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Respiratory Flashcards

1
Q

differentials of coughing dog

A
  • Inflammatory diseases of the bronchi and the lungs (infectious or non-infectious)
  • Tracheal/bronchial collapse
  • Pulmonary edema (cardiogenic/noncardiogenic)
  • Lung tumours
  • Foreign body
  • Haemorrhage
  • Bronchial compression
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2
Q

chronic bronchtiis

A

Defined clinically as cough that occurs on most days of 2 or more consecutive months in the past year in the absence of other active disease

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3
Q

predisposition of chronic bronchitis

A

middle aged- older small breed dogs, cocker spaniels, terriers, poodles

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4
Q

cause of chronic bronchitis

A

unknown  non specific/aspecific chronic bronchitis. Long standing inflammatory process initiated by infection, allergy or inhaled irritants or toxins

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5
Q

pathogenesis of chronic bronchitis

A

irritating factors  chronic airway inflammation  increased mucus secretion  airway thickening  bronchiectasis

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6
Q

signs of chronic bronchitis

A

loud, harsh cough, mucus hypersecretion, exercise intolerance

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7
Q

diagnosis of chronic bronchitis

A

need to exclude: tracheal collapse, idiopathic pulmonary fibrosis, eosinophilic broncho pneumopathy, parasitic pneumonias, bronchial/pulmonary tumours, heart disease
- BALF cytology: lot of mucous, normal or hyperplastic bronchial epithelial cells, predomination of nondegenerated neutrophils, presence of bronchial cylinders, increased number of macrophages, goblet cells and lymphocytes
- bronchoscopy, radiohtaphy, cytology

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8
Q

treatment of chronic bronchtiis

A

maintained symptomatically
Glucocortioids
- decrease the mucosa inflammation and secretion of mucous
- act rapidly
- systemic and local usage
Methyxanthines
- theophylline and aminophylline can be used in combination with glucocorticoids
for cough suppression (antitussive drugs)
- butorphanol, hydrocone, codeine, phocodin

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9
Q

prognosis of chronic bronchitis

A

good if compliant owner

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10
Q

complications of chronic bronchitis

A

bacterial or mycoplasma infection, tracheobronchomalacia, pulmonary hypertension and bronchiectasis

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11
Q

differentials of chronic bronchitis

A

bronchiectasis, CHF, airway foreign body, bacterial pneumonia, pulmonary edema, tracheal collapse

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12
Q

predisposition of feline asthma

A

Siamese + Burmese cats, more common in female and in young-middle aged cats

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13
Q

cause of feline asthma

A

allergens, exercise, physical/chemical factors, infection, drugs, stress

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14
Q

signs of feline asthma

A

cough, respiratory distress, long (forced) expiration, barrel shaped thorax, asymptomatic periods, lethargy, mucus swallowed after cough, increased airway sounds

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15
Q

diagnosis of feline asthma

A
  • CBC – eosinophilia in 20% of cats, elevated stress leucogram
  • biochemistry – Hyperglobinemia
  • bronchoscopy: excessive mucus, roughened mucosa
  • bronchial pattern, hyperinflation, straightening of the diaphragm, middle right lobe atelectasis
  • microbiology of BALF
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16
Q

treatment of feline asthma

A

Emergency
- minimise stress, oxygen, rapid acting glucocorticoids (dexamethasone, methylprednisolone) bronchodilators (terbutaline/aminophylline), last resort: adrenaline
Glucocorticoids
- to control the inflammation in the airways and to stop/slow down the progression of the disease, inflammation is present in asymptomatic patients also
Bronchodilators
- methylxanthines: aminophylline/theophylline, they also have anti-inflammatory effects and increase mucocilliary clearance
- beta-2 agonists: salbutamol (fast acting), salmeterol (slow)

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17
Q

prognosis of feline asthma

A

dependent on response to treatment, if no response – euthanasia

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18
Q

differential of feline asthma

A

pulmonary edema, pneumothorax, lymphoma, anaemia, HCM, thromboembolism

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19
Q

predisposition of bacterial pneumonia

A

young animals < 1 years of age (spontaneous)

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20
Q

cause of bacterial pnuemonia

A

Bordetella bronchiseptica, strep, staph, E.coli, Pasteurella, klebsiella

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21
Q

signs of bacterial pnuemonia

A

cough (less common in cats), bilateral mucopurulent nasal discharge, exercise intolerance and respiratory distress, lethargy, anorexia, fever and weight loss

