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CVNT2 > Diseases of the Respiratory System > Flashcards

Diseases of the Respiratory System Flashcards

1
Q

What are some of the common causes of respiratory failure?

A 
Airway obstruction 
Ruptured diaphragm 
Pulmonary oedema/haemorrhage 
Pneumothorax 
Neoplasia
Infection 
Toxin exposure
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2
Q

What are some of the signs associated with respiratory failure?

A

Cyanosis

Inspiratory/expiratory dyspnoea

Tachycardia, weak pulses

Collapse/unconsciousness

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3
Q

What is orthopnea?

A

Abduction of elbows and extension of neck to aid breathing

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4
Q

What are the sounds associated with inspiratory dyspnoea?

A

snoring
stertor
stridor

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5
Q

What are the sounds associated with expiratory dyspnoea?

A

Wheezes

crackles on auscultation

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6
Q

List some methods of oxygen administration

A 
ET tube 
Flow by 
Nasal catheter 
Face mask 
Oxygen tent 
Oxygen cage/incubator
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7
Q

Aside from an ET tube, what is another method of maintaining a patent airway?

A

Tracheostomy tube (requires constant monitoring)

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8
Q

What are some common clinical signs of upper respiratory tract disease?

A

Nasal discharge
Sneezing/reverse sneezing
Stertor/snoring
Systemic/CNS signs

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9
Q

How might nasal discharge appear?

A

Serous
Mucopurulent
Haemorrhagic

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10
Q

What factors should be examined for suspected upper respiratory tract disease?

A

Breathing noises

Nasal discharge, planum depigmentation

Assess regional lymph nodes

Retropulsion of eyeballs/exophthalmia

Dental disease

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11
Q

Name some inflammatory causes of nasal disease

A

Idiopathic
allergic
irritation

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12
Q

Name some infectious causes of nasal disease

A

Bacterial/viral/fungal/parasitic

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13
Q

Name some viral causes of nasal disease

A

Herpesvirus and calicivirus in cats

Canine distemper

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14
Q

Name some fungal causes of nasal disease

A

Aspergillus in dogs

Cryptococcus in cats

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15
Q

Name some parasitic causes of nasal disease

A

Pneumonyssus caninum in dogs

Cuterebra sp.

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16
Q

What are the main categories in differential diagnosis for nasal disease?

A 
Inflammatory
Infectious 
Neoplasia 
Trauma/fracture 
Foreign body 
Systemic causes (epistaxis)
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17
Q

What are some systemic causes of nasal disease?

A

Coagulopathy
Hyperviscosity syndrome
Systemic hypertension

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18
Q

What is one of the main anatomical reasons for nasal disease?

A

Brachycephalic syndrome

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19
Q

What lab investigations can be done to help diagnose upper respiratory tract disease?

A

Tests for bleeding disorders

Serology for fungal disease

Viral testing in cats

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20
Q

What investigations can be done under GA to help diagnose upper respiratory tract disease?

A

Full oral examination
Dental probing
Nasopharyngeal swab in cats

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21
Q

What imaging investigations might be carried out to help diagnose upper respiratory tract disease?

A

Intra-oral nasal x-ray

CT scan of head for better detail

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22
Q

Why might endoscopy be helpful in diagnosing upper respiratory tract disease?

A

Retrograde view of nasopharynx
Anterograde rhinoscopy
Nasal flush can be diagnostic and therapeutic
Nasal biopsy useful for histopathology and culture

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23
Q

Why is it important to check coagulation factors before performing a nasal biopsy?

A

Nasal tissue is highly vascularised and can bleed profusely

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24
Q

How can bleeding be made less severe during rhinoscopy investigations?

A

Ice packs on nose

Intranasal adrenaline/soaked swabs

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25
Q

Which types of dogs are predisposed to Aspergillus infections?

A

Meso/dolicocephalic breeds

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26
Q

How does Aspergillus cause damage to the upper respiratory tract?

A

Production of aflatoxins by the fungus provokes a profound inflammatory response

Causes extensive turbinate and bone destruction

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27
Q

Which type of cat is predisposed to Aspergillus felis?

A

Brachycephalic breeds

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28
Q

What are the clinical signs of Aspergillus infection?

A

Mucopurulent nasal discharge or epistaxis (uni/bilateral)
Sneezing
Nasal pain
Nasal depigmentation

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29
Q

Which methods might help diagnose an Aspergillus infection?

