Diseases of The Respiratory System Flashcards
what forms the upper respiratory tract?
from the nose to the thoracic inlet (includes nasal cavity, oral cavity and cervical portion of trachea)
what makes up the lower respiratory tract?
trachea, bronchi, bronchioles and alveoli
define medical condition
abnormality/malfunction of a body system
what can give an idea of potential causes/differential diagnoses of medical conditions?
a through history and clinical exam
what is used to confirm a diagnosis?
diagnostic and labs tests
what can be formulated after a diagnosis is reached?
treatment plan
what is happening during acute respiratory failure?
lungs are unable to oxygenate blood or exchange carbon dioxide
is acute respiratory failure an emergency?
yes - patient will die without intervention
what are some common causes of respiratory failure?
airway obstruction (e.g. BOAS) ruptured diaphragm pulmonary oedema/haemorrhage pneumo/pyo/haemo/chylothorax neoplasia infection toxin ingestion
what is chylothorax?
chest filled with lymphocyte rich fluid
what are the signs of respiratory failure?
cyanosis distress inspiratory dyspnoea expiratory dyspnoea dyspnoea tachypnoea orthopnoea tachycardia weak pulses collapse unconciousness
what type of dyspnoea is associated with upper respiratory tract noises?
inspiratory
what sounds are associated with inspiratory dyspnoea?
snoring
stertor
stridor
what is stridor?
high pitched sound from the larynx
what sounds are associated with expiratory dyspnoea?
wheezes
crackles on auscultation
what is orthopnoea?
position adopted by dogs and cats when they are dyspnoeic
abduction of elbows and extension of neck
how may oxygen be administered to the conscious patient?
flow by nasal catheter nasal prongs face mask oxygen tent oxygen cage or incubator
what may be needed if oxygen is being provided to the conscious patient?
sedation (butorphanol)
how does a nasal catheter provide oxygen?
inserted into the nasal passages and connected to an oxygen supply
what can an oxygen tent be formed from?
cage covered in cling film or buster collar with cling film covering
what must be ensured if creating an oxygen tent?
that there is an escape route for expired gas/heat
how may oxygen be administered to the unconscious patient?
endotracheal intubation
what is ensured by ET tube use?
patent airway
how can you ensure that your patient has a patent airway?
ET tube
head and neck extension
tracheostomy
what is required if a patient has a tracheostomy tube?
constant monitoring
when may a tracheostomy tube be placed?
with profound disease which affects the larynx/pharynx making intubation impossible
what are the key nursing considerations for a patient with acute respiratory failure?
observe and monitor medication (sedation) care of drains patient is likely to recumbent change in environment where possible exercise inhalation therapies feeding barrier nursing
what are the 3 main sections of the respiratory system?
upper respiratory tract
lower respiratory tract
pleural cavity
what are the clinical signs of upper respiratory tract diseases?
nasal discharge (uni/bilateral) sneezing reverse sneezing stertor/snoring systemic or CNS signs
what is reverse sneezing?
rapid inspiration of a large volume of air
how may nasal discharge appear?
serous
mucopurulent
haemorrhagic
what are you looking for in the physical examination of a patient with upper respiratory tract diseases?
listen for noises nasal discharge facial deformity/pain nasal planum depigmentation assess airflow bilaterally assess regional lymph nodes retropulsion of the eyeballs (exophthalmia) look for dental disease look for ophthalmic disease
what are the inflammatory differential diagnoses for nasal disease?
idiopathic
allergic
irritation
what are the main differential diagnoses for nasal disease?
inflammatory infectious neoplastic trauma/fracture foreign body systemic causes misc.
what are the infectious differential diagnoses for nasal disease?
bacterial (secondary)
virus
fungal
parasitic
how can nasal disease be investigated without GA?
routine bloods
tests for bleeding disorders
serology for fungal diseases
viral testing in cats
what tests are available for bleeding disorders?
platelet count
PT/APTT
what investigations of nasal disease may be performed under anaesthesia?
full oral exam
dental probing
nasopharyngeal swab in cats
what imaging techniques may be used to investigate nasal disease?
x rays
CT scan of the head
endoscopy
what x-ray views are most helpful when assessing nasal disease?
