PLEURISY (PLUR-ih-se)
INTRODUCTION
Pleurisy or pleuritis is the inflammatory involvement of pleura. Where pleura consist of two layers visceral and parietal. Visceral pleura covers the lungs and extends into the fissures while the parietal pleura limits the mediastinum and covers the dome of the diaphragm and inner aspect of the chest wall, between these two layers there is a thin space called pleural space. Normally this space is filled with a lubricating fluid. This fluid helps the two layers of pleura to slide smoothly on each other when we breathe.
Pleurisy occurs when the layers of pleura become irritated and inflamed, instead of sliding smoothly on each other they rub against each other each time when we breathe and rubbing causes sharp pain called pleuritic pain.
CLASSIFICATION
Depending upon the resultant exudate, it is divided into-
- Serous , Fibrinous and Serofibrinous pleuritis
- Suppurative pleuritis
- Hemorrhagic pleuritis
1. SEROUS, FIBRINOUS AND SEROFIBRINOUS PLEURITIS– Acute inflammation of the pleural sac (acute pleuritis) can result in serous, fibrinous and serofibrinous exudates .Most of the cause of such pleuritis are infective in origin, particularly in lungs ,such as tuberculosis , pneumonias , pulmonary infract , lung abscess and bronchiectasis . Other causes are few collagen diseases (e.g. rheumatoid arthritis and disseminated lupus erythematosus), uraemia, metastatic involvement of the pleura, and irradiation of lung tumors and diffuse systemic infection (e.g. typhoid fever tularaemia, blastomycosis and coccidioidomycosis).
2. SUPPURATIVE PLEURITIS– Bacterial or mycotic infection of the pleural cavity that converts a serofibrinous effusion into purulent exudates is termed as suppurative pleuritis or empyema thoracis .The most common cause is direct spread of pyogenic infection from lung. Other causes are direct extension from subdiaphragmatic abscess or liver abscess and penetrating injuries to chest wall. Occasionally, the spread may occur by haematogenous or lymphatic routes.
3. HAEMORRHAGIC PLEURITIS– Hemorrhagic pleuritis differs from haemothorax in having inflammatory cells or exfoliated tumour cells in the exudates. The cause of haemorrhagic pleuritis are metastatic involvement of the pleura , bleeding disorders and rickettsial diseases.
SIGN AND SYMPTOMS
The main symptoms of pleurisy is sharp chest pain .The pain gets worse during deep breathing cough or sneezing .The pain stay in one place or spread to shoulders or back .sometimes pain may be fairly constant dull ache.
Depending upon causes there may be other symptoms such as –
- Shortness of breath or rapid, shallow breathing.
- Malaise
- Coughing
- Fever and chills.
- Unexplained weight loss
- vomiting of blood
- ventricular trachycardia
CAUSES
-There are many causes of pleurisy of which Viral infection are most common cause.
Other causes-
-Bacterial infection such as pneumonia and tuberculosis or infection from fungi and parasites.
- Pulmonary embolism i.e. sudden block in lungs artery by blood clot.
- Autoimmune disorders such as lupus rheumatoid arthritis.
- Cancers like lung cancer, lymphoma and mesothelioma.
- Aortic dissection.
- High blood pressure.
- Chest and heart surgery.
- Lung diseases like asbestosis.
- Familial mediterranian fever (an inherited condition which causes fever and swelling in abdomen and lungs.
COMPLICATION
- Pleural effusion
- Pneumothorax
- Haemothorax
DIAGNOSIS
On auscultation – Pleural friction rub
Chest X Ray – May show air or fluid in pleura
Ultrasonography – fluid in pleura
Blood test may detect – virus, bacteria, pneumonia, rheumatic, pulmonary embolism.
Arterial blood gas – for O2 and CO2
PROGNOSIS
Pleurisy and other disorders of pleura can be dangerous, depending upon cause of infection in pleura. If the cause of pleurisy is not serious and is diagnosed and treated early we can expect full recovery.
