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8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
http://slidepdf.com/reader/full/2physiology-of-the-pleural-space-pl-ds-ser-08 1/17
. PHYSIOLOGY
. PHYSIOLOGY
OFF
THE PLEURAL SPACE
HE PLEURAL SPACE
PLEURAL DISEASES SERIES 08
BY WIDIRAHARDJO
8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
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2. PHYSIOLOGY OF THE PLEURAL2. PHYSIOLOGY OF THE PLEURAL
SPACESPACE
•PLEURAL PRESSUREPLEURAL PRESSURE
The coupling syste o! the pleu"#lThe coupling syste o! the pleu"#lsp#ce$sp#ce$
potenti#lly to inc"e#se% o! it p"essu"e.potenti#lly to inc"e#se% o! it p"essu"e.
Th"ee ipo"t#nt st"uctu"es& lung$ he#"tTh"ee ipo"t#nt st"uctu"es& lung$ he#"t#n% the tho"#cic c#'ity$ #"e %ete"ining#n% the tho"#cic c#'ity$ #"e %ete"ining
to the pleu"#l p"essu"e g"#%ient.to the pleu"#l p"essu"e g"#%ient.
(The pleu"#l p"essu"e "ep"esents the(The pleu"#l p"essu"e "ep"esents the
)#l#nce )et*een in*#"% pull )y the)#l#nce )et*een in*#"% pull )y the
el#stic "ecoil o! the lung #n% out*#"%el#stic "ecoil o! the lung #n% out*#"%
pull o! the tho"#cic c#'ity$ lung #n%pull o! the tho"#cic c#'ity$ lung #n%
he#"t otion+.he#"t otion+.
8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
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. PHYSIOLOGY OF THE PLEURAL
. PHYSIOLOGY OF THE PLEURAL
SPACE
PACE
“
“
PLEURODYNAMIC”: th !"#"!$t%
LEURODYNAMIC”: th !"#"!$t%
&' th #()*"( +#"! t& !h",- $,' th #()*"( +#"! t& !h",- $,
th #()*"( #*++)* "*$"/$($t%.
h #()*"( #*++)* "*$"/$($t%.
Th ,&*"( #()*"( #*++)* *",-1
h ,&*"( #()*"( #*++)* *",-1
'*& 2 834 t& 2443 !H O 5th*& 2 834 t& 2443 !H O 5th
,-"t$ &* +)/ "t&+#h*$!
-"t$ &* +)/ "t&+#h*$!
#*++)*6.
*++)*6.
Th #()*"( #*++)* !h",-+ 7*
h #()*"( #*++)* !h",-+ 7*
"++&!$"t1 7$th ",% #()*"(
++&!$"t1 7$th ",% #()*"(
1$+"++3 !&&,(% /% $,!*"+$,-
$+"++3 !&&,(% /% $,!*"+$,-
&' #()*"( #*++)*.
' #()*"( #*++)*.
8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
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Intrapleural pressure
- 8,1 Cm H2O 0 Cm H2O
inspiration expiration
,eg#ti'e - su) #tosphe"ic p"essu"e
-11,2 Cm H2O
. PHYSIOLOGY OF THE PLEURAL SPAC
. PHYSIOLOGY OF THE PLEURAL SPAC
8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
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PHYSIOLOGY OF THE PLEURAL SPACEPHYSIOLOGY OF THE PLEURAL SPACE
HOW IMPORTANT IS THE
OW IMPORTANT IS THE
PLEURAL SPACELEURAL SPACE Th #()*"( +#"! $+ $#&*t",t $,
h #()*"( +#"! $+ $#&*t",t $,
th !"*1$&#)(&,"*% #h%+$&(&-%3
h !"*1$&#)(&,"*% #h%+$&(&-%3
"+ " /)''* 9&, '&* &* (&"1$,- &'+ " /)''* 9&, '&* &* (&"1$,- &'
'()$1 $, th $,t*+t$t$"( &' th (),-.
()$1 $, th $,t*+t$t$"( &' th (),-.
Th '()$1 th"t ,t*+ th
h '()$1 th"t ,t*+ th
$,t*+t$t$) &' th (),- $+ *&1,t*+t$t$) &' th (),- $+ *&1
/% th (%#h"t$!+ $, th #"*$t"(
% th (%#h"t$!+ $, th #"*$t"(
#()*".
