Dog and Cat 10 Flashcards
Canine infectious respiratory disease complex clinical signs and diagnosis (when to investigate)
Clinical signs - 3-5 day incubation - Acute hacking paroxysmal cough worse with: ○ Exercise ○ Excitement ○ Tracheal pressure - Pneumonia rare ○ Puppies ○ Immunocompromised ○ Chronic airway disease Diagnosis - Usually presumptive - history and clinical signs - Investigate if: ○ Not resolving in 7-10d ○ Systemic signs ○ Uncontrolled pathogen in kennel/shelter - Thoracic radiographs, bloodwork - TTW ○ Cytology ○ Cultures/PCRs
Canine infectious respiratory disease complex treatment and complications (treatment for these)
- REST for 7 days ○ no exercise/excitement - Avoid neck pressure ○ walk on harness - Antitussives IF cough frequent/severe ○ not if productive Complications -Systemic signs - Bronchopneumonia -> Young puppies (< 6-8 wks) ○ Bordetella causes 50% bronchopneumonia - binding to cilia - mucociliary clearance failure -> Treatment - (C&S based ideally) ○ Doxycycline ○ Potentiated amoxicillin ○ 5d beyond resolution
Canine infectious respiratory disease complex prevention
1) Minimise exposure
- In shelter/kennel environments:
- Isolate puppies and recently boarded dogs from other dogs
- Disinfect cages, bowls, runs etc
- No nose-nose contact
- At least 10-15 air exchanges/hour (good ventilation) and < 50% relative humidity
2) Maintain good general health
- Good nutrition, regular deworming, limit stress
3) Vaccination
- Do not prevent infection and none are completely effective in preventing clinical signs
Collapsing trachea and tracheobronchomalacia what occurs and pathogenesis
- Narrowing of the tracheal lumen due to
○ weakening of the cartilaginous rings
○ and/or redundant dorsal tracheal membrane - and/or bronchial involvement
○ hence ‘tracheobronchial malacia’
Pathogenesis
1. underlying weakeness but trigger altere airway pressure -> weak cartilage flattens, dorsal membrane stretches -> ligament and wall contact -> cough and inflammation (results in more weakened of cartilage) -> also increased mucus and poor clearance which begins again at altered pressure eventually resulting in airway obstruction
Collapsing trachea what are some trigger factors and signalment
Exacerbating factors - Anything causing: ○ Cough ○ Increased respiratory effort ○ Airway inflammation Signalment - Middle-aged toy and miniature dogs ○ Congenital predisposition ○ 50% all coughing dogs will have this condition - Acquired in other dog breeds ○ Chronic inflammation - Rare in cats - not predisposed to cartilage weakness ○ Obstruction generally chronic
Collapsing trachea what are the main clinical presentations in history and physical examination
- History
○ Goose-honk cough
§ Excitement, Exercise
§ Neck pressure
○ Slow progression (years) to dyspnoea with
§ Excitement
§ Stress
§ Overheating - mainly - exercised in heat weather -> present in clinic with respiratory distress - Physical examination
○ Tracheal sensitivity + Extrathoraciccollapse:
§ Inspiratory obstruction, stertor, distress
§ Cough less
○ Intrathoracic collapse:
§ Cough
§ Expiratory wheeze
Tracheal collapse diagnosis what is tricky, how generally diagnosed and teh 3 others ways to diagnose
- Whole trachea is diseased however it is a dynamic disease so certain areas of the trachea will be collapsing depending on the individual
- MOST will diagnosis via clinical presentation
1. Lateral radiographs
○ Cervical (inspiration) trachea collapse
○ Thorax (expiration) trachea collapse
2. Fluoroscopy - video x-ray
○ Elicit cough - may only collapse during coughing
3. Bronchoscopy - very mild collapse
○ Light anaesthesia - won’t cough under anaesthesia
○ Evaluate URT
○ Collect wash samples - possibly secondary infections
What are the 4 main ways of treating tracheal collapse
1) acute stabilisation if in respiratory distress
2) chronic medical management
3) surgical correction of URT obstruction - stenting whole of trachea - 75-90% improvement but salvage as will fatigue overtime
4) manage cocurrent exacerbating conditions
In terms of chronic medical management for tracheal collapse what are the 6 main things involved and percentage that is controlled this way
- Weight loss! - condition score minus 1 -. Can improve clinical signs by 50%
- Avoid:
§ neck pressure
§ excitement
§ exercising in hot weather - Remove potential respiratory irritants
- Antitussives - prevent cough collapse cycle within pathogenesis
