Diseases of the lung in dogs and cats Flashcards
(40 cards)
1
Q
Diseases of the small airways
A
- Canine chronic bronchitis
- Bronchiectasis
- Feline lower airway disease/feline asthma vs. chronic bronchitis
- Airway foreign bodies
- Bronchial neoplasia
2
Q
Types of Bronchitis
A
- different causes and anatommical localisations (tracheobronchitis, bronchitis, bronchopneumonia)
- Infectious:
- Canine infectious respiratory disease complex (CIRDC):
- CDV, CaHV-1, CRCoV, CIV
- Kennel cough: CAdV-2, CPIV, Bordetella br., Mycoplasma spp.
- FHV in cats
- Parasites
- fungal
- Non-infectious:
- Aspiration
- Canine chronic bronchitis
- Feline asthma
3
Q
Canine chronic bronchitis (CCB)
- clinical signs and history
A
–> idiopathic form of bronchitis
- Middle-aged to older dogs; small breeds > large breeds
- Daily cough for more than 2 months (productive/non productive), exercise intolerance
- doog condition/overweight, tracheal sensitivity, inspiratory crackles, expiratory wheezes
- prolonged expiration and expiratory push (expiratory type dyspnea)
- increased vagal tone –> sinus arrytmia
4
Q
Canine chronic bronchitis (CCB)
- Diagnosis
A
- Blood examination: uslually negative
- Radiography: we can recognize the alveolar pattern
- doughnut sign
- right-sided cariomegaly
- cor pulmonale or negative
- Bronchoscopy: we can recognize the inflammation, the sickened bronchial mucosa
- Hyperemic mucosa
- mucoid or purulent secretions
- fibrous nodules on the mucosa
- BAL, TTL: for microbiology and cytology
- bacteria +/-
- nondegenerate neutrophils
- eosinophils
- mucous
5
Q
Differential diagnosis of CCB
A
- Infection: kennel cough, parasites, fungi, D.immits
- Aspiration: Accidental, pharyngeal dysphagia, esophageal disease, gastrooesophageal reflux, laryngeal dysfunction
- Eosinophilic bronchopneumopathy
- endocardosis (congestive heart failure)
- pulmonary fibrosis
6
Q
Treatment of CCB
A
- Can be controlled but never cured. Goals: control inflammation, prevent worsening of airway disease
- Short acting glucocorticoids:
- 0.5-1.0 mg/kg prednisolone BID, decreased by half every 5-10 days
- Bronchodilators:
- Theophylline (GI, tachycardia, excitability)
- terbutaline (1-2-4 mg/dog PO BID)
- Albuterol (50ug/kg PO TID)
- Antitussives:
- if inflammation has beed effectively treated!
- otherwise mucos can trap in the bronchi and worsen clinical signs
- Antibiotics: if BAL cytology and microbiology is postive
- Ancillary therapy:
- weight reduction,
- harness instead of collar
- cool, clean area (smoke, dust, heat)
- nebulization
- Inadequately treated: pulmonary hypertension, bronchiectasis, vasular remodelling
7
Q
What is Bronchiectasis?
A
- Irreversible dilatation of large airways (bronchi), with accumulation of pulmonary secretions.
- common in Cocker spaniels
- Histopathologic response due to long-standing inflammation/irritation (CCB, primary dyskinesia, foreign body, smoke, dust)
8
Q
Bronchiectasis
- history, symptoms and diagnosis
A
- History:
- chronic productive cough, frequent bouts of pneumonia (initially respond to antibiotics/relapse)
- Symptoms:
- loud bronchial sounds,
- nasal discharge +/- (pneumonia),
- hemoptysis
- Diagnosis: Radiography, broncoscopy, CT
9
Q
Bronchiectasis
- Treatment
A
- drugs can not cure the damaged bronchi, only prevent the problem with corect treatment of the underlying disease
- Lobar bronchiectasis –> lobectomy, antibiotics (based on culture), bronchodilators
- Cough suppresents must be avoided!
