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Diseases of the Respiratory System Flashcards

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1
Q

What are some of the common causes of respiratory failure?

A 
Airway obstruction 
Ruptured diaphragm 
Pulmonary oedema/haemorrhage 
Pneumothorax 
Neoplasia
Infection 
Toxin exposure
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2
Q

What are some of the signs associated with respiratory failure?

A

Cyanosis

Inspiratory/expiratory dyspnoea

Tachycardia, weak pulses

Collapse/unconsciousness

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3
Q

What is orthopnea?

A

Abduction of elbows and extension of neck to aid breathing

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4
Q

What are the sounds associated with inspiratory dyspnoea?

A

snoring
stertor
stridor

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5
Q

What are the sounds associated with expiratory dyspnoea?

A

Wheezes

crackles on auscultation

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6
Q

List some methods of oxygen administration

A 
ET tube 
Flow by 
Nasal catheter 
Face mask 
Oxygen tent 
Oxygen cage/incubator
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7
Q

Aside from an ET tube, what is another method of maintaining a patent airway?

A

Tracheostomy tube (requires constant monitoring)

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8
Q

What are some common clinical signs of upper respiratory tract disease?

A

Nasal discharge
Sneezing/reverse sneezing
Stertor/snoring
Systemic/CNS signs

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9
Q

How might nasal discharge appear?

A

Serous
Mucopurulent
Haemorrhagic

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10
Q

What factors should be examined for suspected upper respiratory tract disease?

A

Breathing noises

Nasal discharge, planum depigmentation

Assess regional lymph nodes

Retropulsion of eyeballs/exophthalmia

Dental disease

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11
Q

Name some inflammatory causes of nasal disease

A

Idiopathic
allergic
irritation

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12
Q

Name some infectious causes of nasal disease

A

Bacterial/viral/fungal/parasitic

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13
Q

Name some viral causes of nasal disease

A

Herpesvirus and calicivirus in cats

Canine distemper

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14
Q

Name some fungal causes of nasal disease

A

Aspergillus in dogs

Cryptococcus in cats

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15
Q

Name some parasitic causes of nasal disease

A

Pneumonyssus caninum in dogs

Cuterebra sp.

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16
Q

What are the main categories in differential diagnosis for nasal disease?

A 
Inflammatory
Infectious 
Neoplasia 
Trauma/fracture 
Foreign body 
Systemic causes (epistaxis)
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17
Q

What are some systemic causes of nasal disease?

A

Coagulopathy
Hyperviscosity syndrome
Systemic hypertension

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18
Q

What is one of the main anatomical reasons for nasal disease?

A

Brachycephalic syndrome

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19
Q

What lab investigations can be done to help diagnose upper respiratory tract disease?

A

Tests for bleeding disorders

Serology for fungal disease

Viral testing in cats

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20
Q

What investigations can be done under GA to help diagnose upper respiratory tract disease?

A

Full oral examination
Dental probing
Nasopharyngeal swab in cats

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21
Q

What imaging investigations might be carried out to help diagnose upper respiratory tract disease?

A

Intra-oral nasal x-ray

CT scan of head for better detail

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22
Q

Why might endoscopy be helpful in diagnosing upper respiratory tract disease?

A

Retrograde view of nasopharynx
Anterograde rhinoscopy
Nasal flush can be diagnostic and therapeutic
Nasal biopsy useful for histopathology and culture

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23
Q

Why is it important to check coagulation factors before performing a nasal biopsy?

A

Nasal tissue is highly vascularised and can bleed profusely

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24
Q

How can bleeding be made less severe during rhinoscopy investigations?

