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Cardiology and Respiratory SA Med > Common Respiratory Cases > Flashcards

Common Respiratory Cases Flashcards

1
Q

What does cough with tracheal palpation mean?

A
  • Elicits a cough due to any disease below the thoracic inlet
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2
Q

Diseases of the airways below the thoracic inlet

A
  • Chronic obstructive pulmonary disease (canine chronic bronchitis)
  • Allergic bronchitis (feline asthma)
  • Infectious bronchitis
  • Airway collapse or compression or obstruction due to foreign body
  • Peribronchial to interstitial fibrosis
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3
Q

Diagnostic tests for lower airway disease

A
  • Thoracic radiographs
  • Bronchoscopy
  • Bronchial lavage
  • Cytology
  • CBC
  • Fecal
  • Culture and sensitivity
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4
Q

What can airway wash rule out?

A
  • Infectious agents
  • Neoplasia
  • Parasites
  • Direct specific therapy
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5
Q

Types of airway wash

A
  • Bronchoalveolar lavage +/- bronchial brush
  • Trans-tracheal wash
  • She prefers bronchoalveolar lavage
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6
Q

What does cytology from a bronchoalveolar lavage look like for canine obstructive pulmonary disease?

A
  • High neutrophilic component
  • +/- High macrophage component
  • ALWAYS SUBMIT CULTURES
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7
Q

What is canine chronic bronchitis or canine COPD?

A
  • Long-term airway inflammation, typically some component of irreversible changes
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8
Q

Typical findings of canine COPD

A
  • Mixed inflammatory cell infiltrates (neutrophils +/- macrophages))
  • Ciliary dysfunction
  • Glandular and epithelial hyperplasia
  • Excessive mucus production
  • Bronchiectasis
  • Airway thickening
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9
Q

Type A COPD characteristics

A
  • Minimal to no coughing until late in the course (more like emphysema)
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10
Q

Type B COPD characteristics

A
  • Chronic coughing

- Predominates in the large airways

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11
Q

Which form of COPD is more common?

A
  • COPD Type B
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12
Q

Who gets canine chronic bronchitis?

A
  • Middle-aged, older small and toy breeds of dogs

- NOTE: THIS IS THE SAME signalment for mitral regurgitation

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13
Q

Characteristics of the canine chronic bronchitis cough

A
  • Loud, resonant, and classically has terminal gag
  • Owners may not appreciate the productive cough due to swallowing
  • Often may cough MORE at night or first thing in the morning after being recumbent due to settling of airway secretions
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14
Q

Common comorbidities with canine chronic bronchitis

A
  • Collapsing trachea
  • Bronchiectasis
  • Pulmonary hypertension
  • Infectious agents (Bordetella and Mycoplasma spp especially) - may need to put on secondary doxycycline
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15
Q

Incidence of K9 bronchitis, allergic bronchitis, and infectious bronchitis

A

K9 bronchitis: most common airway disease of small dogs

Allergic bronchitis: more in cats

Infectious bronchitis: more common in young animals or multi animals (kennel cough)

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16
Q

Cytology of k9 chronic bronchitis

A
  • Chronic irritant with mixed inflammation

- Possible 2° opportunistic infections

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17
Q

Cytology of allergic bronchitis

A
  • Eosinophilic component

- Allergic sensitization to allergen

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18
Q

Etiology of infectious bronchitis in dogs

A
  • CA adenovirus 2 +/- parainfluenza +/- Bordetella
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19
Q

Etiology of infectious bronchitis in cats

A
  • Herpesvirus
  • Calicivirus
  • Bordetella
  • Mycoplasma
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20
Q

Clinical scenario of K9 chronic bronchitis

A
  • Coughing (typical bronchitis, type B)

- Non-coughing types (emphysema like, type A)

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21
Q

Clinical scenario of allergic bronchitis in cats

A
  • Acute or chronic

- Can be a component of a chronic bronchitis disorder

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22
Q

Clinical scenario of infectious bronchitis

A
  • Sudden onset, self limiting usually

- Can complicate another airway disorder (to left)

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23
Q

What are the mainstays of therapy for chronic bronchitis (broad categories)

A
  1. Bronchodilators
  2. Corticosteroids
  3. Combos
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24
Q

Which oral bronchodilators are used for treatment of chronic bronchitis?