()*".
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2. PHYSIOLOGY OF THE PLEURAL2. PHYSIOLOGY OF THE PLEURAL
SPACESPACE
•PLEURAL FLUI FOR/ATIO,PLEURAL FLUI FOR/ATIO,
Pleu"#l 0ui% c#n o"igin#te coePleu"#l 0ui% c#n o"igin#te coe
!"o&!"o&
1 Pleu"#l c#pill#"ies1 Pleu"#l c#pill#"ies 1 Inte"stiti#l o! the lung1 Inte"stiti#l o! the lung
1 Pe"itone#l c#'ity1 Pe"itone#l c#'ity
1 Tho"#cic %uct o" )loo% 'essel1 Tho"#cic %uct o" )loo% 'essel
%is"uption%is"uption
2 PHYSIOLOGY OF THE PLEURAL
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2. PHYSIOLOGY OF THE PLEURAL.SPACESPACE
P()*"( !"#$(("*$+
()*"( !"#$(("*$+
#"*$t"( #()*" #()*"( +#"! $+!*"( #()*""*$t"( #()*" #()*"( +#"! $+!*"( #()*"
h%1*&+t"t$!
%1*&+t"t$!
#*++)* ;<0 2=
*++)* ;<0 2=
; >
>
;<= ; ?<= ; ?
;@ 0
@ 0
; ? ; ?
? ; ?
O,!&t$! ;<> ;=
,!&t$! ;<> ;=
;<>
<>
#*++)**++)*
2 PHYSIOLOGY OF THE PLEURAL
8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
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2. PHYSIOLOGY OF THE PLEURAL2. PHYSIOLOGY OF THE PLEURAL
SPACESPACE
• Inte"stiti#l o! the lungInte"stiti#l o! the lung
1 Usu#lly p#thogenic con%ition1 Usu#lly p#thogenic con%ition
1 High hy%"ost#tic p"essu"e1 High hy%"ost#tic p"essu"e 1 High pe"e#)ility1 High pe"e#)ility
1 Rel#te% to pulon#"y e%e#1 Rel#te% to pulon#"y e%e#
1 Lo* oncotic p"essu"e1 Lo* oncotic p"essu"e
2 PHYSIOLOGY OF THE PLEURAL2 PHYSIOLOGY OF THE PLEURAL
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2. PHYSIOLOGY OF THE PLEURAL2. PHYSIOLOGY OF THE PLEURAL
SPACESPACE
•
Pe"itone#l c#'ityPe"itone#l c#'ity Pleu"#l 0ui% #ccuul#tion c#n occu"Pleu"#l 0ui% #ccuul#tion c#n occu"
!"o !"ee 0ui% in the pe"itone#l c#'ity!"o !"ee 0ui% in the pe"itone#l c#'ity
th"ough #n opening in the %i#ph"#g$th"ough #n opening in the %i#ph"#g$
in&in&
1 hep#tic hy%"otho"#1 hep#tic hy%"otho"#
1 /eigs3 syn%"oe1 /eigs3 syn%"oe
1 pe"itone#l1 pe"itone#l 0ui% (#scites$0ui% (#scites$ %i#lysis%i#lysis++
1 u"inotho"#1 u"inotho"#
2 PHYSIOLOGY OF THE PLEURAL2 PHYSIOLOGY OF THE PLEURAL
8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
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2. PHYSIOLOGY OF THE PLEURAL2. PHYSIOLOGY OF THE PLEURAL
SPACESPACE
•Tho"#cic %uct o" )loo% 'esselTho"#cic %uct o" )loo% 'essel
%is"uption.%is"uption. I! the tho"#cic %uct is %is"upte%$ lyphI! the tho"#cic %uct is %is"upte%$ lyph
*ill #ccuul#te% in the pleu"#l sp#ce*ill #ccuul#te% in the pleu"#l sp#ce
(chylotho"#+.(chylotho"#+.
The )loo% c#n #ccuul#te% in theThe )loo% c#n #ccuul#te% in thepleu"#l sp#ce (heotho"#+ *hen thepleu"#l sp#ce (heotho"#+ *hen thel#"ge )loo% 'essel %is"upte% )y t"#u#l#"ge )loo% 'essel %is"upte% )y t"#u#o" %ise#se.o" %ise#se.