A

Ice packs on nose

Intranasal adrenaline/soaked swabs

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25
Which types of dogs are predisposed to Aspergillus infections?
Meso/dolicocephalic breeds
26
How does Aspergillus cause damage to the upper respiratory tract?
Production of aflatoxins by the fungus provokes a profound inflammatory response Causes extensive turbinate and bone destruction
27
Which type of cat is predisposed to Aspergillus felis?
Brachycephalic breeds
28
What are the clinical signs of Aspergillus infection?
Mucopurulent nasal discharge or epistaxis (uni/bilateral) Sneezing Nasal pain Nasal depigmentation
29
Which methods might help diagnose an Aspergillus infection?
``` Imaging Rhinoscopy Cytology and histopathology Fungal culture Serology and PCR ```
30
What might be seen on an Aspergillus radiograph?
Turbinate destruction Increased soft tissue opacity Increased soft tissue density in frontal sinuses
31
What are the main methods of treating Aspergillus infections?
Topical antifungal application into the nasopharynx and rostral nasal cavity Trephination and flushing with saline then clotrimazole flush
32
What are the main anatomical abnormalities in dogs with BOAS?
Excessive soft tissue Stenotic nares Elongated soft palate Hypoplastic trachea
33
What are the secondary problems caused by BOAS?
Laryngeal collapse and hiatal hernia
34
How do BOAS animals present?
``` Loud breathing Snoring Heat/exercise intolerance Gagging/regurgitation/vomiting Sleep deprivation ```
35
What tests might be used to diagnose BOAS?
Examination under sedation Fluoroscopy/barium swallow CT/x-ray of head and/or chest Rhinoscopy
36
How does laryngeal paralysis occur?
Can be congenital/trauma/nerve infiltration
37
How does laryngeal paralysis present?
Exercise intolerance | Inspiratory stridor and a soft ineffective cough
38
How is laryngeal paralysis diagnosed?
Laryngeal exam under sedation/GA
39
What are the main nursing considerations for patients with laryngeal paralysis?
Keep animal calm and cool Provide oxygen Monitor for signs of aspiration pneumonia/dysphagia/megaoesophagus Steroids to reduce oedema Surgical intervention often required
40
In which dogs is tracheal collapse most commonly seen?
Small/toy breeds
41
Which part of the trachea is more prone to collapse?
Most common at thoracic inlet
42
What causes tracheal collapse?
Unknown aetiology - obesity may be a predisposition
43
What is the main sign of tracheal collapse?
'Goose honking' cough
44
How is tracheal collapse diagnosed?
Physical exam | X-ray/fluoroscopy with assess tracheal positioning
45
What are the nursing considerations for tracheal collapse?
``` Sedation (butorphanol) Anti-tussive/bronchodilators/corticosteroids Exercise restriction Oxygen therapy Intubation if acute respiratory episode ```
46
What are the long-term solutions for tracheal collapse?
Weight loss | +/- surgery (stent)
47
what is a cough?
a sudden respiratory effort against a closed epiglottis, resulting in a sudden noisy expulsion of air from the lungs
48
what is dyspnoea?
difficulty breathing; increased respiratory effort
49
what is hyperpnoea?
increased respiratory effort without dyspnoea
50
what is orthopnoea?
adopting a posture to facilitate breathing - usually sit/stand with elbows abducted and neck extended
51
what is the aim of a cough?
protective reflex to clear excess secretions/foreign material
52
where are the cough receptors?
in large airways low density of cough receptors in nose/sinuses/pharynx/pleura
53
what is the cough arc reflex?
afferent = sensory nerves (vagus) cough centre = medulla oblongata efferent = via vagus, phrenic and spinal motor nerves to diaphragm/abdominal wall/muscles
54
what cardiovascular condition can also be associated with a cough?
congestive heart failure due to enlarged left atrium oedema causes more tachypnoea
55
what are the harmful effects of chronic coughing?
exacerbates airway inflammation and irritation emphysema pneumothorax weakness and exhaustion dissemination of infections
56
what are the clinical signs of a cough?
``` coughing tachypnoea and dyspnoea exercise intolerance weakness, syncope cyanosis ```
57