- Limitation of therapy:
- if the bronchiectasis affects several lung lobes then the only chance is repeated AB-therapy –> multiresistance
- if only one lung lobe is affected, then surgical removal of he affected lung lobe can solve the problem
10
Q
Bronchiectasis
- Prognosis and prevention
A
- Prognosis:
- chronic recurrent infection
- resistance to AB treatment
- pulmonary hypertension, cor pulmonale
- Prevention:
- appropriate AB therapy in infectious disease
- promp removal of foreign bodies
- appropriate managment of CCB
11
Q
Feline lower airway disease / feline bronchitis
asthma vs chronic bronchitis
- history and symptoms
A
- main key of feline asthma –> bronchoconstriction!
- increased airway resistance (smooth muscle hypertrophy, bronchial wall edema, glandular hyperplasia) -> cough and respiratory distress
- Symptoms:
- paroxysmal-, dry- “hacking” cough, open mouth (loud) brething, prolonged exhalation. expiratory type dyspnea
- auscultation: harsh lung sounds, crackles, expiratory wheezes or normal
- percussion: increased resonance
12
Q
Diagnostic evaluation of feline asthma
A
- blood test: eosinophilia in 30%, negative heartworm antibody test
- fecal examination: exclusion of Aelurostrongylus, paragonimus spp, capillaria infection
- Radiopgraphy:
- interstitial-, bronchial-, alveolar pattern or normal, hallmark: peribronchial cuffing
- infiltrated medial lung lobe
- pulmonary emphysema
- Bronchoscopy:
- BAL cytology: sthma eosinophilia vs. neutrophilia in chronic bronchitis, culture
- Specific test for asthma:
- whole body plethysmography (increased airway reactivity to nonspecific aerosol stimulant)
13
Q
Diff diagnosis of feline asthma
A
- infection:
- pulmonary parasites, toxoplasmosis, D. immitis, mycoplasmosis, bacterial, fungal, viral infection)
- Aspiration: accidental, esophageal disease -> reflux
- idiopathic pulmonary fibrosis
- neoplasia (carcinoma)
14
Q
Treatment of feline asthma
A
-Acute therapy: emergency situation
- cyanosis, open mouth breathing
- oxygen cage; terbutaline, glucocorticoids + bronchodilatoros
- chronic managment
- glucocorticcosteroids
- prednisolone
- inhaled fluticasone
- methyl-perdisolone acetate
- bronchodilators (terbutaline)
- anitbiotics
15
Q
Prevention and prognosis of Feline asthma
A
- Prevention:
- Beta-blockers should be avoided! (propranolol, atenolol)
- cigarette smoke, aerosol spray, upper respiratory viruses
- Prognosis:
- anti-inflammatories and bronchodilators alleviates acute clinical signs
- recurrance of signs
16
Q
Brochial neoplasia
- clinical signs, diagnosis, treatment
A
- Cough, obstructive breathing pattern (loud respirations), hemoptysis
- Ausculatation: harsh wheezing noises
- Radiography: soliter mass lesion
- Treatment: same as pulmonary neoplasia
17
Q
Pulmonary parenchymal diseases
A
- Pneumonia
- infectious diseases
- aspiration pneumonia
- eosinophil bronchopneumopathy
- pulmonary edema
- pulmonary contusions
- smoke inhalation
- ARDS
- Pulmonary fibrosis
- Lung lobe torsion
- pulmonary thromboembolism
- pulmonary neoplasia
18
Q
Pneumonia classification
A
- Anatomy:
- Bronchopneumonia: can be parenchyma and bronchi affected together. e.g in viral infections like Distemper
- pneumonia
- interstitial pneumonia: if only the interalveolar space in the level of alveoli is inflammed
- Lobular or diffuse
- Origin:
- Infectious: bacterial, viral, fungal, parasitic
- Non- infectious: aspiration, idiopathic
- Duration:
- acute, subacute, chronic
19
Q
Bacterial pneumonia
- common complications and protection mechanisms
A
- Common complications:
- laryngeal dysfunction, viral pneumoni, aspiration, GI disease, encephalopathy
- protection mechanism of lower airways:
- laryngeal function, coughing reflex, mucociliary clearance, epithelial barrier, IgA, alveolar macrophages, IgG
20
Q
Bacterial pneumonia
- symptoms
A
- lethargy, fever, dyspnea, coughing (dog >> cat) acute/chronic, exercise intolerance, nasal discharge, hemoptysis and severe dyspnea
- underlying disease (dysphagia, regurgitation, vomiting, muscular weakness)
- increased lung sounds and crackles or wheezes + inflammatory fluid
21
Q
Bacterial pneumonia
- diagnosis and treatment
A
- Diagnostic evaluation:
- hematology: WBC increased
- Radiography:
- focal or diffuse alveolar pattern (aspiration: cranioventral lung regions)
- brochiectasis, megaesophagus, mass
- TTL, Bronchoscopy:
- BAL (culture, cytology), mass, foreign body, bronchooesophageal fistule, lobular pneumonia (aspiration)
- Treatment:
- AB, bronchodilator, lobectomy (focal pneumonia, abscess),
- saline nebulization, underlying disease (foreign body, neopplasia, GI disease)
- Organisms: E.coli, Bordetella, Klebsiella, Pasterurella, Pseudomonas, Mycoplasma spp.
