Lecture 23: Pleural space disease and pulmonary neoplasia

Question 1

Define pleura

Answer 1

Serous membrane lining entire thoracic cavity

Question 2

visceral pleura covers the __, whereas the parietal pleural lines the __

Answer 2

lung, chest wall, diaphragm and mediastinum

Question 3

disruption of starling forces- an increased ___pressure and decreased __ pressure can lead to fluid leakage

Answer 3

increase hydrostatic pressure, decreased oncotic pressure

Question 4

__vascular permeability can lead to fluid leakage

Answer 4

increased

Question 5

transudate effusions typically secondary to increase in __ or decrease in __

Answer 5

increase hydrostatic pressure, decrease oncotic pressure

Question 6

what are some causes of transduate effusions

Answer 6

1. Hypoalbuminemia
2. CHF, cardiac tamponade
3. Vascular obstruction

Question 7

exudate is __rich fluid with __cells

Answer 7

protein rich, inflammatory cells

Question 8

exduate effusion typically secondary to alterations in __ and/or __

Answer 8

vascular permeability and/or obstruction

Question 9

what are some causes/examples of exudate transfusion

Answer 9

1. Chyle
2. Neoplasia
3. FIP
4. Pancreatitis

Question 10

what is tx for effusions

Answer 10

thoracocentesis

Question 11

if thoracocentesis is ultrasound guided insert needle __ if not insert needle __

Answer 11

largest fluid pocket, 7-9th ICS

Question 12

what are TP values for transudate, modified transudate, chylous and exudate

Answer 12

transudate: <2.5
Modified transudate: >2.5
Chylous: >2.5
Exudate: >2.5 commonly >4

Question 13

what wrong

Answer 13

pneumothorax

Question 14

what are some signs of pneumothorax

Answer 14

increased inspiratory effort, tachypnea, panting

Question 15

What is cause of primary spontaneous pneumothorax

Answer 15

air bubble rupture

Question 16

what is cause of secondary spontaneous pneumothorax

Answer 16

abscess, granuloma, neoplasia, lung disease

Question 17

dogs get __spontaneous pneumothorax whereas cats get __

Answer 17

primary, secondary

Question 18

what are tx options for pneumothorax

Answer 18

1. Thoracocentesis
2. If continues- place chest tube
3. If still continues- sx

Question 19

hemothorax typically classified by HCT of effusion > or = __% of peripheral HCT

Answer 19

25%

Question 20

most common causes of hemothorax are secondary to __

Answer 20

trauma

Question 21

what are some non-traumatic causes of hemothorax

Answer 21

1. Defect in secondary hemostatics (most common- coagulopathy)
2. Defect in primary hemostasis

Question 22

what is tx for traumatic hemothorax

Answer 22

1. Supportive care
2. Repeat thoracocentesis
3. Transfusion

Question 23

what is common cause of secondary hemostasis defect leading to hemothorax

Answer 23

rodenticide

Question 24

what is tx for secondary hemostasis caused by rodenticide

Answer 24

plasma and vitamin K supplementation

Question 25

how do you dx chylothorax

Answer 25

1. Gross appearance: white to pink 2. Cytology: small lymphocytes 3. Compare fluid to serum triglyceride levels: fluid >serum

Question 26

what are the 3 functions of lymphatic system

Answer 26

1. Maintain fluid balance 2. Immune response 3. Uptake and transport of dietary fats

Question 27

define lymph

Answer 27

fluid derived from interstitial spaces that circulates through the lymphatic system and contains wBC and proteins

Question 28

define chyle

Answer 28

milky fluid containing lymph and emulsified fats (chylomirons) formed in SI

Question 29

what is lymph pathway

Answer 29

1. Fluid/interstitial space 2. Lymphatic capillaries 3. Larger lymphatic vessels 4. Thoracic duct 5. Cranial vena cava

Question 30

what is chyle pathway

Answer 30

1. Small intestine 2. Lacteals 3. Cisterna chyli 4. Thoracic duct 5. Cranial vena cava

Question 31

what are 2 pathogenesis for chylothorax

Answer 31

1. Trauma to thoracic duct (rare) 2. Secondary to any condition that : obstructs thoracic duct, prevents lymph flow to venous circulation, increased lymphatic flow

Question 32

what is most common cause of chylothorax

Answer 32

idiopathic

Question 33

what breeds of dogs and cats predisposed to chylothorax

Answer 33

dogs: afghan hounds, Shiba Inu Cats: Himalayan, Siamese

Question 34

What is medical management for chylothorax

Answer 34

1. Repeated thoracocentesis 2. Low fat diet 3. Rutin 4. Otreocide

Question 35

what is sx management for chylothorax

Answer 35

1. Thoracic duct ligation 2. Cisterna chyli ablation

Question 36

what is goal of thoracic duct ligation

Answer 36

occlude thoracic duct and force formation of extra pleural lymphatic connections

Question 37

Be suspicious of __ if there is lack of improvement of chylothorax with thoracocentesis and difficult to obtain pleural fluid

Answer 37

restrictive/fibrosing pleuritis

Question 38

what is palliative tx for restrictive/fibrosing pleuritis

Answer 38

Pleural port device

Question 39

Pleural port device requires what type of needles

Answer 39

Huber needles

Question 40

what breeds are predisposed to histiocytic sarcomas

Answer 40

BMD, flat coated retrievers

Question 41

what cat breed is overrepresented for primary pulmonary neoplasia

Answer 41

Persians

Question 42

what is most common primary pulmonary neoplasia

Answer 42

adenocarcinoma

Question 43

dogs __metastasis is most common, whereas cats __metastasis more common with pulmonary neoplasia

Answer 43

intrathoracic, extra thoracic

Question 44

what is most common sign of pulmonary tumors

Answer 44

cough

Question 45

what is an example of a paraneoplastic syndrome from pulmonary tumors

Answer 45

hypertrophic osteopathy

Question 46

what odd place do pulmonary tumors like to metastasize in cats

Answer 46

digits

Question 47

what is tx for pulmonary tumors

Answer 47

surgery- complete lung lobe to my

Question 48

what chemotherapy can you use in dogs with malignant pleural effusions

Answer 48

intracavitary cisplastin