what are the main differential diagnoses for cough/dyspnoea?
``` BOAS laryngeal paralysis kennel cough tracheal collapse chronic bronchitis asthma (cat) pneumonia lungworm pneumothorax pleural effusion ```
58
what should be involved in physical examination of a coughing/dyspnoeic patient?
posture RR and rhythm, effort --> listen for stertor/stridor/wheezing thoracic auscultation (breathing and heart sounds)
59
how can you investigate coughing/dyspnoea?
clinical pathology assessment of oxygenation laryngeal examination imaging assessment of pleural space disease
60
how would you assess the level of oxygenation in the patient?
SpO2 (pulse ox) | PaO2 (arterial blood gas analysis)
61
what are you looking for during radiography?
pulmonary patterns heart and vessels masses pleural space
62
why might bronchoscopy be carried out when investigating cough/dyspnoea?
help collection of broncho-alveolar lavage (BAL) | aid to coupage
63
why might you want to collect fluid from a broncho-alveolar lavage?
assess cytology and bacterial culture
64
what equipment is required for a bronchoscopy?
``` endoscope syringes of sterile saline collection pots mouth gag urinary catheter crash box/induction agent ```
65
what nursing considerations are there during bronchoscopy?
requires several people, needs to be fast coupage will be required monitor patient carefully until full recovered have assess to emergency drugs/oxygen
66
what is canine chronic bronchitis?
lower airway disease, chronic bronchial inflammation with over-secretion of mucus
67
which age dogs typically get chronic bronchitis?
common in middle aged to older dogs
68
what are some concurrent morbidities with chronic bronchitis?
tracheal/bronchial collapse mitral valve disease pulmonary hypertension
69
what is the pathophysiology of bronchitis?
smaller airways become obstructed by mucus alteration to the mucociliary escalator inflammation of the lower airways - narrowing, bronchomalacia, bronchiectasis
70
what is bronchiectasis?
end-stage bronchial change (widening and inflammation)
71
what are the clinical signs of canine chronic bronchitis?
chronic cough >2 months +/- dyspnoea/tachypnoea gagging/retching pyrexia wheezes, crackles if pneumonia
72
how is canine chronic bronchitis investigated?
bronchoscopy | bronchoalveolar lavage
73
what is typically seen on BAL of dog with bronchitis?
mucus and neutrophils +/- bacteria consider other cause if eosinophils
74
what are the management methods for bronchitis?
weight control harness avoid tobacco smoke/dust/airway irritants medication
75
what medications might be used to manage/treat bronchitis?
glucocorticoids bronchodilators antibiotics if required antitussives and mucolytics??
76
what is the first line antimicrobial used to bronchitis treatment?
doxycycline - broad spectrum, empirical treatment for 7-10 days (+1 more week if positive response)
77
which medications for bronchitis might be nebulised?
corticosteroids (fluticasone) and bronchodilator (salbutamol) not for antimicrobials
78
what is the prognosis for chronic bronchitis in dogs?
chronic and progressive but can live for years if well managed worse if bronchiectasis or bacterial pneumonia
79
what is canine infectious tracheobronchitis also known as?
kennel cough
80
what is kennel cough?
a complex of several viruses, bacteria and other microorganisms
81
what viruses can be involved in kennel cough?
canine adenovirus 2 canine parainfluenza virus canine herpes virus
82
what is the main bacterial causal agent of kennel cough?
Bordetella bronchiseptica
83
how is kennel cough treated?
antibiotics/antiinflammatories | antitussives
84
what conditions fall under feline lower airways disease (FLAD)?
feline asthma, feline bronchitis
85
what is FLAD?
chronic bronchial inflammation with mucus hypersecretion
86
which cats are more likely to suffer with FLAD?
young/middle-aged cats | siamese over-represented
87
what is the essential difference between FLAD and canine lower airway diseases?
FLAD often causes bronchoconstriction
88
what is the pathophysiology of FLAD?
type I hypersensitivity leading to histamine and serotonin production by mast cells smooth muscle contraction (bronchoconstriction) Oedema and eosinophilic inflammation of the lower airways mucus hypersecretion obstruction of bronchus