§ Long-term, lowest effective dose - Anti-inflammatory glucocorticoids - some needed initially or low ongoing doses
§ Address secondary infection first
§ Side effects of increase appetite therefore weight gain can make it worse -> if so and needs to be on longterm treatment may need to give inhaled corticosteroids - Bronchodilators -> possibly help relieve suffering doesn’t treat
Good control in 71% of cases
Canine chronic bronchitis define, what occurs and pathogenesis
- “Cough that occurs on most days for 2 or more consecutive months in the past year, in the absence of other active disease”
- Bronchial inflammation
Pathogenesis
Infection, allergy, inhalant irritants -> airway inflammation -> proteases, oxidative injury epithelium -> reduced mucociliary clearance -> chronic muscle thickening, fibrosis, epithelial hyperplasia -> retained mucous, inflammation products -> airway inflammation and repeats
canine chronic bronchitis complications and presentation
Complications
- Secondary bacterial or Mycoplasma infection
- Tracheobronchomalacia
- Pulmonary hypertension
- Bronchiectasis
○ Permanent structural airway damage/dilation
Presentation
- slow progression
- loud, harsh cough - dry or productive, possible tracheal sensitivity, often present after stress/excitement, infection, irritation
- usually well - NO HYPOXIC
- often overweight
- increased breaths sounds, crackles, wheezes, expiratory effort and end-expiratory click (TBM)
canine chronic bronchitis diagnosis 3 main ways and what are the general management and prognosis
- Radiograph
○ Can be normal but normally bronchointerstitial pattern - tram tracks and donuts - CT more sensitive
- Tracheobronchoscopy
○ Imaging - see what is going on
§ Inflammation, mucous, casts of mucous (chronic stasis of mucous)
○ +/- BAL cytology and culture (non-degenerate neutrophils - mild inflammatory reaction)
Management - general management
- medications for most dogs
- medication for some cases
- intermittent medication
Prognosis
- Cannot be cured
- Good prognosis for control for signs/good quality of life in most cases
canine chronic bronchitis what are some general management principles and medications used for most dogs
- Weight loss
- Remove irritants/improve air quality
- Reduce excitement/stress
- Maintain good oral hygiene
- Maintain airway hydration
○ systemic hydration
○ +/-humidification via a nebuliser
Most dogs: - Glucocorticoids to control inflammation - side effects not good so want to maintain on low dose - possibly inhaled
- Aminophylline/theophylline - bronchodilator
○ Anti-inflammatory
○ Mucociliary-clearance
○ -> Reduced fatigue
canine chronic bronchitis medication for some cases and what use intermittently
For some cases:
- Antitussives (opiates)
○ Cough incessant, exhausting, ineffective
○ Lowest effective dose
Intermittently:
- Antibiotics
○ Inhaled oropharyngeal flora (gram negatives)
○ C&S best
○ Need to penetrate airways and respiratory secretions (doxycycline)
○ At least3-4 weeks
Feline bronchial disease why cats predisposed 3 main diseases within and differentials
- Cats have very reactive airways
- Many diseases can cause cough, wheeze and respiratory distress
- Airway resistance -> radius to the power of 4 -> largest determinant of resistance
- Diseases within
- Asthma
- Acute bronchitis
- Chronic bronchitis
What are some differentials for coughing cats and the most common
- Allergic bronchitis
- Respiratory parasites
- heartworm disease
- Bacterial bronchitis
- Mycoplasmal bronchitis
- Interstitial pneumonias (rare)
- Carcinoma
- Aspiration pneumonia
- Toxoplasmosis
- Idiopathic feline bronchitis - most common
Idiopathic feline bronchitis most common cause of what and presentation
cough in cats presentation - cough, slowly progressive, systemically well - normal physical exam if NOT having episode - if episode - - Expiratory obstruction ○ Tachypnoea ○ Expiratory dyspnoea ○ Expiratory wheeze ○ Expiratory push \+/-Wheeze, crackles on auscultation
Idiopathic feline bronchitis diagnosis what need to do first and rule out what
1) stabilise first
2) rule out lungworm - haematology, faecal baermann (lungworm), antibody heart worm test
3) radiographs - bronchial pattern, may be normal (if normal CT)
4) endotraheal wash or BAL in referral centers for mycoplasma or lungworm
Idiopathic feline bronchitis treatment program what involved