A
  • Methylxanthines like theophylline (mucociliary apparatus and mucolytic effects)
  • Beta 2 stimulants (Terbutaline)
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25
Q

Which inhaled bronchodilators are used for treatment of chronic bronchitis?

A
  • Albuterol (shorter acting/rescue) Beta 2 stimulant

- Combivent (albuterol/ipratropium combo that is longer acting Beta 2 stimulant)

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26
Q

Corticosteroids used for chronic bronchitis

A
  • Fluticasone (inhaled steroid)
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27
Q

Combination drugs for chronic bronchitis

A
  • Advair (fluticasone/salmeterol)

- Symbicort (Budesonide/formoterol)

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28
Q

Additional treatment strategies for canine bronchitis

A
  • Weight loss
  • Environment
  • Cough suppressants
  • Antibiotics
  • Antiprostaglandins
  • Emergency therapy as needed
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29
Q

Purpose of weight loss in treatment for chronic bronchitis

A
  • Increase lung compliance and volume
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30
Q

Things to look at for environment for chronic bronchitis

A
  • Possible allergens

- Smoking

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31
Q

Cough suppressants to use for chronic bronchitis

A
  • Hycodan
  • Butorphanol
  • Lomotil
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32
Q

ANtibiotics used for chronic bronchitis secondary infections

A
  • Doxycycline for Bordetella and Mycoplasma

- Base on cultures

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33
Q

Antiprostaglandins that can be used for chronic bronchitis

A
  • COX-2 inhibitors
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34
Q

Emergency therapy for chronic bronchitis

A
  • Epinephrine
  • Atropine
  • Albuterol inhaler
  • Oxygen therapy
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35
Q

What two devices can be used for inhaling aerosolized drugs?

A
  • Aerokat for local therapy
  • Can also use a giant Ziploc bag
  • Either way, animals need training to use an inhaler device
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36
Q

Prognosis for type B chronic bronchitis

A
  • Good for control, no cure
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37
Q

Prognosis for type A chronic bronchitis

A
  • Guarded to poor, often advanced at the time of diagnosis
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38
Q

Typical presentation, observation, and physical exam for cat with asthma

A
  • Alert
  • Open mouth breathing when examined
  • Elevated respiratory right
  • Prolonged inspiratory pull
  • Can hear wheezing, harsh sounds on inspiration
  • Cough elicited by tracheal palpation
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39
Q

What is the most appropriate test to look at with the airways with a coughing cat?

A
  • Thoracic radiograph
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40
Q

Do cats generally cough with heart failure?

A
  • Nope, that’s mostly dogs
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41
Q

Appearance of thoracic radiographs in a cat with asthma

A
  • Fine honeycomb type pattern

- Some evidence of railroad tracks and donuts

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42
Q

Cytology with feline allergic bronchitis

A
  • Often an eosinophilic component

- TTW or BAL

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43
Q

Pathophysiology of allergic bronchitis/feline asthma

A
  • Re-exposure releases mediators (histamine, kinins, eosinophilic chemotactic factor)
  • Bronchioconstriction occurs
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44
Q

Chronic bronchoconstriction characteristics with feline asthma

A
  • Primarily coughing

- Inspiratory effort and noise

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45
Q

Acute bronchoconstriction

A
  • Status asthmaticus
  • Tachypnea, dyspnea
  • Inspiratory and expiratory effort (+/- abdominal push) if end-terminal bronchioles are affected
46
Q

Key therapy for allergic bronchitis

A
  1. Bronchodilators
  2. Corticosteroids (this is even more important with cats, as they are often steroid dependent)
  3. Combos
47
Q

Examples of bronchodilators for allergic bronchitis that are oral

A
  • Methylxanthines (theophylline)

- Beta 2 stimulant

48
Q

Inhaled bronchodilators for allergic bronchitis

A
  • Albuterol (shorter acting/rescue Beta 2 stimulant)

