3. Diseases of the lungs Flashcards by Holly Barr

Clinical evaluation of the lungs

Challenging
Signalment
general history
physical
Lab d
diagnostic imaging
bronchoscopy
Resp sampling
Blood gas analysis

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Signalment of Juvenile patients

Infection
congenital diseases

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Signalment of old patients

Chronic Inflammatory disorders
Tumour

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Signalment of siamese cats

Felines asthma

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History of Lung diseases

When did the owner obtain the animal
Travel history
Environment
Known hypersensitivities
previous resp issues

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Physical exam of lungs

Varying degrees of resp distress
cough
dyspnoea
panting
increased resp rate
adventitial sounds upon auscultation

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Lab D of lung disorders

Anaemia
Leucocytosis
Leukopenia
Eosinophilia
Hypoalbuminaemia
Pancreatitis
Coagulopathy
Thrombocytopathy
Hypercalcaemia

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Diagnostic Imaging of Lungs

XRAY - bronchitis, oedema, pneumonia, haemorrhage, granuloma
US
CT - neoplasia, abscess
CT angiography - pulmonary thromboembolism

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Radiography of lungs

VD, LL (do LL last to avoid lung compression)
Patterns - bronchial, interstitial, alveolar, nodular

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US of Lungs

can be used for thoracocetesis in case of fluid accumulation

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Bronchoscopy of Lungs

Direct visualisation - oedema, inflammation, foreign body, ulcer, tumour

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Respiratory sampling of Lungs

BAL, TTL, Cytology brush, biopsy

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Arterial Blood Gas Analysis

indicator of alveolar ventilation and oxygenation of pulmonary arterial blood

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PaO2

90-100mmHg

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PaCO2

36-40mmhg

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Diseases of the small airways

Bronchitis
Canine Chronic Bronchitis
Bronchiectasis
Feline Asthma
Foreign bodies
Neoplasia

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Infectious Bronchitis

CIRDC
CRCoV
CIV
Kennel cough
FHV
parasites
fungal infections

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Non infectious causes of bronchitis

Aspiration
Canine chronic bronchitis
Feline asthma

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Which animals are most susceptible to canine chronic bronchitis

Middle aged / older dogs
small breeds

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History of canine chronic bronchitis

daily cough for >2 months
exercise intolerance

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diagnosis of canine chronic bronchitis

good BCS
tracheal sensitivity
insp crackles
exp wheezes
prolonged exp
increased vagal tone

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xray of canine chronic bronchitis

donut signs
RS cardiomegaly
+/-

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Bronchoscopy of canine chronic bronchitis

hyperaemic mucosa
mucoid / purulent secretions
fibrous nodules on mucosa

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Differential of canine chronic bronchitis

infection
aspiration
eosinophilic broncho- pneumopathy
endocardiosis
pulmonary fibrosis

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Treatment of canine chronic bronchitis

Never cured only controlled Pred Bronchodilators Antitiussives AB Ancillary therapy Nebulisation

What may inadequate treatment of canine chronic bronchitis lead to

pulmonary hypertension bronchiectasis vascular remodelling

What is bronchiectasis

irreversible dilation of the bronchi with accumulation of pulmonary secretions

Susceptible breeds to bronchiectasis

Cocker spaniel

History of bronchiectasis

chronic productive cough frequent bouts of pneumonia

Clinical signs of bronchiectasis

loud bronchial sounds nasal discharge haemoptysis

diagnosis of bronchiectasis

xray bronchoscopy ct

Treatment of bronchiectasis

Lobar bronchiectasis ---> lobectomy & AB bronchodilators AVOID antitussives

Prevention of bronchiectasis

AB removal of foreign bodies CCB management

Prognosis of bronchiectasis

Chronic recurrent infection AB reistance pulmonary hypertension

Clinical Signs of feline lower airway diseasae

Paroxysmal cough dry hacking cough open mouth breathing prolonged exhalation crackles exp wheezes increased resonance