intra-oral nasal views
where should endoscopic investigation of the nasal cavity be started with?
retrograde view of the nasopharynx
what is nasal flush useful for?
both diagnosis and therapy
what must be done when performing a nasal flush?
pack pharynx appropriately
how can nasal biopsy be performed?
blind or endoscopic
why must you be careful when performing nasal biopsy?
ensure that biopsy is taken of the nasal cavity and not the brain (due to degeneration of cribriform plate)
why should you check coagulation times before you perform a nasal biopsy?
the nasal cavity is highly vascular and so bleeding is likely
what are the nursing considerations associated with rhinoscopy?
nose will bleed alot
be prepared
biopsy will often be needed
consider topical agents
what level of anaesthesia is required for rhinoscopy?
requires GA
local blocks LA/IV
what can be done to aid slowing of bleeding that occurs during rhinoscopy?
ice packs on the nose
intranasal adrenaline
- both to lead to vasoconstriction
what are the key elements of nursing care for nasal disease?
treat dyspnoea first if present try and stop haemorrhage remove foreign object if present monitor food/fluid intake correct and adequate nutrition removal of dried nasal discharge grooming decongestant therapy isolate if infection suspected
how can nasal haemorrhage be stopped?
ice packs, pressure and adrenaline soaked swabs
what is sino-nasal aspergillosis most commonly caused by in dogs?
Aspergillus fumigatus
what dogs are predisposed to aspergillosis?
meso/dolichocephalic breeds
what is the effect of aflatoxins produced by aspergillosis on the nasal cavity?
profound inflammatory response
extensive turbinate and bone destruction
what can aspergillosis be secondary to?
tumor or foreign body
what is sino-orbital aspergillosis in cats due to?
Aspergillis felis
what cat breeds are predisposed to aspergillosis?
brachycephalic breeds
what are the common clinical signs of aspergillosis?
mucopurulent nasal discharge or epistaxis (uni/bilateral)
sneezing
nasal pain
nasal depigmentation
what are the uncommon clinical signs of aspergillosis?
stertor
facial deformity
CNS signs
how can aspergillosis be diagnosed?
challenging! serology PCR imaging rhinoscopy cytology histopathology fungal culture
how can rhinoscopy aid diagnosis of aspergillosis?
visualisation of plaque
what imaging modalities may be used for diagnosis of aspergillosis?
radiography
MRI
CT
what is shown on MRI or CT images of a patient with aspergillosis?
turbinate destruction
increased soft tissue opacity
increased soft tissue density in frontal sinuses
when is trephination required to treat aspergillosis?
if frontal sinuses only involved
what is trephination?
catheters inserted into frontal sinus
how is aspergillosis treated?
mechanical debridement endoscopically
topical antifungal
oral itraconazole (not generally effective)
refurral needed
when should topical antifungal not be used to treat aspergillosis?
if cribriform plate is not intact as the brain is exposed
what is the preferred treatment method for aspergillosis?
trephination and flushing with saline followed by clotrimazole flush and instillation of clotrimazole cream
are repeated aspergillosis treatments required?
often yes
what are BOAS conditions the result of?
poor breeding and body confirmation in dogs with short noses
what breeds is BOAS common in?
french bulldogs
english bulldogs
pugs
what is BOAS?
brachyocephalic obstructive airway syndrome
what are the primary abnormalities found in animals with BOAS?
excessive soft tissues in skin and airways
stenotic nares
elongated/thick soft palette
hypoplastic trachea
are BOAS associated congenital defects normal presentations?
no - severely compromise quality of life
why is an elongated soft palette problematic in brachycephalic dogs?
soft palate passes epiglottis and can block airway
what secondary problems can be caused by BOAS?
respiratory and digestive issues
what is the main digestive issue caused by BOAS?
hiatal hernia leading to regurgitation
what is the main secondary respiratory issue caused by BOAS?
laryngeal collapse
how do patients compensate for BOAS issues?
pull harder on inspiration which creates negative pressure in the throat, neck and chest leading to secondary respiratory and digestive problems
what are the presenting signs of BOAS syndrome?
load breathing exercise intolerance sleep deprivation gagging regurgitation vomiting
how is BOAS diagnosed?
