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RUSVM SAM 1 > Bronchial Disease And Tracheal Collapse > Flashcards

Bronchial Disease And Tracheal Collapse Flashcards

1
Q

What are the bronchial diseases?

A

Chronic bronchitis

Esopinophilic bronchopneumopathy

Primary ciliary dyskinesia

Neoplasia

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2
Q

What is chronic bronchitis?

A

Chronic inflammation of the bronchial mucosa with no identifiable underlying cause

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3
Q

What are the proposed etioliges of chronic bronchitis?

A

Allergens

Airway pollution

Previous airway infection

Gastroesophageal reflux disease

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4
Q

What is the pathophysiology of chronic bronchitis?

A

Bronchial inflammation and mucus cause coughing —>thickening of bronchial walls —> narrowing and weakening of airways —> cause more cough and inflammation

It’s a cycle really..

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5
Q

What is the signalment of chronic bronchitis?

A

Middle age to older

Often small breed and overweight

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6
Q

What is the usually the presenting complaint and history in a patient with chronic bronchitis?

A

Chronic cough (>1 month)

  • non productive
  • “harsh”, “hacking”, or “deep”
  • terminal retch and paroxysms of cough
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7
Q

What are potential abnormal exam findings in chronic bronchitis ??

A

Pulmonary crackles, wheezes, or snapping

Expiratory dyspnea

Tachypnea

Cyanosis

Murmur of tricuspid regurgitation (R apical systolic)
Murmur of mitral regurgitation (L apical systolic)

Obesity and periodontal disease

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8
Q

What is the differential diagnosis for chronic cough??

A 
Tracheal collapse 
Pulmonary fibrosis 
Eosinophilic bronchopneumopathy 
Parasitic lung disease 
Neoplasia 
Laryngeal disease 
Degenerative mitral valve disease 
Dilated cardiomyopathy
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9
Q

What diagnostics do you do in chronic bronchitis?

A

Minimum database (MDB)- no specific abnormalities

Heartworm antigen test and fecal analysis
Thoracic radiographs with cervical region

Presumptive diagnosis of CB is often made based in history, exam, radiographs ad ruling out other cause with HW and fecal testing

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10
Q

What do you see in radiographs with chronic bronchitis?

A

Diffuse bronchial, interstitial, or bronchointerstitial markings, or rads may be normal

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11
Q

What are advanced respiratory diagnostics can help diagnose chronic bronchitis

A

Fluoroscopy/bronchoscope —> airway collapse

Bronchoscope evaluates for neoplasia, foreign body, parasites, bronchitis, brochiectasis, bronchomalacia

BAL for infectious neoplastic

Laryngeal exam for paralysis

Thoracic computed tomography

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12
Q

What is the treatment for chronic bronchitis?

A

Avoid/reduce potential allergens

Corticosteroid therapy

Weight loss

Eliminate/reduce periodontal disease

Eliminate any secondary respiratory infection (eg mycoplasma and bordetella) —>doxycycline, azithromycin, enrofloxacin

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13
Q

When can you use cough suppressants in chronic bronchitis cases?

A

Short term basis to break cycle

Long term if cough is refractory to other therapies

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14
Q

What drug therapy is helpful in chronic bronchitis with concurrent bronchoconstriction

A

Theophylline

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15
Q

What are common complications of chronic bronchitis?

A

Brochiectasis -permanent dilation of bronchi due to inflammation

Bronchomalacia -collapse due to weakened walls

Chronic obstructive pulmonary disease -obstruction of small airways due to thickening of walls and mucus accumulation

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16
Q

What is eosinophilic bronchopneumopathy (EBP)

?

A

Eosinophilic infiltration of bronchial mucosa and pulmonary parenchyma suspected to be the result of immunologic hypersensitive

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17
Q

What breeds are predisposed to eosinophilic bronchopneumopathy ?

A

Siberian husky
Malamute

Young adult
Female>male

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18
Q

What pattern do you see on radiographs for esopinophilic bronchopneumopathy ?

A

Moderate to severe diffuse bronchointerstitial pattern

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19
Q

What would you see on a MDB for eospinophilic bronchopneumopathy ?

A

Esopinophilia
Basophilia
Neutrophilia

20
Q

What is your DDX for

Coughing, gagging/retching, and dyspneic dog
Nasal discharge
MDB: eosinophilia, basophilia, and neutrophilia

A

Eosinophilic bronchopneumopathy

Parasitic —> rule out with fecal sed or float

21
Q

What is the treatment for eosinophilic bronchopneumopathy ?

A

Corticosteroid

22
Q

What is primary ciliary dyskinesia?

A

Defective ciliary motility resulting in mucus accumulation, inflammation, and recurrent bacterial infections

23
Q

What is the cause of primary ciliary dyskinesia ?

A

Generic mutation

-identified in old English sheepdogs

24
Q

What other tissues can be affected in primary ciliary dyskinesia ?

