A difficult pet show

Question 1

What is stertor?

Answer 1

Stertor is noisy breathing that occurs during inhalation. It is a low-pitched, snoring type of sound that usually arises from the vibration of fluid, or the vibration of tissue that is relaxed or flabby. It usually arises from airway blockage in the throat (pharynx).

Question 2

What is stridor?

Answer 2

Stridor is high-pitched, noisy breathing. The higher-pitched sounds result when relatively rigid tissues vibrate with the passage of air. It often occurs as the result of partial or complete blockage of the nasal passages or voice box (larynx), or collapse of the upper part of the windpipe (known as cervical tracheal collapse).

Question 3

Case 1:

In the middle of the afternoon Mrs White brings her French Bulldog Jasper to see you, she is very concerned. Jasper is struggling to breathe he is exhibiting marked inspiratory difficulty and his tongue is blue. Each inhalation is accompanied by marked stertor, which seemed to be localised to the pharynx.

You remember Jasper from 2 years previously he had a long history of respiratory compromise, the owner had previously reported that he pants excessively even after short periods of lead walking and that he snored so loudly at night that it wakes her up. You note that Jasper has not lost any weight over the last 2 years.

Case 2

At the same time Mr Cohen rushes over to the pet show tent, struggling with his very overweight 10 year old retriever, Flintoff, The dog had collapsed on the way to the fete, and, like Jasper, he is mouth breathing, exhibiting marked inspiratory difficulty and his tongue and mucous membranes were blue. Each inhalation is accompanied by marked stridor, which seemed to be localised to the upper respiratory tract.

Case 3

As if this was not enough, Miss Carstairs arrives in a state, carrying Trixie, her 10 year old, neutered male Yorkshire terrier. You do not know Miss Carstairs or her dog, she has house visits from the senior partner, but you do recall your colleague discussing the fact that the dog has a chronic cough. The dog had been admitted for a plain lateral thoracic radiograph and subsequent to that Mrs C had been advised that the dog would improve if it lost some weight. On presentation Trixie is exhibiting marked inspiratory and expiratory difficulty and his tongue and mucous membranes were blue. Each breath is accompanied by marked wheezing and the occasional dry, hacking cough, which seemed to be localised to the upper respiratory tract.

List the features each of these cases has in common.?

Answer 3

All have signs of an upper respiratory tract issue, with difficulty breathing and obvious hypoxia from the colour of their mucous membranes

Question 4

Describe the pathophysiology of the development of the mucous membrane colour?

Answer 4

Mucous membranes go blue due to decreased oxygen entering the animals lungs meaning that the haemoglobin circulating in the body is not fully oxygenated. This means there is more deoxyhaemoglobin circulating which appears as a dark red which gives the skin a blue tone.

Question 5

What action can you take to manage these cases in the short-term?

Answer 5

• As long as the animal is still conscious you should provide oxygen via a mask or tube – if they lose consciousness you need to place an endotracheal tube to maintain the airway
• If they are struggling or panicking you could sedate with acp and buprenorphine
• If they seem at all asthmatic steroids or adrenaline are indicated.
• Could give bronchodilators such as aminophylline or terbutaline

Question 6

What are the common features of the management of these cases?

Answer 6

In all of the cases a clear airway needs to be established so the animal can breathe and sufficiently oxygenate their bodies

Question 7

What do these cases have in common with regards long-term treatment?

Answer 7

Weight loss, investigate underlying cause

Question 8

What equipment will you make sure you take with you to the show in future?

Answer 8

Oxygen and masks

Question 9

Write a radiological report for Trixie’s radiograph.

Answer 9

Contrast of image is good but there is some rotation. No artefacts and the image is labelled. Collimated slightly too far forwards?

Stentoic trachea at the point of the shoulder? Dilated behind this and bronchial pattern?