Pleurisy - description, diagnosis. What is exudative pleurisy and how to treat? In the treatment of other diseases of the pleura, drugs are used

Pleurisy- an inflammatory disease of the pleura, manifested by pain when breathing and coughing. Genetic aspects, frequency, predominant sex and age depend on the pathology against which pleurisy developed.

Code according to the international classification of diseases ICD-10:

• R09.1

Classification.
. By the nature of the lesion of the pleura.
.. Dry (fibrinous) - pleurisy, characterized by the deposition of fibrin on the surface of the pleura with a small amount of exudate ... Adhesive pleurisy (adhesive, productive, fibrous) - fibrinous pleurisy, occurring with the formation of fibrous adhesions between the pleura ... Armored (pachypleuritis) - indurative pleurisy, characterized by the appearance of foci of ossification or calcification in the pleura.
.. Exudative (exudative) - pleurisy, flowing with accumulation of exudate in the pleural cavity ... According to the prevalence of exudate .... Cloak-like - exudate is located evenly over the entire surface of the lung .... Encapsulated - the area of ​​accumulation of exudate in the pleural cavity is delimited by adhesions between sheets of pleura ... By the nature of the exudate .... Serous - accumulation of serous exudate .... Hemorrhagic (serous - hemorrhagic) - exudate contains a significant amount of red blood cells .... Purulent - the formation of purulent exudate .... Putrid (ichorothorax, ichorous) - caused by putrefactive microflora and characterized by the formation of a fetid exudate; usually found in gangrene of the lung.
. By localization (regardless of the nature of the lesion of the pleura) .. Apical (apical) - pleurisy, limited to the area of ​​​​the pleura, located above the tops of the lungs .. Basal (diaphragmatic) - fibrinous or encysted pleurisy, localized in the diaphragmatic pleura .. Costal (paracostal) - pleurisy limited by any part of the costal pleura .. Mediastinal (paramediastinal) - encysted pleurisy, exudate accumulates between the mediastinal and pulmonary pleura .. Interlobar (interlobar) - encysted pleurisy, exudate accumulates in the interlobar groove.
. By etiology .. Metapneumonic - arising during the period of convalescence after pneumonia .. Parapneumonic - arising during the development of pneumonia .. Tubercular (see Tuberculosis) .. Rheumatic - exudative pleurisy that occurs as a manifestation of polyserositis during exacerbation of rheumatism .. Hypostatic (congestive pleurisy, circulatory pleurisy) - caused by venous hyperemia and pleural edema in right ventricular failure .. Carcinomatous - exudative, usually hemorrhagic pleurisy, caused by seeding of the pleura with a cancerous tumor .. Aseptic - arising without the penetration of pathogenic microorganisms into the pleural cavity ... Traumatic - aseptic pleurisy due to damage chest (for example, a closed fracture of the rib).
. By pathogenesis .. Hematogenous - caused by the ingress of infectious agents into the pleura with blood flow .. Lymphogenic - caused by the ingress of infectious agents into the pleura through the lymphatic pathways.
Clinical picture. Pain when breathing and coughing; irradiation into the abdominal cavity is possible with an imitation of a picture of an acute abdomen. Dyspnea. Dry cough. Inspection: forced position on the affected side. Palpation: weakening of voice trembling with pleural effusion. Percussion: shortening of percussion sound with pleural effusion. Auscultation: .. pleural friction noise with dry pleurisy; .. weakening of breathing with pleural effusion.

Diagnostics

Diagnostics. Dry pleurisy has no specific laboratory and radiological signs. The diagnosis is based on the presence of pain during breathing and pleural friction rub. Exudative pleurisy - see Pleural effusion.
Differential Diagnosis. THEM. Sharp belly. Intercostal neuralgia. Spontaneous pneumothorax. Pericarditis.
Treatment. General tactics.. Treatment of the underlying disease.. In the presence of an effusion visible on the radiograph (volume more than 500 ml), pleurocentesis, fluid evacuation (with its subsequent cytological, bacteriological and biochemical studies) and the introduction of fibrinolytic agents into the pleural cavity are indicated. ... Bandaging the chest with elastic bandages ... Paracetamol 0.65 g 4 r / day ... In the absence of effect, severe pain and dry cough - codeine 30-60 mg / day .. Expectorants (during the cough of the patient fixes the sore side to reduce pain). Treatment of exudative pleurisy- see Pleural effusion. Treatment of pleurisy complicating pneumonia - intravenous antibiotics: fluoroquinolones (levofloxacin) or agents protected by  - lactams (amoxicillin + clavulanic acid, amcillin + sulbactam) in combination with macrolides. Treatment of tuberculous pleurisy - see Tuberculosis.
Complications. Bronchopleural fistula. Pleural empyema.

