2.physiology of the pleural space pl ds ser 08

8/10/2019 2.Physiology of the Pleural Space Pl Ds Ser 08

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. PHYSIOLOGY

. PHYSIOLOGY

OFF

THE PLEURAL SPACE

HE PLEURAL SPACE

PLEURAL DISEASES SERIES 08

BY WIDIRAHARDJO



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+.



. 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 !&&,(% /% $,!*"+$,-

&' #()*"( #*++)*.

' #()*"( #*++)*.



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



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"(

#()*".

()*".




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



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




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




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"#





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.




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"(

#()*".

()*".



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



.

. 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&+$+.t*",+!%t&+$+.





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&*.





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*$!)("* '"$()*.

2.physiology of the pleural space pl ds ser 08

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