A 
Imaging 
Rhinoscopy 
Cytology and histopathology 
Fungal culture 
Serology and PCR
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30
Q

What might be seen on an Aspergillus radiograph?

A

Turbinate destruction
Increased soft tissue opacity
Increased soft tissue density in frontal sinuses

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31
Q

What are the main methods of treating Aspergillus infections?

A

Topical antifungal application into the nasopharynx and rostral nasal cavity

Trephination and flushing with saline then clotrimazole flush

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32
Q

What are the main anatomical abnormalities in dogs with BOAS?

A

Excessive soft tissue
Stenotic nares
Elongated soft palate
Hypoplastic trachea

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33
Q

What are the secondary problems caused by BOAS?

A

Laryngeal collapse and hiatal hernia

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34
Q

How do BOAS animals present?

A 
Loud breathing 
Snoring 
Heat/exercise intolerance 
Gagging/regurgitation/vomiting 
Sleep deprivation
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35
Q

What tests might be used to diagnose BOAS?

A

Examination under sedation
Fluoroscopy/barium swallow
CT/x-ray of head and/or chest
Rhinoscopy

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36
Q

How does laryngeal paralysis occur?

A

Can be congenital/trauma/nerve infiltration

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37
Q

How does laryngeal paralysis present?

A

Exercise intolerance

Inspiratory stridor and a soft ineffective cough

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38
Q

How is laryngeal paralysis diagnosed?

A

Laryngeal exam under sedation/GA

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39
Q

What are the main nursing considerations for patients with laryngeal paralysis?

A

Keep animal calm and cool
Provide oxygen

Monitor for signs of aspiration pneumonia/dysphagia/megaoesophagus

Steroids to reduce oedema
Surgical intervention often required

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40
Q

In which dogs is tracheal collapse most commonly seen?

A

Small/toy breeds

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41
Q

Which part of the trachea is more prone to collapse?

A

Most common at thoracic inlet

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42
Q

What causes tracheal collapse?

A

Unknown aetiology - obesity may be a predisposition

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43
Q

What is the main sign of tracheal collapse?

A

‘Goose honking’ cough

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44
Q

How is tracheal collapse diagnosed?

A

Physical exam

X-ray/fluoroscopy with assess tracheal positioning

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45
Q

What are the nursing considerations for tracheal collapse?

A 
Sedation (butorphanol) 
Anti-tussive/bronchodilators/corticosteroids 
Exercise restriction 
Oxygen therapy 
Intubation if acute respiratory episode
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46
Q

What are the long-term solutions for tracheal collapse?

A

Weight loss

+/- surgery (stent)

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47
Q

what is a cough?

A

a sudden respiratory effort against a closed epiglottis, resulting in a sudden noisy expulsion of air from the lungs

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48
Q

what is dyspnoea?

A

difficulty breathing; increased respiratory effort

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49
Q

what is hyperpnoea?

A

increased respiratory effort without dyspnoea

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50
Q

what is orthopnoea?

A

adopting a posture to facilitate breathing - usually sit/stand with elbows abducted and neck extended

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51
Q

what is the aim of a cough?

A

protective reflex to clear excess secretions/foreign material

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52
Q

where are the cough receptors?

A

in large airways

low density of cough receptors in nose/sinuses/pharynx/pleura

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53
Q

what is the cough arc reflex?

A

afferent = sensory nerves (vagus)

cough centre = medulla oblongata

efferent = via vagus, phrenic and spinal motor nerves to diaphragm/abdominal wall/muscles

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54
Q

what cardiovascular condition can also be associated with a cough?

A

congestive heart failure due to enlarged left atrium

oedema causes more tachypnoea

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55
Q

what are the harmful effects of chronic coughing?

A

exacerbates airway inflammation and irritation

emphysema

pneumothorax

weakness and exhaustion

dissemination of infections

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56
Q

what are the clinical signs of a cough?

A 
coughing 
tachypnoea and dyspnoea 
exercise intolerance 
weakness, syncope 
cyanosis
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57
Q

what are the main differential diagnoses for cough/dyspnoea?

A 
BOAS 
laryngeal paralysis 
kennel cough 
tracheal collapse 
chronic bronchitis
asthma (cat) 
pneumonia 
lungworm 
pneumothorax
pleural effusion
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58
Q

what should be involved in physical examination of a coughing/dyspnoeic patient?

A

posture

RR and rhythm, effort
–> listen for stertor/stridor/wheezing

thoracic auscultation (breathing and heart sounds)

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59
Q

how can you investigate coughing/dyspnoea?