A

Tissues with ciliated epithelial

  • otitis media
  • infertility
  • renal fibrosis
25
Q

How do you treat ciliary dyskinesia?

A

Antibiotics
Hydration
Courage
Close monitoring for infections

26
Q

What is the difference between chronic bronchitis and asthma

A

Both are inflammation, mucus, and wall thickening of the bronchi

Asthma also includes bronchospasm (primary feature of the disease)

27
Q

What is the etiology of asthma vs chronic bronchitis

A

Asthma: allergic

CB: previous insult/injury to airways

28
Q

What are the primary effector cells in allergic asthma?

A

Eosinophils

—> release proteins that case smooth muscle to be hyper-reactive

29
Q

What is the signalment of feline asthma?

A

Young to middle aged cats

Increase prevalence in Siamese cats

30
Q

What is the common presenting history in asthmatic cats?

A

Coughing, wheezing

Dyspnea/tachypnea

Cats with bronchitis cough every day
Asthmatic cats have intermittent/episodic signs

Episodes can be severe—> respiratory distress
Precipitated by environmental allergen, stress, or exercise

31
Q

What do you hear on pulmonary auscultation of an asthmatic cat?

A

Normal or wheezes, increased BV sounds, or crackles

32
Q

What pattern do you see on radiographs of an feline asthma patient?

A

Bronchial or bronchointerstitial pattern
Often diffuse

Hyperinflation (air trapping) —> increased size and lucency of lung field, flattening of diaphragm

Right middle lung lobe atelectasis

33
Q

What diagnostics do you do in a suspected feline asthma patient? What are you ruling out?

A

Thoracic radiographs

Heartworm and feacal testing

Bronchoscope and BAL fluid (only done in cats that do NOT respond to medial therapy for bronchitis or asthma because of small and hyper-responsive airways in cats)

  • > eosinophils in asthma
  • > neutrophils in bronchitis
34
Q

What is the acute (emergency) treatment for a cat presenting with respiratory distress

A

Minimize stress/handling
Supplemental O2
Rapid-acting corticosteroid
If CHF is high on list, do short furosemide trial

35
Q

What is the chronic treatment for feline asthma?

A

Oral corticosteroid : pred

36
Q

What is tracheal collapse?

A

Dorsoventral flattning of the tracheal rings

37
Q

What are etiologies of tracheal collapse?

A

Primary- cartilage rings are deficient in glycosaminoglycan, chondrotoxicity, and calcium

Secondary- increased pressure/mechanical forces on the trachea in association with other chronic respiratory disease (eg chronic bronchitis, idiopathic pulmonary fibrosis

38
Q

What is the pathophysiology of tracheal collapse?

A

Dorsal tracheal membrane gets over stretched and becomes inflamed and pendulous —> exacerbates airway narrowing during expiration

During inspiration, when intrathoracic pressure is negative, the membrane in the thoracic portion gets pulled outward

39
Q

Collapse of the cervical trachea occurs during _________, collapse of the thoracic trachea occurs during ___________

A

Inspiration, expiration

40
Q

What is the signalment for tracheal collapse?

A

Small breed

Middle age to older

41
Q

What is the most common clinical sign in tracheal collapse?

A

Chronic “honking”
Episodes often terminate with a retch or gag

—>often precipitated by pressure on trachea, excitement/activity, or drinking water

Exercise intolerance 
Dyspnea
Excessive panting 
Cyanosis 
Syncope
42
Q

What do your hear on auscultation of trachea on a dog with tracheal collapse?

A

Stridorous sounds

43
Q

T/F: a left apical systolic murmur may be present in dogs with tracheal collapse

A

Yes but it is because DMVD is a common disease in this demographic

44
Q

How do you diagnose tracheal collapse?

A

Thoracic radiographs including cervical region

  • lateral views on inspiration, expiration, and coughing
  • diameter of trachea may be asymmetric and dilated areas may be due to and over stretched dorsal membrane

Fluoroscopy to tracheostomy for definitive diagnosis

45
Q

What is the treatment for tracheal collapse?

A

Lifestyle and environmental modifications —> weight loss, and avoid heat, humid, and stress

Medical therapy —> cough suppressant, corticosteroid short term, antibiotic, sedation in stress conditions, bronchodilator

Intraluminal stent or surgical prostheses for patients with life-threatening dyspnea or patients that fail medical therapy

46
Q

How do you treat a patient that comes into your clinic in respiratory distress due to severe tracheal collapse?

A 
Sedation
Supplemental O2
Corticosteroid 
Minimize handling/stress
Cooling if hyperthermia

If in severe distress, or no improvement —> intubation and mechanically ventilated, may need emergency stenting or surgery

47
Q

What is the prognosis for patients with tracheal collapse?

A

Well controlled clinical signs —> can survive for years if they do not have a fatal respiratory crisis or develop post op complications

Moderate to severe clinical signs are usually euthanized due to poor quality of life

RUSVM SAM 1 (26 decks)

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