22
Q
Viral bronchipneumonia
A
- Distemper, Morbillivirus (paramyxoviridae family)
- Exposure (inhalation, po infected secretions) –> replication in macrophages, tonsils –> viremia (2-4 daus: initial fever) –> several tissues (lung, bowel, skin, CNS) –> bronchopneumonia, enteritis, encephalitis
- Mucopurulent oculonasal discharge, fever, PCR (blood, urine), lethargy, neurologic symptoms (50%), radiography (interstitial, alveolar pattern)
- treatment: largely supportive (AB, bronchodilators, fluid), seizure control (diaxepam, KBr, phenobarbital), antobody
23
Q
Fungal pneumonia
A
- Histoplasma capsulatum, Blastomyces dermatitidis, coccidioides immitis, cryptococcus neoformans, aspergillus fumigatus, pneumocystis carinii
- Diagnosis:
- BAL/fine needle aspiration of lung; cytology, microbiology, PCR; blood: serology
- Therapy:
- itraconazole
- pneumocystis: trimethoprim + sulfamethoxazole
24
Q
Aspiration pneumonia
- findings
A
- aspiration of fluid, food, gastric contents results in pulmonary inflammation
- megaesophagus
- laryngeal and pharyngeal dysfunction
- neuromuscular disease
- anesthesia, encephalopathy
- brachycephalic airway conformation
- forced feeding (contrast radiography)
- severity of lung injury:
- volume, pH, toxicity –> obstruction, pulmonary hemorrhage, edema, inflammation, necrosis, bronchoconstriction, infection
25
Aspiration pneumonia
- clincal signs, diagnosis
- clinical signs:
* cough, tachypnea, acute onset of rspiratory distress, fever, lethargy, shock
* cats: wheezes (bronchospasm)
- diagnostic evaulation:
* history of vomiting, regurgitation
* radiography: quite different (interstitial/alveolar, focal/diffuse), but interstitio-alveolar pattern in cranioventral and middle lung lobes
* megaesophagus
* complete blood count: leukocytosis
* bronchoscopy: BAL for culture, cytology
26
Treatment of aspiration pneumonia
- respiratory distress:
* oxygen
* fluid therapy (but increased capillary permeability can lead to oedema)
* Bronchoscopy: removal of the content
- Antibiotics:
* culture or empirical; after fever/X-ray lesions + 2-3 weeks
- Saline inhalation, coupage; +/- bronchodilators
- corticosteroids: NOT allowed!!
- prognisis: severity of lung injury/underlying cause
27
Eosinophilic bronchopneumopathy
- history, clinical signs
- inflammatory disease, unknown etiology
* hypersensitivity to an environmental or endogenous antigen
* all breeds, huskies
- history:
* coughing, gagging, difficulty breathing, nasal discharge (mucopurulent or serous), ethargy and anorexia
- physical examination:
* nasal dicharge, crackles, increased lung sounds (or normal auscultation)
28
Eosinophilic bronchopneumopathy
- diagnosis and treatment
- Radiography:
* diffuse interstitial, alveolar, bronchial or combination
* nodules or mass-like lesions (eosinophilic granulomatosis)
- Blood test:
* peripheral eosinophilia
- Bronchoscopy:
* green, green-yellow mucos, mucosal thickening
* BAL, mucosal brushing (large number of eosinophils)
- Diagnosis:
* rule out other causes!
