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Pleurisy: symptoms, treatment




Pleurisy is an inflammatory disease of the pulmonary and parietal sheets of the serous membrane that surrounds the lung and is called the pleura.

There are two types of pleurisy:

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

Causes of pleurisy

Most often, the development of pleurisy is preceded by an infectious disease of the organs of the respiratory system, but sometimes pathology can also arise as an independent disease. Depending on the reasons that provoked inflammation, pleurisy can be divided into infectious and non-infectious pathology.

Causes of infectious pleurisy are:

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

The causes of non-infectious pleurisy are:

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

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

Pleurisy can develop against the background of increased vascular permeability in systemic blood diseases, decreased immunity, the presence of cancer tumors, 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 sooner than its outflow, then exudative pleurisy develops (with accumulation of effusion in the pleural cavity).

Exudative pleurisy: symptoms

The intensity of the 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 in this form of the disease are:

  • pain in the chest,
  • dyspnea
  • cough,
  • lethargy,
  • temperature rise,
  • increased sweating.

Chest pain is the main symptom of pleurisy. Depending on the degree of damage to the pleural cavity, the pain can be acute or moderate. When fluid accumulates in the pleural cavity, the intensity of painful sensations in the patient decreases, but the shortness of breath increases.

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

Cough is observed at the initial stage of development of pleurisy. First, it is dry and without sputum, 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 resting on the hands.

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

On examination of the chest, the doctor notes the frequent and shallow breathing of a mixed-type patient. Visually, the thorax is asymmetric - the affected side is enlarged and lags behind in the act of breathing.

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

Classification of exudative pleurisy

  • According to the etiology distinguish - infectious and non-infectious;
  • By the nature of the fluid accumulated in the cavity - serous, purulent-serous, purulent, hemorrhagic;
  • With the flow - acute, subacute and chronic.

Diagnosis of exudative pleurisy

When a large amount of fluid is accumulated in the pleural cavity above the lungs, diagnostic zones are determined by which changes in the results of listening and tapping the affected organ can be determined.

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

As a rule, the diagnosis of pleurisy consists in the clinical examination of blood, the analysis of pleural fluid, and radiography of the lungs.

Dry pleurisy

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

Dry pleurisy is characterized by a sharp onset. The patient has pain in the side and tingling sensation. Most often, all the discomfort is localized in the armpits. The disease is characterized by severe pains, the intensity of which increases during inhalation, sneezing, coughing or touching the affected side. Sometimes pain may radiate to the shoulder, armpit, and abdomen. In parallel with the pains, the patient has a dry, torturous cough that does not bring relief and causes severe pain. The patient tries to suppress such a cough by any means.

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

On examination, the doctor may notice that the patient seems to spare the affected side: takes a forced position of the body, limits mobility, breathes intermittently and shallowly. On palpation of the chest, there is an increased sensitivity of the skin on the affected side, and during auscultation a pleural friction noise is clearly heard.

The prognosis for dry pleurisy is favorable if the treatment is started on time and the patient fulfills all instructions of the doctor. Recovery occurs in 1-2 weeks. If the patient ignores the recommendations of the doctor, then dry pleurisy can occur for a long time with the development of adhesions 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 increased pain when tilted to the healthy side of the body, and with neuralgia - to the sick side.

Complications of pleurisy

As a rule, the outcome of the disease is always favorable, but if patients ignore medical prescriptions, it is possible:

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

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

Pleurisy treatment

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

If pleurisy developed on the background of pneumonia, antibiotics are prescribed to the patient without fail. When pleurisy on the background of rheumatism nonsteroidal anti-inflammatory drugs are used. In case of pleurisy, in parallel with tuberculosis, a phthisiatric consultation and antibiotics for the destruction of Koch sticks are shown to the patient.

To relieve pain, the patient is prescribed analgesics and drugs to improve the cardiovascular system. For resorption of the accumulated fluid - physiotherapy treatment and physical therapy.

When exudative pleurisy with the formation of a large amount of effusion raises the question of conducting a pleural puncture in order to drain or pump out the exudate from the cavity. For one such procedure, it is recommended to pump out no more than 1.5 liters of effusion, in order to avoid a dramatic lung smoothing and the development of cardiovascular complications.

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

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

When treating dry pleurisy, the patient is prescribed bed rest and rest. In order to relieve pain, the staging of mustard plaster, warming compresses, cans, as well as tight bandaging of the chest is shown. To suppress the cough center the patient is prescribed drugs that have a depressing effect - codeine, dionin and the like. With dry pleurisy, highly effective drugs such as acetylsalicylic acid, nurofen, nemisil and others. After the acute phase of the disease subsides, the patient is prescribed to perform respiratory exercises in order to prevent adhesions of the pleural sheets.

In chronic purulent pleurisy, surgical intervention is recommended to remove areas of the pleura and release the lung from the pleural membrane.

Folk treatment of pleurisy

At the initial stage of the development of the disease, you can try to resort to the popular treatment of pleurisy:

  • Mix in equal parts sage leaves, Altea root, licorice root and anise fruit. One tablespoon of such a collection pour a glass of boiling water and let it brew for 5 hours. Strain the resulting solution and take it in the form of heat 5 times a day, 1 tablespoon.
  • In a container, mix 30 grams of camphor oil, 3 ml of lavender oil, 3 ml of eucalyptus oil. Rub the mixture into the affected side of the chest at night, then bandage tight and warm.
  • One tablespoon of horsetail pour a glass of boiling water and let it brew for several hours. After that, strain the solution and take 1 tablespoon 3 times a day in the form of heat.
  • With exudative pleurisy, this remedy helps well: mix 1 cup of linden honey, 1 cup of aloe juice, 1 cup of sunflower oil, and 1 cup of lime-colored decoction. It is recommended to take this tool for 1 tablespoon 3 times a day before meals.

It is important to understand that pleurisy alone cannot be treated with folk remedies, since the disease can progress rapidly and lead to respiratory failure and festering effusion. The successful outcome of therapy depends largely on the timely treatment of the patient to the doctor. Folk methods in the treatment of pleurisy are relevant, but only in combination with medication.

Prevention of pleurisy

Of course, it is impossible to predict how the body will react to the action of a particular factor. However, any person is able to follow simple recommendations for the prevention of pleurisy:

  • First of all, it is impossible to prevent complications in the development of acute respiratory infections. So that the pathogenic microflora does not penetrate the mucous membrane of the respiratory tract, and then into the pleural cavity, colds should not be allowed to run on gravity!
  • If you suspect pneumonia, it is better to make an x-ray of the chest organs in time and start an adequate therapy. Improper treatment of the disease increases the risk of complications such as 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 waking up will serve as an excellent prevention of the development of inflammatory diseases of the respiratory system.
  • Try to strengthen the immune system. In the warmer months, do tempering, more fresh air.
  • Give up smoking. Nicotine is the first cause of pulmonary tuberculosis, which in turn can provoke inflammation of the pleura.

Remember: any disease is better to prevent than to cure!

| 17 December 2014 | | 8 397 | Uncategorized