ICD-10. R09.1 Pleurisy

Pleurisy - inflammation of the pleura with the formation of a fibrous growth on its surface and the appearance of an effusion. It manifests itself as an accompanying pathology or as a result of various diseases.

Pleurisy can occur as an independent disease (primary pleurisy), but most often it is the consequences of acute and chronic inflammatory processes in the lungs (secondary pleurisy). The disease is divided into dry or fibrous pleurisy and effusion (serous, serous-fibrous, purulent, hemorrhagic) pleurisy.

Also, pleurisy can occur due to pathogenic bacterial microflora, exposure to viruses and allergens.

For many years there has been pleurisy with unknown etiology.

Depending on the causes that caused pleurisy, the signs of the disease also differ. Exudative pleurisy can be either left-sided or right-sided.

In the initial stage of exudative pleurisy (another name for this form of the disease is hydrothorax), with a decrease in the amplitude of respiratory movements of the diseased side of the chest, a characteristic sound of pleural friction is observed. A dry, painful cough is often present. In the process of accumulation of effusion, exudations disappear, there is a feeling of heaviness, increasing dyspnea, cyanosis of moderate intensity, a small tumor on the diseased side, and smoothing of the intercostal space.

According to ICD-10, exudative pleurisy is classified under the number J.90.

• With the help of the effusion, you can listen to the percussion-pulmonary sound.
• Voice trembling and bronchophony are lower than normal levels in healthy lungs.
• Air does not pass or is too weak.
• Tympanic percussion sound, murmurs, bronchial breathing and fine bubbling rales.
• During radiological examination, a special outline of the main area of ​​the effusion may be found.

A strong effusion contributes to the movement of the mediastinum to the healthy half of the lung and severe defects in the function of external respiration due to the failure of the mechanics of respiration: a decrease in the depth of respiration, as it becomes very frequent.

By means of functional diagnostics, it is possible to calculate the drop in indicators of external respiration (vital lung volume, ventilation reserves, etc.).

Failures in the work of the cardiovascular system show:

• contraction and small volume of the heart due to a decrease in blood tension in the central veins due to ventilation of defects;
• changes in cardiac and large vessels in rich pleural effusions.
• compensatory increase in tachycardia, blood pressure gradually falls.

Among patients with exudative pleurisy, the age group of 20-25 years is distinguished. The most frequent time of the year for exudative pleurisy is spring and autumn.

Exudative pleurisy: treatment, symptoms, signs

Symptoms of exudative pleurisy directly depend on its location and volume of exudate.

To remove new foci of exudative pleurisy, such a thing as pleural pain is introduced. At the heart of the pain is the same disease process as with dry pleurisy, the difference lies only in the degree of exudative reaction. Removal of foci of inflammation in the exudative form of pleurisy usually occurs at high temperatures (up to 39.0-39.5 °). With the accumulation of effusion, the pain passes, and then stops completely.

Cough is the first and constant symptom of exudative pleurisy. It is dry in nature, but can take on a whooping cough-like character when the enlarged lymph nodes press on the vagus nerve. With the accumulation of effusion, there is a decrease in cough and shortness of breath.

Most of the shortness of breath on a small inflammation is caused by psychosomatic features and shortness of breath. A large accumulation of fluid (500 ml), causing a change in the mediastinum, interferes with the normal penetration of air into the lungs. Severe shortness of breath in some cases can be a serious threat to the patient's life.

Sometimes pleurisy is caused by functional deviations in the regulation of metabolic processes., while a distorted water-salt metabolism is observed, there is a delay in the mass of water and salt in the body. Daily urine volumes are reduced to 200-300 ml.

Treatment of exudative pleurisy is aimed primarily at treating the underlying cause that causes pleural inflammation. Examples of pleural treatment include courses of antibiotics for pneumonia or diuretics for congestive heart failure.

Large, infected, or inflamed pleural cavities often require drainage to relieve symptoms and avoid complications.

For the treatment of pleural inflammation of an exudative nature, the following are used:

The main complications of exudative pleurisy

Exudative pleurisy with embolic infarcts develops pulmonary contraction due to reactive inflammation of the internal pleura with the formation of fibrin zones first, and then serous-fibrinous, serous-hemorrhagic and pleural inflammation. This is often the main signs of latent thrombophlebitis.