89
what are the clinical signs of FLAD?
cough dyspnoea/tachypnoea cyanosis wheezing crackles if emphysema dull lung sounds if pneumothorax
90
how is FLAD investigated?
chest x-rays/CT scan bronchoscopy bronchoalveolar lavage
91
what investigations might be done into the BAL fluid with FLAD?
cytology - mucous and inflammatory cell count Bordetella bronchiseptica and Mycoplasma spp. PCR faecal parasitology bacterial culture
92
what nursing considerations are there for emergency FLAD?
stress-free environment sedation (butorphanol) provide oxygen ASAP bronchodilators corticosteroids
93
why is nebulisation not recommended for FLAD patients?
could cause bronchoconstriction
94
what medications might be used to control FLAD longer term?
glucocorticoids bronchodilators (theophylline orally) doxycycline if mycoplasma infection Fenbenzadole if parasitic infection
95
what is the prognosis for FLAD?
variable chronic - good if treated appropriately acute - can be fatal if management not prompt
96
what are the classes of pulmonary parasites?
intestinal worms lungworms heartworms
97
what is the most common type of heartworm in dogs?
angiostrongylus vasorum
98
what is the pathogenesis of angiostrongylus?
infection by eating intermediate host (mollusk) or paratenic host (frog) L3 larvae liberated in intestines and travel to pulmonary vasculature adult worms live in the pulmonary arteries and right side of heart larvae migrate into alveoli and are coughed and swallowed
99
what are the clinical signs of angiostrongylus infection?
chronic cough, acute dyspnoea severe pulmonary hypertension syncope increased bleeding tendency - unknown mechanism neurological signs - CNS haemorrhage
100
how can suspected angiostrongylus be investigated?
chest x-rays/CT scan ``` angio detect (blood test) - antigen detection PCR ``` faecal smear Baermann faecal examination empirical treatment
101
what is the treatment for angiostrongylus vasorum infection?
moxidectin or fenbenzadole (antithelmintics)
102
what are the side effects of antithelmintic treatment for angiostrongylus vasorum?
watch out for post-treatment reaction - dyspnoea, ascites and sudden death
103
what is the prognosis for angiostrongylus vasorum infection?
depends on severity of clinical signs
104
what is bacterial pneumonia?
secondary bacterial mixed flora infection can be acute or chronic and affect one or more lung lobes
105
how is bacterial pneumonia spread?
inhaled bacteria/haematogenous spread
106
what are some of the predisposing causes for bacterial pneumonia?
``` chronic bronchitis bronchiectasis immunosuppression foreign body aspiration ```
107
what are the clinical signs of bacterial pneumonia?
soft productive cough, mixed dyspnoea, tachypnoea, exercise intolerant crackles +/- wheezes on auscultation systemic: pyrexia, lethargy, inappetence
108
what investigations can be done to help diagnose bacterial pneumonia?
chest x-rays/CT scan haematology (neutrophilia/neutropenia) C reactive protein (inflammation) SpO2/ABG
109
why should you wait for culture results when treating bacterial pneumonia, rather than treating empirically?
high risk of developing bacterial resistance
110
what treatment might be used for aspiration pneumonia?
IV amoxycillin-clavulanic acid
111
what is used in the empirical treatment of bacterial pneumonia?
PO doxycycline
112
what is used in treatment of patients with septic bacterial pneumonia?
IV fluoroquinolones plus ampicillin or clindamycin
113
what are the nursing considerations for patients with bacterial pneumonia?
oxygen supplementation if hypoxic fluid therapy nebulisation to increase mucus fluidity bronchodilators
114
what is the prognosis for bacterial pneumonia?
depends on severity of clinical signs | pneumothorax and abscessation may require lung lobectomy
115
what happens to the lungs during pneumothorax?
gradual collapse of the lungs, increase in intrathoracic pressure (becoming positive)
116
what are the cardiac effects of pneumothorax?
decreased cardiac output | cardiac arrest
117
what is the clinical presentation of a pleural space disease?