physical exam and owner history exam under sedation fluroscopy/barium swallow CT of head rhinoscopy chest x-rays CT scan
what are the key elements of nursing care involved with BOAS patients?
owner education discourage ownership/breeding keep calm and stress free avoid excessive heat often require surgery use harness instead of collar to prevent breathing difficulties
what are the main causes of laryngeal paralysis?
congenital
trauma
nerve infiltration
in what type of dog does laryngeal paralysis often occur?
older, large breed dog
why is it thought that laryngeal paralysis occurs in older dogs?
decline in nerve function
how does laryngeal paralysis present?
exercise intolerance
soft, ineffectual cough
inspiratory stridor
may present as an emergancy
how is laryngeal paralysis diagnosed?
laryngeal exam under sedation/GA
what are the main nursing considerations for laryngeal paralysis?
keep animal calm - sedate avoid collar/anything around neck keep animal cool provide oxygen as long as it doesnt cause stress provide steroids may require surgical intervention
what should patients with laryngeal paralysis be monitored for?
aspiration pneumonia
dysphagia
megaoesophagus
why may laryngeal paralysis patients be given steroids?
to reduce laryngeal oedema
in what types of animal is tracheal collapse seen?
small / toy breeds
whereabouts on the trachea does tracheal collapse most often occur?
any part possible but most often at thoracic inlet
what appears to predispose patients to tracheal collapse?
obesity
what is the key sign of tracheal collapse?
goose honking cough
how is tracheal collapse diagnosed?
physical exam
x-ray / fluoroscopy
how does x-ray / fluoroscopy aid tracheal collapse diagnosis?
shows tracheal positioning
what are the key nursing considerations associated with tracheal collapse?
sedation (butorphanol) provide medication cage rest exercise restriction harness only - no collar oxygen therapy possibly intubate if acute
what are the long term changes needed for a patient with tracheal collapse?
weight loss
surgery with possible stent
what medication may be given to a patient with tracheal collapse?
antitussive
corticosteroids
bronchodilators
why is intubation risky in patients with tracheal collapse?
will lead to further inflammation which may worsen condition
define cough
sudden expiratory effort against a closed glottis - results in sudden noisy expulsion of air from lungs
define dyspnoea
difficulty breathing, increased respiratory effort
define tachypnoea
increased rate of breathing
define hyperpnoea
increased respiratory effort without dyspnoea
define orthopnoea
adapting posture to facilitate breathing - often sit or stand with elbows abducted and neck extended
what is a key sign of lower respiratory tract disease?
cough
what is the aim of a cough?
protective reflex to clear excess secretions / foreign material
where are the majority of cough receptors located?
in large airways
where are fewer cough receptors located?
nose, sinuses, pharynx and pleura
what is detected in the respiratory tract by mechanical receptors?
mucous
foreign body
what is detected in the respiratory tract by chemical receptors?
acid
heat
what nerves form the afferent pathway of the cough reflex?
sensory vagus nerve
where is the cough centre located in the brain?
medulla oblongata
what nerves make up the efferent cough reflex pathway?
vagus, phrenic and spinal motor nerves
what muscles are supplied by efferent cough reflex pathways?
diaphragm
abdominal wall
what is cough associated with aside from LRT disease?
congestive heart failure
why is a cough associated with congestive heart failure?
due to enlarged right atrium
what effect does oedema have on the respiratory system?
more tachypnoea
what are the main harmful effects of a cough?
exacerbate airway inflammation and irritation
emphysema
pneumothorax
weakness and exhaustion of respiratory muscle
dissemination of infections
what are the signs of lower respiratory tract disease?
cough tachypnoea dyspnoea exercise intolerance weakness cyanosis syncope
when diagnosing a patient with LRT disease what should be assessed first?
patient - are they getting enough oxygen and how can stress be reduced
what must be considered when trying to reduce stress in respiratory patients?
offering sedation
calm environment
what must be done with a LRT patient following triage?
stabilise (e.g. oxygen tent)
what should be observed about the patient with suspected LRT disease?
posture
rate and rhythm of breathing
what must be observed about the LRT patients respiratory rate and rhythm?
is there inspiratory or expiratory effort / both
shallow or labored breathing
when observing a LRT patient from a distance what are you looking for?