* migrating parasites, bacterial or fungal infections, heartwor or neoplasia, allergy testing
- Treatment:
* glucocorticoids at immunosuppresove dosages lasting weeks to months; hyposensitization?
- prognosis: generally good
29
Pulmonary oedema
- physiological processes
- Fluid accumulation in the interstitium and alveoli
1. vascular hydrostatic pressure increases: left-sided congestive hearth failure (CHF), excessive fluid administration (anuric renal failure)
2. plasma oncotic pressure decreases: hypoalbuminemia
3. vascular permability increases: vasculitis, ARDS
* Protein rich fluid will enter the interstitium, and this protein will bind water. fureosemide will not be so effective in this case.
4. impared lymphatic drainage: left-sided CHF, neoplastic process
5. decreased transpulmonary pressure: upper airway obstruction
- Noncardiogenic oedema: ARDS, acute upper airway obstruction, neurogenic oedema (seizures, head trauma)
- Cardiogenic pulmonary oedema: CHF
30
Pulmonary oedema
- symptoms, diagnosis and treatment
- Symptoms
* restricted type dyspnea. It is superficial, rapid respiration without coughing.
* panting + cyanosis
* Coughing: in severe cases bloody expectoration of blood-tinged fluid
- Auscultation:
* Lung: crackles hear on inspiration and end-expiration (in dorso-caudal lung fields). In severe edeme quiet lung sounds in cats!
* Heart: murmur +/- (but mitral endocardiosis, cardiomyopathy), arrhytmia, tachycardia
* Heart murur without sinus tachycardia: pulmonary disease \> cardiogenic edema
- Radiography:
* Cardiogenic edema: interstitial pattern in the hilar and caudo-dorsal lung regions, cardiomegaly, pulmonary veous enlargement
* Noncardiogenic: absence of cardiac and pulmonary venous changes
- Treatment:
* Furosemide (2-4 mg/kg IV every 4-12 hr)
* oxygen therapy (intubation, positive pressure ventilation)
* sedatives: acepromazine in dog and cat. Morphine sulfate in dog
- prognosis: variable
* severity of edema, treatment and underlying disease
31
Smoke inhalation
- history and etiology
- direct injury: heat, particulate matter, toxic gases
- etiology:
* acute phase (0-36 hr) tissue injury --\> capillary permability increases --\> oedema, tissue hypoxia
* shock, pain
* CO gas inhibits oxygen binding to Hb --\> tissue hypoxia
* Later phase (2-4 days): edema decrease, mucosal secretion increase, decreased mucociliary clearance, secondary bacterial colonization --\> tracheobronchtis, pneumonia
32
Smoke inhalation
- clinica signs, diagnosis
- Clinical signs:
* skin injury, smell of smoke, loss of consciousness, upper airway stridor (laryngeal edema), ocular and nasal discharge, cyanosis
* some patients have minima signs but 24-36 hr later then can occur! (ARDS, infection, laryngeal edema).
- Diagnostic evaluation:
* history, clinical signs, radiography (oedema, pneumonia), BAL, culture
- Carboxyhemoglobin is not distinguished from oxyhemoglobi with blood gas analysis or pulse oxymetry!
33
Smoke inhalation
- treatment
* observation for at least 24-48hr
* tracheostomy: severe laryngeal oedema, obstruction
* oxygen cage: half-life of CO in room air is 4hr, in 100% O2 30 min
* bronchodilators, antibiotics (culture)
* fluid therapy (but edema!)
* analgesic
* Corticosteroids: laryngeal edema/acute cardiovascular shock!
