Lecture 30 11/21/24 Flashcards by Danika Boltz

What is pulmonary edema?

abnormal accumulation of liquid and solute in the interstitial tissues, airways, and alveoli of the lung

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What are the characteristics of pulmonary edema?

-not a disease, but a consequence
-can be cardiogenic or non-cardiogenic

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What is the sequence of edema accumulation?

-fluid accumulates faster than it can be absorbed
-fluid in the alveoli leads to V/Q mismatch and hypoxemia

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What are the pathophysiologic causes of pulmonary edema?

-increased pulmonary capillary hydrostatic pressure
-decreased plasma oncotic pressure
-decreased capillary wall integrity
-impaired lymphatic functions

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What can cause increased hydrostatic pressure?

-left heart failure
-overhydration
-venous obstruction and compression

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What can cause decreased plasma oncotic pressure?

-hypoalbuminemia
-overhydration

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What can cause altered lymphatic drainage?

-cancer
-lymphatic hypoplasia/aplasia
-lymphangitis (from tick-borne disease)

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What can cause altered capillary membrane permeability?

-electric cord shock
-infection/sepsis
-smoke/irritants
-gastric fluid aspiration

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What are the predisposing factors for non-cardiogenic edema development?

-neurogenic pulmonary edema
-post-obstructive pulmonary edema
-systemic disease leading to ARDS
-direct pulmonary injury
-profound hypoalbuminemia
-impaired lymphatic drainage
-drowning
-transfusion-related
-pulmonary thromboembolism
-high altitude

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What are the consequences of edema?

-pulmonary fluid accumulation
-atelectasis
-decreased compliance
-V/Q inequality
-hypoxemia

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What are the clinical signs of pulmonary edema?

-crackles/harsh bronchovesicular sounds
-moist cough that may produce foam
-tachypnea
-orthopnea
-dyspnea
-open mouth breathing
-cyanosis
-hemoptysis

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How is pulmonary edema diagnosed?

-history
-physical exam
-blood work
-blood gas
-radiology

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Which signs on radiology are indicative of pulmonary edema?

-unstructured interstitial or peribronchial pattern
-patchy infiltrates
-caudodorsal fields affected

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Which diagnostics are used to determine whether or not pulmonary edema results from heart disease?

-auscultation
-ECG
-TFAST
-echo
-NT-proBNP

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What are the treatment steps for pulmonary edema?

-cage rest/reduce stress; use sedatives PRN
-improve oxygen with supplemental O2 and bronchodilators
-decrease hydrostatic pressure with diuretics and vasodilators
-identify and treat underlying disease
-supportive care
-intubation and ventilation for severe cases

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What is ARDS?

acute respiratory failure due to non-cardiogenic edema and inflammation

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How does ARDS differ from acute lung injury?

acute lung injury is a less severe version of ARDS

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What are the risk factors for ARDS?

-risk factors for non-cardiogenic pulmonary edema
-injury to vascular endothelium
–aspiration pneumonia
–bacterial pneumonia
–sepsis
–trauma
–shock

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What are the clinical signs of ARDS/ALI?

-rapid onset of resp. signs
-bilateral pulmonary infiltrates on rads
-no evidence of left atrial hypertension

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What are the characteristics of PaO2:FiO2 ratio?

-ratio between arterial O2 and inspired O2
-PaO2 measured on blood gas
-severe ARDS ratio = <100 mmHg
-moderate ARDS ratio = 100-200 mmHg
-mild ARDS/ALI ratio = 200-300 mmHg

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How is ARDS/ALI treated?

-treat underlying disease
-supplemental O2
-ventilator for resp. support
-supportive care
-refer case to emergency/critical care facility

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What are the characteristics of the pleural space?

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-serous membrane
-mediastinum is incomplete
-normal pleural fluid is produced by transudation

Why is it important that normal intrathoracic pressure is negative?

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negative intrathoracic pressure keeps the alveoli open in health

What can cause pneumothorax?