The main complication of exudative pleurisy is cancer. Pleural malignancy occurs quite often. An extremely important point for the pathogenesis of exudative pleurisy is a violation of the patency of the blood and lymphatic vessels of the lungs and pleura and blood disorder in the blocking lymph node metastases.

With primary cancer, which patients in this case encounter quite rarely, there is a selection of areas of the pleura (mesothelioma) and the penetration of tumor cells into the parietal pleura, which therefore loses its physiological ability to absorb fluid. Under such conditions, at the beginning of the disease, there is an accumulation of large amounts of effusion. Further, due to damage to the internal pleura, the amount of exudants gradually decreases, as a result of which the pleura does not collapse and retains its integrity.

The leading clinical symptoms of pleurisy with mesothelioma are constant and acute pain in the chest, the accumulation of effusion only increases. The effusion is often hemorrhagic in nature, bilateral, rapidly accumulating. Body temperature in most cases is normal or subfebrile.

More common in malignant pleurisy is its secondary origin.

The earliest signs of malignant exudative pleurisy:

• Persistent and dry cough.
• Bone ache.
• Weakness.
• Dyspnea.

Accession to a secondary infection and penetration into the lung tissue often occurs with the formation of an abscess, which is accompanied by an increase in body temperature, and the body's reaction is similar to the reaction to neutrophilic leukocytosis with a sharp acceleration of ESR.

The main complication of exudative pleurisy caused by chlamydial infection is the rapid accumulation of hemorrhagic effusion and compression of the mediastinum.

Exudative pleurisy is a disease of the respiratory system, which is characterized by damage to the pleura of an infectious, tumoral or other nature. Most often, this disease acts as a secondary factor in any pathological changes. It is manifested by unilateral chest pain, which, as fluid accumulates, is replaced by a feeling of heaviness and pressure.

What is exudative pleurisy?

Exudative pleurisy is a pathology in which inflammation of the pleural sheet of the lungs occurs with the accumulation of fluid in the costophrenic sinus. About 80% of cases of hydrothorax occur in patients with pulmonary tuberculosis. Every year, pathology is diagnosed in 1 million people.

In its etiology, exudative pleurisy is similar to dry pleurisy, differs in that it often develops with pancreatitis, cirrhosis or liver tumors, subdiaphragmatic processes, and also accompanies some systemic diseases.

Exudate is a liquid released into the pleural cavity from the capillaries during inflammation.

Fluid in the pleural cavity may accumulate diffusely or limitedly. In the case of limited accumulation of effusion, encysted pleurisy (supradiaphragmatic, paracostal, paramediastinal) is formed, resulting from the adhesive process in the pleura.

• ICD-10 code: J.90.

Exudative pleurisy, according to its etiology, is divided into infectious and aseptic. Given the nature of the exudation, pleurisy can be serous, serous-fibrinous, hemorrhagic, eosinophilic, cholesterol, chylous (chylothorax), purulent (pleural empyema), putrefactive, mixed.

Taking into account the location, it can be:

• diffuse;
• left-sided;
• encysted;
• right hand;
• exudative pleurisy.

Based on the degree of flow, there are:

• subacute;
• acute;
• chronic form.

In many cases, the disease is localized on the right, but more severe forms of the flow are also likely - pleurisy of the left-sided and bilateral type.

The reasons

The infectious form of exudative pleurisy appears against the background of the following processes in the lungs:

• lung abscess;
• gangrene;
• tuberculosis.

In this case, the cause of the disease is the ingress of infectious irritants from the listed diseases into the pleural cavity.

The aseptic type, as a rule, accompanies all kinds of pulmonary and extrapulmonary pathological processes, aggravating the development of such diseases as:

• postinfarction autoallergic pericarditis;
• Dressler's syndrome;
• hypersensitivity interstitial pneumonitis;
• various allergic reactions.

However, approximately 75 percent of cases of effusion pleurisy are diagnosed in patients with tuberculosis.

Symptoms

Signs and symptoms of exudative pleurisy depend on the volume, nature and intensity of fluid accumulation.

The main symptoms are:

• patients complain of severe shortness of breath and discomfort in the chest area during breathing,
• hacking cough with sputum difficult to separate,
• general weakness,
• loss of appetite
• short-term increase in body temperature to high numbers.

The severity of the manifestations of the disease depends on the rate of accumulation of effusion, volume, severity of the underlying inflammation. With intensive accumulation of fluid, pain appears.