HOMOEOPATHIC TREATMENT-
Bryonia– This remedy suits most cases of pleurisy and its symptom pictures the disease more closely than any other remedy. It should be given after the stage of exudation has arrived and the fever has abated somewhat, thought the fever may still be considered, there are friction sounds present and the great characteristic of sharp, stitching pain which becomes worse from the slightest motion, even on breathing is painful and the patient lies on the painful side of lesson the motion ‘DRY’ pleasure during pneumonia or phthisis. It comes in after Aconite.
Aconite– This remedy is for chill, high grade fever, sharply defined chill, but it is only useful in first stage before the exudation has taken place there may be sharp stitching in chest from the intense congestion, but if this marked usually indicate bryonia. An for aconite additional indication for aconite would be in case of attack caused from chill following with checked perspiration. Ranunculus bulbosus sharp stitching pain in the chest worse on the right side. It is often useful to absorb the effusion. Stannun cutting pain in the left axilla. Asclepias also a pleuritic remedy. There is a dry cough; scanty expectoration pain relieved by bending forward, the suffering is intense.
Apis- Pleurisy with exudation, hydrothorax very useful remedy in stage of effusion after the fever has abated and pain have disappeared, sulphur also suits all from of exudation, sharp stitching pain through left lung to back worse only ,on back and least motion It follows aconite and bryonia well. It is one of the most valuable absorbent, Heper sulph purulent exudation also an excellent in pleurisy complicated with bronchitis .It will hardly ever fail in plastic pleurisy when its special indications are present It will often clear up cases of purulent pleurisy which tends to induce effusion. Belladonna is suited in pleurisy of congestive type often presented with convulsion instead of fever.
Arnica– Pleurisy caused due to external injury calls for Arnica. It is useful in traumatic and hemorrhagic cases.
Cantharis– A valuable remedy in profuse serofibrinous exudation is indicated by dyspnoea, palpitation profuse sweats, weakness, tendency to syncope with scanty and albuminous urine, it is leading remedy for pleurisy with effusion.
Arsenicum– Serous pleurisy it mostly promptly reliver the painful asthmatic respiration and favors absorption. It is usually quick acting remedy. Arsenicum iodatum is suited to tubercular cases.
by:
Miss. Leena Clement James
4th year student
Narayan Shree Homoeopathicmedical College Hospital,
Bhopal. (M.P.)
INTRODUCTION
Pleurisy or pleuritis is the inflammatory involvement of pleura. Where pleura consist of two layers visceral and parietal. Visceral pleura covers the lungs and extends into the fissures while the parietal pleura limits the mediastinum and covers the dome of the diaphragm and inner aspect of the chest wall, between these two layers there is a thin space called pleural space. Normally this space is filled with a lubricating fluid. This fluid helps the two layers of pleura to slide smoothly on each other when we breathe.
Pleurisy occurs when the layers of pleura become irritated and inflamed, instead of sliding smoothly on each other they rub against each other each time when we breathe and rubbing causes sharp pain called pleuritic pain.
CLASSIFICATION
Depending upon the resultant exudate, it is divided into-
- Serous , Fibrinous and Serofibrinous pleuritis
- Suppurative pleuritis
- Hemorrhagic pleuritis
1. SEROUS, FIBRINOUS AND SEROFIBRINOUS PLEURITIS– Acute inflammation of the pleural sac (acute pleuritis) can result in serous, fibrinous and serofibrinous exudates .Most of the cause of such pleuritis are infective in origin, particularly in lungs ,such as tuberculosis , pneumonias , pulmonary infract , lung abscess and bronchiectasis . Other causes are few collagen diseases (e.g. rheumatoid arthritis and disseminated lupus erythematosus), uraemia, metastatic involvement of the pleura, and irradiation of lung tumors and diffuse systemic infection (e.g. typhoid fever tularaemia, blastomycosis and coccidioidomycosis).
2. SUPPURATIVE PLEURITIS– Bacterial or mycotic infection of the pleural cavity that converts a serofibrinous effusion into purulent exudates is termed as suppurative pleuritis or empyema thoracis .The most common cause is direct spread of pyogenic infection from lung. Other causes are direct extension from subdiaphragmatic abscess or liver abscess and penetrating injuries to chest wall. Occasionally, the spread may occur by haematogenous or lymphatic routes.