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-leakage from inside airway
-air from the outside
-trauma
-bullae in the lung
-iatrogenic
-neoplasia
-spontaneous pneumothorax

What is the treatment for pneumothorax?

-remove air -continuous drainage if needed -possibly surgery

What are the potential etiologies of pleural effusion?

-increased hydrostatic pressure -decreased oncotic pressure -increased capillary membrane permeability -lymphatic obstruction

What happens as pleural effusion forms?

there is a gradual collapse of lung parenchyma and an increase in intrathoracic pressure

What can cause pleural effusion?

-CHF -pneumonia -malignancy -atelectasis -hypoalbuminemia -diaphragmatic defect -thoracic duct rupture/disease -idiopathic chylothorax

What are the clinical signs of pleural effusion?

-restrictive breathing pattern -rapid, shallow breathing -resp. distress -strong abdominal component to breathing -muffled lung sounds

Which aspects of the physical exam are most important when dealing with pleural effusion?

-breathing pattern -percussion -auscultation

What are the characteristics of diagnostic thoracocentesis?

-often done before rads to stabilize patient -not a benign procedure -down with aseptic technique -should provide supplemental oxygen -insert needle anterior to rib -remove air or fluid

What is the diagnostic approach to pleural effusion?

-do not stress animal -TFAST/ultrasound -radiology -thoracocentesis before or after rads

What should be done after removing air/fluid via thoracocentesis?

-re-radiograph -remove remaining fluid if present -determine underlying disease

What is the therapy for pleural effusion patients?

-oxygen -temporary thoracocentesis/repeated as necessary -chest tubes in severe patients

Which conditions are responsible for the majority of pleural effusion in cats?

cardiac disease and neoplasia

What are the causes of hemothorax?

-coagulopathy -trauma/rib fracture -cancer

How does hematocrit help to indicate hemothorax?

-pleural effusion has HCT greater than 20% -HCT of pleural effusion is greater than 50% of patient's peripheral HCT

What are the causes of pure transudates?

-hypoproteinemia -early heart failure

What are the causes of modified transudates?

-feline cardiomyopathy -diaphragmatic hernia

What are the causes of non-septic exudates?

-neoplasia -lung lobe torsion -FIP -pancreatitis

What clinical signs are seen in patients with septic exudate?

-systemic signs of illness -inflammatory leukogram -fever -degenerative neutrophils and bacteria on cytology

What are the characteristics of pyothorax?

-purulent exudate in pleural cavity -result of bacterial invasion

What are the potential etiologies of pyothorax?

-migrating foreign bodies -bite wounds -extension from lungs -esophageal perforation -parasitic migration -hematogenous spread -iatrogenic

Which organisms are typically involved in pyothorax?

-anaerobes -Actinomyces -Norcardia -Pasteurella

How is pyothorax diagnosed?

-ultrasound -radiology -thoracocentesis -cytology -culture and sensitivity -blood work -CT scan

What is the treatment for pyothorax?

-oxygen -IV fluids -nutrition -systemic antibiotics -drainage -thoracotomy tubes -surgery

What are the sequelae of of pyothorax?

-constrictive pleuritis -adhesions -abscessation

What are the characteristics of chylothorax?

-contains chyle/lymphatic fluid from the gut -effusion is a mixture of intestinal and thoracic lymph

What are the causes of chylothorax?

-congenital abnormalities of thoracic duct -cranial mediastinal masses/neoplasia -fungal granulomas -heart disease -trauma -lung lobe torsion -thrombosis -idiopathic

How is chylothorax diagnosed?

-pleural disease signs -radiology -thoracocentesis -fluid analysis; cytology and triglyceride on fluid and serum

What is the treatment for chylothorax?

-drainage -low fat diet -rutin/octreotide medications -surgery

What are the surgical options to treat chylothorax?

-ligation of thoracic duct -shunts -omental drainage -pericardectomy

What are the long term sequelae of chylothorax?

-loss of fluids, proteins, vitamins, and electrolytes when drained -constrictive pleuritis -pneumothorax from constant draining -patient stress from constant draining

Lecture 30 11/21/24 Flashcards

(53 cards)