1) first determine cause - possible allergy - then remove, lungworm - fendendazole 5 days, infection - doxcycline trail, idiopathic - improve air quality
2) most cats need ongoing glucocorticoid +/- bronchodilatory for life (prednisolone slowly taper to good dose)
3) if ongoing signs or intermittent flare up - bronchodilators such as inhaled salbutamol (ventolin)
4) refractory cases/severe - cyclosporin (experimental), crproheptadine (mild bronchodilation), antihistamine (variable)
how to improve air quality for cats
○ Eliminate smoke, aerosols and perfumed products
○ Trial sand or plain clay litter
○ Reduce dust, mould and mildew
§ clean carpets, furnishings, bedding, drapes
- Clean heating units/ducts, change air filters regularly
- Use a vacuum with a HEPA filter
- Use an air purifier
Outcome of idiopathic feline bronchitis
- If not responding… ○ Compliance? ○ Different primary disease. ○ Secondary complication. Prognosis ○ Good for control of signs in most cases, don't expect cure ○ Guarded if permanent airway damage ○ May die during acute asthma attack
In summary what are the treatment options for collapsing trachea, canine chronic bronchitis and feline bronchitis disease
- TBM: antitussives
- CCB: anti-inflammatory glucocorticoids
- FBD: anti-inflammatory glucocorticoids & bronchodilators
Lung interstitial disease what are the common signs and approach for diagnosis
Common - Cough - Tachypnoea - Exercise intolerance - Excessive panting - Increased respiratory effort - Respiratory distress Approach: 1. Thoracic radiographs 2. +/-assess oxygenation 3. Haem/chem/UA
pneumonia what are the 5 main causes and route from most to least common and the distrubution and possible pathogens within
Cause 1. Bacterial - majority 2. Viral 3. Fungal 4. Protozoal 5. Parasitic 1. Aerogenous § Airways not sterile § Aspiration/immune compromise § Cranioventral pattern - gravity dependent § Bacterial/viral -> Bordetella bronchiseptica 2. Haematogenous § Caudal/diffuse distribution § Interstitial origin § Any pathogen § Fungal, protozoal and parasitic commonly through this tract canine lungworm 3. Direct extension § Pleural space § Intrathoracic structures § Bacterial
Bacterial pneumonia wha species common in, how generally arrives, pathogens involved and puppies/kittens and adult why sick
Common in dogs - Aerogenous - Opportunistic pathogens ○ Oral flora ○ Anaerobes(mixed inf.)aspiration/consolidation ○ Mycoplasma spp.† - Bordetella bronchiseptica ○ Primary pathogen Puppies/kittens - virulent organisms (Bordetella) Why adult have pneumonia - ‘stress’ - Lack of immunity
Bacterial pneumonia some predisposing causes, clinical presentation
Predisposing causes 1. Aspiration 2. Reduced mucociliary clearance 3. Immunosuppression 4. Other primary infection 5. Inhaled/migrating FB Clinical signs - Cough (soft, productive) ○ Dogs! - Bilateral mucopurulent nasal discharge - Exercise intolerance - Respiratory distress - Lethargy, anorexia, fever and weight loss Physical exam - Fever (50%) - Tachypnoea or hyperpnoea - Nasal discharge - Focal crackles, +/-expiratory wheeze (auscultation)
Bacterial pneumonia diagnosis what are the 4 ways
evaluate primary disease when stable/recovered 1. Clinical presentation 2. Haematology ○ Neutrophiliawith left shift, toxic change ○ Normal! 3. Thoracic radiographs (3 views) ○ Alveolar pattern ○ +/-consolidation (dependent) ○ +/-bronchointerstitial 4. Cytology and culture ○ TTW - trans tracheal wash - safest way to do this ○ Septic, suppurative cytology ○ Positive culture ○ Gram stain § Guide initial therapy § Unusual organisms
Bacterial pneumonia what are the 4 treatment options and what is contraindicated
1) antibiotics
2) supportive care - airway hydration (humidify), physiotherapy
3) bronchodialtor - cat bronchospasm, dogs expiratory effort
4) oxygen therapy - PaO2 <80mmHg
Glucocorticoids and antitussives are CONTRAINDICATED
What antibiotics use for bacterial pneumonia for mild infection, severe and puppies/kittens and how long treat
- Milder infections: - relatively stable
○ Oral broad spectrum
○ Potentiated amoxicillin or TMS - Severe infections/septic:
○ IV broad spectrum
○ e.g. (potentiated) ampicillin + fluoroquinolone - Pups/kittens (Bordetella):
○ Amoxicillin or doxycycline - Treat at least a week beyond resolution
Bacterial penumonia treatment monitoring and prognosis
