Signs Of Respiratory Disease Flashcards by Harrie Long

What does the respiratory system defend against?

Inhaled non-infectious particulates

Infectious agents

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What non-infectious agents must the respiratory system defend against?

Dust, LPS, allergens

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What are the respiratory defence mechanisms?

Airway smooth muscle tone
Mucous production and mucociliary clearance 
Coughing 
Infiltrating cells 
Mediators

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How can airway smooth muscle tone be altered?

Bronchostriction - prevent pathogens getting further down the respiratory tract

Bronchodilation - physiological e.g. exercise induced

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How is airway smooth muscle tone mediated?

Neural mechanisms
Hormones
Mediators

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How does the parasympathetic nervous system influence airways?

Smooth muscle contracts - airway constricts

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What is the effect of epinephrine on airways?

What receptor does it use ?

Relaxes smooth muscle - dilates airways

B2 receptors

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What effects do anti-cholinergics and beta 2 agonists have on airways?

Dilation

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How can excess mucous production be treated therapeutically?

Mucolytics

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Briefly outline the cough reflex.

Irritant receptors in the respiratory tract stimulated by particulate matter

Vagus nerve transmits to cough centre in brain stem

Efferent motor n. Transmission and cough.

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What effects do endorphins and enkephalins have on the cough reflex?

What receptors do they act on?

Where are these located?

Suppress reflex

Opioid receptors in cough centre of brain stem

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How can the cough reflex be targeted pharmacologically?

Demulcents (not common)

Opioid receptor agonists

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Give examples of opioid receptor agonists which can be used to suppress the cough reflex.

Butorphanol

Codeine

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What are the resident cells in the lungs?

Alveolar macrophages

Mast cells

Lymphocytes

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What is the role of alveolar macrophages?

—Phagocytosis of foreign particles
—Antigen presentation to lymphocytes
—Formation/ release of mediators
—Clearance of effector cells to turn off inflammation at the end of an infection

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What immunoglobulins are involved in respiratory defence?

IgA

IgG

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What is the role of IgA in respiratory defence?

Upper airways

Inhibits adherence of bacteria to epithelium

Binds and neutralises foreign particles

Initiates immune response via leukocytes

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What is the role of IgG in respiratory defence?

Lower airways

Binds and neutralises foreign particles

Activates compliment cascade

Involved in antibody dependent cytotoxicity

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What are the infiltrating cells?

Neutrophils 
Eosinophils 
Basophils 
Lymphocytes 
Monocytes
Platelets

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What is the physiological role of mediators in host defence?

Airway smooth muscle tone 
Blood flow and vascular permeability 
Cell accumulation and activation
Mucous production
Neural reflex mechanisms 
Antibacterial activity

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Which drugs are best for addressing problems associated with the presence of excessive mediators in the respiratory tract?

CORTICOSTEROIDS

Anti-inflammatory drugs - steroids better than NSAIDs

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What are the clinical manifestations of respiratory disease?

Coughing and bronchoconstriction 
Sneezing 
Tachypnoea and hyperpnoea 
Respiratory distress (dyspnoea)
Nasal discharge
Epistaxis 
Haemoptysis 
Cyanosis 
Abnormal Respiratory Noise - STRIDOR

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What is the definition of ‘cough’?

Sudden noisy expulsion of air through the glottis to clear mucous and other material from the larger airways.

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How does coughing aid in mucous clearance?

High velocity of air flow creates shear forces to separate mucous from airway

helps the mucociliary escalator

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What are the stimuli for coughing?

``` Bronchoconstriction Excessive mucous Inhaled particles Hot or Cold air Intramural or extramural pressure Epithelial sloughing (due to damage) Enhanced epithelial permeability ```

What type of cough MIGHT you associate with an upper airway problem?

Harsh, loud, non-productive

What type of cough MIGHT you associate with a lower airway condition?

Soft muted, productive

What type of cough MIGHT you associate with painful conditions?

More muted cough Animal tries not to cough as it hurts

What behaviours would indicate a productive cough?

Swallowing after coughing | Coughing up mucous

How would bronchoconstriction present on auscultation?

Wheezing

How does bronchoconstriction relate to cough?

Separate reflex Slower onset and longer lasting - may improve the efficiency of coughing

What is meant by the term tachypnoea?

Increased respiratory rate

What is the normal resp rate for a dog? What is the normal resp rate for cows, and pigs?

10-30 10-30

What is the normal resp rate for a cat?

24-42

What is the normal resp rate for a horse?

8-16

What is the normal resp rate for a rabbit?

30-60

What is the normal resp rate for a foal or calf?

20-40

What are the physiological causes of tachy/hyperpnoea?

Pain, exertion, heat, anxiety | Stimulation of autonomic nervous system

What are the pathological causes of tachy/hyperpnoea?