As the exudate accumulates, the sheets are wetted, which reduces the severity of the pain syndrome. When you try to press on the intercostal spaces above the location of the inflammatory focus, acute pain occurs due to irritation of the nerve receptors.

The general condition of the patient is severe, especially in the purulent form of exudative pleurisy, which is accompanied by:

• high temperature;
• symptoms of intoxication;
• chills.

There are three phases of the course of the disease:

Left-sided exudative pleurisy leads to an acceleration of the heart rate, arrhythmia may develop. Lack of air causes a noticeable swelling of the veins in the neck area. At the same time, the pulse quickens and reaches one hundred and twenty beats per minute.

More often, exudative pleurisy is unilateral, however, with metastatic tumor processes, SLE, lymphoma, bilateral pleural effusion can be determined. The volume of fluid in the pleural cavity with exudative pleurisy can reach 2-4 or more liters.

In most patients, after resorption of the exudate, especially if it was significant, adhesions (moorings) remain. In some cases, adhesions are so numerous and massive that they cause impaired lung ventilation.

After suffering exudative pleurisy, patients may feel pain in the chest, aggravated by changes in the weather, changing weather conditions. This is especially pronounced with the development of adhesions.

Diagnosis of the disease

Informative diagnostic methods:

• physical. During its implementation, doctors note the lag of the affected side of the chest during the act of breathing, its weakening, dullness of percussion sound during percussion, splashing noise during auscultation;
• x-ray examination (a method for diagnosing hydrothorax of any etiology, including tuberculosis). In the lower parts of the lungs there is a significant darkening;
• Ultrasound of the pleural cavity;
• thoracocentesis. All patients with suspected exudative pleurisy undergo this procedure. During its implementation, doctors receive some of the effusion, which is then used for cytological, bacteriological and biochemical studies;
• thoracoscopy;
• computed tomography of the lungs;
• blood chemistry.

Exudative pleurisy caused by nonspecific lung diseases, even with a prolonged course, as a rule, have a favorable outcome.

Treatment of exudative pleurisy

The main principles of the treatment of exudative pleurisy is the evacuation of the accumulated fluid from the pleural cavity and the impact on the underlying pathological process that caused the reaction of the pleura.

Taking into account the cause of pleurisy, medication is prescribed:

1. Tubersculostatic drugs (with tuberculous form of exudative pleurisy);
2. Antibacterial agents (with pneumatic pleurisy);
3. Cytostatic agents (for tumors and metastases);
4. Glucocorticoid drugs (for lupus erythematosus and)
5. Diuretic treatment for pleurisy caused by cirrhosis of the liver (usually affecting the lung located on the right).

Regardless of the etiology of the disease, analgesics, anti-inflammatory, antitussive, desensitizing agents are prescribed.

To increase the effectiveness of treatment after pleural puncture, physiotherapy is recommended:

• chest massage;
• Vibration massage;
• Paraffin therapy;
• electrophoresis;
• Breathing exercises.

The chronic form of empyema is removed through surgical intervention, carried out in the process of thoracostomy or decortication of the lung. One of the most important diagnostic and treatment measures is pleural puncture.

1. The patient sits on a chair with his back to the doctor, and the doctor, after preliminary anesthesia, makes a puncture with a special beveled needle in the sixth intercostal space along the scapular line.
2. When the needle enters the pleural cavity, exudate begins to stand out from it.
3. The fluid is removed slowly and in small volumes in order to prevent a sharp displacement of the mediastinum and the occurrence of acute heart failure.
4. The pleural cavity is drained and washed with antiseptics, and it also becomes possible to administer antibiotics intrapleurally.

With the presented comprehensive approach to restoring the state of health in case of a disease, it will be possible to exclude the development of complications and negative consequences of the lungs. The medical history in this case will be the most positive.

After 4-6 months after the end of the treatment of pleurisy, a control radiograph is taken. To avoid exudative pleurisy in the future, it is necessary to treat all respiratory diseases in a timely manner, avoid hypothermia and injuries, and strengthen the immune system.

The exudative form of pleurisy is a dangerous, but not a critical disease, for recovery in which it is necessary to start the recovery process and prevention in time. This will allow you to get out of the state with minimal losses, even if the dry subtype of the disease has been identified.

23.11.2018

Exudative pleurisy is characterized by damage to the pleura, in which exudation is formed, that is, fluid is released and effusion accumulates in the cavity. Another name is effusion pleurisy, hydrothorax. It acts as an independent disease, but more often occurs against the background of other diseases. Therefore, it is divided into primary and secondary forms.

