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Internal Medicine/ Ettinger > Disease of the Pulmonary Parenchyma > Flashcards

Disease of the Pulmonary Parenchyma Flashcards

1
Q

What are the general clinical signs of pulmonary parenchymal disease?

A
  • cough
  • exercise intolerance
  • tachypnea
  • excessive panting
  • increased respiratory effort/ distress (mixed inspiration/ expiration effort)
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2
Q

What are the clinical signs generally associated with upper airway obstruction or pleural space disease?

A
  • increased inspiratory effort
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3
Q

What are the clinical signs generally associated with lower airway/ bronchial disorders?

A
  • increased expiratory effort
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4
Q

What is a potential rapid test to determine cardiogenic vs pulmonary cause of respiratory distress?

A

NT-pro-BNP
- BNP = brain natriuretic protein
- release when there is volume overload (ex. pulmonary hypertension, esp with cardiac dysfunction and failure
- antagonizes renin-angiotensin, promotes vasodilation, and increases diuresis through the kidneys
- could be one way to rapidly diagnose between cardiac or pulmonary cause respiratory distress (higher in cardiogenic cases)
- in cats, can use pleural fluids –> but also elevated with increased creatinine - can be difficult in patients with azotemia

  • overall, still cannot completely replace other diagnostics, such as imaging
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5
Q

What’s the limitation of the tracheal lavage?

A
  • may be negative if the disease is deeper down in the lungs in a patient with non-productive cough
  • in those cases, a bronchioalveolar lavage would be more beneficial
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6
Q

What’s the limitation of pulmonary FNA?

A
  • better if there is a discrete/ focal/ consolidated mass/ region
  • not helpful if diffuse –> biopsy would be more useful (ex. pulmonary fibrosis)
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7
Q

What are some ddx for pulmonary parasites?

A
  • eosinophilic pneumonia
  • asthma
  • bronchopneumonia
  • pulmonary granulomatosis
  • pulmonary neoplasia
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8
Q

What are some examples of pulmonary parasites?

A
  • hookworms (ancylostoma) - young puppies
  • lungworms (migrates from GI system)
  • usual treatment = fenbendazole or ivermectin
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9
Q

What are some examples of pulmonary parenchymal parasites?

A
  • lung fluke: bullae on rads. Coughing. crayfish ingestion
  • filaroides: bronchoinsterstial to alveolar pattern. Coughing, respiratory distress. fecal-oral
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10
Q

What are some examples of airway parasites?

A
  • feline lungworm (A. abstrusus), mimics feline asthma
  • C. vupis, nematode, in dogs only
  • O. osleri, can lead to secondary bacterial infection
  • E. aerophilus, nematode, worldwide
  • Troglostrongylus spp., also infects wild cats
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11
Q

What are some other parasites relevant to the lungs?

A
  • heartworm (D. immitis)
  • French heartworm (Angiostrongylus vasorum)
    - ingestion of mollusk or frog
    - similar to heartworm
    - inflammatory response, chronic cough, general thriftiness
    - bleeding diathesis
    - CXR: bronchial, interstitial, and/ or peripheral alveolar lung patterns
    - CT is better
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12
Q

What are some common bacteria that causes bacterial pneumonia?

A

it’s unusual for healthy adults (esp cats) to develop bacterial pneumonia - usually there is another inciting cause (other than kennel cough)
- enteric pathogens (E coli, Klebsiella)
- Pasteurella
- coagulase-positive staphylococci
- streptoccoci
- Mycoplasma spp
- bordetella bronchiseptica

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13
Q

What are common presentations of bacterial penumonia?

A
  • extremes in age, immunocompromised, or other predisposing factors
  • coughing, nasal discharge, exercise intolerance, respiratory distress
  • anorexia, lethargy
  • fever not always present
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14
Q

What are some typical CBC changes that could be noted in patients with bacterial pneumonia?

A
  • neutrophilia +/- left shit, anemia, lymphopenia
  • CXR: alveolar pattern, ventral distribution
  • caudodorsal distribution – hematogenous spread
  • need to identify pulmonary sepsis - tracheal or bronchiolar lavage
  • watch for commensal bacteria in tracheal lavage
  • Mycoplasma require PCR rather than just culture
  • empiric treatment = inappropriate in about 1/4 of patients, almost 2/3 if had previous antibiotic therapy
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15
Q

What are the treatments for bacterial pneumonia?

