Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
External splinting of the chest wall and pain medication can reduce the pain
of pleurisy. Treatment of the underlying disease, of course, ultimately relieves
the pleurisy.
If the pleural fluid shows signs of infection, appropriate treatment involves
antibiotics and drainage of the fluid. If there is pus inside the pleural space,
a chest drainage tube should be inserted.
What is pleurisy?
Pleurisy describes the chest pain syndrome characterized by a sharp
chest
pain that worsens with breathing.
Pleurisy is caused by inflammation of the linings around the lungs
(the pleura), a condition also known as pleuritis. There
are two layers of pleura: one covering the lung (termed the visceral pleura) and
the other covering the inner wall of the chest (the parietal pleura).
These two layers are lubricated by pleural fluid.
Pleurisy is frequently associated with the accumulation
of extra fluid in the space between the two layers of pleura. This fluid is
referred to as a pleural effusion.
The pain fibers of the lung are located in the pleura.
When this tissue becomes inflamed, it results in a sharp pain in the chest that
is worse with breathing. Other symptoms of pleurisy can include
cough, chest tenderness, and
shortness of breath.
What causes pleurisy?
Pleurisy can be caused by any of the following conditions:
Infections: bacterial
(including those that cause tuberculosis),
fungi, parasites, or
viruses
Inhaled chemicals or toxic substances: exposure to some cleaning agents like ammonia
Pulmonary embolism: blood
clot inside the blood vessels to the lungs. These clots sometimes severely
reduce blood and oxygen to portions of
the lung and can result in death to that portion of lung tissue (termed lung infarction). This, too, can cause
pleurisy.
Obstruction of lymph
channels: as a result of centrally located lung tumors
Trauma:rib fractures or
irritation from chest tubes used to drain air or fluid from the pleural cavity
in the chest
Certain drugs: drugs that
can cause lupus-like syndromes (such as
hydralazine [Apresoline], Procan [Pronestyl, Procan-SR, Procanbid
- these brands no longer are available in the U.S.], phenytoin [Dilantin],
and
others)
Pneumothorax: air in the pleural space, occurring spontaneously or from
trauma.
How does the pleura work?
The pleura is composed of two layers
of thin lining tissue. The layer covering the lung (visceral pleura) and the
parietal pleura that covers the inner wall of the chest are lubricated by
pleural fluid. Normally, there is about 10-20 ml of clear liquid that acts as a
lubricant between these layers.
The fluid is continually absorbed and replaced, mainly through the outer lining
of the pleura. Pressure inside the pleura is negative (as in sucking) and
becomes even more negative during inspiration (breathing in). The pressure
becomes less negative during exhalation (breathing out). Therefore, the space
between the two layers of pleura always has a negative pressure. The
introduction of air (positive pressure) into the space (such as from a knife
wound) will result in a collapse of the lung.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Lung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due
to tobacco smoke. Lung cancers are classified as either small cell or non-small
cell cancers.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
A pulmonary embolism occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the U.S. Symptoms include a lump in the breast or underarm area, nipple pain, change in breast size or shape, an inverted nipple, nipple discharge, and breast skin changes. Treatment may involve chemotherapy, radiation therapy, biological therapy, hormone therapy, or surgery.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Ascites, the accumulation of fluid in the abdominal cavity is most commonly caused by cirrhosis of the liver. Some of the other causes of ascites include portal hypertension, congestive heart failure, blood clots, and pancreatitis. The most common symptoms include increased abdominal girth and size, abdominal bloating, and abdominal pain. Treatment depends on the cause of ascites.
The spleen enlarges if it is asked to do excessive work in filtering or manufacturing blood cells, if there is abnormal blood flow to it, or if it is invaded with abnormal cells or deposits. Symptoms of an enlarged spleen may include weakness and fatigue, easy bleeding, and poor white blood cell function. Treatment of an enlarged spleen is focused toward the cause of the splenomegaly. Surgery may be required to remove the spleen.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
Pulmonary edema (swelling or fluid in the lungs) can either be caused by cardiogenic causes (congestive heart failure, heart attacks, abnormal heart valves) or noncardiogenic causes such as ARDS, kidney failure, high altitude, pneumothorax, pleural effusion, aspirin overdose, pulmonary embolism, and infections. The treatment of pulmonary edema depends on the cause of the condition.
A pneumothorax is free air in the chest outside the lung, that causes the lung to collapse (collapsed lung). There are two types of pneumothorax, spontaneous or primary pneumothorax and secondary pneumothorax. Symptoms include sudden chest pain, shortness of breath, rapid heart rate, rapid breathing, cough, and fatigue.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Asbestos exposure lung disease is divided into three main types, asbestosis (lung scarring caused by asbestos fibers), disease of the lining of the lung (pleural plaques, scarring, or fluid accumulation), and lung cancer. Mesothelioma is cancer of the lining of the lung caused by asbestos exposure. Cancers of the larynx, throat, kidney, esophagus, and gallbladder have been linked to asbestos exposure. Treatment is dependant upon the type of condition related to asbestos exposure.
Mesothelioma is a form of cancer that forms in the chest lining (pleural mesothelioma), abdomen (peritoneal mesothelioma), and the heart sac (pericardial mesothelioma) in rare cases. Chest pain, shortness of breath, weight loss, and night sweats are symptoms and signs of mesothelioma. Treatment depends upon the stage and type of mesothelioma.
Bone fracture, broken bone, bone crack all mean he same thing. The bone has
been damaged such that. None of these terms indicate the severity of the bone
damage.
Bones are the body's storage place for calcium. Under hormone control,
calcium content of bone is constantly increasing or decreasing.
Bones break when they cannot withstand a force or trauma applied to them.
Sometimes the bones are so weak that force may be just gravity, like compression
fractures of the back in the elderly.
Fracture descriptions help explain how the breakage appears. For examples,
whether or not the fragments are aligned (displaced fracture) and whether or not
there is skin overlying the injury is damaged (compound fracture).
Fractures may be complicated by damage to nearby blood vessels, nerves and
muscles and joints.
Children's fractures may be more difficult to diagnose because their bones
lack ...