DISEASES OF THE PLEURAL SPACE

Question 1

most important diseases of the pleural space

Answer 1

▪ Pleuropneumonia
▪ Pneumothorax
▪ Hemothorax
▪ Diaphragmatic hernia

Question 2

pleuropl=neumonia risk factors

Answer 2

▪ Untreated bronchopneumonia
▪ Inappropriate antimicrobials
▪ Long-distance travel
▪ General anesthesia
▪ Esophageal obstruction
▪ Immunosuppression
▪ Dysphagia
▪ Penetrating thoracic trauma

Question 3

pleuropneumonia pathophysiology

Answer 3

▪ Extension of pre-existing pneumonia
▪ Penetrating thoracic trauma
▪ Penetrating airway trauma

Question 4

pleuropneumonia etiologic agents

Answer 4

▪ Same as bacterial pneumonia
▪ Increased risk of anerobic bacteria
▪ Mixed infections possible
▪ Left vs. right side can be different

Question 5

pleuropneumoia distribution? most common agent?

Answer 5

• typically starts cranioventral > then moves to whole lung, usually bilateral
• strep equi ss zooepidemicus

Question 6

PLEUROPNEUMONIA
▪ Clinical signs

Answer 6

▪ Fever
▪ Tachycardia
▪ Tachypnea/ Dyspnea
▪ Respiratory distress
▪ Fetid breath
▪ Mucopurulent- hemorrhagic nasal discharge
▪ Mucous membranes-Injected- toxic line
▪ Dehydration
▪ Anorexia
▪ Ventral edema > lose protein with fluid into thorax, then can get distal limb edema, chest edema, facial edema… edema of head and face is the worst as it can occlude nostrils

Question 7

PLEUROPNEUMONIA
▪ Diagnostics

Answer 7

• usually reliant on ultrasound > fluid within pleural space
  <><><><>
  ▪ Arterial blood gas
  > Hypercapnea
  > Hypoxia
  ▪ Thoracic ultrasonography
  ▪ Thoracic radiography > better after draining fluid
  ▪ Thoracocentesis > also therapeutic, can send a sample for culture
  ▪ Endoscopy > find where it is? also Tracheobronchial aspirate

Question 8

in pleuropneumonia, what can stop us from effectively draining lfuid?

Answer 8

accumulation of fibrin in the pleural space

Question 9

thoracocentesis for pleuropneumonia
- how to do it?

Answer 9

▪ Locate site with ultrasound > Ventral and cranial preferred
▪ Sedate, clip, and aseptically prepare
▪ Block with lidocaine
▪ Stab incision > Cranial to rib
▪ Insert teat cannula
▪ Drain fluid
▪ Remove teat cannula and suture site

Question 10

how to use a thoracic drain for pleuropneumonia

Answer 10

larger, easier to keep in for extended time
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▪ 24 to 32 French gauge > Removable trochar
▪ Same preparation as thoracocentesis
▪ Firmly insert trochar > Subcutaneous tunneling not needed
▪ Slide tubing off and remove trochar
▪ Clamp tubing off if flow of fluid not
continuous
▪ Suture tubing in place
▪ Attach one-way valve

Question 11

Pleural fluid vs septic fluid

Answer 11

Pleural fluid
▪ Clear to pale yellow
▪ Odorless
▪ Protein < 4.7 g/dL
▪ Nucleated cell count < 8-10,000/ uL
> 75% neutrophils
> 20% macrophages
> 5% lymphocytes
<><>
Septic fluid
▪ > 80% degenerate neutrophils
▪ Presence of phagocytized bacteria
▪ Glucose < 40mg/dL
▪ Lactate > systemic lactate

Question 12

PLEUROPNEUMONIA
▪ Treatment, prognosis

Answer 12

▪ Broad-spectrum antimicrobials
> Anaerobic coverage important
▪ Analgesics
▪ Anti-inflammatories
▪ Anti-thrombotic therapy
▪ Fibrinolytic therapy
▪ Fluid therapy
▪ Pleural drainage
▪ Thoracic lavage
▪ Excellent nursing care
<><><><>
▪ Prognosis= Guarded- poor

Question 13

plauropneumonia sequelae

Answer 13

Intrathoracic
▪ Abscess formation
▪ Effusive or restrictive pericarditis
▪ Fibrin adhesions
▪ Bronchopleural fistulae
▪ Pneumothorax
▪ Hemothorax
<><><><>
Extrathoracic
▪ Endotoxemia
▪ Edema
▪ Laminitis
▪ Renal failure

Question 14

PNEUMOTHORAX
▪ Risk factors

Answer 14

▪ Pleuropneumonia
▪ Trauma > Open wounds, Blunt, closed trauma
▪ Surgery of the airway or thorax
▪ Rupture of bullae
▪ Idiopathic

Question 15

PNEUMOTHORAX
▪ Clinical signs

Answer 15

▪ Tachypnea
▪ Dyspnea
▪ Cyanosis
▪ Fever
▪ Depression
▪ Anxiety
▪ Colic

Question 16

pneumothorax thoracic auscultation sound

Answer 16

▪ Absent dorsal lung sounds

Question 17

PNEUMOTHORAX
▪ Diagnosis

Answer 17

▪ Thoracic ultrasonography
▪ Thoracic radiographs > actually better in this case!

Question 18

pneumothorax treatments

Answer 18

▪ Prevent additional air if possible, prevent entrance of more air > tap them dorsally and caudally (teat canulla is best as it is sturdy), then saran wrap around any wound to prevent it leaking more air into the thorax
▪ If asymptomatic > Monitor for progression, Monitor for respiratory compromise
▪ If symptomatic > Thoracocentesis, Thoracic drains

Question 19

HEMOTHORAX
▪ Risk factors

Answer 19

▪ Pleuropneumonia
▪ Trauma
▪ Surgery of the airway or thorax
▪ Thoracocentesis
▪ Coagulopathy
▪ Neoplasia
▪ Idiopathic

Question 20

HEMOTHORAX
▪ Clinical signs

Answer 20

▪ Tachypnea
▪ Dyspnea
▪ Tachycardia
▪ Pale-cyanotic mucous membranes
▪ Colic signs
▪ Epistaxis

Question 21

hemothorax diagnosis

Answer 21

▪ PCV/TP
> May not reflect blood loss for 24 hours
▪ Thoracic ultrasound (best) > look for hyperechoic ‘smokey’ looking fluid

Question 22

HEMOTHORAX
▪ Treatment, prognosis

Answer 22

▪ Intravenous fluid therapy
▪ Blood transfusion
▪ Broad-spectrum antimicrobials > blood can predispose to nasty pneumonia
▪ Analgesics
▪ Anti-inflammatories
▪ Thoracocentesis > ONLY if severe respiratory compromise (better for it to be sterile, you will break this… they will eventually also reabsorb this blood and use those ingredients to help themselves)
<><><><>
Prognosis
▪ Dependent on source of blood and quantity

Question 23

DIAPHRAGMATIC HERNIA
▪ Risk factors, clinical signs

Answer 23

Risk factors
▪ Blunt trauma
▪ Fall
▪ Parturition
<><><><>
Clinical signs
▪ Severe colic, persist no matter what you give them
▪ Tachycardia
▪ Respiratory distress
▪ Exercise intolerance

Question 24

DIAPHRAGMATIC HERNIA
▪ Diagnosis, treatment, prognosis

Answer 24

Diagnosis
▪ Thoracic ultrasonography
▪ Thoracic radiography
▪ Exploratory celiotomy
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Treatment
▪ Exploratory celiotomy
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Prognosis
▪ Guarded to poor