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Causes of exudative pleurisy

With exudative pleurisy, inflammatory processes develop in the pleural sheet of the lungs, and fluid accumulates in the costal diaphragmatic sinus. The effusion is formed in a diffuse or limited way, which leads to the formation of encysted pleurisy, since adhesive processes occur in the pleura.

The etiology of occurrence is infectious and aseptic (non-infectious). The first is caused by the defeat of pathogenic organisms - in 80 cases out of 100 it is a tubercle bacillus. Other pathogens: pneumococcus, streptococcus, Staphylococcus aureus, Klebsiella, Haemophilus influenzae and typhoid bacillus, Brucella, Mycoplasma, viruses, fungi, etc. Thus, the main reasons for the development of exudative pleurisy are the following:

• tissue necrosis;
• inflammation of a purulent nature in the tissues of the lungs;
• tumor and;
• pancreatitis and renal failure;
• the presence of malignant neoplasms in the respiratory tract;
• chest injury with subsequent internal bleeding;
• chronic pathologies of connective tissues;
• diseases of the lymph and blood;
• pancreatic damage.

ICD code 10

The International Classification of Diseases defines exudative pleurisy according to the J.90 code.

Symptoms

The severity of manifestations depends on the rate of accumulation of exudate, the volume of fluid and the stage of severity of the disease. When there is an intense accumulation of effusion, the patient experiences a powerful pain syndrome. With slow accumulation, wetting of the sheets is carried out, which prevents severe pain. If you press on the intercostal space, nerve receptors begin to irritate, so palpation is considered painful.

Other signs:

1. In areas where the effusion is located, pulmonary sound is dulled.
2. Weakening of breathing from below the lungs, but bronchial breathing is clearly audible from the upper side.
3. Against the background of respiratory failure, shortness of breath and reflex cough occur.
4. Decreased blood pressure and blanching of the skin, sometimes cyanosis in the face. These symptoms usually occur on the affected side (left or right).
5. Slight increase in body temperature, accompanied by chills, weakness, fever and headache.
6. Intoxication signs (with infectious etiology), as well as increased sweating, decreased appetite.

As hydrothorax progresses, many pleural adhesions occur, due to which the mobility of the lungs is limited and purulent contents are formed.

Kinds

Based on the period of development:

1. Exudative phase: lasts until the 21st day, is characterized by a gradual accumulation of fluid, the symptoms are pronounced.
2. Stabilization phase: the formation of effusion stops, but adsorption is still absent, the signs subside.
3. Resorption: the exudate is absorbed, a mooring is formed.

Depending on the cause:

• infectious type;
• aseptic appearance.

The nature of the exudate:

• serous;
• cholesterol;
• purulent;
• putrefactive;
• eosinophilic;
• chylous;
• serous-fibrinous;
• hemorrhagic.

What is dangerous exudative pleurisy?

If you do not treat pleurisy, this leads to compaction of the sheets of the lungs, the formation of adhesions, mooring, etc.

But the following pathological disorders may also develop:

• pneumosclerosis;
• respiratory failure;
• pulmonary calcification;
• bronchial dilatation, characterized by irreversible processes;
• heart disease;
• diseases of the circulatory system;
• violation of the integrity of the pleura;
• pneumothorax;
• fatal outcome.

Which doctor is treating?

Since exudative pleurisy develops for various reasons, many specialists take part in the process of diagnosis and treatment. First of all, this is a therapist and pulmonologist, additionally an oncologist, a phthisiatrician, a thoracic surgeon, a cardiologist, a gastroenterologist, an immunologist.

Diagnostic methods

At the initial appointment, the doctor visually examines the patient and collects an anamnesis. The nature of the manifested symptoms is necessarily specified, the history of the transferred pathologies and the presence of chronic diseases are studied. The following follows:

1. Physical diagnosis involves listening to the lungs, which makes it possible to note the level of lagging in breathing of the side that is prone to the formation of effusion. The emitted sounds and noises are considered.
2. X-ray of the lungs reveals dark zones.
3. Ultrasound examination of the pleural cavity allows you to assess the condition of the organ.
4. Thoracocentesis - a part of the effusion is removed for biochemical, bacteriological and cytological analysis.
5. Other methods - computed tomography, biochemical blood test, thoracoscopy.

How to treat exudative pleurisy?