tachypnoea restrictive dyspnoea paradoxical breathing
118
what happens to the lung sounds in an animal with pleural effusion?
muffled lung sounds ventrally | decreased resonance ventrally
119
what happens to the lung sounds in an animal with pneumothroax?
absent lung sounds dorsally | increased resonance dorsally
120
what are the signs that an animal is in respiratory distress?
orthopnoea restrictive dyspnoea mouth-breathing + respiratory noises tachy/hyperpnoea cyanosis
121
how is pleural space disease diagnosed?
chest radiographs thoracic ultrasound thoracocentesis with fluid analysis
122
what will be seen on a chest radiograph of a patient with pleural space disease?
decreased details reduced cardiac silhouette rounded lung margins
123
what types of analysis should be done on the pleural fluid?
cytology (EDTA tube) culture (plain tube) biochemistry (plain tube)
124
what is a thoracocentesis?
aspiration of air/fluid from the pleural cavity by inserting a needle/catheter/drain via a caudal rib space
125
where is a thoracocentesis performed?
around the level of the 7-8th rib space
126
which aspect of the rib should a thoracocentesis be performed on?
cranial aspect - caudal has nerves/blood vessels
127
what is pure transudate?
protein-poor, clear fluid TP <20g/L
128
what is modified transudate?
yellow, blood-tinged fluid protein rich TP >20g/L
129
what is exudate?
turbid fluid TP >20g/L
130
why might an animal have a pure transudate effusion?
Hypoalbuminaemia | due to liver failure, protein-losing enteropathy/nephropathy
131
why might an animal have a modified transudate effusion?
congestive heart failure pericardial disease neoplasia diaphragmatic rupture
132
what types of cells are present in non-septic exudate?
neutrophils macrophages eosinophils lymphocytes
133
why might an animal have non-septic exudate?
``` FIP neoplasia diaphragmatic hernia lung lobe torsion resolving pyothorax ```
134
what types of cells are present in septic exudate (pyothorax)?
degenerate neutrophils | possibly intra/extracellular bacteria (anaerobic, foul-smelling)
135
what are the possible causes of pyothorax?
bite foreign bodies iatrogenic parapneumonic
136
what is chyle?
fluid with milky appearance, TP >25g/L | mainly small lymphocytes and triglycerides
137
what are the causes of chylothorax?
``` idiopathic cardiac disease (cats) cranial vena cava thrombosis/mass heartworm disease neoplasia ```
138
what is haemothorax?
collection of blood-containing fluid in the pleural cavity
139
how much blood needs to be present in the fluid for it to be considered a haemothorax?
Hct >20% OR >50% normal patient hct
140
what are the causes of haemothorax?
``` anticoagulant rodenticide coagulopathy lung lobe torsion trauma neoplasia (rib) ```
141
what are the complications of thoracocentesis?
pyothorax or pneumothorax
142
how are pleural effusions treated?
thoracocentesis | treatment of underlying cause (e.g. chemo, lobectomy for torsion or diaphragmatic rupture)
143
how is pyothorax treated?
IV antibiotics (de-escalation if possible) therapeutic drainage +/- lavage surgery
144
how is chylothorax treated?
management of underlying disease Rutin surgery for idiopathic causes may heal spontaneously (traumatic rupture)
145
what are the causes of pneumothorax?
trauma spontaneously (blebs, bullae, chronic airway disease) iatrogenic
146
how does pneumothorax appear on auscultation?
no lung sounds audible on dorsal aspect | hyper-resonant percussion
147
how is pneumothorax diagnosed?
radiography (heart does not sit against ribs ventrally) | ultrasound
148
how is pneumothorax treated?
rest thoracocentesis as required/chest drain oxygen therapy may require exploratory thoracotomy if recurrent
149
what are the nursing considerations for pneumothorax?
delay diagnostics until stable stress = death, consider sedation obtain SpO2, supplement oxygen cover any obvious chest wounds prepare for thoracocentesis
150
what are the roles of the vet nurse during pleural disease cases?
chest drain care oxygen and fluid therapy observation and monitoring medication (inc. analgesia) shock treatment recumbent patient care feeding and exercise adjustments

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