empyema - PARAPNEUMONIC EMPYEMA Uncomplicated effusion....

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PARAPNEUMONIC EMPYEMA Uncomplicated effusion. Thoracic empyema.
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Uncomplicated Effusion Nonpurulent. Negative Gram’s stain result, negative culture. Free flowing, pH 7.3, normal glucose level, LDH less than 1000 IU/L. Most resolve with appropriate antibiotics treatment and resolution of the pulmonary infection.
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Thoracic Empyema Bacteria invade the normally sterile pleural space. Three stage Table 58-1
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Thoracic Empyema-- Stage 1 Exudative effusion. Increase permeability of the inflammatory and swollen pleural surface. Correspond to the uncomplicated parapneumonic effusion. Sterile, fibrin and PMN may present.
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Thoracic Empyema-- Stage 2 Fibropurulent, true empyema, complicated pleural effusion. Initial-- fluid is clear : WBC greater than 500 cell/μL, gravity greater than 1.08, protein level greater than 2.5 g/dL, ph less 7.2, LDH reach 1000 IU/L, fibrin deposit. Angioblastic and fibroblastic proliferation, heavy fibrin deposition on both pleura, particularly the parietal pleura. Later– fluid purulent, WBC 15000, ph less 7.0, glucose less than 50 mg/dL, LDH greater 1000 IU/L.
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Thoracic Empyema-- Stage 3 1 week after infection-- collagen organization, entrapment the underlying lung. 3-4 week-- mature, turned peel. Chronic-- dense fibrosis contraction and trapping the lung, atelectasis and prolonged pulmonary infection, reduction the size of hemithorax. Fibrothorax-- invasion the chest wall and narrow the intercostals space-- As the end stage of the process.
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Complication of Empyema Early or late. Necrosis of visceral pleura.
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empyema - PARAPNEUMONIC EMPYEMA Uncomplicated effusion....

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