• the risk of pus formation;
• excessive pressure of the effusion on nearby internal organs;
• too much liquid.

Drainage

Drainage is designed to pump out liquid contents, thereby reducing the volume of the pleural cavity, which reduces the level of pressure on the organs. During the procedure, the surgeon makes a puncture in the interval between the 7th, 8th, 9th intercostal space, after which he inserts a drainage tube into the cavity.

Preparations

Drug therapy is necessary to reduce the severity of symptoms and eliminate the cause of the development of effusion pleurisy. Drugs are selected on the basis of etiology, but there are general remedies for eliminating symptoms. These are painkillers, diuretics, antitussives, non-steroidal anti-inflammatory and desensitizing drugs.

Other medicines:

1. Anti-tuberculosis drugs are taken for a long time (about 8-10 months): Rifampicin, Isoniazid, Pyrazinamide, Streptomycin, Ethambutol. The patient is placed in stationary conditions, bed rest, a protein-vitamin diet are prescribed. In this case, salt and liquid are largely limited.
2. If the disease has developed against the background of pneumonia, antibiotics are used: Levofloxacin, Erythromycin, Ceftriaxone, Imipenem, Amoxiclav, Azithromycin, Oxacillin.
3. Tumor hydrothorax is treated with a cytostatic group: Fluorouracil, Thiotepa, Mitoxantrone, Cisplatin.
4. With a rheumatic nature of origin, glucocorticosteroids are used: Berlicort, Prednisolone, Dexamethasone, Hydrocortisone.
5. In infectious etiology, antibacterial agents are needed, based on the type of pathogen.
6. For the discharge of sputum, preparations based on codeine are prescribed.
7. Non-steroids will help reduce temperature and inflammation: Medicam, Aspirin, Ibuprofen.
8. Nise, Nimesil, Cefekon, Tramadol are used as analgesics.
9. To eliminate puffiness, antihistamines are needed: Diazolin, Erius, Citrine.
10. Among diuretics, Indapamide, Veroshpiron, Diakarb are popular.

Other methods of conservative therapy

In the treatment of exudative pleurisy, the following methods are also used:

1. Carrying out pleurodesis - funds with talc are injected into the pleural cavity, so that the sheets do not stick together.
2. Physiotherapeutic procedures - electrophoresis, UHF, diathermy, inductothermy, ozokerite therapy, paraffin therapy, regular and vibration massage.
3. Breathing exercises.
4. vitamin therapy.

Puncture of the pleural cavity

Puncture is carried out by piercing the pleural cavity. The procedure makes it possible to pump out excess fluid, relieve symptoms and restore pulmonary evenness.

After the puncture, the doctor inserts a needle into the cavity, which sucks out the pathological fluid. Then the cavity is douched and treated with medical substances.

An antiseptic, antibiotic, hormones, fibrolytics, antitumor or proteolytic enzymes are injected. Local anesthesia is used during the procedure.

Along with the exudate, excess air is also removed in the second and third intercostal spaces. After pumping out the liquid, the biological material is sent to the laboratory for further research.

Approximately six months after the end of therapeutic measures, the patient is sent for a second (control) examination. Most often limited to X-ray examination. With an infectious lesion, blood must be donated.

How this procedure is carried out, as well as what exudative pleurisy is, you will learn from this video:

Patient care

Therapeutic measures are usually carried out in a hospital, where a patronage nurse takes care of the patient. If a person has a mild form of the disease, then he can be treated at home. In this case, and after discharge from the clinic, certain rules must be observed, which are included in the requirements for patient care:

• bed, and then a quiet mode;
• the introduction of high-calorie foods;
• fractional special diet;
• daily measurement of blood pressure, respiration, pulse;
• comfortable position of the body with a raised head;
• access to fresh air (open vents, windows, take for a walk);
• frequent change of bed linen, especially at elevated body temperature.

Folk remedies

Additionally, at home, you can use traditional medicine recipes:

1. Curd compress reduces the inflammatory process. Rub the cottage cheese, lay it on the affected area from the back. Keep at least 3 hours, the number of procedures per day - 2-3 times.
2. Daily you need to consume 100-200 grams of boiled lungs.
3. To remove the liquid, onions are used. You will need 300 grams of vegetable, pre-chopped with a knife. Pour the onion into 0.5 l of white wine, add 100 ml of honey. Infuse the mixture for a week, then take 4 times a day before meals, 1 tbsp. l.
4. In case of pneumonia, badger fat is used. For a glass of liquid honey, you need to take 250 grams of fat, 300 grams of aloe leaves, which are peeled and cut. Put the mass in the oven for 15 minutes, then carefully strain. Take orally 1 tbsp. l. thrice.
5. Breathe in the smell of chopped onions.
6. Rubbing. You will need: turpentine - 20 grams, camphor oil - 30 ml, essential oil of eucalyptus and mountain pine - 5 ml each. The mixture is used twice a day.

