Pleural Effusion Homeo Cure
The pleural space lies between the lung and chest wall and normally contains a very thin layer of fluid, which serves as a coupling system
. A pleural effusion is present when there is an excess quantity of fluid in the pleural space.
Etiology
Pleural fluid accumulates when pleural fluid formation exceeds pleural fluid absorption.
Normally, fluid enters the pleural space from the capillaries in the parietal pleura and is removed via the lymphatics situated in the parietal pleura.
Fluid can also enter the pleural space from the interstitial spaces of the lung via the visceral pleura or from the peritoneal cavity via small holes in the diaphragm.
The lymphatics have the capacity to absorb 20 times more fluid than is normally formed.
Accordingly, a pleural effusion may develop when there is excess pleural fluid formation from the interstitial spaces of the lung, the parietal pleura, or the peritoneal cavity or when there is decreased fluid removal by the lymphatics.
Types of effusion:
Transudate effusion
Exudates effusion
Effusion Due to Heart Failure
The most common cause of pleural effusion is left ventricular failure. The effusion occurs because the increased amounts of fluid in the lung interstitial spaces exit in part across the visceral pleura. This is more than the capacity of the lymphatics in the parietal pleura to remove fluid. Isolated right-sided pleural effusions are more common than left-sided effusions in heart failure. A diagnostic thoracentesis should be performed if the effusions are not bilateral and comparable in size, if the patient is febrile, or if the patient has pleuritic chest pain, to verify that the patient has a transudative effusion. If the effusion persists despite diuretic therapy, a diagnostic thoracentesis should be performed.
Para pneumonic Effusion
Para pneumonic effusions are associated with bacterial pneumonia, lung abscess, or bronchiectasis and are probably the most common cause of exudative pleural effusion. Empyema refers to a grossly purulent effusion.
Effusion Secondary to Pulmonary Embolization
The diagnosis most commonly overlooked in the differential diagnosis of a patient with an undiagnosed pleural effusion is pulmonary embolism. Dyspnea is the most common symptom.
Tuberculous Pleuritis
In many parts of the world, the most common cause of an exudative pleural effusion is tuberculosis (TB). Tuberculous pleural effusions are usually associated with primary TB and are thought to be due primarily to a hypersensitivity reaction to tuberculous protein in the pleural space. Patients with tuberculous pleuritis present with fever, weight loss, dyspnea, and/or pleuritic chest pain.
AIDS
Pleural effusions are uncommon in such patients. The most common cause is Kaposi's sarcoma, followed by para pneumonic effusion. Other common causes are TB, cryptococcosis, and primary effusion lymphoma. Pleural effusions are very uncommon with Pneumocystis carinii infection.
Differential diagnosis:
Transudative pleural effusions
1. Congestive heart failure
2. Cirrhosis
3. Pulmonary embolization
4. Nephrotic syndrome
Exudative pleural effusions:
1. Neoplastic diseases
a. Metastatic disease
b. Mesothelioma
2. Infectious diseases
a. Bacterial infections
b. Tuberculosis
c. Fungal infections
d. Viral infections
e. Parasitic infections
3. Pulmonary embolization
4. Gastrointestinal disease
Laboratory investigations:
Complete blood picture
Chest radiograph
Erythrocyte sedimentation rate
Thoracocentesis
Homoeopathic approach
Bryonia:
This remedy suits most cases of pleurisy, and its symptoms picture
this disease more closely than any of our remedies.
It should be given after the stage of exudation has arrived and the fever has abated somewhat, though the fever may still be considerable.
There are friction sounds present and the great characteristic of sharp, stitching pains
Pains which are worse from the slightest motion; even breathing is painful and the patient lies on the painful side of lessen the motion.
Apis :
Pleurisy with exudation, hydrothorax a useful remedy in the stage of
effusion after the fever has abated and the pains have disappeared.
It suits all forms of exudation there is a sharp, stitching
pain through the left lung to the back, worse lying on back and from
least motion.
It follows Aconite and Bryonia well.
It is one of our most valuable absorbents.
Hepar sulph:
Purulent exudation is also an excellent remedy in pleurisy complicated with bronchitis.
It will hardly ever fail in plastic pleurisy when its specific indications
are present.
It will often clear up cases of purulent pleurisy which tend to induce consumption.
Cantharis:
A valuable remedy in profuse sero-fibrinous exudations, is indicated
by dyspnoea, palpitation, profuse sweats, weakness, tendency to
syncope with scanty and albuminous urine.
Cantharis a leading drug in pleurisy with effusion.
Arsenicum alb:
Serous pleurisy and it oftentimes promptly relieves the painful asthmatic respiration and favors absorption.
It usually is a quick acting remedy.
by: Gen Wright
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