Lecture 17: Disease of the Lower RT (Specht)

Question 1

Bacterial pneumonia more common in dogs/cats?

Answer 1

dogs

Question 2

routes on infection for bacterial pneumonia

Answer 2

inhalation
aspiration
hematogenous spread

Question 3

bacterial pneumonia CS

Answer 3

Can be acute/chronic/mild/severe

• coughing and dyspnea*
• fever
• nasal d/c
• cyanosis
• crackles
• non-specific anorexia, dehydration, weight loss

Question 4

Dx of bacterial pneumonia

Answer 4

• inflammatroy leukogram
• interstitial or alveolar pattern in rads
• TTW/BAL/pulmonary aspirate positive culture***

Question 5

Tx of bacterial pneumonia

Answer 5

• Abx (based on culture/sensitivity!) until at least 2 weeks after complete resolution of all clinical/rad signs
• supportive care (hydration, nutrition, turning)
• O2
• nebulization, coupage, mild exercse to loosen phlegm

Question 6

prog. of bacterial pneumonia

Answer 6

• fair to good

- affected by severity, underlying conditions, complications

Question 7

2 main causes of viral pneumonia

Answer 7

canine distemper, flu

Question 8

tx of viral pneumonia

Answer 8

supportive care

tx of 2ary bacterial infections

Question 9

route of infect./CS of fungal pneumonia

Answer 9

inhalation, hematogenous

CS: cough, dyspnea, lethargy, weight loss, anorexia

Question 10

dx of fungal pneumonia

Answer 10

• rads show diffuse interstitial pattern or hilar lymphadenopathy
• cytology/culture/histo (i.e. TTW, BAL, pulmonary aspirate) have pyogranulomatous/eosinophilic inflamm. + organisms assoc. with macs**
• serology possible

Question 11

tx/prog. of fungal pneumonia

Answer 11

Tx: antifungals 1-2 mo. after resolution, oxygen therapy, +/- steroids
Prog: fair to poor, requires long-term tx

Question 12

aspiration pneumonitis

Answer 12

• occurs when foreign material enters the lungs
• can be 2ary to v, dysphagia, megaesophagus, force-feeding, feeding tubes, etc.
• can be followed by 2ary bact. infection

Question 13

dx of aspiration pneumonia

Answer 13

classic: alveolar pattern in R middle lung lobe on rads**
+/- megaesophagus
-cytology/cutlure

Question 14

tx of aspiration pneumonia

Answer 14

• symptomatic care (O2, nebulization, coupage, exercise)
• abx only if no improvement, inflammatory leukogram worsens, fever develops, or animal has been on H2 blockers or proton pump inhibitors

Question 15

prog. of aspiration pneumonia

Answer 15

depends…mild to fatal

Question 16

number 1 differential for asthma**

Answer 16

pronounced expiratory effort

Question 17

feline bronchitis (asthma)

Answer 17

dz char. by wheezing, coughing, dyspnea due to spontaneous bronchoconstriction

Question 18

contributing factors of asthma

Answer 18

• bronchospasm
• bronchial smooth m./epithelial hypertrophy
• inc. mucus prod. or dec. clearance
• inflamm. exudate w/n lumen or of airway walls
• fibrosis
• emphysema
• airway hypersensitivity

Question 19

only potential difference between asthma and bronchitis

Answer 19

asthma may have more eos in wash than bronchitis

Question 20

CS of feline bronchitis

Answer 20

• young/middle aged
• small airway obstruction –> sudden dyspnea; cough/wheezing/crackles, inc. expiratory effort
• slowly progressive pathology
• exacerbated by env. changes

Question 21

Dx of feline bronchitis (asthma)

Answer 21

• history, CS, PE**
• TXR: bronchial wall thickening/pulm. hyperinflation
• TW/BAL cytology (inflammaotry, cultures usually negative)
• HW Ag and Ab tests
• Fecal

Question 22

Tx of feline bronchitis

Answer 22

• airway management
• env. mod.
• long-term corticosteroids
• bronchodilators

Question 23

Prog. of feline bronchitis

Answer 23

• poor for complete cure
• fair to good for control of CS
• sudden death possible

Question 24

canine chronic bronchitis

Answer 24

long-term airway inflamm. probably assoc. with irritants, recurrent infection, allergies. Targets overweight, small to medium breedsover 5 yo

Question 25

CS of canine chronic bronchitis

Answer 25

-progressively worsening dry cough exacerbated by excitement | +/- wheezes, crackles

Question 26

Dx of canine chronic bronchitis

Answer 26

TXR: -prominent bronchial pattern +/- interstitial -bronchiectasis if severe -R sided cardiomegaly if severe (cor pulmonale) Tracheal wash: -cytology: nonspecific inflamm., excess mucous -culture: generally negative Bronchoscopy: -membranes hyperemic, edematous, excess mucous, small airway collapse

Question 27

Tx of canine chronic bronchitis

Answer 27

focused on relieving CS, not curing** - glucocorticoids - bronchodilators - cough suppressants - antibiotics

Question 28

Pulmonary Thromboembolism

Answer 28

thrombosis or embolism causes perfusion/ventilation mismatch (increased V/Q)** - dec. cardiac output, inc. pulmonary resistance, bronchoconstriction - loss of surfactant, infarction

Question 29

virchow's triad

Answer 29

describes the three broad categories of factors that are thought to contribute to thrombosis: ``` Hypercoagulability Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction ```

Question 30

Dz assoc. with pulmonary thromboembolism

Answer 30

- hyperadrenocorticism - pancreatitis - sepsis - IMHA - trauma/surgery - DIC - Protein-losing nephropathy

Question 31

CS of pulmonary thromboembolism

Answer 31

SUDDEN ONSET** of resp. distress, dyspnea, tachypnea +/- increased breath sounds tachycardia shock, hemoptysis, syncope, collapse, death

Question 32

Dx of pulmonary thromboembolism

Answer 32

- presumptive - coag. panels - TXR: usually do NOT rule out PTE***, but may wee hypovascular regions/blunted pulmonary vessels - angiography, scintigraphy

Question 33

Tx of PTE

Answer 33

- supportive care - anticoagulants - fibrinolytic meds (streptokinase, TPA)

Question 34

Prog. of PTE

Answer 34

- guarded/poor - depends on severity - risk of sudden death

Question 35

Chars. of pulmonary/bronchial neoplasia

Answer 35

- 1ary neoplasia RARE - common site of mets - older animals - variable CS: cough, tachypnea, dyspnea, pleural space problems, hypertrophic osteodystrophy

Question 36

Dx/Tx/Prog. of pulmonary/bronchial neoplasia

Answer 36

Dx: imaging for localization (rads, CT, bronchoscopy), cytology/biopsy for defin. dx Tx: sx, chemo, radiation, palliative tx (alleviating pain) Prog: complete excision possible

Question 37

eosinophilic bronchopneumonopathy

Answer 37

- wide spectrum of disorders char. by severe eosinophilic infiltration - variable CS

Question 38

eosinophilic bronchopneumonopathy Dx/Tx/Prog.

Answer 38

Dx: R/O other causes, +/-eosinophilia in peripheral blood, cytology/biopsy with eos infiltration Tx: steroids Prog: variable

Question 39

bronchiectasis

Answer 39

- permanent dilation of bronchi - complication of chronic resp. dz such as chronic bronchitis - extremely susceptible to infection - sx removal possible - prognosis guarded to poor