Dorothy FarrarPleurisy
Pleuritis is an inflammation of the pleura or pleura . There are infectious and non-infectious causes of pleurisy. The cardinal symptom of the disease is breath-dependent, mostly unilateral chest pain.
What is pleurisy?
Pleurisy is inflammation of the pleura. The pleura, in turn, is the two-leaved mesothelial layer of the thorax. From this it can be deduced that pleurisy is used as a designation for pleurisy or pleura inflammation. The pleura lines the inside of the chest ( thorax ) and covers the lungs. From this it can be concluded that pleurisy is usually associated with breathing-dependent pain, which usually occurs on one side.
Pleurisy is often the result of an underlying lung disease, such as pneumonia or bronchial carcinoma. There are two forms of pleurisy. On the one hand there is infectious pleurisy, which – as the name suggests – is triggered by an infection.
Infectious pleurisy is usually caused by bacteria , viruses or fungi . On the other hand, there is the non-infectious form of pleurisy. All other occurring pleurisy are summarized under non-infectious pleurisy.
Non-infectious pleurisy usually occurs in connection with pulmonary embolism, pancreatitis, pleural carcinoma and rheumatic diseases. Non-infectious pleurisy can also occur postoperatively or after instillation of drugs that irritate the pleura.
Furthermore, there is often a classification into a dry and a wet form of pleurisy. Here, the existing pleural effusion is assessed. The assessment takes place sonographically. A strict subdivision is not made, since at least a minimal pleural effusion can be found in almost every case. Even minimal or small pleural effusions are often counted among the dry pleuritis.
In earlier times, tuberculous pleuritis was common. These are very rarely found in Western Europe.
causes
As already described, the causes of pleurisy are diverse and can be distinguished primarily between infectious and non-infectious pleurisy. The infectious forms of pleurisy are triggered by an infection with pathogens, mostly bacteria, viruses or fungi. If these germs colonize the pleura, the immune reaction causes inflammation of the affected tissue. In the dry form, the two layers of the pleura rub against each other, causing pain and sounds typical of auscultation. All pleurisy is initially dry, so that these symptoms occur in almost every case at the beginning of the disease. As a result, a pleural effusion occurs in some cases.In the non-infectious form of pleurisy, it is often caused by an underlying condition, often lung disease. From this it can be deduced for the clinic that if pleurisy is present, attention should be paid to any symptoms of an underlying or accompanying lung disease. These non-infectious causes include, for example, a pulmonary embolism , bronchial carcinoma , rheumatic diseases or pancreatitis (inflammation of the pancreas).
symptoms and course
Typical symptoms:
- chest pain
The most typical symptom of the disease is a mostly unilateral breath-dependent pain. This brought the name “side sickness” to the disease, which has been known and described since antiquity. It should be noted here that the side sickness described in the novel “Der Medicus” is not pleuritis but appendicitisacts. The pain occurs in the chest and is particularly pronounced in the dry form of pleurisy (pleuritis sicca). Since the two parts of the pleura rub directly against each other, a noise typical of pleurisy, a so-called “leather creaking”, can be heard on auscultation. The rubbing of the two parts of the pleura also relieves breathing-related chest pain. It can be deduced that particularly wet forms of pleurisy (exudative pleuritis; i.e. pleurisy associated with a pleural effusion) can also be painless.
In general, however, pleurisy causes pain in the chest. Non-specific symptoms of pleurisy include coughing, shortness of breath and fever. The general condition of the patient is usually severely affected by the pain. The existing feeling of illness is usually very pronounced. It should be noted that pain may decrease or disappear as the disease progresses. This is because a pleural effusion has developed and does not mean that the disease is improving. The pleural effusion is clearly visible on sonography.
With regard to the course of pleurisy, it can be said that it usually heals completely and without consequences. However, scarring adhesions of the pleura can occur as a result of pleurisy. If left untreated, purulent and tuberculous pleuritis can lead to death.
Diagnose
In the anamnestic, attention should be paid to the presence of breathing-related pain. These usually occur on one side of the chest. However, the absence of pain does not rule out the presence of pleurisy, as this circumstance may be due to a pleural effusion. The causal clarification of pleurisy usually involves difficulties, since infectious and non-infectious causes can often only be differentiated with difficulty without invasive diagnostics. In addition, there are numerous differential diagnoses to be considered for chest pain. The basic diagnostics for suspected pleurisy consists first of all of the anamnesis already mentioned; an auscultation in which the rubbing of the pleural layers (“leather creaking”) can be heard in the presence of pleurisy; a sonography in which pleural effusions and an irregular lung contour can be seen as well as measuring body temperature (fever) and determining some laboratory parameters. For laboratory diagnostics, the determination of the C-reactive protein and the general blood count are necessary in order to be able to determine the degree of inflammation.
Other diagnostic options include an ultrasound of the veins in the legs to detect a possible thrombosis and a chest x-ray ( X-ray of the chest) to rule out pneumonia. Tuberculosis diagnostics and rheumatism diagnostics are also possible. A pleural puncture is possible as part of the invasive diagnostics. With the pleura puncture, cytological and bacteriological examinations are possible, which can be used to determine the cause of the pleurisy. In normal cases, invasive diagnostics are not carried out in the case of uncomplicated courses of pleurisy.
treatment and therapy
Treatment depends on the underlying cause. If the pleuritis is not due to a bacterial or fungal infection, an underlying rheumatic disease or cancer, the therapy is symptomatic and aims to relieve the pain. Antibiotics are necessary for bacterial infections of the pleura (including pleuropneumonia and purulent pleurisy) . If rheumatic pleurisy is present, immunosuppressive treatment with glucocorticoids is carried out. In the presence of pleural carcinosis, an infestation of the pleura with metastases of malignant tumors, the instillation of a cytostatic is indicated.If there is a larger pleural effusion, it may need to be punctured. In severe shortness of breath, oxygen may be given. In the presence of purulent pleurisy, in addition to antibiotics, flushing and drainage of the pleural space are useful. Bed rest should be observed during pleurisy. Strenuous activities should be avoided until the symptoms are free. If the symptoms improve, breathing exercises (as part of physiotherapy) make sense, which teaches the patient to breathe deeply despite the pain.
prevention
Effective prevention is not possible.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.