Clinical exam and investigation of respiratory disease Flashcards Preview

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Flashcards in Clinical exam and investigation of respiratory disease Deck (49):
1

What history is important in respiratory disease? 6

Herd/individual problem
Age
Animal use
General management and environment
Disease time course and features
Response to tx

2

What to observe from a distance

General behaviour, demeanor
RR, effort and pattern
Inspiratory/expiratory noise
Nostril flare
Nostril airflow
Noises

3

General clinical exam - respiratory disease - 8

BCS
Posture
Abdominal effort
Abdominal mm hypertrophy (heaves lines)
MM
Eyes (discharge)
Jugular veins (SOL --> increased jugular pulse height)
Pectoral oedema

4

Specific clinical exam - respiratory disease

Paranasal sinuses - symmetry and percussion, facial and maxillary
Pharyngeal area - GPs, LNs and larynx
Thoracic auscultation and percussion

5

Define empyema

= collection of pus in the pleural space

6

What should the larynx be looked at for?

look for asymmetry of the cricoarytenoideus dorsalis mm (horses). You can assess the movement of this muscle by the slap test where you slap the withers (gently) and then there is a reflex which causes this muscle to move.

7

Define lung consolidation

a region of (normally compressible) lung tissue that has filled with liquid, a condition marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. It is considered a radiologic sign.

8

Is thoracic ausculation normally louder in foals and thin anials?

yes

9

What are the borders for auscultation in ruminants?

6th ICS (point on elbow)
9th ICS 9midway)
11th ICS (level with tuber coxae)
Diaphragmatic border (straight, unlike equines)

10

Outline small animal auscultation

not a reliable indicator of respiratory disease. usually significant if noise is increased. Beware of referred noise from the URT.

11

What do crackles indicate?

small airways and alveoli

12

What do wheezes indicate?

partial obstruction of longer airways.

13

Why is it important to palpate the apex beat in small animals?

there may be caudal displacement of the apex beat due to a SOL.

14

What should further diagnostic tests be based on?

Focus on diagnositic goals:
- rule in/out DDx
- will results change therapy/managment options
- specific advantages/disadvantages of each test.

15

What can you examine using endoscopy of the RT in horses?

nasal passages
GPs
Nasopharynx
soft palate
larynx
trachea (to bifurcation)
At rest, minimal restraint, and exercise

16

What can you examine using endoscopy of the RT in small animals?

Trachea, mainstem bronchi an dlarger divisions of the main bronchi

17

How do you perform RT endoscopy in small animals?

Take radiographs first (artefacts following washes)
In patient able to tolerate GA with trachea of sufficient diameter to accommodate an endoscope.
Sternal recumbency.

18

Strengths - endoscopy of RT?

can detect disease of major airways AND dynamic disease of URT.

19

Weaknesses - endoscopy of RT?

unable to visualise smaller airways or parenchymal lesions

20

What techniques can be performed via endoscope? 3

aspiration
biopsy (discrete lesions)
FB retrieval

21

What possible tests can be conducted if viral infection is suspected?

Paired serology
Virus isolation - buffy coat, nasopharyngeal swabs
Viral Ag detection - FAT (nasopharyngeal swabs)
PCR - specific virus ID

22

What RespT samples can you perform cytology and/or bacteriology on? 6

nasopharyngeal swab
endoscopically guided tracheal aspirate
transtracheal aspirate
BALV
pleural fluid
lung biopsy

23

When is a nasopharyngeal swab suitable?

Only suitable for bacterial culture of specific organisms that aren't normally commensal of the pharynx - Streptococcus equi equi

24

How do you do a GP lavage?

Endoscope within GP and aspirate discharge or lavage and aspirate (sterile saline) - commensal organisms are present. Most commonly used for detection of Strep equi equi via culture and/or PCR

25

Describe endoscopically-guided tracheal aspirate (equine)?

position endoscope in trachea, advance catheter, 30ml sterile buffered saline, withdraw saline

26

How do you do endoscopically-guided tracheal aspirate (small animals)?