* prognosis: wrong if severe respiratory distress, infectious pneumonia, neurological signs and cutaneous burns
34
ARDS
- history, pathogenesis
= Acute Respiratory Distress Syndrome
- acute hypoxemic respiratory failure caused by lung injury and pulmonary capillary permeability increase
* Sepcial form of pulmonary edema caused by damaged capillary network, caued by cytochrome storm
* the cytochrome storm will increase capillary permability. protein rich fluid can enter the pulmonary interstitium, leading to intersitial pattern o X-ray and interstitial hypoxia
- Secondary to: sepsis, pancreatitis, aspiration, shock, microbal pneumonia, SIRS, babesiosis
- Pathogenesis: pporly understood
* early phase: proteinaceous fluid (capillary perm increase)
* Later: inflammtory cells increase, hyaline membrane formation, fibrosis --\> pulmonary hypertension
* irreversible
35
ARDS
- clinical signs, diagnosis, treatment
- Clinical signs:
* extreme anxiety, tachycardia, cyanosis, crackles (end-inspiration, expiration), wheezes, underlying disease
- Diagnosis:
* noncardiogenic lung oedema: auscultation, radiography, echocardiography
* protein (edema)/protein(plasma): 80-90%, in cardiogenic edema 50%
- Treatment:
* oxygen therapy (intubation, PEEP)
* fluid therapy (low-normal circulatory volume)
* furosemide (early phase)
* glucocorticoids?
* blood gas analysis (control)
- prognosis: generally poor
36
Pulmonary fibrosis
- Idiopathic interstitial lung disease (pneumonia): WHW, staffordshire bill terriers, (cats)
- pathologically: alveolar septic fibrosis, interstitial fibrosis, epithelial hyperplasia, focal calcification
- dyspnea, exercise intolerance, cough +/-, cyanosis, crackles
* - Ca: chronic and progressive pulmonary signs
* - Fe: rare, faster course of the disease. Acute!
- radiography: diffuse interstitial pattern
- echocardiography: moderate to severe pulmonary hypertension
- biopsy, poor prognosis: die of hypoxaemia
* dog: 1-3 years
* cat: few weeks
- there is no effective treatment!
* cough suppressants, PHT: syldenafil, glucocorticoids?, bronchodilators?
37
Lung lobe torsion
- Large, deep-chested dogs (greyhounds)
- idiopathic, pleural effusion, surgery, trauma= acute disease
- lung lobe torsion --\> venous congestion --\> exudation (bloody pleural effusion), necrosis, anemia
- clinical signs:
* respiratory distress, tachypnea, cough, hypotension, dyspnea, fever, lethargy
- diagnosis:
* deep chested dogs, pleural effusion,
* radiography: rounding of the lung lobe edges
* bronschospy, CT
* surgical exploration
- treatment:
* removal of pleural flud, oxygen, fluid/shock therapy, surgery
38
Pulmonary thromboembolism (PTE)
- secondary to:
* heartworm disease, IMHA, neoplasia, DIC, hyperadrenocorticism, PLE, PL-nephropathy etc.
- PTE: abnormal gas exchange, pulmonary infarction
- Clinical signs:
* middle-aged to older, acute respiratory distress, tachypnea, cyanosis
* acute, lethat disease
- Diagnosis:
* difficult to diagnose
* D-dimer, antitrombin III, blood gas, radiography, echocardiography (logated in the pulmonary artery)
* pulmonary agniogram is the gold standard
- treatment:
* Thrombolytic therapy (surgical, catheter, drugs: tissue plasminogen activator etc.)
* + underlying disease
39
Pulmonary edema
- clinical sigs, diagnois
- Metastatic \> primary (carcinoma, osteosarcoma)
- chronic cough, exercise intolerance, respiratory distress, dyspnea, weight loss, anorexia
- physcal examination:
* origin of metastasis: abdominal mass, effusion, lameness
* auscultation, percussion
- radiography:
* is the key tool in the diagnostic approach!
* LL x2, VD/DV
* false negative: size, obscured by the heart or liver; periosteal proliferation (hypertrophic osteopathy)
* false positive: eosinophlic bronchopneumopaty
- CT: more sensitive to tumors
- Definitive diagnosis: biopsy ,(thoracoscopy) or FNA
- Treatment:
* primary pulmonary neoplasia: lobectomy
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