``` High CO2, low pH, low O2 Metabolic acidosis Excessive environmental heat Damaged or diseases CNS (resp. Centres) Pain or restriction in structures involved in breathing ```

What are the signs of respiratory distress?

-Abnormal rate, rhythm and character -Nostril flaring -Exaggerated intercostal and/or abdominal effort, -abducted elbows, -stridor, -Anxious expression, Inactivity

When would you not expect to see mouth breathing in respiratory distress?

HORSES | Obligate nasal breathers

What are the causes of inspiratory distress?

Extrathoracic non-fixed airway obstruction Restrictive disease

How can extrathoracic non fixed airway obstructions cause inspiratory distress?

The negative pressure of breathing in draws the obstructing thing into the airway to obstruct them. This is then pushed away when breathing out.

Give an example of an extrathoracic non-fixed airway obstruction

Upper airway obstructions Laryngeal hemiplegia Soft palate disorders

How can restrictive diseases lead to inspiratory distress? Give an example

Limit lung expansion Pleural effusion

What can cause intrathoracic airway obstruction?

Severe Equine Asthma in horses Farmers disease in cattle Tracheal collapse in dogs and horses

What can cause expiratory distress?

Intathoracic airway obstruction Hypertrophy of the body wall

What can cause both inspiratory and expiratory distress?

Extrathoracic fixed obstruction

Give examples of an extrathoracic fixed obstruction

Fb | Intraluminal mass

What is orthopnoea?

Difficulty breathing while recumbent

What might cause orthopnoea?

Pleural fluid accumulation Neonates Diaphragmatic hernia CHF

How can you avoid orthopnoea in neonates?

Place them in sternal recumbency if lying down

How can you describe the appearance of nasal discharge?

Serous Mucoid Purulent Sanguinous (Or a combination of these)

How can nasal discharge be characterised?

Serous/mucoid/purulent/sanguinous Profuse or scant Continuous or intermittent Unilateral or bilateral

When might you see ingested food in nasal discharge?

GI disease Dysphagia Communication between oral and nasal cavities e.g. cleft palate

When do you tend to see unilateral nasal discharge?

Originates in structures rostral to the caudal end of the nasal septum — easier to drain forward due to gravity

When do you tend to see bilateral discharge?

From caudal structures or bilaterally affected rostral structures

What might a foul odoured nasal discharge indicate?

Anaerobic infections Necrotising conditions Connection to the oral cavity e.g. tooth root infections in horses

What can cause epistaxis and/or haemoptysis?

``` Trauma Coagulopathies Vasculitis Erosive or invasive conditions (parasites, fungi) EPIH in horses ```

What is EPIH? What region does it tend to affect?

Exercise induced pulmonary haemorrhage Caudo-dorsal lung lobe

What arterial oxygen concentration is required for cyanosis to be seen?

Less than 50 mmHg

What is the normal arterial oxygen concentration?

100 mmHg

When is cyanosis evident?

When Hb is normal or near normal

When would low arterial O2 not be evident as cyanosis?

Anaemic patients - has to fall lower than 50 Polycythaemic patients - may appear cyanosic at higher O2 concentrations

When can peripheral cyanosis occur?

Poor peripheral perfusion - e.g. shock, heart failure

What can cause pulmonary cyanosis?

Ventilation/ perfusion mismatch Alveolar hypoventilation Shunting Diffusion impairment

What can cause cardiac cyanosis?

Shunting (R-L)

What can cause acquired cyanosis?

Reducing chemical e.g. nitrates, red maple leaf

What is the term for abnormal respiratory noise?

Stridor

What can cause respiratory stridor?

Fixed or dynamic obstructions ``` E.g. Laryngeal paralysis Stenotic/paralysed nerves Nasal masses Soft palate elongation - BOAS ```

Signs Of Respiratory Disease Flashcards

(70 cards)