•O"igin o! no"#l pleu"#l 0ui%.O"igin o! no"#l pleu"#l 0ui%.
Coe !"o c#pill#"ies in the p#"iet#lCoe !"o c#pill#"ies in the p#"iet#l
pleu"#$ #pp"oi#tely 45 l # %#y.pleu"#$ #pp"oi#tely 45 l # %#y.
8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08
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2. PHYSIOLOGY OF THE PLEURAL2. PHYSIOLOGY OF THE PLEURAL
SPACESPACE
•PLEURAL FLUI A6SORPTIO,PLEURAL FLUI A6SORPTIO,
L%#h"t$! !("*",!
%#h"t$! !("*",!
St"*($,-+ ("7 &' T*",+ !"#$(("*%
t"*($,-+ ("7 &' T*",+ !"#$(("*%
!h",-: ,& -*"1$,t '&* '()$1
!h",-: ,& -*"1$,t '&* '()$1
"/+&*#t$&, th*&)-h $+!*"( #()*".
/+&*#t$&, th*&)-h $+!*"( #()*".
C"*/&, $,t*"#()*"( $,+t$(("t$&, 5$,
"*/&, $,t*"#()*"( $,+t$(("t$&, 5$,
&,%6 "'t* 4= !"*/&, -& 1$*!t(%&,%6 "'t* 4= !"*/&, -& 1$*!t(%
t& th !&+t"(3 1$"+t$,"( ",1
& th !&+t"(3 1$"+t$,"( ",1
1$"#h*"-"t$! #()*".
$"#h*"-"t$! #()*".
Th #()*"( +#"! $+ $, !&),$!"t$&,
h #()*"( +#"! $+ $, !&),$!"t$&,
7$th th (%#h"t$! ++(+ $, th$th th (%#h"t$! ++(+ $, th
#"*$t"( #()*" /% +t&" $, th #"*$t"(
"*$t"( #()*" /% +t&" $, th #"*$t"(
#()*".
()*".
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2 PHYSIOLOGY OF THE PLEURAL2 PHYSIOLOGY OF THE PLEURAL
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2. PHYSIOLOGY OF THE PLEURAL2. PHYSIOLOGY OF THE PLEURALSPACESPACE
Cle#"#nce th"ough c#pill#"ies in 'isce"#lCle#"#nce th"ough c#pill#"ies in 'isce"#lpleu"#.pleu"#.
Until i% 4789s$ it *#s thought th#t theUntil i% 4789s$ it *#s thought th#t thep"i#"y "oute !o" pleu"#l cle#"#ncep"i#"y "oute !o" pleu"#l cle#"#nce
*#s th"ough c#pill#"ies in the 'isce"#l*#s th"ough c#pill#"ies in the 'isce"#l
pleu"#.pleu"#. Th#t is t"ue !o" species *ith thin pleu"#Th#t is t"ue !o" species *ith thin pleu"#
(%og$ c#t$ etc+ *he"e is 0ui% o'es(%og$ c#t$ etc+ *he"e is 0ui% o'es#c"oss the thin pleu"# o"e e#sily.#c"oss the thin pleu"# o"e e#sily.
In%ee%$ *#te" #n% s#ll si:e oleculesIn%ee%$ *#te" #n% s#ll si:e oleculesech#nge% e#sily #c"oss )oth pleu"#lech#nge% e#sily #c"oss )oth pleu"#lsu"!#ces.su"!#ces.
PHYSIOLOGY OF THE PLEURALPHYSIOLOGY OF THE PLEURAL
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.
. PHYSIOLOGY OF THE PLEURALPHYSIOLOGY OF THE PLEURAL
SPACESPACE
A(t*,"t$ !h",$++
(t*,"t$ !h",$++ '&* #()*"('&* #()*"(
'()$1 *0&"('()$1 *0&"( T*",+!%t&+$+ !&,t*$/)t+ t& thT*",+!%t&+$+ !&,t*$/)t+ t& th
*0&"( &' #*&t$, '*&0 th #()*"(*0&"( &' #*&t$, '*&0 th #()*"(
+#"!.+#"!.Th ("/(1 "(/)0$, ",1 1Bt*", t&Th ("/(1 "(/)0$, ",1 1Bt*", t&
/ #*&,/ #*&, #"*t$"((%#"*t$"((% *0&1 /%*0&1 /%
t*",+!%t&+$+.t*",+!%t&+$+.
