SA Lower Respiratory Diseases

Question 1

bacterial pneumonia

Answer 1

• most common in dogs than cats
• route of infection may be inhalation, aspiration, or hematogenous spread
• any age, breed, or gender
• chief complaint is usually coughing or dyspnea
• clinical signs may also include fever, nasal discharge, cyanosis, and/or auscultable crackles

Question 2

diagnosis of bacterial pneumonia

Answer 2

• MDB- inflammatory leukogram?
• radiography- interstitial to alveolar pattern
• TTW/BAL or pulmonary aspirate
  
  • positive culture provides diagnosis
  • cytology/gram stain

Question 3

treatment of bacterial pneumonia

Answer 3

• antibiotics
• antitussives are generally contraindicated
• supportive care
• oxygen if needed
• nebulization, coupage, and mild exercise 3-4x daiily
• abx tx should continue more than 2 weeks beyond complete resolution of all clinical/radiographic signs

Question 4

prognosis of bacterial pneumonia

Answer 4

• generally fair to good
• influenced by
  
  • severity and chronicity
  • underlying condition(s)
  • development of complications

Question 5

viral pneumonia

Answer 5

• canine distemper, canine influenza
• rare complication of other respiratory viral infections
• esp. young, unvaccinated, highly exposed patients
• no specific treatment?
  
  • supportive care
  • tx of secondary bacterial infections

Question 6

fungal pneumonia

Answer 6

• rare locally (FL)
• middle aged, male large breed dogs
• route of infection is commonly inhalation
• patients may have obvious signs of lower respiratory tract disease (cough, dyspnea…)

Question 7

diagnosis of fungal pneumonia

Answer 7

• radiography
  
  • diffuse miliary/nodular interstitial pattern
  • hilar lymphadenopathy
• cytology/culture/histopathology
  
  • TTW/BAL, pulmonary aspirate
• serology possible for several species

Question 8

treatment of fungal pneumonia

Answer 8

• antifungal drugs >1-2 months beyond resolution
• oxygen therapy
• corticosteroids are controversial
  
  • only short-term and only with antifungals

Question 9

prognosis of fungal pneumonia

Answer 9

• fair to poor depending upon organism and other factors
• requires expensive long-term therapy

Question 10

aspiration pneumonitis

Answer 10

• occurs when foreign material enters the lungs
• secondary to vomiting, dysphagia, megaesophagus, altered state of consciousness, force-feeding, incorrect placement of feeding tubes…
• severity of signs depends on nature and amount of material aspirated

Question 11

diagnosis of aspiration pneumonitis

Answer 11

• radiography
  
  • alveolar pattern in right middle lung lobe or dependent lobe
  • +/- megaesophagus
• cytology/culture (TTW, BAL…)
• look for cause of problem!

Question 12

treatment of aspiration pneumonitis

Answer 12

• symptomatic care
  
  • oxygen, nebulization, coupage, mild exercise
• often sterile in acute phase (no bacteria in gastric fluid) so abx use is controversial
  
  • may use abx in certain cases

Question 13

prognosis of aspiration pneumonitis

Answer 13

• depends on underlying cause and severity of aspiration event
• may be mild/self-limiting to fatal

Question 14

feline bronchitis (asthma)

Answer 14

• disease characterized by wheezing, coughing, and dyspnea due to spontaneous bronchoconstriction
• factors that may contribute to signs of dz:
  
  • bronchospasm, inflammation in airway walls, fibrosis, emphysema, airway hypersensitivity…

Question 15

clinical signs of feline bronchitis (asthma)

Answer 15

• young adult and middle-aged cats typical
• PE findings due to small airway obstruction
  
  • often sudden onset of dyspnea
  • increase expiratory time/effort
• slowly progressive pathology
• signs may be exacerbated by environmental changes

Question 16

dx of feline bronchitis (asthma)

