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  • Voiceover: So when we get into talking about

  • plural effusions, that fluid that's

  • accumulating in the actual plural space,

  • is either a transudate or an exudate,

  • and that can be a really confusing idea

  • to try and wrap your head around,

  • so let's write this just over here in the corner.

  • We're either talking about transudate fluid,

  • or exudate fluid.

  • The real difference between the two

  • is how that fluid came about to be in that space.

  • How did that fluid get in that space in other words.

  • There are a couple common causes.

  • For instance if somebody has

  • congestive heart failure, liver failure,

  • if somebody had pneumonia, lupus,

  • and how we really break those

  • up is based off of two things.

  • Our transudate and our exudate is going

  • to help differentiate how these things happened.

  • Now normally when we're talking about

  • an exudate it's something that was inflammatory.

  • That would be our pneumonia.

  • Whereas something that was transudate

  • is something that's changed

  • the hydrostatic...oops, I think I spelled that wrong.

  • Let's go back.

  • Static pressure.

  • So something that's changed in pressure

  • in the vessels, or something that has

  • actually caused inflammation in the vessels,

  • so that's how we differentiate those two.

  • Let's start with this image here.

  • What we're looking at here is

  • an image of a normal vessel.

  • You'll see that this is our vessel wall, right?

  • Then we have our endothelial cells

  • which are these guys poking out here.

  • Then these little yellow dots,

  • these represent my proteins,

  • so my plasma protein.

  • Then that blue fuzz, that's going

  • to be our actual fluid.

  • In a normal vessel, this is normal,

  • everything is pretty much even, it's equal,

  • we don't have any fluid that's

  • leaking out of the vessels,

  • we don't have anything that's

  • coming in that shouldn't be,

  • this is our normal representation.

  • Now if we actually come down here,

  • and we're going to come right below,

  • let's look at something that would not be normal.

  • Let's look at this second image that I have here.

  • Now what we're looking at,

  • this is going to represent my transudate leakage.

  • Now in our transudate leakage, what happens?

  • What you'll notice is that we have less

  • of these plasma proteins than we

  • did in our normal scenario.

  • As a result, having less plasma protein cells,

  • let's put less protein, is going to cause

  • the fluid to actually shift out.

  • Let me just change my colors

  • so we can see that we're talking about fluid.

  • It's going to cause the fluid

  • to actually shift out in between my

  • endothelial cells outside of the actual vessels,

  • so i'm going to have fluid shift out.

  • Now you'll see that the endothelial cells

  • in the vessel, this hasn't changed.

  • My vessel looks the same,

  • and the endothelial cells are

  • still sitting next to each other.

  • They had the same

  • inter-endothelial spaces as they did.

  • The only thing that's different about this

  • is that my protein is down,

  • and that's going to cause the fluid to shift out.

  • Another way we can have a transudate leak

  • is by let's say congestive heart failure.

  • You heard me talk about that earlier.

  • Here's our heart, right?

  • Here we're going to draw our heart,

  • I know it's a Valentine's heart,

  • but just so we have an idea.

  • We know that in our heart we have four chambers.

  • We have our right atrium, we have our right ventrical,

  • we have our left atrium, and our left ventrical.

  • Now let's say that this person

  • had left sided heart failure,

  • so we've got heart failure on the left side.

  • That's our congestive heart failure.

  • What's going to happen?

  • Well we know that with that

  • failure on the left side we're going

  • to have increased pressure on

  • the left side of the heart.

  • We know that the left side

  • of the heart will back up to our lungs.

  • Here's our lungs.

  • Now if the pressure is increased

  • that means that it's backing up towards our lungs,

  • and the vessels in our lungs,

  • it's going to cause an increase in pressure.

  • That would be the increase

  • in our hydrostatic pressure that causes transudate,

  • and as a result the same idea here,

  • that fluid that we have going on here,

  • that fluid is going to be forced out

  • in-between the endothelial cells because

  • the pressure is so high.

  • That fluid leaking out is going

  • to leak into the actual plural space.