3. HAEMORRHAGIC PLEURITIS– Hemorrhagic pleuritis differs from haemothorax in having inflammatory cells or exfoliated tumour cells in the exudates. The cause of haemorrhagic pleuritis are metastatic involvement of the pleura , bleeding disorders and rickettsial diseases.
SIGN AND SYMPTOMS
The main symptoms of pleurisy is sharp chest pain .The pain gets worse during deep breathing cough or sneezing .The pain stay in one place or spread to shoulders or back .sometimes pain may be fairly constant dull ache.
Depending upon causes there may be other symptoms such as –
- Shortness of breath or rapid, shallow breathing.
- Malaise
- Coughing
- Fever and chills.
- Unexplained weight loss
- vomiting of blood
- ventricular trachycardia
CAUSES
-There are many causes of pleurisy of which Viral infection are most common cause.
Other causes-
-Bacterial infection such as pneumonia and tuberculosis or infection from fungi and parasites.
- Pulmonary embolism i.e. sudden block in lungs artery by blood clot.
- Autoimmune disorders such as lupus rheumatoid arthritis.
- Cancers like lung cancer, lymphoma and mesothelioma.
- Aortic dissection.
- High blood pressure.
- Chest and heart surgery.
- Lung diseases like asbestosis.
- Familial mediterranian fever (an inherited condition which causes fever and swelling in abdomen and lungs.
COMPLICATION
- Pleural effusion
- Pneumothorax
- Haemothorax
DIAGNOSIS
On auscultation – Pleural friction rub
Chest X Ray – May show air or fluid in pleura
Ultrasonography – fluid in pleura
Blood test may detect – virus, bacteria, pneumonia, rheumatic, pulmonary embolism.
Arterial blood gas – for O2 and CO2
PROGNOSIS
Pleurisy and other disorders of pleura can be dangerous, depending upon cause of infection in pleura. If the cause of pleurisy is not serious and is diagnosed and treated early we can expect full recovery.
HOMOEOPATHIC TREATMENT-
Bryonia– This remedy suits most cases of pleurisy and its symptom pictures the disease more closely than any other remedy. It should be given after the stage of exudation has arrived and the fever has abated somewhat, thought the fever may still be considered, there are friction sounds present and the great characteristic of sharp, stitching pain which becomes worse from the slightest motion, even on breathing is painful and the patient lies on the painful side of lesson the motion ‘DRY’ pleasure during pneumonia or phthisis. It comes in after Aconite.
Aconite– This remedy is for chill, high grade fever, sharply defined chill, but it is only useful in first stage before the exudation has taken place there may be sharp stitching in chest from the intense congestion, but if this marked usually indicate bryonia. An for aconite additional indication for aconite would be in case of attack caused from chill following with checked perspiration. Ranunculus bulbosus sharp stitching pain in the chest worse on the right side. It is often useful to absorb the effusion. Stannun cutting pain in the left axilla. Asclepias also a pleuritic remedy. There is a dry cough; scanty expectoration pain relieved by bending forward, the suffering is intense.
Apis- Pleurisy with exudation, hydrothorax very useful remedy in stage of effusion after the fever has abated and pain have disappeared, sulphur also suits all from of exudation, sharp stitching pain through left lung to back worse only ,on back and least motion It follows aconite and bryonia well. It is one of the most valuable absorbent, Heper sulph purulent exudation also an excellent in pleurisy complicated with bronchitis .It will hardly ever fail in plastic pleurisy when its special indications are present It will often clear up cases of purulent pleurisy which tends to induce effusion. Belladonna is suited in pleurisy of congestive type often presented with convulsion instead of fever.
Arnica– Pleurisy caused due to external injury calls for Arnica. It is useful in traumatic and hemorrhagic cases.
Cantharis– A valuable remedy in profuse serofibrinous exudation is indicated by dyspnoea, palpitation profuse sweats, weakness, tendency to syncope with scanty and albuminous urine, it is leading remedy for pleurisy with effusion.
Arsenicum– Serous pleurisy it mostly promptly reliver the painful asthmatic respiration and favors absorption. It is usually quick acting remedy. Arsenicum iodatum is suited to tubercular cases.
by:
Miss. Leena Clement James
4th year student
Narayan Shree Homoeopathicmedical College Hospital,
Bhopal. (M.P.)
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