Clinical exam and investigation of respiratory disease Flashcards
What history is important in respiratory disease? 6
Herd/individual problem Age Animal use General management and environment Disease time course and features Response to tx
What to observe from a distance
General behaviour, demeanor RR, effort and pattern Inspiratory/expiratory noise Nostril flare Nostril airflow Noises
General clinical exam - respiratory disease - 8
BCS Posture Abdominal effort Abdominal mm hypertrophy (heaves lines) MM Eyes (discharge) Jugular veins (SOL --> increased jugular pulse height) Pectoral oedema
Specific clinical exam - respiratory disease
Paranasal sinuses - symmetry and percussion, facial and maxillary
Pharyngeal area - GPs, LNs and larynx
Thoracic auscultation and percussion
Define empyema
= collection of pus in the pleural space
What should the larynx be looked at for?
look for asymmetry of the cricoarytenoideus dorsalis mm (horses). You can assess the movement of this muscle by the slap test where you slap the withers (gently) and then there is a reflex which causes this muscle to move.
Define lung consolidation
a region of (normally compressible) lung tissue that has filled with liquid, a condition marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. It is considered a radiologic sign.
Is thoracic ausculation normally louder in foals and thin anials?
yes
What are the borders for auscultation in ruminants?
6th ICS (point on elbow) 9th ICS 9midway) 11th ICS (level with tuber coxae) Diaphragmatic border (straight, unlike equines)
Outline small animal auscultation
not a reliable indicator of respiratory disease. usually significant if noise is increased. Beware of referred noise from the URT.
What do crackles indicate?
small airways and alveoli
What do wheezes indicate?
partial obstruction of longer airways.
Why is it important to palpate the apex beat in small animals?
there may be caudal displacement of the apex beat due to a SOL.
What should further diagnostic tests be based on?
Focus on diagnositic goals:
- rule in/out DDx
- will results change therapy/managment options
- specific advantages/disadvantages of each test.
What can you examine using endoscopy of the RT in horses?
nasal passages GPs Nasopharynx soft palate larynx trachea (to bifurcation) At rest, minimal restraint, and exercise
What can you examine using endoscopy of the RT in small animals?
Trachea, mainstem bronchi an dlarger divisions of the main bronchi
How do you perform RT endoscopy in small animals?
Take radiographs first (artefacts following washes)
In patient able to tolerate GA with trachea of sufficient diameter to accommodate an endoscope.
Sternal recumbency.
Strengths - endoscopy of RT?
can detect disease of major airways AND dynamic disease of URT.
Weaknesses - endoscopy of RT?
unable to visualise smaller airways or parenchymal lesions
What techniques can be performed via endoscope? 3
aspiration
biopsy (discrete lesions)
FB retrieval
What possible tests can be conducted if viral infection is suspected?
Paired serology
Virus isolation - buffy coat, nasopharyngeal swabs
Viral Ag detection - FAT (nasopharyngeal swabs)
PCR - specific virus ID
What RespT samples can you perform cytology and/or bacteriology on? 6
nasopharyngeal swab endoscopically guided tracheal aspirate transtracheal aspirate BALV pleural fluid lung biopsy
When is a nasopharyngeal swab suitable?
Only suitable for bacterial culture of specific organisms that aren’t normally commensal of the pharynx - Streptococcus equi equi
How do you do a GP lavage?
Endoscope within GP and aspirate discharge or lavage and aspirate (sterile saline) - commensal organisms are present. Most commonly used for detection of Strep equi equi via culture and/or PCR