Forecast

The prognosis is affected by the main cause of exudative pleurisy, as well as the state of the immune system, metabolism (how reactively the body recovers). If adequate treatment is carried out, then the patient's ability to work is fully restored, but throughout his life he will have to be registered with a dispensary (especially in the case of c).

Prevention measures

To avoid relapses and prevent the occurrence of exudative pleurisy, follow simple preventive rules:

1. Lead an active lifestyle - do exercises and be sure to pay attention to breathing exercises.
2. Do not start respiratory pathologies that can cause dangerous diseases.
3. Treat any pathological disorders, especially infectious ones, in a timely manner.
4. Get a lung x-ray every year.
5. Don't overcool.
6. Avoid contact with tuberculosis.
7. Dedicate your summer vacation to relaxing at sea, since it is the sea air that heals the body and has a positive effect on the respiratory system.
8. Strengthen your immune system - eat right, consume fresh fruits and vegetables. If necessary, use vitamin and mineral premixes.
9. Give up bad habits that not only weaken the body's defenses, but are also external irritants for the lungs.

You can get rid of exudative pleurisy quickly - just go to the clinic right away, undergo a comprehensive examination and strictly adhere to the prescribed treatment regimen. If this is not done, complications will follow that lead to the death of the patient.

Information: PLEURITIS - inflammation of the pleura with the formation of fibrinous plaque on its surface or effusion in its cavity. It is always secondary, is a syndrome or complication of many diseases, but in a certain period it can come to the fore in the clinical picture, masking the underlying disease. Etiology, pathogenesis. The occurrence of pleurisy of an infectious nature is due to the inaction of specific pathogens (mycobacterium tuberculosis, pale treponema) and nonspecific (pneumococci, staphylococci, E. coli, viruses, fungi, etc.) infections; pathogens penetrate into the pleura by contact, lymphogenous, hematogenous, in violation of the pleural cavity. A common cause of pleurisy is systemic diseases of the connective tissue (rheumatism, systemic lupus erythematosus, etc.); neoplasms; thromboembolism and thrombosis of the pulmonary arteries. The pathogenesis of most pleurisy is allergic. In the development of blastomatous pleurisy, blocking by tumor metastases of the lymph nodes, lymphatic and venous vessels is of great importance, with the germination of the tumor from adjacent organs, the destruction of the serous integuments. Symptoms, the course are determined by the localization, prevalence, nature of inflammation of the pleura, changes in the function of neighboring organs. The main forms of pleurisy: dry, or fibrinous, effusion, or "exudative. Exudative pleurisy, in turn, is divided according to the nature of the effusion into serous, serous-fibrinous, purulent, hemorrhagic, chylous, mixed. By determining the nature of the effusion, you can clarify the cause of the development of pleurisy and choose pathogenetic therapy.So, the cause of dry and serous, serous-fibrinous pleurisy is more often tuberculosis, pneumonia (parapneumonic, metapneumonic pleurisy), rheumatism and other systemic diseases of the connective tissue (rheumatic, lupus and other pleurisy). with neoplasms, thromboembolism and thrombosis of the pulmonary vessels, hemorrhagic diathesis, influenza, less often with tuberculosis, rheumatism.According to the localization of the effusion, paracostal, diaphragmatic, paramediastinal, interlobar are distinguished.Dry, or fibrinous, pleurisy.The main symptom is pain in the side, aggravated by inhale, cough, pain decrease in the position on the affected side. Restriction of respiratory mobility of the corresponding half of a thorax is noticeable; with unchanged percussion sound, weakened breathing can be heard due to the sparing of the affected side by the patient, the noise of pleural friction. Body temperature is often subfebrile, there may be chills, night sweats, weakness. Diagnosis of diaphragmatic dry pleurisy is difficult. They are characterized by pain in the chest, hypochondrium, in the lower ribs, hiccups, abdominal pain, flatulence, tension in the abdominal muscles, pain when swallowing. A type of chest breathing involving only the upper part of the chest and increased pain in its lower part with a deep breath. Pain points are identified: between the legs of the sternocleidomastoid muscle, in the first intercostal spaces near the sternum, at the point of attachment of the diaphragm to the ribs, on the spinous processes of the first cervical vertebrae. An x-ray examination helps in recognizing diaphragmatic pleurisy, which reveals indirect symptoms of functional disorders of the