Diagnosis of feline asthma

blood test - eosinophilia in 30% of cases faecal exam - aelurostrongylus xray bronchoscopy - BAL cytology

Xray of feline asthma

interstitial, bronchial, alveolar pattern peribronchial cuffing, infiltrated medial lung lobe, pulmonary emphysema

Differential of feline asthma

infection aspiration allergic bronchitis idiopathic pulmonary fibrosis neoplasia

Treatment of feline asthma

emergency - terbutaline, gcc chronic - gcc, fluticasone, bronchodilators, AB

What is considered emergency in case of feline asthma

cyanosis and open mouth breathing

Prevention of feline asthma

Avoid beta blockers cigarette smoke aerosol

incidence of Foreign bodies in bronchi

Accidental laryngeal paralysis dental problems

Clinical signs of Foreign bodies in bronchi

Acute / chronic cough cyanosis recurrent airway infection

diagnosis of Foreign bodies in bronchi

xray, bronchoscopy

Treatment of Foreign bodies in bronchi

removal

clinical signs of neoplasia of bronchi

cough obstructive breathing pattern haemoptysis

auscultation of neoplasia of bronchi

harsh wheezing noises

diagnosis of neoplasia of bronchi

mass

Cause of Bacterial Pneumonia

e. coli bordetella Klebsiella Pasteurella Pseudomonas Mycoplasma

Bacterial Pneumonia is a common complication of

laryngeal dysfunction viral pneumonia aspiration pneumonia gi disease encephalopathy

What are the protection mechanisms against Bacterial Pneumonia

laryngeal function coughing reflex mucociliary clearance epithelial barrier IgA alveolar macrophages IgG

clinical signs of Bacterial Pneumonia

lethargy fever dyspnoea coughing exercise intolerance nasal discharge haemoptysis increased lung sounds

diagnosis of Bacterial Pneumonia

increased WBC xray bronchoscopy BAL / TTL

treatment of Bacterial Pneumonia

AB bronchodilators lobeectomy saline nebulisation treat underlying disease

Cause of Viral BronchoPneumonia

Distemper morbillivirus

Clinical signs of Viral BronchoPneumonia

mucopurulent oculonasal discharge fever lethargy CNS signs

diagnosis of Viral BronchoPneumonia

xray - interstitial / alveolar pattern

treatment of Viral BronchoPneumonia

supportive seizure control may be necessary

Prevention of Viral BronchoPneumonia

vaccination

Causes of Fungal Pneumonia

histoplasma capsulatum COccidiosis Cryptococcus Aspergillus

Diagnosis of Fungal Pneumonia

BAL FNA Bloods

Treatment of Fungal Pneumonia

Itraconazole

Aspiration pneumonia disposition

megaoesophagus laryngeal & pharyngeal dysfunction

Factors affecting the severity of lung injury in Aspiration pneumonia

volume, pH, toxicity Obstruction Pulmonary Haemorrhage Oedema Inflammation Necrosis Bronchoconstriction Infection

Clinical signs of Aspiration pneumonia

cough tachypneoa acute resp distress syndrome fever lethargy shock wheezing in cats only

diagnosis of Aspiration pneumonia

history of vomiting/ regurgitation xray CBC bronchoscopy

What is seen on xray in case of Aspiration pneumonia

interstitio - alveolar pattern in CV and middle lobes

Treatment of Aspiration pneumonia

resp distress AB saline inhalation corticosteroids are contraindicated

aetiology of Eosinophilic Bronchopenumopathy

unknown

which breed is predisposed to Eosinophilic Bronchopenumopathy

huskies

history of Eosinophilic Bronchopenumopathy

coughing gagging dyspnoea nasal dischrage lethargy anorexia

clinical signs of Eosinophilic Bronchopenumopathy

nasal discharge crackling increased lung sounds

diagnosis of Eosinophilic Bronchopenumopathy

rule out other causes xray bronchoscopy

Treatment of Eosinophilic Bronchopenumopathy

gcc at immunosuppressive dosage

What is pulmonary oedema

fluid accumulation in the interstitium and alveoli

causes of pulmonary oedema

non cardiogenic - ARDS, acute upper airway obstruction, neirogenic oedema cardiogenic - CHF

