DISEASES OF THE PLEURAL SPACE Flashcards
most important diseases of the pleural space
▪ Pleuropneumonia
▪ Pneumothorax
▪ Hemothorax
▪ Diaphragmatic hernia
pleuropl=neumonia risk factors
▪ Untreated bronchopneumonia
▪ Inappropriate antimicrobials
▪ Long-distance travel
▪ General anesthesia
▪ Esophageal obstruction
▪ Immunosuppression
▪ Dysphagia
▪ Penetrating thoracic trauma
pleuropneumonia pathophysiology
▪ Extension of pre-existing pneumonia
▪ Penetrating thoracic trauma
▪ Penetrating airway trauma
pleuropneumonia etiologic agents
▪ Same as bacterial pneumonia
▪ Increased risk of anerobic bacteria
▪ Mixed infections possible
▪ Left vs. right side can be different
pleuropneumoia distribution? most common agent?
- typically starts cranioventral > then moves to whole lung, usually bilateral
- strep equi ss zooepidemicus
PLEUROPNEUMONIA
▪ Clinical signs
▪ Fever
▪ Tachycardia
▪ Tachypnea/ Dyspnea
▪ Respiratory distress
▪ Fetid breath
▪ Mucopurulent- hemorrhagic nasal discharge
▪ Mucous membranes-Injected- toxic line
▪ Dehydration
▪ Anorexia
▪ Ventral edema > lose protein with fluid into thorax, then can get distal limb edema, chest edema, facial edema… edema of head and face is the worst as it can occlude nostrils
PLEUROPNEUMONIA
▪ Diagnostics
- usually reliant on ultrasound > fluid within pleural space
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▪ Arterial blood gas
> Hypercapnea
> Hypoxia
▪ Thoracic ultrasonography
▪ Thoracic radiography > better after draining fluid
▪ Thoracocentesis > also therapeutic, can send a sample for culture
▪ Endoscopy > find where it is? also Tracheobronchial aspirate
in pleuropneumonia, what can stop us from effectively draining lfuid?
accumulation of fibrin in the pleural space
thoracocentesis for pleuropneumonia
- how to do it?
▪ Locate site with ultrasound > Ventral and cranial preferred
▪ Sedate, clip, and aseptically prepare
▪ Block with lidocaine
▪ Stab incision > Cranial to rib
▪ Insert teat cannula
▪ Drain fluid
▪ Remove teat cannula and suture site
how to use a thoracic drain for pleuropneumonia
larger, easier to keep in for extended time
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▪ 24 to 32 French gauge > Removable trochar
▪ Same preparation as thoracocentesis
▪ Firmly insert trochar > Subcutaneous tunneling not needed
▪ Slide tubing off and remove trochar
▪ Clamp tubing off if flow of fluid not
continuous
▪ Suture tubing in place
▪ Attach one-way valve
Pleural fluid vs septic fluid
Pleural fluid
▪ Clear to pale yellow
▪ Odorless
▪ Protein < 4.7 g/dL
▪ Nucleated cell count < 8-10,000/ uL
> 75% neutrophils
> 20% macrophages
> 5% lymphocytes
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Septic fluid
▪ > 80% degenerate neutrophils
▪ Presence of phagocytized bacteria
▪ Glucose < 40mg/dL
▪ Lactate > systemic lactate
PLEUROPNEUMONIA
▪ Treatment, prognosis
▪ Broad-spectrum antimicrobials
> Anaerobic coverage important
▪ Analgesics
▪ Anti-inflammatories
▪ Anti-thrombotic therapy
▪ Fibrinolytic therapy
▪ Fluid therapy
▪ Pleural drainage
▪ Thoracic lavage
▪ Excellent nursing care
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▪ Prognosis= Guarded- poor
plauropneumonia sequelae
Intrathoracic
▪ Abscess formation
▪ Effusive or restrictive pericarditis
▪ Fibrin adhesions
▪ Bronchopleural fistulae
▪ Pneumothorax
▪ Hemothorax
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Extrathoracic
▪ Endotoxemia
▪ Edema
▪ Laminitis
▪ Renal failure
PNEUMOTHORAX
▪ Risk factors
▪ Pleuropneumonia
▪ Trauma > Open wounds, Blunt, closed trauma
▪ Surgery of the airway or thorax
▪ Rupture of bullae
▪ Idiopathic
PNEUMOTHORAX
▪ Clinical signs
▪ Tachypnea
▪ Dyspnea
▪ Cyanosis
▪ Fever
▪ Depression
▪ Anxiety
▪ Colic
pneumothorax thoracic auscultation sound
▪ Absent dorsal lung sounds
PNEUMOTHORAX
▪ Diagnosis
▪ Thoracic ultrasonography
▪ Thoracic radiographs > actually better in this case!
pneumothorax treatments
▪ Prevent additional air if possible, prevent entrance of more air > tap them dorsally and caudally (teat canulla is best as it is sturdy), then saran wrap around any wound to prevent it leaking more air into the thorax
▪ If asymptomatic > Monitor for progression, Monitor for respiratory compromise
▪ If symptomatic > Thoracocentesis, Thoracic drains
HEMOTHORAX
▪ Risk factors
▪ Pleuropneumonia
▪ Trauma
▪ Surgery of the airway or thorax
▪ Thoracocentesis
▪ Coagulopathy
▪ Neoplasia
▪ Idiopathic
HEMOTHORAX
▪ Clinical signs
▪ Tachypnea
▪ Dyspnea
▪ Tachycardia
▪ Pale-cyanotic mucous membranes
▪ Colic signs
▪ Epistaxis
hemothorax diagnosis
▪ PCV/TP
> May not reflect blood loss for 24 hours
▪ Thoracic ultrasound (best) > look for hyperechoic ‘smokey’ looking fluid
HEMOTHORAX
▪ Treatment, prognosis
▪ Intravenous fluid therapy
▪ Blood transfusion
▪ Broad-spectrum antimicrobials > blood can predispose to nasty pneumonia
▪ Analgesics
▪ Anti-inflammatories
▪ Thoracocentesis > ONLY if severe respiratory compromise (better for it to be sterile, you will break this… they will eventually also reabsorb this blood and use those ingredients to help themselves)
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Prognosis
▪ Dependent on source of blood and quantity
DIAPHRAGMATIC HERNIA
▪ Risk factors, clinical signs
Risk factors
▪ Blunt trauma
▪ Fall
▪ Parturition
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Clinical signs
▪ Severe colic, persist no matter what you give them
▪ Tachycardia
▪ Respiratory distress
▪ Exercise intolerance
DIAPHRAGMATIC HERNIA
▪ Diagnosis, treatment, prognosis
Diagnosis
▪ Thoracic ultrasonography
▪ Thoracic radiography
▪ Exploratory celiotomy
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Treatment
▪ Exploratory celiotomy
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Prognosis
▪ Guarded to poor