- Combivent which is albuterol and ipratropium (longer acting)

49
Q

Inhaled corticosteroids for cats

A
  • Fluticasone
50
Q

Combos for allergic bronchitis

A
  • Same as before
  • Fluticasone/salmeterol
  • Budesonide/formoterol
51
Q

Prognosis for feline asthma

A
  • Good for control, no cure
  • Identifying environmental allergens is difficult
  • Long term steroid use can be challenging, so consider inhaled
52
Q

Where is the disease:

Coughing >1 year, esp with activity

  • No ∆ in behavior or appetite
  • G 2/6 systolic murmur, left apex
  • Wheezes on inspiration heard with a scope
A
  • Airway disease

- Radiograph the chest

53
Q

What is tracheal collapse?

A
  • Flattening of tracheal rings and/or redundant dorsal trachealis membrane
54
Q

Who gets tracheal collapse?

A
  • Toy and small breed
55
Q

Classic sound of the cough of a dog with tracheal collapse

A
  • Goose honk +/- terminal gag
56
Q

Concurrent diseases that are common with tracheal collapse

A
  • Mitral valve regurgitation

- Chronic bronchitis

57
Q

Radiographic appearance of collapsing trachea

A
  • Collapse in cervical or thoracic region
58
Q

Managing bronchial collapse

A
  • Weight loss**
  • Avoid using a collar/leash (use a harness)
  • Cough suppressants may be used in severe cases of coughing fits
  • Treat concurrent conditions
  • Severe cases may require surgery to stent the airway open
  • Prognosis for medical management is reasonably good; for cure is poor
59
Q

What is one of the most important aspects of managing bronchial collapse?

A
  • Weight loss
  • Many dogs will palliate with weight loss alone
  • Reduces intrathoracic pressures, increases lung compliance and volume, decreases compression of fat
60
Q

Cough suppressants for treatment of tracheal collapse

A
  • Can be used in severe cases but caution is advised as cough suppressants may predispose already compromised airways to opportunistic infections
61
Q

Where is the disease process:

  • 2 year old DSH
  • Obtained from shelter as a kitten
  • “Breathing problem” for about 4 months
  • Progressively worse
  • Eating and drinking normally
A
  • Upper airways
  • Can be heard without stethoscope
  • Over the nasopharyngeal area
62
Q

Possibly ways to diagnose an upper airway problem in a kitty

A
  • Sedated oropharyngeal exam

- CT

63
Q

Who gets nasopharyngeal polyps?

A
  • Usually young cats
64
Q

What are nasopharyngeal polyps?

A
  • Secondary to chronic mid-ear inflammation
  • Non-cancerous growth
  • Space occupying lesion
  • Surgical removal
  • Sometimes bulla osteotomy
65
Q

Nasopharyngeal polyps prognosis

A
  • Can recur

- Usually good once removed

66
Q

Where is the disease process:

  • 10 year old Brittany
  • Anorexia and vomiting for 3 days
  • Acute onset respiratory distress and soft cough
  • HR 140, RR 66
  • Crackles, late inspiration and expiration
A
  • Parenchymal disease

- Not as much worried about heart disease because not tachypneic enough

67
Q

Differentials for parenchymal disease

A
  • Pneumonia (bacterial, viral, parasitic, aspiration)
  • Pulmonary edema (cardiogenic vs non-cardiogenic)
  • Small bronchial diseases (terminal airways)
  • Pulmonary parenchymal diseases (parasitic, fungal, neoplasia)
68
Q

Non-cardiogenic causes of edema

A
  • ARDS

- Electrocution

69
Q

Diagnostic plan for suspected parenchymal disease

A
  • Thoracic radiographs
70
Q

Appearance of alveolar disease on radiograph

A
  • Alveolar pattern (very dense interstitial)
  • Assess heart for any evidence of congestive heart failure as well
  • Severely might see an air bronchogram
71
Q

Which lung region is most likely to be affected with aspiration pneumonia?