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22
Q

diagnosis of bacterial pneumoni

A

CBC, thoracic radiographic findings, tracheal wash fluid cytologic analysis and bacterial culture
- CBC = neutrophilic leucocytosis with a left shift, neutropenia with degenerative left shift

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23
Q

treatment of bacterial pneumonia

A

ATB and supportive care, airway hydration, physiotherapy, bronchodilators, expectorant (questionable), acetylcysteine

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24
Q

prognosis of bacterial pneumonia

A

more guarded in animals with underlying problems

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25
Q

complication of bacterial pneumonia

A

pulmonary abscess formation is an uncommon complication

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26
Q

cause of viral pneumonia

A

Distemper, canine influenzas, feline calicivirus, feline herpes virus

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27
Q

signs of viral pneumonia

A

lethargy, anorexia, tachypnoea, coughing, resp distress, collapse, exercise intolerance, increased lung sounds, crackles on lung auscultation, nasal and ocular discharge, fever

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28
Q

diagnosis of viral pneumonia

A

x-ray
- direct airway sampling  transtracheal wash, bronchoscopy with BAL or fine needle aspiration of lungs

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29
Q

treatment of viral pneumonia

A

fluid therapy, supplemental oxygen, nutritional support, airway therapy (saline nebulisation for 5-10minx 3-4x daily followed by coupage)
Antimicrobial therapy
- puppy (outpatient) = doxycycline, puppy (inpatient) = ampicillin and gentamicin
- adult (OP) = co-amoxiclav/ fluoroquinolone and beta lactam combination, adult (IP) = ampicillin and gentamicin
- adult dog hospital acquired = carbapenems or 3rd gen cephalosporins

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30
Q

follow up of pnuemonia

A

repeat x-ray, stay in hosp until no longer oxygen dependent, treatment at home continue for 2-6 weeks and at least 1 week after complete resolution of clinical signs

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31
Q

prognosis of viral pneumonia

A

survival in puppy is 90%, older depends on underlying disease

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32
Q

cause of pleural effusion

A

can be blood (trauma, poison), chyle (thoracic duct rupture), exudate (bacteria into pleural space, bite etc), transudate (imbalance of absorption + filtration of fluid across pleura = hypoproteinemia) or modified transudate (long standing transudate, CHF)

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33
Q

pathogenesis of pleural effusion

A

luid accumulates, lung lobes retract and lung lobe borders become rounding

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34
Q

signs of pleural effusion

A
  • problem in lower airways: pronounced + prolonged expirium, loud auscultation, whistles
  • problem in upper airways: stridor +/or stertor, gasping, increased RR + labour, voice change, panting
  • problem in lung parenchymal cyanosis, increased RR + labour, crackles, productive cough
  • problem in pleural space: shallow breathing, Paradoxal breathing, muffled respiratory sounds
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35
Q

diagnosis of pleural effusion

A

radiography: fluid silhouettes the heart and diaphragm, obscuring their borders, displaced trachea dorsally
- thoracocentesis = detect fluid type (lower 1/3 = fluid, upper third = air)
- CBC – neutrophil with left shift in pyothorax
- cytopathology = for fluid type
o degenerate neutrophils and bacteria = pyothorax
o lymphocytes = chylothorax
o neoplastic cells = tumour

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36
Q

treatment of pleural effusion

A

thoracocentesis and treatment of underlying cause, placement of chest drain

37
Q

prognosis of pleural effusion

A

guarded overall, uncommonly cured but may be successfully managed

38
Q

differential of pleural efusion

A

mediastinal disease, diaphragmatic hernia, lobe collapse, pulmonary neoplasia, pulmonary edema

39
Q

transudation

A

o due to increased hydrostatic pressure
o decreased colloid – osmotic pressure
o clear, TP <25g/L, <1500cell/uL, CHF or hypoproteinemia, SG < 1.0.17

40
Q

exudate

A

o due to trauma/ rupture
o increased endothelial permeability
o variable colour- septic/aseptic
o TP > 30g/L, neutrophils, RBC, bacteria, SG > 1.025
- If exudate:
o tomato soup = neoplasia
o pyothorax = trauma/ infection
o chylothorax = mediastinal lymphoma