URT noise (e.g. stertor/stridor) wheezing
when should thoracic auscultation only take place?
when patient is stable
when auscultating the chest what are you listening for?
crackles wheezes HR and rhythm heart murmur muffled or lack of heart sounds
what are you listening for while percussing the chest?
increased or decreased resonance
what investigations may be performed on a patient to diagnose LRT disease?
clinical pathology assessment of oxygenation laryngeal exam imaging of chest assessment of pleural space disease advanced techniques
what test can be used for lungworm?
faecal smear
how does a faecal smear for lungworm work?
faeces are suspended in water and viewed under the microscope to check for worms
how can a patients oxygenation be assessed?
pulse oximetry (SpO2) arterial blood gas analysis (PaO2)
what is being assessed when performing laryngeal exam?
structure of larynx (any masses/collapse) function (any paralysis)
when is a laryngeal exam performed?
under GA
what are you looking for when performing radiography of the chest?
pulmonary patterns (bronchial, alveolar, interstitial)
heart and vessels appearance
masses
pleural space
when may a CT scan of the thorax be used?
more sensitive so can show things not seen on x ray
when may an ultrasound be used to assess LRT disease?
looking for thoracic mass
T-FAST for thoracic fluid
what is bronchoscopy used for?
collection of brochoalveolar lavage
view of lower airways
foreign body removal
what must cats be pre-treated with before bronchoscopy?
terbutaline
what can samples collected through BAL be used for?
cytology
culture
PCR
what can be performed if no bronchoscope available?
blind BAL and tracheal wash
what equipment is needed for bronchoscopy?
endoscope sterile saline in syringes collection pots for BAL mouth gag (or can go through ET tube) urinary catheter emergency box/induction agent
what are the key nursing considerations associated with bronchoscopy?
requires several people
needs to be quick
react fast if things go wrong as they can quite quickly
coupage will be required
monitor patient carefully until fully recovered
easy access to emergency drugs / oxygen
thoracocentesis may be required
what is coupage?
pressing on left and right sides of chest
what is the most common cause of coughs in dogs?
canine chronic bronchitus
what is canine chronic bronchitis?
chronic bronchial inflammation with over secretion of mucous
in what age of dog is canine chronic bronchitis common?
middle aged to older
what co-morbidities are seen with canine chronic bronchitis?
tracheal / bronchial collapse
mitral valve disease
pulmonary hypertension
what are the initial predisposing factors to canine chronic bronchitis?
history of kennel cough
environmental irritants or allergens
parasites
what happens during canine chronic bronchitis?
smaller airways become obstructed by mucous
alteration of the mucocilliary escalator
inflammation of the lower airways
what does obstruction of smaller airways by mucous during canine chronic bronchitis lead to?
progressive narrowing of airway
what causes an alteration in the mucociliary escalator during canine chronic bronchitis?
due to narrowing of airway this is less effective
what may patients become prone to is the mucociliary escalator is damaged?
concurrent bacterial infections
what does inflammation of the lower airways during canine chronic bronchitis lead to?
narrowing of the lower airways
what is bronchomalacia?
weakened cartilage of bronchi
what is bronchiectasis?
extreme dilation of bronchi - end stage change
what are the clinical signs of canine chronic bronchitis seen on exam?
chronic cough (>2 months) - often productive
+/- dyspnoea and tachypnoea
+/- gagging and retching
+/- pyrexia if concurrent pneumonia
what are the clinical signs of canine chronic bronchitis seen on thoracic auscultation?
wheezes
+/- crackles if concurrent pneumonia / emphysema
when investigating canine chronic bronchitis what are you looking for on x ray or CT scan?
bronchial pattern (doughnuts or tramlines) possible interstitial pattern (net curtain)
what may be seen in healthy older dogs on x ray?
mild broncho-interstitial pattern
what are you looking for when examining a dog with suspected canine chronic bronchitis with bronchoscopy?
mucosal erythema
excessive mucous
what is mucosal erythema?
redness of MM
what will be found on BAL of a patient with canine chronic bronchitis?
mucous
neutrophils
+/- bacteria
what is suggested if eosinophils are found during BAL of a patient with canine chronic bronchitis?