A
  • Cranioventral alveolar pattern generally

- Right cranial lung lobe is the most impacted

72
Q

Air bronchogram

A
  • Airways are “flooded” which highlights the open airway
73
Q

Definition of aspiration pneumonia

A
  • Inhalation of food, fluid, +/- bacteria
74
Q

What are risk factors for aspiration pneumonia?

A
  • Anything that can alter laryngeal-pharyngeal function
  • Neuromuscular disease
  • Megaesophagus, chronic reflux, chronic vomiting
  • Anesthesia or depressed mental states (why we do NPO and blow up the cough)
  • Accidental tubing
75
Q

Treatment for aspiration pneumonia (acute fulminate or chronic insidious)

A
  • Oxygen therapy
  • Bronchodilators
  • Antibiotics based on cultures (they can aspirate the area)
  • Shock therapy if fulminate or septic
  • Prevent further aspiration
76
Q

Fluids with aspiration pneumonia and shock

A
  • Be cautious

- There is lung/capillary injury and worsening edema

77
Q

Where is the disease?

  • Coughing for 1 week, progressive
  • Decreased appetite/activity
  • Decreased G4/6 systolic murmur, left apex
  • End-inspiratory and expiratory crackles (RR =66)
  • HR is 220 BPM
A
  • Parenchyma

- Take thoracic radiographs

78
Q

Hallmarks of left heart congestive heart failure on thoracic radiographs

A
  • congested pulmonary veins
  • Left sided heart enlargement
  • Hilar region interstitial pattern
79
Q

Treatment options for endocardiosis and secondary pulmonary edema

A
  1. Diuretics (furosemide)
  2. ACE inhibitor (Enalapril)
  3. Pimobendan
  4. +/- Spironolactone, other vasodilators like amlodipine
80
Q

Where is the disease process?

  • 11 year old Lhasa apso with history of mitral regurgitation
  • On enalapril as a prophylactic
  • Bout of pancreatitis
  • 2 days later, acute respiratory distress
  • HR 160, RR 80
  • Increased expiratory effort
  • Crackles, late inspiration and expiration
A
  • Parenchymal disease
  • COULD BE HEART FAILURE or something else too
  • Thoracic radiographs
81
Q

Radiographs of a dog with ARDS

A
  • Generalized parenchymal opacity

- Not hilar specific

82
Q

Treatment for dog that is very sick, with generalized increased lung opacity, and history of heart disease?

A
  • Treat as heart failure in addition to the lung disease
  • They weren’t convinced that he had venous congestion
  • Gave positive inotropes
  • Oxygen therapy
  • Furosemide
83
Q

Cytology of non-cardiogenic pulmonary edema

A
  • mild inflammation
  • High protein fluid
  • Edema protein:serum protein ratio (~80%)
84
Q

Non-cardiogenic pulmonary edema protein: serum protein ratio compared to CHF

A
  • 80% compared to <50% in CHF
  • Non-cardiogenic edema fluid is protein rich due to a capillary permeability issue
  • CHF is protein poor due to a hydrostatic pressure issue
85
Q

What is acute respiratory distress syndrome or non-cardiogenic edema?

A
  • Aucte pulmonary edema (non-cardiogenic) secondary to lung injury and increased capillary/tissue permeability
86
Q

What causes ARDS?

A
  • Often idiopathic

- Can occur secondary to electrocution too

87
Q

Predisposing causes of ARDS

A
  • Sepsis
  • Drug reaction
  • Pancreatitis - Aspiration
  • Inhalant injury
  • Major trauma or surgery
88
Q

Prognosis for ARDS

A
  • Poor in general
89
Q

Treatment for ARDS

A
  • Treat underlying condition if known
  • O2 therapy is essential
  • Maintain low-normal circulatory volume with cautious fluid therapy
  • Steroids are of unconfirmed benefit
  • Diuretics may be helpful initially, but are of no benefit in latter phases of ARDS (>5-7 days)
  • Nitric oxide as an endogenous mediator of vascular smooth muscle relaxation under investigation
90
Q

O2 therapy for ARDS

A
  • Intubation and mechanical ventilation

- Positive end-expiratory pressure (PEEP) methods are ideal

91
Q

Why is it important to maintain low-normal circulatory volume in ARDS?