A

clinical pathology

assessment of oxygenation

laryngeal examination

imaging

assessment of pleural space disease

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60
Q

how would you assess the level of oxygenation in the patient?

A

SpO2 (pulse ox)

PaO2 (arterial blood gas analysis)

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61
Q

what are you looking for during radiography?

A

pulmonary patterns
heart and vessels
masses
pleural space

62
Q

why might bronchoscopy be carried out when investigating cough/dyspnoea?

A

help collection of broncho-alveolar lavage (BAL)

aid to coupage

63
Q

why might you want to collect fluid from a broncho-alveolar lavage?

A

assess cytology and bacterial culture

64
Q

what equipment is required for a bronchoscopy?

A 
endoscope 
syringes of sterile saline 
collection pots 
mouth gag 
urinary catheter 
crash box/induction agent
65
Q

what nursing considerations are there during bronchoscopy?

A

requires several people, needs to be fast

coupage will be required

monitor patient carefully until full recovered

have assess to emergency drugs/oxygen

66
Q

what is canine chronic bronchitis?

A

lower airway disease, chronic bronchial inflammation with over-secretion of mucus

67
Q

which age dogs typically get chronic bronchitis?

A

common in middle aged to older dogs

68
Q

what are some concurrent morbidities with chronic bronchitis?

A

tracheal/bronchial collapse
mitral valve disease
pulmonary hypertension

69
Q

what is the pathophysiology of bronchitis?

A

smaller airways become obstructed by mucus

alteration to the mucociliary escalator

inflammation of the lower airways - narrowing, bronchomalacia, bronchiectasis

70
Q

what is bronchiectasis?

A

end-stage bronchial change (widening and inflammation)

71
Q

what are the clinical signs of canine chronic bronchitis?

A

chronic cough >2 months
+/- dyspnoea/tachypnoea

gagging/retching

pyrexia

wheezes, crackles if pneumonia

72
Q

how is canine chronic bronchitis investigated?

A

bronchoscopy

bronchoalveolar lavage

73
Q

what is typically seen on BAL of dog with bronchitis?

A

mucus and neutrophils
+/- bacteria
consider other cause if eosinophils

74
Q

what are the management methods for bronchitis?

A

weight control
harness
avoid tobacco smoke/dust/airway irritants
medication

75
Q

what medications might be used to manage/treat bronchitis?

A

glucocorticoids
bronchodilators
antibiotics if required
antitussives and mucolytics??

76
Q

what is the first line antimicrobial used to bronchitis treatment?

A

doxycycline - broad spectrum, empirical treatment for 7-10 days (+1 more week if positive response)

77
Q

which medications for bronchitis might be nebulised?

A

corticosteroids (fluticasone) and bronchodilator (salbutamol)
not for antimicrobials

78
Q

what is the prognosis for chronic bronchitis in dogs?

A

chronic and progressive but can live for years if well managed
worse if bronchiectasis or bacterial pneumonia

79
Q

what is canine infectious tracheobronchitis also known as?

A

kennel cough

80
Q

what is kennel cough?

A

a complex of several viruses, bacteria and other microorganisms

81
Q

what viruses can be involved in kennel cough?

A

canine adenovirus 2
canine parainfluenza virus
canine herpes virus

82
Q

what is the main bacterial causal agent of kennel cough?

A

Bordetella bronchiseptica

83
Q

how is kennel cough treated?

A

antibiotics/antiinflammatories

antitussives

84
Q

what conditions fall under feline lower airways disease (FLAD)?

A

feline asthma, feline bronchitis

85
Q

what is FLAD?

A

chronic bronchial inflammation with mucus hypersecretion

86
Q

which cats are more likely to suffer with FLAD?

A

young/middle-aged cats

siamese over-represented

87
Q

what is the essential difference between FLAD and canine lower airway diseases?

A

FLAD often causes bronchoconstriction

88
Q

what is the pathophysiology of FLAD?

A

type I hypersensitivity leading to histamine and serotonin production by mast cells

smooth muscle contraction (bronchoconstriction)

Oedema and eosinophilic inflammation of the lower airways

mucus hypersecretion

obstruction of bronchus

89
Q

what are the clinical signs of FLAD?

A

cough
dyspnoea/tachypnoea
cyanosis
wheezing

crackles if emphysema
dull lung sounds if pneumothorax

90
Q

how is FLAD investigated?