underlying bacterial disease
what are the nursing management considerations of a patient with canine chronic bronchitis?
weight control to reduce fat in chest cavity
harness only
avoid tobacco smoke, dust and airway irritants
what medication is needed to treat canine chronic bronchitis?
lowest possible does glucocorticoids bronchodilators antibiotics if required antitussives mucolytics
what are glucocorticoids used for in the treatment of canine chronic bronchitis?
anti-inflammatory
what bronchodilators are used to treat canine chronic bronchitis?
theophylline
why may antibiotic be required when treating canine chronic bronchitis?
concurrent bacterial infection
when would antimicrobials be indicated in canine chronic bronchitis patients?
depends on BAL and severity of signs
what is the main antimicrobial used to treat canine chronic bronchitis?
Doxycycline
what is essential to remember when giving doxycycline?
must be given with food or water as can cause oesophageal stricture
how long are animals with canine chronic bronchitis treated with Doxycycline if needed?
7-10 days
what should happen if there is a positive response to Doxycycline treatment after 7-10 days?
continue for an additional 7 days past resolution of clinical signs
what drugs may be given to canine chronic bronchitis patients via inhaled therapy?
corticosteroids and bronchodiator
is inhaled therapy recommended for antimicrobials?
no
when should inhaled therapy for canine chronic bronchitis patients begin?
once clinically stabilised or if mild signs
what is the prognosis for patients with canine chronic bronchitis?
chronic and progressive condition
can live for years if managed
when is prognosis of canine chronic bronchitis worse?
if bronchiectasis or bacterial pneumonia due to degeneration of mucociliary escalator
what diseases may e seen concurrently with canine chronic bronchitis?
mitral valve disease and/or pulmonary hypertension
what is canine infectious tracheobronchitis also known as?
kennel cough
what is the cause of canine infectious tracheobronchitis?
a complex of several viruses, bacteria and other microorganisms
what are the main viruses that cause canine infectious tracheobronchitis?
canine adenovirus 2
canine parainfluenza virus
canine herpes virus
what is the main bacterial causal agent of canine infectious tracheobronchitis?
Bordatella bronchiseptica
when do most cases of canine infectious tracheobronchitis resolve?
within 14-21 days
what must be done if canine infectious tracheobronchitis is suspected?
animal should be kept away from other animals as disease is highly contagious
wait in the car rather than waiting room
how is canine infectious tracheobronchitis treated?
anti-biotic/anti inflammatory treatment
cough suppressants may be used
what can prevent canine infectious tracheobronchitis?
client education and vaccination protocol
what diseases are on the spectrum of feline lower airway disease?
feline asthma and feline bronchitis
what occurs during feline lower airway disease?
chronic bronchial inflmmation (neutrophillic and eosinophillic) with mucous hypersecretion
in what cats is feline lower airway disease most often seen?
young/middle aged cats
siamese seem over represented
what is the difference between cats and dogs in terms of LRT disease?
cats will present with bronchoconstriction - emergancy
what is bronchoconstriction?
severe sudden narrowing of airways
what are the initial predisposing factors of feline lower airway disease?
bacteria viruses parasites irritants allergens
what is the cause of feline lower airway disease?
type 1 hypersensitivity
what happens during a type 1 hypersensitivity reaction?
histamine and seratonin produced by mast cells which leads to smooth muscle contraction, oedema and eosinophillic inflammation of the lower airways and mucous hypersecretion
what is the effect of type 1 hypersensitivity mediated smooth muscle contraction?
bronchodilation
what do all the effects of type one hypersensitivity reaction in the lungs lead to?
obstruction of bronchus
what immunoglobulin mediates type 1 hypersensitivity?
IgE
what are the signs of feline lower airway disease?
wide spectrum (none - asthmatic crisis) cough dyspnoea tachypnoea open mouth breathing cyanosis
what will be found on thoracic auscultation of a patient with feline lower airway disease?
wheezes
+/- crackles if emphysema
+/- dull lung sounds if pneumothorax
what may be found on the chest x ray/CT scan of a feline lower airway disease patient?
generalised bronchial pattern with possible interstitial or alveolar patterns overinflated lungs flattened diaphragm possible pneumothorax may be normal!
what are the risks associated with bronchoscopy in cats?
can cause bronchoconstriction
what can be given the night and morning before bronchoscopy to cats to reduce bronchoconstriction risk?
