Ward Round Notes

Lung cancer is one of the most common malignancies worldwide, but has one of the poorest outcomes as 2/3rds of patients present late with the disease. Given this it is important to be vigilant of the possibility of lung cancer in patients. Patients with lung cancer may present with r espiratory symptoms , with worsening chronic disease such as COPD, with symptoms suggestive of malignancy without symptoms specific to the respiratory system, and occasionally with other symptoms which are neither respiratory or point to a malignancy. NICE guidelines suggests that an urgent chest x ray (within 1 week) should be considered for the following symptoms: Haemoptysis Persistent (+3 weeks) cough Persistent shortness of breath Persistent chest signs Persistent hoarseness Persistent weight loss Persistent clubbing Persistent cervical lymphadenopathy Persistent chest or shoulder pain (think of pancoast tumours) Persistent signs or symptoms suggesting metastases such as bone pain...

"Pulsus paradoxus" refers to an abnormal decrease of over 10mmHg in pulse pressure and subsequently pulse volume on inspiration. It is caused by a decrease in intrathoracic pressure.  On inspiration the intrathoracic pressure decreases The pressure intrathoracically is lower than the pressure extrathoracically which leads to an increased venous return to the right ventricles The right ventricles bulges into the left side reducing left ventricular volume.  Reduced intrathoracic pressure also leads to dialation of the pulmonary vessels Blood from the right ventricle pools in the lungs leading to reduced blood returning to the left ventricles Reduced blood in the left ventricles leads to a reduced stroke volume according to starling's law.  Reduced thoracic pressure on the aorta also contributes to the reduced pulse pressure Reduction of pulse pressure leads to a weaker or absent pulse volume being felt whist a contraction is heard on auscultation.  Pu...

Definition Pleural effusion is a collection of fluid in the pleural space between the visceral pleura surounding the lungs and the parietal pleural attatched to the throacic wall. Demographics Pleural effusions are relatively common, but it is a manifestation of other underlying diseases. The prevalence and incidence of pleural effusions is therefore dependent on it's cause. Pathophysiology/causes Pleural fluid is usually filtered from the parietal pleura into the pleural space, due to hydrostatic pressure from the capillaries, negative pressure in the pleural space and pleural oncotic pressure. The visceral pleura is perfused by the pulmonary system which has a lower pressure, and fluid in the pleural space is therefore drawn back in through the visceral pleura due to the higher oncotic pressure in plasma. Some of this fluid is then drained by the lymphatic system.

Definition: Chronic obstructive pulmonary disease is defined as a condition of restricted airflow which is not fully reversible. It is often a progressive disease caused by abnormal inflammatory responses to obnoxious substances.  Demographics: COPD is a common condition, The prevalence of COPD increases with age, with most patients being diagnosed at around the age of 50.  Aeitiology and pathophysiology:  Airway obstruction in COPD is caused by;  1) increase in mucus secretion, leading to obstruction.  many COPD patients show increased number of goblet cells in their airways, which block airways.  2) inflammation and scarring to the airways, leading to narrowed airways.  Inflammatory cells infiltrate the bronchi and bronchiole walls. The inflammation causes scarring and thickening of walls which cause small airways to narrow. Initially, inflammation is reversible, but this become irreversible with continued smoking. As the dis...

Lung cancer Definition : Uncontrolled invasive (malignant) growth originating from the lungs Presentation:   Depends on the site of the tumour and the type of cancer.  Patients may present with Chest signs and symptoms : (more common in cancers occurring centrally in the bronchial tree, late symptoms in peripheral cancers, may also present on a background of existing lung problems eg. COPD or emphysema)  *Haemoptysis *Cough Wheeze Stridor Pain Hoarse voice clubbing lymphadenopathy localized chest signs superior vena cava obstruction - caused by compression of the superior vena cava