A

chest x-rays/CT scan
bronchoscopy
bronchoalveolar lavage

91
Q

what investigations might be done into the BAL fluid with FLAD?

A

cytology - mucous and inflammatory cell count

Bordetella bronchiseptica and Mycoplasma spp. PCR

faecal parasitology

bacterial culture

92
Q

what nursing considerations are there for emergency FLAD?

A

stress-free environment
sedation (butorphanol)
provide oxygen ASAP

bronchodilators
corticosteroids

93
Q

why is nebulisation not recommended for FLAD patients?

A

could cause bronchoconstriction

94
Q

what medications might be used to control FLAD longer term?

A

glucocorticoids
bronchodilators (theophylline orally)

doxycycline if mycoplasma infection
Fenbenzadole if parasitic infection

95
Q

what is the prognosis for FLAD?

A

variable
chronic - good if treated appropriately
acute - can be fatal if management not prompt

96
Q

what are the classes of pulmonary parasites?

A

intestinal worms
lungworms
heartworms

97
Q

what is the most common type of heartworm in dogs?

A

angiostrongylus vasorum

98
Q

what is the pathogenesis of angiostrongylus?

A

infection by eating intermediate host (mollusk) or paratenic host (frog)

L3 larvae liberated in intestines and travel to pulmonary vasculature

adult worms live in the pulmonary arteries and right side of heart

larvae migrate into alveoli and are coughed and swallowed

99
Q

what are the clinical signs of angiostrongylus infection?

A

chronic cough, acute dyspnoea
severe pulmonary hypertension
syncope

increased bleeding tendency - unknown mechanism

neurological signs - CNS haemorrhage

100
Q

how can suspected angiostrongylus be investigated?

A

chest x-rays/CT scan

angio detect (blood test) - antigen detection 
PCR

faecal smear
Baermann faecal examination

empirical treatment

101
Q

what is the treatment for angiostrongylus vasorum infection?

A

moxidectin or fenbenzadole (antithelmintics)

102
Q

what are the side effects of antithelmintic treatment for angiostrongylus vasorum?

A

watch out for post-treatment reaction - dyspnoea, ascites and sudden death

103
Q

what is the prognosis for angiostrongylus vasorum infection?

A

depends on severity of clinical signs

104
Q

what is bacterial pneumonia?

A

secondary bacterial mixed flora infection

can be acute or chronic and affect one or more lung lobes

105
Q

how is bacterial pneumonia spread?

A

inhaled bacteria/haematogenous spread

106
Q

what are some of the predisposing causes for bacterial pneumonia?

A 
chronic bronchitis 
bronchiectasis 
immunosuppression 
foreign body 
aspiration
107
Q

what are the clinical signs of bacterial pneumonia?

A

soft productive cough, mixed dyspnoea, tachypnoea, exercise intolerant

crackles +/- wheezes on auscultation

systemic: pyrexia, lethargy, inappetence

108
Q

what investigations can be done to help diagnose bacterial pneumonia?

A

chest x-rays/CT scan

haematology (neutrophilia/neutropenia)

C reactive protein (inflammation)

SpO2/ABG

109
Q

why should you wait for culture results when treating bacterial pneumonia, rather than treating empirically?

A

high risk of developing bacterial resistance

110
Q

what treatment might be used for aspiration pneumonia?

A

IV amoxycillin-clavulanic acid

111
Q

what is used in the empirical treatment of bacterial pneumonia?

A

PO doxycycline

112
Q

what is used in treatment of patients with septic bacterial pneumonia?

A

IV fluoroquinolones plus ampicillin or clindamycin

113
Q

what are the nursing considerations for patients with bacterial pneumonia?

A

oxygen supplementation if hypoxic
fluid therapy

nebulisation to increase mucus fluidity
bronchodilators

114
Q

what is the prognosis for bacterial pneumonia?

A

depends on severity of clinical signs

pneumothorax and abscessation may require lung lobectomy

115
Q

what happens to the lungs during pneumothorax?

A

gradual collapse of the lungs, increase in intrathoracic pressure (becoming positive)

116
Q

what are the cardiac effects of pneumothorax?

A

decreased cardiac output

cardiac arrest

117
Q

what is the clinical presentation of a pleural space disease?

A

tachypnoea
restrictive dyspnoea
paradoxical breathing

118
Q

what happens to the lung sounds in an animal with pleural effusion?

A

muffled lung sounds ventrally

decreased resonance ventrally

119
Q

what happens to the lung sounds in an animal with pneumothroax?