SC terbutaline
what are you looking for during bronchoscopy of a patient with feline lower airway disease?
inflammation
mucous
airway narrowing
what can you test BAL sample for in feline lower airway disease patients?
cytology - mucous and inflammatory cells (neutrophils and eosinophils)
PCR - Bordetella bronchiseptica and Mycoplasma spp
faecal parasitology or PCR - Aelurostrongylus
culture
how should the emergency feline lower airway disease patient be treated?
stress free supplement O2 use bronchodilators corticosteroids sedation
what corticosteroids may be used in acutely ill feline lower airway disease patients?
dexmethasone
what is the issue with using dexmethasone?
can impact subsequent cytology samples (balance risk vs reward)
what bronchodilator may be used to treat acute feline lower airway disease?
terbutaline
what is the main management involved in treating feline lower airway disease?
dust free litter
no smoking
reduce use of aerosols
what medication may be given to treat feline lower airway disease?
lowest effective dose glucocorticoids
bronchodilators
Doxycycline if Mycoplasma infection
Fenbendazole if parasitic infection
what is not recommended for treatment of feline lower airway disease?
nebulization - may lead to bronchoconstriction
what may inhaled therapy be used for in treatment of feline lower airway disease?
corticosteroids and bronchodilator
what is inhaled therapy not recommended for when treating feline lower airway disease?
antimicrobials
when should inhaled therapy be given to feline lower airway disease patients?
once clinically stabilised or mild signs
what is the prognosis of feline lower airway disease?
variable
good if chronic, acute can be fatal
what are the main groups of pulmonary parasites?
intestinal worms with pulmonary migration
lung worms
heart worms causing respiratory signs
what are the main worms that have pulmonary migration before the adult reaches the gut?
Toxocara
Ancylostoma
what are the main species of heartworms that cause respiratory signs?
Angiostrongylus vasorum
what is Angiostrongylus vasorum also known as?
french heartworm
how is Angiostrongylus vasorum infection caused?
by eating intermediate host (mollusk) or paratenic host (frog)
what larvae stage of Angiostrongylus vasorum travel to pulmonary vasculature from the intestines?
L3
where do adult Angiostrongylus vasorum worms live?
pulmonary arteries and right side of the heart
what happens to larvae of Angiostrongylus vasorum worms in the lungs?
migrate to alveoli and are coughed and swallowed
what are the clinical signs of Angiostrongylus vasorum?
wide range
respiratory disease
increased bleeding tendency
neurologic signs
what are the main signs of respiratory disease resulting from Angiostrongylus vasorum?
inflammatory response - chronic cough and acute dyspnoea
severe pulmonary hypertension - syncope, abnormal right ventricular structure and function
what is the most common sign of Angiostrongylus vasorum?
chronic cough
what is increased bleeding tendency seen with Angiostrongylus vasorum infection caused by?
unknown mechanism - may be consumptive coagulopathy
what are the neurological signs of Angiostrongylus vasorum caused by?
CNS haemorrhage
what would be seen on the chest x ray/CT scan of a patient with Angiostrongylus vasorum?
combination of patchy bronchial, interstitial and alveolar patterns
peripheral distribution of defects
no vascular changes
how can Angiostrongylus vasorum be diagnosed?
Angio-detect - antigen detection PCR faecal smear Baermann faecal examination empirical treatment (e.g. advocate) for clinical improvement
what does a positive Angio Detect result indicate?
Angiostrongylus vasorum
what does a negative Angio Detect result indicate?
A. vasorum is very unlikely but another lungworm is possible
how can Angiostrongylus vasorum be treated?