Monitor - clinical signs frequently - Haematology and thoracic radiographs ○ q 24-72 hrs initially; ○ 1 week after DC ○ then q 2-4 weeks after DC Prognosis is usually good
Aspiration pneumonia what due to and results in
Inhalation of solid or liquid material into the lungs: ○ Food ○ Gastric content ○ Iatrogenic - feeding tubes § bowel prep solutions § mineral oil § barium § food - Dogs>> cats - Can mimic drowning - Severe chemical injury and inflammation (first 24-48 hrs) - Secondary bacterial infection-75%, often mixed ○ Non-sterile fluid ○ Oropharyngeal flora
Aspiration pneumonia predisposing factors and radiographic changes
Predisposing causes - shouldn't get in health - Oesophageal dysfunction (regurgitation) ○ Megaoesophagus ○ Dysmotility ○ Oesophagitis ○ Obstruction - Neurologic, muscular or NM disease ○ Localised (larynx/pharynx) ○ Systemic - Depressed mentation - Iatrogenic Radiographic changes - may lag 12-24 hours - severe clinical signs - localised (cranioventral) crackles - signs of primary disease
Aspiration pneumonia treatment what are the 4 options and prognosis
- Suction
○ If observed and unconscious
○ No lavage! - Pending cultures
○ Broad-spectrum antibiotics,
○ Mixed infections, anaerobes - If respiratory distress
○ Oxygen, fluid therapy +/-bronchodilator
○ Nebulisation and coupage - If deteriorating (24-48 hr):
○ Cautious anti-inflammatory glucocorticoids
○ NOT USED IN BACTERIAL PNEUMONIA
- Investigate/manage predisposing causes when stable
Prognosis guarded if disease severe or primary cause not correctable - 80% survival rate
What are the 4 causes of pulmonary hypertension
- Left sided CHF
- Chronic pulmonary parenchymal disease or hypoxia
- Pulmonary thromboembolism
- Pulmonary arterial over-circulation
Idiopathic pulmonary fibrosis (IPF) what breed common in, what occurs, and clinical signs
- WHWT - west highland terriers»_space;SBT, JRT, Cairnterrier, Schipperkes
- Usually middle aged-older
- Severe collagen deposition in the lungs -> pulmonary hypertension
Clinical signs - Exercise intolerance > cough
- Dyspnoea, cyanosis, fainting
- Syncope (PHT)
Exam: - LOUD CRACKLES typical
- Wheezes ~50%
- +/-Tricuspid murmur, split s2 (cor pulmonale)
- +/-secondary polycythaemia
Idiopathic pulmonary fibrosis treatment and prognosis
Treatment
- Corticosteroids (cats) +/-bronchodilators (if wheezing)
- Treat PHT (phosphodiesterase 5)
○ Sildenafil (Viagra) - increase blood flow
○ PDE5 inhibitor. $$$$
- Losartan? (angiotensin II receptor blocker)
○ Antifibrotic
Prognosis
- Guarded (older literature)
- MST 18 mo in WHWT
- Cats 2/3 die within weeks, rest > 12 mo.
Eosinophilic bronchopenumopathy (EB) what diseases does it involve and presentation
- Airways or interstitium ○ Bronchitis/ bronchiectasis ○ Interstitial to nodular to alveolar ○ Large granulomas ○ hilar lymphadenopathy Presentation - Dogs > cats - Young adults - Females - Siberian husky, malamute, rottweiler - 50% peripheral eosinophilia - Allergens -> parasite treatment, diet trials - Productive cough ○ green exudate - Can be acute/severe - 50-90% eosinophils on airway wash
Eosinophilic bronchopenumopathy (EB) management and prognosis
Management
- Exclude HW or pulmonary parasites
- Treatment trial fenbendazole20-50 mg/kg PO SID 14d
- Consider inhaled or food allergens
- Idiopathic cases:
○ Prednisolone1-2 mg/kg/day
○ Taper once clinical, radiographic + haematologic remission.
○ Inhaled fluticasone?
Prognosis fair to good
- Eosinophilic pulmonary granulomatosis may need additional immunosuppression.
- Bronchiectasis some dogs.
Pulmonary neoplasia metastatic how arise, what can look like and examples of multicentric
- Lung capillaries are fantastic filters!
- Diffuse (haematogenous)
- Often multiple nodules
- Can look like - inflammatory nodules - need to rule out - needle aspirate
Screen for primary tumour +/-aspirate nodule
Multicentric - Interstitial-bronchial
○ Lymphoma
○ Mast cell tumour
○ Bronchoalveolar lavage
○ Screen elsewhere first! - Multiple nodules
○ Histiocytic sarcoma
○ Aspirate for cytology
Primary pulmonary neoplasia how common, what most common, where metastasis, clinical signs
- Less common
- Dogs > cats
- Older animals
○ Dogs median 11 yo,. Cats older! - Urban living risk
- Carcinoma most common
- Metastasis
○ Lungs (dogs)
○ Digits (cats) - 30% asymptomatic
- Non-specific signs common - hypercalcaemia, fever possible with neoplasia
- Respiratory signs
○ Cough (Dog)
○ Tachypnoea(Cat)
○ Haemoptysis
○ Exercise intolerance
