- Hydrothorax symptoms
- Hydrothorax reasons
- Treatment of the Hydrothorax
Hydrothorax is called accumulation in pleural polosyotyakh of transudate, i.e. an exudate of a noninflammatory origin. Pathological processes, privoyodyashchy to increase in a ratio between a hydrostatic davyoleniye in capillaries and the colloid osmotic pressure of a blood plasma are the cornerstone of transudation. If hydrostatic pressure in pleural capillaries begins to exceed colloid осмотическое plasma pressure, comes to the propotevayena otnositelyyono of liquid poor in protein through not changed capillary wall and its accumulation in a pleural cavity.
Clinical manifestations of a hydrothorax usually supplement and make heavier manifestations of a basic disease. At znachitelyyony accumulation of transudate an asthma usually arises or amplifies, the feeling of weight in the corresponding half of a breast appears. The patient aims to accept forced situation with the raised upper part of a trunk and with an inclination towards transudate accumulation. Fnzikalny and rentgenologiyochesky symptoms are similar to signs of accumulation of liquid at exudative pleurisy.
At a trial puncture receive almost transparent zhidyokost of light-straw color giving a negative reakyotion of Rivalt with the specific weight less than 1015 and protein content less than 30 g/l (in inflammatory exudate sootvetstyovuyushchy indicators are represented by higher). The deposit is poor in cells among which the slushchepny mesothelium prevails.
Most often congestive seryodechny insufficiency of various origin (dekompen-sirovanny heart diseases, the squeezing pericardis, the porazheyoniya of a cardiac muscle) leading to increase in vnutrikapnllyarny hydrostatic pressure, and in far come cases and to the hypoproteinemia reducing a colloid and osmotic davyoleniye of plasma is the reason of a hydrothorax. Besides, to transudation in a pleural poyolost the diseases which are characterized by a vyrazhenyony hypoproteinemia, for example damages of kidneys, сопровождающиеся a considerable albuminuria, the liver diseases causing disturbances of synthesis of protein (for example, цирроз), etc. can lead. Some authors find possible a proniknoyoveniye from an abdominal cavity in pleural an ascitic zhidyokost at cirrhosis (through minor defects and limfaticheyosky ways of a diaphragm). The hydrothorax at a myxedema is described, and also at some forms of fibromas of ovaries (a so-called syndrome of Meygs). Emergence of transudation in the latter case did not find a satisfactory objyoyasneniye yet.
Small on transsudata volume significantly do not otrazhayotsya on a current and manifestations of a basic disease. At a nayokopleniya of a significant amount of liquid disorders of breath and blood circulation, svyayozanny with a compression of lungs and sdavlenny or the shift of oreganos of a mediastinum come or are aggravated. Though theoretically conditions for transudation in both pleural cavities are represented identical, more often the right-hand hydrothorax is observed in the beginning, kotoyory further can become bilateral. The partial or full obliteration of a pleural cavity limits or iskyolyuchat transudation with corresponding the parties.
Treatment of the Hydrothorax:
The hydrothorax moderated on volume usually does not treyobut special medical events and rezorbirutsya, as a rule, at successful treatment of a basic disease (a napriyomer, heart failure). At the considerable accumulation of transudate conducting to the expressed functional rasyostroystvo the puncture with aspiration of liquid from a plevyoralny cavity which at massive it is long a sushchestvoyovavshy hydrothorax (more than 1,5-2 l) is shown it is recommended осуществлять in two steps as elimination of a compression ateyolektaz comes not at once, and in I will shift bystry movement of a mediastinum from where the exudate was evacuated, sometimes it pereyonositsya badly by patients.
It is necessary to use all opportunities of conservative treatment of a basic disease (cordial and diuretics, intravenous nnfuziya of proteinaceous drugs etc.) to avoid frequent repeated punctures with transudate evacuation" as the last lead to considerable loss of protein and usugubyolyat a ginoproteinemiya therefore can сформироваться a vicious circle.