diaphragm: its high standing, limitation of its mobility on the diseased side (Williams symptom). The course is favorable, the duration of the disease is 10-14 days, but relapses of dry pleurisy are possible for several weeks with an exploratory recovery. Exudative, or exudative, pleurisy. At the beginning of pleural exudation, pain in the side, restriction of respiratory mobility of the affected side of the chest, pleural rub are noted. Often there is a dry painful cough of a reflex nature. As the effusion accumulates, the pain in the side disappears, there are sensations of heaviness, increasing shortness of breath, moderate cyanosis, some swelling of the affected side, smoothing of the intercostal spaces. Percussion above the exudate reveals a dull sound; voice trembling and bronchophony are weakened, breathing is not carried out or is significantly weakened; above dullness - a tympanic shade of percussion sound, a bronchial shade of breathing and fine bubbling rales. Percussion and x-ray examination can determine the characteristic contour of the upper border of the effusion. A large effusion causes a shift of the mediastinum to the healthy side and significant impairment of the function of external respiration due to a violation of the mechanics of respiration: the depth of respiration decreases, it becomes more frequent; functional diagnostic methods reveal a decrease in external respiration (vital lung capacity, ventilation reserves, etc.). There are disorders of the cardiovascular system: a decrease in stroke and minute volume of the heart due to a decrease in blood suction into the central veins due to ventilation disorders, displacement of the heart and large vessels with large pleural effusions; compensatory tachycardia develops, blood pressure tends to decrease. Exudative pleurisy, especially of an infectious nature, is characterized by febrile body temperature from the very beginning of pleural exudation, severe symptoms of intoxication, neutrophilic leukocytosis, and an increase in ESR. The pleural exudate has a relative density above 1016-1018, is rich in cellular and elements, gives a positive Rivalt test. The tumor etiology of pleurisy is excluded by cytological examination of the exudate. The course depends on the etiology of pleurisy. With infectious-allergic pleurisy, including tuberculous, exudate can resolve within 2-4 weeks. An outcome is possible with the development of an adhesive process in the pleural cavity, overgrowth of the pleural cavities and interlobar fissures, the formation of massive overlays, mooring, thickening of the pleura, the formation of pleuropneumocirrhosis and respiratory failure. For purulent pleurisy, see Pleural empyema. The treatment is complex, includes an active effect on the underlying disease and early vigorous treatment of pleurisy, with effusion pleurisy is carried out in a hospital. Treatment consists of the following components. 1. Antibacterial therapy for infectious-allergic pleurisy and targeted chemotherapy for pleurisy of another etiology (for example, tumor); antibiotics and chemotherapy drugs are administered parenterally, if indicated, intrapleurally. 2. Sanitation of the pleural cavity by evacuation of exudate, and, if necessary, washing with antiseptic solutions. Indications for urgent evacuation: displacement of the heart and large vessels to the healthy side with severe cardiac dysfunction, lung collapse (severe shortness of breath, cyanosis, frequent small pulse, arterial hypotension). Non-urgent indications: sluggish, protracted course of pleurisy, no tendency to resorption of exudate. 3. Appointment of desensitizing and anti-inflammatory drugs (sodium salicylate and other preparations of salicylic acid, butadione or phenylbutazone, amidopyrine, calcium chloride). With pleurisy of tuberculous and rheumatic etiology, the use of prednisolone in a daily dose of 15-20 mg is effective. 4. The inclusion of funds aimed at mobilizing the protective and immunobiological reactions of the body: an individual regimen (in the acute period, bed rest), a rational fortified diet with a sufficient amount of protein (1.5-2 g / kg), water and salt restriction, parenteral administration of ascorbic acids, vitamins of group B, intravenous drip injections of plasma-substituting solutions, individually dosed physiotherapy exercises, oxygen therapy, during the period of subsiding pleurisy - physical methods of treatment. 5. Symptomatic therapy - warming compresses, mustard plasters, immobilization of the diseased half of the chest with tight bandaging (for pain), codeine, ethylmorphine hydrochloride for coughing; cardiotonic drugs for circulatory failure. In the future, patients are subject to dispensary observation for 2-3 years. Occupational hazards are excluded, a high-calorie diet rich in vitamins is recommended.