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. PHYSIOLOGY OF THE PLEURAL
. PHYSIOLOGY OF THE PLEURAL
SPACE
PACE
PATHOGENESIS OF PLEURAL EFFUSIONS
ATHOGENESIS OF PLEURAL EFFUSIONS
P()*"( '()$1 "!!))("t+ 7h, th *"t &' #()*"(
()*"( '()$1 "!!))("t+ 7h, th *"t &' #()*"(
'()$1 '&*"t$&, !1+ th *"t &' #()*"( '()$1
()$1 '&*"t$&, !1+ th *"t &' #()*"( '()$1
"/+&*#t$&,./+&*#t$&,.
G,*"( !")++ &' #()*"( '')+$&,+:
,*"( !")++ &' #()*"( '')+$&,+:
2 I,!*"+1 #()*"( '()$1 '&*"t$&,
,!*"+1 #()*"( '()$1 '&*"t$&,
I,!*"+1 $,t*+t$t$"( '()$1 $, th (),-: ('t
I,!*"+1 $,t*+t$t$"( '()$1 $, th (),-: ('t
,t*$!)("* '"$()*3 #"*"#,)&,$! '')+$&,3
,t*$!)("* '"$()*3 #"*"#,)&,$! '')+$&,3
ARDS3 (),- t*",+#(",t"t$&, ",1 #)(&,"*%
RDS3 (),- t*",+#(",t"t$&, ",1 #)(&,"*%
/&()+.
/&()+.
I,!*"+1 $,t*""+!)("* #*++)* $, #()*":
I,!*"+1 $,t*""+!)("* #*++)* $, #()*":
*$-ht &* ('t ,t*$!)("* '"$()*3 +)#*$&* ,"$-ht &* ('t ,t*$!)("* '"$()*3 +)#*$&* ,"
!""( +%,1*&.
""( +%,1*&.
I,!*"+1 #*"/$($t% &' th !"#$(("*$+ $, th
I,!*"+1 #*"/$($t% &' th !"#$(("*$+ $, th
#()*": #()*"( $,'(""t$&,3 $,!*"+1 ((+
()*": #()*"( $,'(""t$&,3 $,!*"+1 ((+
&' "+!)("* ,1&th($"( -*&7th '"!t&*.
' "+!)("* ,1&th($"( -*&7th '"!t&*.
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. PHYSIOLOGY OF THE PLEURAL
. PHYSIOLOGY OF THE PLEURAL
SPACE
PACE
I,!*"+1 #()*"( '()$1 #*&t$, ((I,!*"+1 #()*"( '()$1 #*&t$, ((
D!*"+1 #()*"( #*++)*: "t(!t"+$+ &* D!*"+1 #()*"( #*++)*: "t(!t"+$+ &*
$,!*"+1 ("+t$! *!&$( &' th (),-.$,!*"+1 ("+t$! *!&$( &' th (),-.
I,!*"+1 '()$1 $, th #*$t&,"( !"$t%: "+!$t+ I,!*"+1 '()$1 $, th #*$t&,"( !"$t%: "+!$t+
&* #*$t&,"( 1$"(%+$+.&* #*$t&,"( 1$"(%+$+.
D$+*)#t$&, &' th th&*"!$! 1)!t D$+*)#t$&, &' th th&*"!$! 1)!t
D$+*)#t$&, &' th /(&&1 ++(+ $, D$+*)#t$&, &' th /(&&1 ++(+ $,
th th&*"B.th th&*"B.
22 D!*"+1 #()*"( '()$1 "/+&*#t$&,D!*"+1 #()*"( '()$1 "/+&*#t$&, O/+t*)!t$&, &' th (%0#h"t$! 1*"$,$,- th O/+t*)!t$&, &' th (%0#h"t$! 1*"$,$,- th
#"*$t"( #()*".#"*$t"( #()*".
E("t$&, &' +%+t0$! "+!)("* #*++)*: SCS E("t$&, &' +%+t0$! "+!)("* #*++)*: SCS
&* *$-ht ,t*$!)("* '"$()*.&* *$-ht ,t*$!)("* '"$()*.