A

absent lung sounds dorsally

increased resonance dorsally

120
Q

what are the signs that an animal is in respiratory distress?

A

orthopnoea

restrictive dyspnoea

mouth-breathing + respiratory noises

tachy/hyperpnoea

cyanosis

121
Q

how is pleural space disease diagnosed?

A

chest radiographs
thoracic ultrasound
thoracocentesis with fluid analysis

122
Q

what will be seen on a chest radiograph of a patient with pleural space disease?

A

decreased details
reduced cardiac silhouette
rounded lung margins

123
Q

what types of analysis should be done on the pleural fluid?

A

cytology (EDTA tube)
culture (plain tube)
biochemistry (plain tube)

124
Q

what is a thoracocentesis?

A

aspiration of air/fluid from the pleural cavity by inserting a needle/catheter/drain via a caudal rib space

125
Q

where is a thoracocentesis performed?

A

around the level of the 7-8th rib space

126
Q

which aspect of the rib should a thoracocentesis be performed on?

A

cranial aspect - caudal has nerves/blood vessels

127
Q

what is pure transudate?

A

protein-poor, clear fluid

TP <20g/L

128
Q

what is modified transudate?

A

yellow, blood-tinged fluid
protein rich

TP >20g/L

129
Q

what is exudate?

A

turbid fluid

TP >20g/L

130
Q

why might an animal have a pure transudate effusion?

A

Hypoalbuminaemia

due to liver failure, protein-losing enteropathy/nephropathy

131
Q

why might an animal have a modified transudate effusion?

A

congestive heart failure
pericardial disease
neoplasia
diaphragmatic rupture

132
Q

what types of cells are present in non-septic exudate?

A

neutrophils
macrophages
eosinophils
lymphocytes

133
Q

why might an animal have non-septic exudate?

A 
FIP 
neoplasia 
diaphragmatic hernia 
lung lobe torsion 
resolving pyothorax
134
Q

what types of cells are present in septic exudate (pyothorax)?

A

degenerate neutrophils

possibly intra/extracellular bacteria (anaerobic, foul-smelling)

135
Q

what are the possible causes of pyothorax?

A

bite
foreign bodies
iatrogenic
parapneumonic

136
Q

what is chyle?

A

fluid with milky appearance, TP >25g/L

mainly small lymphocytes and triglycerides

137
Q

what are the causes of chylothorax?

A 
idiopathic 
cardiac disease (cats) 
cranial vena cava thrombosis/mass 
heartworm disease 
neoplasia
138
Q

what is haemothorax?

A

collection of blood-containing fluid in the pleural cavity

139
Q

how much blood needs to be present in the fluid for it to be considered a haemothorax?

A

Hct >20% OR >50% normal patient hct

140
Q

what are the causes of haemothorax?

A 
anticoagulant rodenticide 
coagulopathy 
lung lobe torsion 
trauma 
neoplasia (rib)
141
Q

what are the complications of thoracocentesis?

A

pyothorax or pneumothorax

142
Q

how are pleural effusions treated?

A

thoracocentesis

treatment of underlying cause (e.g. chemo, lobectomy for torsion or diaphragmatic rupture)

143
Q

how is pyothorax treated?

A

IV antibiotics (de-escalation if possible)
therapeutic drainage +/- lavage
surgery

144
Q

how is chylothorax treated?

A

management of underlying disease
Rutin
surgery for idiopathic causes
may heal spontaneously (traumatic rupture)

145
Q

what are the causes of pneumothorax?

A

trauma
spontaneously (blebs, bullae, chronic airway disease)
iatrogenic

146
Q

how does pneumothorax appear on auscultation?

A

no lung sounds audible on dorsal aspect

hyper-resonant percussion

147
Q

how is pneumothorax diagnosed?

A

radiography (heart does not sit against ribs ventrally)

ultrasound

148
Q

how is pneumothorax treated?

A

rest

thoracocentesis as required/chest drain

oxygen therapy

may require exploratory thoracotomy if recurrent

149
Q

what are the nursing considerations for pneumothorax?

A

delay diagnostics until stable

stress = death, consider sedation

obtain SpO2, supplement oxygen

cover any obvious chest wounds

prepare for thoracocentesis

150
Q

what are the roles of the vet nurse during pleural disease cases?

A

chest drain care

oxygen and fluid therapy

observation and monitoring

medication (inc. analgesia)

shock treatment

recumbent patient care

feeding and exercise adjustments

CVNT2 (47 decks)

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