compresses, cans, as well as tight bandaging of the thorax is shown. To suppress the cough center, the patient is prescribed drugs that have a depressing effect - codeine, dionine and the like. With dry pleurisy, such drugs as acetylsalicylic acid, nurofen, nemisil and others are highly effective. After the acute phase of the disease subsides, the patient is given the performance of respiratory gymnastics in order to prevent the adhesion of pleural sheets.

In chronic purulent pleurisy, surgical intervention to remove the pleural parts and release the lung from the pleural membrane is indicated.

Folk treatment of pleurisy

At the initial stage of the development of the disease you can try to resort to folk treatment for pleurisy:

  • Mix in equal parts sage leaves, althea root, licorice root and anise fruits. One tablespoon of such a collection pour a glass of boiling water and let it infuse for 5 hours. The received solution to filter and take in a warm kind 5 times a day on 1 table spoon.
  • In a container, mix 30 grams of camphor oil, 3 ml of lavender oil, 3 ml of eucalyptus oil. The resulting mixture is rubbed into the affected side of the chest for the night, after which it is tightly bandaged and warmed.
  • One tablespoon of field horsetail pour a glass of boiling water and let it brew for several hours. After this, drain the solution and take 1 tablespoon 3 times a day in a warm form.
  • With exudative pleurisy, such a remedy is good: mix 1 glass of lime honey, 1 glass of aloe juice, 1 cup of sunflower oil and 1 glass of decoction of lime blossom. It is recommended to take this remedy for 1 tablespoon 3 times a day before meals.

It is important to understand that one can not treat pleurisy with folk remedies alone, as the disease can quickly progress and lead to respiratory failure and suppuration of effusion. The successful outcome of therapy largely depends on the timely treatment of the patient to the doctor. Folk methods in the treatment of pleurisy are relevant, but only in combination with medications.

Prophylaxis of pleurisy

Of course, one can not foresee how the organism reacts to the action of this or that factor. However, any person is able to follow simple recommendations for the prevention of pleurisy:

  • First of all, one should not allow complications in the development of acute respiratory infections. To prevent pathogenic microflora from penetrating the mucous membrane of the respiratory tract, and then into the pleural cavity, colds should not be allowed to drift!
  • If there is a suspicion of pneumonia, it is better to take an X-ray of chest organs in a timely manner and begin adequate therapy. Improper treatment of the disease increases the risk of complications in the form of inflammation of the pleura.
  • With frequent infections of the respiratory tract, it is good to change the climate for a while. Sea air is an excellent means of preventing respiratory tract infections, including pleurisy.
  • Perform breathing exercises. A couple of deep breaths after awakening will serve as an excellent prophylaxis for the development of inflammatory diseases of the respiratory system.
  • Try to strengthen the immune system. In the warm season, do tempering, more out in the fresh air.
  • Refuse from smoking. Nicotine is the first cause of pulmonary tuberculosis, which in turn can trigger inflammation of the pleura.

Remember: any disease is better to prevent than treat!

| 17 December 2014 | | 8 397 | Uncategorized