Answer 16

• hx, clinical signs, PE
• TXR
• TW/BAL cytology
• heartworm test (Ab and Ag)
• fecal analysis for parasites, esp in youngins

Question 17

tx of feline bronchitis (asthma)

Answer 17

• emergency airway mgmt as needed
• environmental modification
• long-term orticosteroids
• bronchodilators

Question 18

prognosis for feline bronchitis (asthma)

Answer 18

• poor for complete cure
• fair to good for control of clinical signs
  
  • unless changes to pulmonary parenchyma or airways have occurred from chronic inflammation
• sudden death possible

Question 19

canine chronic bronchitis

Answer 19

• long-term arirway inflammation (usually with irreversible damage)
• etiology unknown
• mostly small to medium breeds
• age is generally ≥ 5 years
• many are overweight

Question 20

clinical signs of canine chronic bronchitis

Answer 20

• dry cough is most common
  
  • exacerbated by excitement and exercise
• auscultatory findings variable, nonspecific
  
  • wheezes and crackles may be heard

Question 21

diagnosis of canine chronic bronchitis

Answer 21

• TXR
• tracheal wash
• bronchoscopy

Question 22

treatment of canine chronic bronchitis

Answer 22

• damage to airways is irreversible
• tx is aimed at relieving clinical signs rather than cure
• options for tx:
  
  • glucocorticoids, bronchodilators, cough suppressants, abx

Question 23

pulmonary thromboembolism

Answer 23

• thrombosis or embolism
• respiratory function affected by
  
  • local increase in V/Q
  • release of various humoral factors and stimulation of neurogenic reflexes decreases CO, increases pulm. vascular R, bronchorestriction
• significantly worse with pre-existing respiratory dz
• no particular signalment

Question 24

clinical signs of PTE

Answer 24

• sudden onset respiratory distress, dyspnea, tachypnea
• +/- increased breath sounds
• tachycardia
• also reported: shock, hemoptysis, syncope, collapse, death

Question 25

diagnosis of PTE

Answer 25

• often suspected/presumptive
• MDB, coagulation panels
• TXR
• angiography (fluoro, CT/MRI), scintigraphy

Question 27

tx of PTE

Answer 27

• supportive care
• reversal of prothrombotic state necessary for fibrinolytic mechanisms to dissolve the thrombi
• anticoagulants
• fibrinolytic medications

Question 28

prognosis of PTE

Answer 28

• guarded to poor overall
• depends upon severity
• depends upon underlying cause
• risk of sudden death at anytime

Question 29

pulmonary/bronchial neoplasia

Answer 29

• older dogs and cats
• primary neoplasia is relatively rare
  
  • carcinomas most common
• lungs are common site of metastasis
• clinical signs variable
  
  • cough, tachypnea, dyspnea, non-specific

Question 30

diagnosis of pulmonary/bronchial neoplasia

Answer 30

• imaging for localization (rads, CT, +/- bronchoscopy)
• cytology/biopsy for definitive dx

Question 31

tx of pulmonary/bronchial neoplasia

Answer 31

• surgical excision if possible
• chemotherapy or radiation?
• palliative tx

Question 32

prognosis of pulmonary/bronchial neoplasia

Answer 32

• incidental vs. symptomatic
• complete excision possible

Question 33

eosinophilic bronchopneumonopathy

Answer 33

• wide spectrum of disorders characterized by severe eosinophilic infiltration
• variable clinical signs and severity
• diagnosis:
  
  • rule out other causes
  • eosinophilia in peripheral blood
  • cytology/biopsy with eosinophil infiltration
• often idiopathic
• tx: steoids
• prognosis: variable

Question 34

bronchiectasis

Answer 34

• permanent dilation of bronchi
• copmlication of chronic respiratory dz such as chronic bronchitis
• medical tx options are similar to those for chronic bronchitis
  
  • long term abx, maybe short term corticosteroids and antitussives
• surgical removal may be indicated for focal dz
• prognosis is guarded to poor