A
  1. Antibiotics
    - ideally based on culture & sensitivity results
    - empirical can start with Clavamox +/- TMS; may need a flouroquinolone in severe cases
    - aim for 10-14 days
  2. O2 supplementation
    - start with PaO2 < 80mm Hg or SpO2 < 94%
  3. Fluid therapy
    - dehydration makes the cilia “stuck” in the gel layer, therefore reducing the efficacy
  4. Ancillary therapy
    - Coupage
    - mucolytic, ex. n-acetylcystein (NAC)
    - lung lobectomy
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16
Q

What kinds of infection is due to Bordetella bronchiseptica?

A

tracheobronchitis
- releases entoxins that impairs the mucociliary escalator
- contagious, more common in dogs than cats
- can be difficult to eliminate even with the appropriate antibiotics

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17
Q

What kind of infection is due to steptococcus equi Subspecies Zooepidemicus?

A

necrotizing hemorrhagic pneumonia
- severe, sometimes fatal
- kennel setting

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18
Q

What kind of infection is due to Mycoplasma?

A

difficult to culture, PCR is needed
- likely an opportunistic bacteria
- do NOT use beta lactams as it lacks cell wall

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19
Q

What kinds of infection is due to Mycobacterium?

A

TB and non-TB type infections
- generally granulomatous, with lymphadenopathy, pleural effusions, interstitial to alveolar infiltrates
- zoonotic
- prolonged antibiotic therapy

20
Q

What kind of infection is due Yersinia pestis?

A

Plague!
- cats, dogs appear resistant
- must be a ddx for feline pneumonia in endemic areas
- lymphadenitis –> mandibular/ cervical nodes. bubonic plague
- can then develop into pneumonia
- can FNA the affected lymph nodes to get a diagnosis
- universally fatal if pneumonia left untreated

21
Q

What are some examples of viral penumonia?

A

Dogs:
- canine distemper
- canine influenza virus (H3N8 and H3N2)
- canine parainfluenza virus
- canine herpes virus
- canine infectious hepatitis
Cats:
- feline calicivirus
- feline herpes virus
- feline infectious peritonitis/ coronavirus

22
Q

What are some clinical signs associated with the influenza virus?

A

dogs: H3N2 (avian), H2N8 (equine)
- cough, lethargy, fever
- highly contagious
- marked morbidity but low mortality
Cats: H5N1
- less frequent
- could be life threatening

23
Q

What’s the most common protozoal pneumonia?

A

protozoal pneumonia is uncommon in both cats and dogs
- Toxoplasma gondii = most common one in cats
- can involve GI, respiratory, CNS, abdominal viscera, eyes, and heart
- Tx = potentiated sulfonamides or clindamycin
- often see rapid improvement, but recurrence is possible

24
Q

What are some common mycotic pneumonia?

A

Blastomycosis, histoplasmosis, coccidiosis
- progressive, lower respiratory disease
- extrathoracic signs also possible – weight loss, anorexia, lymphadenopathy
- Tx = expensive and potentially toxic, therefore, need definitive diagnosis
- Diagnosis can be done with extrathoracic sites

25
Q

Which type of mycotic infection is common in Dachshund and King Charles Cavalier?

A

pneumocystis carinii
- Dachshund and King Charles Cavalier
- not very highly virulent
- but in immunocomprised patient = high morbidity and mortality
- clue: absence of fever despite severe pneumonia

26
Q

What are the 3 phases of aspiration pneumonia?

A
  1. acute airway response
  2. lung inflammation
  3. opportunistic bacterial infection
27
Q

What are the typical radiographic signs of aspiration pnuemonia?

A

patchy or foal alveolar infiltrate - R middle, R cranial, and caudal portion of the L cranial

28
Q

How is aspiration pneumonia treated?

A

Supportive therapy
- minimize risk in the first place
- H2-antagnoist or proton-pump inhibitors may help
- prokinetics may help
- if aspiration was witness, airway lavage
- monitor O2 sat, provide supplemental O2 as needed
- bronchodilator to ameliorate acute bronchospasm
- antibiotics for secondary bacterial infection

29
Q

What are some clinical signs of aspiration pneumonia?

A

excessive panting, tachypnea; coughing, harsh/loud adventitial or reduced lung sounds

30
Q

How does pulmonary edema happen?