41
Q

pneumothorax predisposition

A

: large deep chested (spontaneous)

42
Q

cause of pneumothorax

A

traumatic injury, faulty pleural drainage system, during abdominal surgery

43
Q

pathogenesis of pneumothorax

A

as greater volume of air accumulates in pleural space, the lung parenchyma becomes more dene

44
Q

signs of pneumothorax

A

respiratory distress, cyanosis, orthopnea

45
Q

tension pneumothorx

A

one-way valve is created by tissue at site of leakage, such that air can enter into pleural space during inspiration but cannot return to the airways or atmosphere during expiration
- severe lung compression, over distension of thorax

46
Q

traumatic pneumothorax

A

from trauma
- cage rest, removal of accumulating air by periodic thoracocentesis or by chest tube and radiograph

47
Q

spontaneous pneumothorax

A

pre-existing pulmonary lesions rupture
- more often in dogs than cats
- thoracocentesis is for initial stabilisation
- radiographs and faecal exams,

48
Q

diagnosis of pneumothorax

A

radiograph: heart generally elevated above sternum, with air opacity between two structures

49
Q

treatment of pneumothorax

A

removal of free air from pleural space, cage rest, thoracocentesis, exploratory thoracotomy

50
Q

prognosis of pneumothorax

A

always guarded initially as volatile situation with sudden deterioration possible

51
Q

differentials of penumothorax

A

diaphragmatic hernia, pleural effusion, metastatic neoplasia, pulmonary contusion

52
Q

predisposition of reverse sneezgin

A

small breed dogs

53
Q

cause of reverse sneezing

A

unknown, mostly idiopathic, exacerbated by allergies, excitement, scents from environment, foreign body, nasopharyngeal inflammation

54
Q

pathogenesis of reverse sneezing

A

air is suddenly drawn into the nose

55
Q

signs of reverse sneeznig

A

dog looks like he’s trying to breathe whilst sneezing, spreads the neck and head forward, immediately returns to normal as soon as event is over

Noisy, laboured inspiration, initiated by nasopharyngeal irritation

56
Q

diagnosis of reverse sneexing

A

recommended when it becomes a frequent problem
- dynamic upper airway obstruction
o stertor: noise absence with mouth open. Nasal/nasopharyngeal obstruction, consider: nasopharyngeal mass, nasal mass or FB
o stridor: noise present with mouth open or closed: laryngeal or laryngopharyngeal obstruction, consider: laryngeal paralysis/collapse or tumour
- lab tests: CBC, serum biochemistry, urinalysis, serology, pulse oximetry and arterial blood gas
- X-ray, CT, MRI, fluoroscopy, US, endoscopy
- collecting sample: culture, cytology, histology
- nasal airways: nasal swabbing/brushing, saline hydrop pulsion, nasal biopsy
- lower airways: BAL, tracheal wash, endobronchial brush, transthoracic needle, surgical and thoracoscopic lung biopsy

57
Q

treatment of reverse sneezing

A

usually self-limited episodes, depending on ddx, drugs used periodically

58
Q

differentials of reverse sneezing

A

upper respiratory tract infection, collapse of trachea, tumours or polyps in the nose, FB and parasites

59
Q

predisposition of tumours of nasal cavity

A

older animals (10yr) more common in dolichocehalic and mesecpahlic animals

60
Q

cause of tumours of nasal cavity

A

carcinomas, sarcomas, rarely polyps

61
Q

tumours of nasal cavity (cats + Dogs_

A

Cats: round cell tumour (lymphoma), cancer (adenocarcinoma, undifferentiated carcinoma)
Dogs: carcinoma (adenocarcinoma, undifferentiated carcinoma), sarcoma (younger animals), round cell

62
Q

pathogenesis of tumours of nasal cavity

A

1/3 of all cause of chronic signs of nose disease, mostly malignant, rarely mts

63
Q

signs of tumours of nasal cavity

A

respiratory, ocular and neurological, nasal discharge, epistaxis, sneezing, facial deformity

64
Q

diagnosis of tumours of nasal cavity

A
  • CBC: anaemia, thrombocytopenia
  • biochemistry: hypercalcaemia
  • X-ray of nasal cavity
  • CT, MRI, endoscopy, histopathology
65
Q

treatment of tumours of nasal cavity

A

radiation + surgery, chemotherapy, piroxicam (NSAID), prednisolone

66
Q

prognosis of tumours of nasal cavity

A

median survival time without treatment approx. 95 days, depending on treatment: radiation + surgery 2-3 years