  • That's what we talk about in a plural effusion.

  • Now what you'll see is that

  • the proteins aren't leaking out,

  • and that's because they're too big

  • to fit in-between these endothelial cells.

  • However, with enough pressure,

  • fluid can be squeezed out of there and

  • that leakage again is what we call our transudate.

  • Now our third scenario would be this.

  • Our exudate, so if we're talking about exudate fluid.

  • Now how does that happen?

  • First thing you should notice

  • is that this vessel looks a lot bigger than the rest.

  • It is, it's much bigger,

  • so i'm going to go ahead

  • and write exudate next to this one.

  • Now you cans see that this

  • vessel's larger than the rest.

  • Remember, what did we say was

  • the big thing with exudate?

  • It's inflammatory.

  • What happens to our vessels

  • in an inflammatory situation?

  • Well they're going to dilate, right?

  • They're going to become bigger.

  • We know that we're going to have some stasis

  • of the fluid and the proteins that are happening,

  • not happening, but that are

  • circulating within the vessel.

  • We know that in an inflammatory scenario

  • our endothelial cells

  • you see how they're much more spaced out?

  • That inter-endothelial space

  • becomes larger.

  • Well larger inter-endothelial space

  • means that not only is fluid going to come out,

  • but what else?

  • What else is going to come out of there?

  • If you're saying protein you'd be absolutely right.

  • Protein is going to come out as well.

  • In an exudate plural effusion we have a mix

  • of both fluid and protein in the effusion.

  • Let's write that over here so we have it down.

  • We're going to have both fluid, so this here is fluid,

  • and protein in the ecudate fluid.

  • Whereas in our transudate we're just

  • looking at fluid because nothing else can fit through.

  • Now how do we test for this?

  • When someone has a plural effusion,

  • of course we do a thoracentesis,

  • and that means that we go in with the needle,

  • we [aserate] the fluid out of the space,

  • out of that plural space,

  • and we're going to test it.

  • That testing is called Light's Criteria.

  • I'm going to go ahead over here

  • and i'm just going to draw a light bulb.

  • Here's my light bulb, let's put

  • a little bottom on my light bulb.

  • That's called Light's Criteria.

  • You can remember how we do that.

  • What they're looking for in the fluid

  • is they're going to look for the presence of protein,

  • they're going to look for a presence of cholesterol,

  • of triglycerides,

  • and if they see those things,

  • protein, triglycerides,

  • basically if they're seeing large solutes,

  • large particles rather,

  • then they know it was exudated.

  • But when they test it and there's

  • a low amount of protein, or a low presence

  • of these solutes or particles

  • that otherwise wouldn't fit in these tiny spaces,

  • then they know it's a transudate.

  • That's how we can tell what type of fluid

  • is present in the plural space

  • and what was the cause of that.

  • Quite honestly because we know

  • in a transudate scenario that protein

  • is not leaking out of these spaces,

  • they may not see any protein at all.

  • That's going to further confirm that it's transudate.

  • Think about these things that we discussed.

  • Transudate, we're talking about

  • the hydrostatic pressure,

  • so that would mean that CHF,

  • that would mean our liver failure,

  • those things change the pressure.

  • Even someone that's in kidney failure rather,

  • so because they're in kidney failure

  • we know they have low protein

  • and low protein can cause these

  • leaky vessels to occur.

  • Then inflammatory, we mentioned that before,

  • inflammatory, think about things that

  • cause an inflammatory response in the body.

  • We're talking about the lungs,

  • definitely pneumonia, that's a big one,

  • we talked about lupus, I used that as an example,

  • that's an inflammatory process as well.

  • When you see these terms

  • think about what's happening, right?

  • Think about what the cause is,

  • and think about what's happening

  • at the level of the vessels.

Voiceover: So when we get into talking about

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B1 fluid protein inflammatory plural vessel failure

Transudate vs exudate | Respiratory system diseases | NCLEX-RN | Khan Academy

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    廖芯琳 posted on 2017/03/20
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