A
  • increased hydrostatic pressure
  • reduced oncotic pressure
  • impaired lymphatic drainage
  • increased vascular permeability
  • all leads to fluid accumulation in the interstitium then flows to the alveoli at a rate faster than its can be absorbed
  • fluid in alveolus = V/Q mismatch
31
Q

What’s the pathophysiology for cardiogenic pulmonary edema?

A

increased hydrostatic pressure due to backup of blood from the left side of the heart
- resultant alveolar edema = non protein rich

32
Q

What’s the treatment for cardiogenic pulmonary edema?

A
  • diuretics
  • afterload reduction
  • treat the underlying cardiac issue
33
Q

What’s the pathophysiology for noncardiogenic pulmonary edema?

A
  • increased epithelial permeability due to epithelial damage –> fluids go from blood vessels to interstitum to alveolus
  • edema = protein rich
  • active removal of fluid will require Na+/Cl- pump, which in damaged epithelium, also isn’t working well –> making the fluid accumulation worse
34
Q

What are some predisposing factors for noncardiogenic pulmonary edema?

A
  • neurogenic, electric shock –> intense pulmonary vasoconstriction leads to increased hydrostatic pressure, plus inflammatory mechanism
  • systemic inflammation
  • post-obstructive
  • direct pulmonary injury
  • toxins
  • hypoalbuminemia (must be profound)
  • impaired lymphatic drainage
  • others (ex. drowning, pheochromocytoma)
35
Q

What are the presenting signs for noncardiogenic pulmonary edema?

A
  • acute or up to 72h delay
  • wet, productive cough, exercise intolerance, tachypnea
  • harsh, loud, bronchovesicular sounds, crackles
    (if cardiogenic, would also hear heart murmur/ arrhythmia)
  • noncardiogenic tend to have respiratory sinus arrhythmia vs sinus tachycardia with cardiogenic edema
36
Q

How can cardiogenic vs noncardiogenic pulmonary edema be differentiated?

A
  • cardiogenic: usually have heart murmur, arrhythmia (sinus tachycardia)
  • noncardiogenic: may not have heart murmur (thought concurrent heart disease is possible), arrhythmia is more a sinus arrhythmia
  • lack of cardiomegaly or pulmonary vein engorgement = likely noncardiogenic
  • ARDS = patchy alveolar infiltrates
37
Q

How is noncardiogenic edema treated?

A
  • correct the underlying cause if possible
  • supportive therapy: reduce stress/ sedation, O2 supplementation
  • avoid cerebral vasodilators
  • synthetic colloids? will need a lot of it and may have adverse reaction
  • mechanical ventilation
38
Q

What is interstitial lung disease?

A

non-infectious, non-malignant respiratory tract disorder

39
Q

How is interstitial lung disease diagnosed?

A

histopathology

40
Q

Describe eosinophilic pneumonia.

A

Eosinophilic Pneumonia
- can see peripheral eosinophilia in some cases (about half)
- reactive eosinophilic airway disease (cats), idiopathic (dogs)
- BAL
- short course of corticosteroids; Px = fair to excellent

41
Q

Describe lipid pneumonia.

A

Exogenous (aspiration) vs Endogenous (unassociated with aspiration) lipid pneumonia
- uncommon/ rare
- pneumocyte injury –> overproduction of cholesterol-rich surfactant. Lipids phagocytosed by macrophages –> accumulate in alveoliW

42
Q

Which breeds are predisposed to idiopathic pulmonary fibrosis?

A

Westies and Staffordshire bull terriers

43
Q

What are the clinical signs associated with idiopathic pulmonary fibrosis?

A
  • cough, exercise intolerance (dogs)
  • cats: acute respiratory distress, sudden death
  • on PE: inspiratory crackles, may hear heard murmur (tricuspid regurgitation); cyanosis (dogs)
  • CXR: dogs- bronchointerstitial infilfrates
  • so crackles + lack of alveolar pattern = very likely pulmonary fibrosis in dogs
  • pulmonary hypertension is common found
44
Q

How is idiopathic pulmonary fibrosis treated?

A

Cats: only survive for days/ weeks
Dogs: long-term survival possible (32m) with treatment
- cough suppressant, phosphodiesterase-5 inhibitors

45
Q

Which breeds are overrepresented in lung lobe torsion?

A

Afghan and Pugs

Internal Medicine/ Ettinger (93 decks)

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