clinical signs of pulmonary oedema

dyspnoea > cyanosis > cough

diagnosis of pulmonary oedema

auscultation: crackles on insp and end exp heart murmur, arrhythmia, tachycardia heart murmur without sinus tachycardia

treatment of pulmonary oedema

furosemide oxygen sedation

aetiology of smoke inhalation

Acute - 0-36hrs: oedema & tissue hypoxia Later - 2-4days: tracheobronchitis, pneumonia

Clinical signs of smoke inhalation

singed hair smell of smoke upper airway stridor ocular & nasal discharge cyanosis

diagnosis of smoke inhalation

BAL xray

Treatment of smoke inhalation

Observation for at least 48hrs tracheostomy oxygen cage bronchodilators IVFT Analgesia corticosteroids

Acute Respiratory Distress Syndrome

acute hypoxemix resp failure caused by lung injury and increased pulmonary capillary permeability

what can Acute Respiratory Distress Syndrome be secondary to

sepsis pancreatitis aspiration shock microbial pneumonia

Pathogenesis of Acute Respiratory Distress Syndrome

Poorly understood Early phase : proteinaceous fluid Later phase : increased inflammatory cells, hyaline membrane formation & fibrosis --> pul hypertension

Clinical signs of Acute Respiratory Distress Syndrome

Anxiety tachycardia cyanosis cracklies wheezes

Diagnosis of Acute Respiratory Distress Syndrome

Non cardiogenic lung oedema - ausculatation, xray, ecg Protein

Treatment of Acute Respiratory Distress Syndrome

Oxygen therapy IVFT furosemide gcc

Susceptible breeds to Pulmonary Fibrosis

westie staffie

Clinical signs of Pulmonary Fibrosis

Dog - chronic & progressive pulmonary signs Cat - rare, dyspnoea, exercise intolerance, cough, cyanosis, crackles

Diagnosis of Pulmonary Fibrosis

xray ecg biopsy

Treatment of Pulmonary Fibrosis

No effective treatment cough suppressants gcc bronchodilators

Susceptbile breeds for Lung lobe torsion

large, deep chested dogs

consequences of Lung lobe torsion

venous congestion -> exudation, necrosis, anaemia

Clinical signs of Lung lobe torsion

Resp distress tachypnoea cough hypotension dyspneoa fever lethargy

Diagnosis of Lung lobe torsion

xray bronchoscopy ct surgical exploration

Treatment for Lung lobe torsion

FLuid drainage oxygen IVFT shock therapy surgery

predisposition to Pulmonary Thromboembolism

Middle- aged / older animals

what can Pulmonary Thromboembolism be secondary to

Heartworm IMHA neoplasia DIC cushings PLE PL- nephropathy

consequences of Pulmonary Thromboembolism

abnormal gas exchange pulmonary infarction

clinical signs of Pulmonary Thromboembolism

acute resp distress tachypnoea cyanosis

diagnosis of Pulmonary Thromboembolism

pulmonary angiography (gold stadard) d - dimer blood gas analysis xray ecg

Treatment of Pulmonary Thromboembolism

thrombolytic therapy treat underlying disease

Pulmonary Neoplasia names

carcinoma, osteosarcoma metastatic > primary

Physical exam of Pulmonary Neoplasia

try to located the origin of metastasis auscultation percussion

clinical signs of Pulmonary Neoplasia

Chronic cough exercise intolerance resp distress dyspnoea weight loss anorexia

3. Diseases of the lungs Flashcards

(108 cards)