A
  • Leaky capillaries
92
Q

What can you look at the estimate hydration status with ARDS?

A
  • Serial measures of arterial blood pressure, PCV, total protein, electrolytes, renal enzymes
93
Q

Where is the disease:

  • 12 year old DSH
  • Presents abnormal breathing and weight loss
  • Indoor only; mostly routine vaccines
  • HR 160; RR 60
  • Quiet lung sounds
A
  • Lung parenchymal disease

- Do chest radiographs

94
Q

Pleural effusion appearance on radiographs

A
  • Retracted lung edge
  • Scalloped, ventral fluid
  • Overall white (fluid) opacity
95
Q

What are the four causes of pleural effusion?

A
  1. Increased hydrostatic pressure in the capillaries
  2. Decreased oncotic pressure (hypoalbuminemia; <1.5 mg/dL)
  3. Increased capillary permeability
  4. Impaired lymphatic drainage (granulomatous disease and cancer)
96
Q

Are pleural effusions usually unilateral or bilateral in dogs and cats?

A
  • Bilateral generally

- Mediastinum of dog and cat is fenestrated or incomplete

97
Q

What type of disease process is suggested with a unilateral pleural effusion in a dog or cat?

A
  • Inflammatory focus almost always
  • Infectious, neoplastic, granulomatous disease
  • The fenestration may be plugged up
98
Q

Management of severe pleural effusion (severe respiratory distress; fragile)

A
  • Oxygen therapy and thoracocentesis should be performed initially before additional diagnostics
  • Thoracocentesis is invasive, but benefit outweighs the small chance of complications
99
Q

Management of mild, stable pleural effusion (stable condition)

A
  • Present in stable condition

- May have chest radiographs taken to confirm presence of pleural effusion before thoracocentesis

100
Q

How to categorize the pleural effusion?

A
  • Measure protein concentration
  • Total cell count
  • Cytologic analysis may reveal a specific diagnosis or assist in directing next diagnostic steps
101
Q

Fluid aspiration tips

A
  • Small volumes just require needle and syringe (+ sterile prep)
  • For larger volume, sterile prep, syringe, butterfly catheter, and 3-way stopcock
  • Sedate cats
  • Can use radiographs or count rib spaces
102
Q

Pure transudate

A
  • Protein <2.5 g/dL

- Cells <1000/µL

103
Q

Rule outs for pure transudate

A
  • Hypoalbuminemia

- PLN, PLE

104
Q

Exudate

A

Protein >3 g/dL

Cells >5000/µL

105
Q

Exudate major categories

A
  • Non-septic
  • Septic
  • Hemorrhagic
  • Chylous
106
Q

Modified transudate

A

Protein <3.5 g/dL

Cell <5000/µL

107
Q

Rule outs for modified transduate

A
  • Right sided congestive heart failure
  • Diaphragmatic hernia
  • Neoplasia
  • Lung lobe torsion
108
Q

Causes of right sided heart failure

A
  • Pulmonary hypertension
  • Tricuspid regurgitation
  • Pericardial effusion or restriction
  • Cardiomyopathy (dilated or hypertrophic)
109
Q

Non-septic exudate rule-outs

A
  • Neoplasia
  • Fungal infection
  • Chronic chylothorax (very irritating)
  • FIP
  • Chronic lung lobe torsion
110
Q

Septic exudate rule-outs

A
  • Penetrating chest wound
  • FOreign body inhalation
  • Ruptured esophagus
  • Ruptured pulmonary abscess or abscessed tumor
  • Hematogenous bacterial infection
111
Q

Hemorrhagic exudate rule-outs

A
  • Neoplasia
  • Coagulopathy
  • Trauma
  • Lung lobe torsion
112
Q

Chylous exudate rule-outs

A
  • Neoplasia
  • Heartworm disease
  • Hypertrophic cardiomyopathy
  • Lung lobe torsion
  • Diaphragmatic hernia

Cardiology and Respiratory SA Med (15 decks)

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