GA - go via ETT - blind wash - use plastic tube via ETT

27

Advantages - endoscopically-guided tracheal aspirate - 3

easy
sample representative of whole lung
non-invasive

28

Disadvantages - endoscopically-guided tracheal aspirate - 4

sample contaminated by pharyngral flora
contaminated by equipment
wide range of normal cell populations
cells tend to be poorly preserved

29

Why do a transtracheal aspirate?

to avoid orophryngeal contamination (uncommon, only do when you need a 100% accurate culture results)

30

Method - transtracheal aspirate - equines

surgically prepare site in lower third of trachea - instill LA - insert guide catheter (10 gauge, 3 inch) or needle between tracheal rings - insert sample catheter (16-14 gauge, 30cm) - instill 25-30mls sterile saline - withdraw sample - remove sample catheter first, then guide catheter

31

Advantages - transtracheal aspirate

- no pharyngeal contamination if procedure performed succesfully
- no specialised equipment
- useful in foals where standard endoscopes too large

32

Disadvantages - transtracheal aspirate - 3

- horse may cough catheter into pharynx and contaminate sample
- invasive procedure
- complications - cellulitis, SC emphysema

33

Indications - small animal transtracheal aspirate - 2

- Collection of tracheal secretions where endoscopy not available (no facilities or anaesthesia is contra-indicated)
- Direct direct access to airway in conscious patient

34

Method - BALV - equine

insert guide catheter into trachea if being used - advance BAL tube into bronchus until it will not advance further, then inflate balloon, instill 120-200mls sterile saline - withdraw sample

35

Advantages - BALV

- sample comes from area of tract most likely to be affected
- narrow range of cell populations (aids interpretation)
- equipment cheap
- accessible equipment (used in all large animals)

36

Disadvantages - BALV

site sampled may not be appropriate in animals with localised pulmonary abscesses or pneumonias

37

What does thoracocentesis allow you to do?

characterise pleural effusion.
therapy

38

Method - thoracocentesis - horse

under ultrasonographic guidance - select 7th or 8th ICS - above lateral thoracic vein - prepare surgically - instill LA - make a stab incision - use blunt teat cannula or drain closed from atmosphere

39

Method - thoracocentesis - small animal

- Cr of Cd to heart
- Site determined by radiography or ultrasound
- If fluid evenly distributed then 8th or 9th ICS, either side
- Use LA (not cats)
- Closed system

40

What do you analyse a thoracocentesis sample for? 3

- Cytology
- Protein (transudate - modified transudate or exudate)
- Triglyceride: cholesterol ratio - identify chylothorax (small animals only)
- Culture

41

Indication - lung aspiration

when discrete intrapulmonary lesion exits which cannot be accessed in any other way. only severely ill patients.

42

What is chylothorax identified (small animals)?

chylothorax fluid triglyceride higher than plasma triglyceride

43

Indications - lung biopsy

not frequently performed
used to ID specific pathology (e.g. interstitial pneumonia and neoplasia)

44

Disadvantages - lung biopsy - 2

- very invasive
- complications - uncontrollable haemorrhage and pneumothorax

45

Why would you take a faecal sample to investigate respiratory disease in small animals?

Angiostrongylus vasorum larvae

46

What cnabe seen with pulmonary radiography?

Pulmonary structures - locate specific pathology
Pleural cavity - fluid/gas
Mediastinum - masses, fluid, gas

47

What is CT useful for? 5

= Pleural, mediastinal and parenchymal structures
= high image quality and detailed sectional anatomical structure
= cheaper, quicker, better detail of lung tissue (vs. MRI)
= doesn't require gating for respiration (vs. MRI)
= radiation exposure unlikely to be an issue in our patients

48

Outline thoracic ultrasonography - 5

- sound doesn't penetrate normal aerated lung
- sound will penetrate non-aerated (diseased) lung
- lesions that don't extend to surface aren't visible
- characterises pleural effusion ( v. useful)
- obtain samples (pleurocentesis, lung biopsy)

49

List examples of pulmonary function tests -6

- tract exercise tests
- treadmill exercise tests
- oesophageal manometry
- flow-volume loops
- oxygen uptake
- blood-gas analysis

ALL can quantify disease effects and monitor response to therapy but all rarely used - mainly studies.