67
Q

differentials of tumours of nasal caivty

A

nasal aspergillosis, rhinitis, other causes of epistaxis

68
Q

aspergillosis predisposition

A

normal inhabitant of nasal cavity in many animals (some dogs, rarely cats), more common in young male dogs, primarily in GSD (disseminated)

69
Q

signs of aspergillosis

A

chronic nasal discharge (bilateral, depigmentation, pain), loss of appetite, periostitis and bone resorption, mild muscular atrophy, messy hair coat, submandibular LN moderately enlarged, sneezing
- highly suggestive of aspergillosis are sensitivity to palpation of the face or depigmentation and ulceration of the external nares

70
Q

diagnosis of aspergillosis

A

chronic nasal discharge (bilateral, depigmentation, pain), loss of appetite, periostitis and bone resorption, mild muscular atrophy, messy hair coat, submandibular LN moderately enlarged, sneezing
- highly suggestive of aspergillosis are sensitivity to palpation of the face or depigmentation and ulceration of the external nares

71
Q

treatment of aspergillosis

A

rhinoscopy: fungal debridement, topical therapy (enilconazole, clotrimazole), re-evaluate 2-3 weeks

72
Q

prognosis of aspergillosis

A

grave with disseminated

73
Q

predisposition of tracheal collapse

A

certain breeds of dogs (yorkies), cervical collapse most often in small breeds, middle and older dogs, any breed: collapse of intrathoracic part, bronchus and bronchioles
- > 7 years = acquired collapse, 4-6 months for congenital

74
Q

cause of tracheal collapse

A

inflammation of respiratory system, difficulty in breathing and cough, glycoprotein and glycosaminogen deficiency

75
Q

pathogenesis of tracheal collapse

A

reduction in the lumen of the trachea resulting from the weaking of cartilage rings of the trachea, relaxation of the dorsal membrane or a combination of these processes

76
Q

consequence of tracheal collapse

A

of trauma, intraluminal mass, extraluminal compression, tracheal hypoplasia

77
Q

signs of tracheal collapse

A

honking cough, trachea (sensitive on palpation), lateral borders of cervical trachea are often palpated, abnormal respiratory sound, inactivity, cyanosis, syncope

78
Q

diagnosis of trahceal collapse

A

X-ray, fluoroscopic examination, Tracheobronchoscopy (4 levels) blood count, biochemistry, ECG, echo

79
Q

treatment of tracheal collapse

A

weight loss, avoid hot environment, short period of steroid administration, broncho dilators (if chronic bronchitis present), ATB if needed, oxygen as needed, reduce excitement (butophanol, acepromazine)
- Stents - hydrocodone, prednisolone, ATB

80
Q

prognosis of tracheal collapse

A

fair to poor

81
Q

differentials of trachealcollapse

A

chronic tracheobronchitis, chronic bronchitis, left atrial enlargement, CHF

82
Q

predisposition of brachycephalic syndrome

A

brachycephalic and in Himalayan cats, many 2- 4 years

83
Q

cause of brachycephalic syndrome

A

congenital shortening of the bones of the skull when the soft tissues within the upper airway don’t reduce in size proportionally
- obesity, hot weather, exercise, excitement, stress

84
Q

pathogenesis of brachycephalic syndroe

A

stenotic nares, elongated soft palate, hypoplastic trachea (bulldogs)

85
Q

signs of brachycephalic syndrome

A

loud breathing sounds, stertor, increased inspiratory efforts, cyanosis, syncope, concurrent gastrointestinal signs, excessive panting, collapse

86
Q

diagnosis of brachycephalic syndroe

A

specific breed, clinical signs, X-ray, laryngoscope, CT, rhinoscopy

87
Q

treatment of brachycephalic syndrome

A

surgery (correction of anatomic defects), emergency therapy: short acting glucocorticoids (prednisolone), laser turbinectomy

88
Q

prognosis of brachycephalic syndrome

A

depends on severity of the abnormalities at the time of diagnosis. Prognosis after early surgical correction of the abnormalities is good for many animals. Laryngeal collapse is generally considered a poor prognostic indicator

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