Moxidectin - 2 doses, 30 days apart
Fenbendazole - SID for 10-20 days
what post treatment reaction may be seen after treatment for Angiostrongylus vasorum?
dyspnoea
ascites
sudden death
what is the prognosis of Angiostrongylus vasorum?
depends on severity of clinical signs
what is bacterial pneumonia caused by?
mixed flora - aerobic and anaerobic
how may bacterial pneumonia be spread?
inhaled bacteria haematogenous spread (blood vessels)
what lobes of the lung may be affected by bacterial pneumonia?
may be unilobar or multilobar
what are the 2 presentations of bacterial pneumonia?
acute and chronic
what is bacterial pneumonia associated with?
abscess
pleural effusion
pneumothorax
why are there predisposing causes for bacterial pneumonia?
should not occur if the mucociliary escalator is working
what are the predisposing causes of bacterial pneumonia?
chronic bronchitis bronchiectasis immunosuppression foreign body aspiration
what may be caused by aspiration?
bacterial pneumonia
chemical pneumonitis
what is chemical pneumonitis?
burning of the airways by stomach acid
what often causes aspiration pneumonia?
brachycephalic breeds
oesophageal disease
laryngeal disease
what are the respiratory signs of bacterial pneumonia?
soft and productive cough mixed dyspnoea tachypnoea exercise intolerance crackles or wheezes on auscultation
what is mixed dyspnoea?
inspiratory and expiratory signs
what are the systemic signs of bacterial pneumonia?
pyrexia
lethargy
inappetance
does normothermia exclude bacterial pneumonia?
no
what investigations will be performed to diagnose bacterial pneumonia?
haematology
C reactive protein
SpO2 or arterial blood gas
chest x rays / CT
what signs are you looking for in haematology tests for bacterial pneumonia?
neutrophillia (left shift)
neutropenia
what is C reactive protein useful for when testing for bacterial pneumonia?
monitoring
at what SpO2 or PaO2 is the patient classed as hypoxic?
<94%
<80mmHg
what signs are you looking for in x ray or CT scans for bacterial pneumonia?
alveolar pattern with ventral distribution
dorso-caudal distribution (haematogenous spread)
interstitial pattern - early pneumonia
when may x rays for bacterial pneumonia be repeated?
48-72 hours later
what should you wait for if prescribing antibiotics?
culture result if possible
what is the empirical treatment for bacterial pneumonia?
PO doxycycline
what is the treatment for aspiration pneumonia?
no antibiotics if chemical pneumonitis
IV amoxycillin-clavulanic acid
what is the treatment for bacterial pneumonia where the patient is also septic?
IV fluroquinolones and ampicillin or clindamycin
de-escalate if possible
how long should bacterial pneumonia patients be treated wirth antibiotics for?
10-14 days and reassess (clinical exam, haematology and chest x rays)
what are the main nursing considerations during treatment of bacterial pneumonia?
oxygen supplementation if hypoxic fluid therapy nebulisation to increase mucous fluidity bronchodilatiors mucolytic? treatment of predisposing factors
what effect can dehydration have on mucocilliary defences?
impairment
what are the issues with using mucolytics?
some may cause bronchoconstriction (e.g. nebulisation of N-acetylcysteine)
what is the prognosis of bacterial pneumonia?
depends on severity of clinical signs
what may be required if the bacterial pneumonia patient has pneumothorax and abscessation?
lung lobectomy
what is required to keep lungs inflated?
negative intrathoracic pressure
what type of defect is a pleural effusion?
restrictive
what does pleural effusion lead to?
gradual collapse of the lungs and and increase in intrathoracic pressure which becomes positive
what will lead to immediate relief of pleural effusion?
removal o fluid
what may be seen secondary to active inflammation / pneumothorax?
pleural effusion (trapped lung)
what happens if pneumothorax is left untreated?
decreased cardiac output cardiac arrest (esp. pneumothorax)
what is the clinical presentation of pleural space diseases?
tachypnoea
restrictive dyspnoea
paradoxical breathing
what is restrictive dyspnoea?
rapid and shallow breathing
what diseases is restrictive dyspnoea only seen with?
pleural space diseases
what are the specific signs on auscultation from pleural effusion?
muffled lung sounds ventrally
decreased resonance ventrally
what are the specific signs associated with pneumothorax?
absent lung sounds dorsally
increased resonance dorsally
why are pleural effusion signs seen ventrally?
gravity pulls fluid down
why are pneumothorax signs seen ventrally?
air collects at highest point
what are the signs of respiratory distress?
orthopnoea (body position) mouth breathing tachypnoea/hyperpnoea respiratory noises cyanosis restrictive dyspnoea
what is inspiratory dyspnoea linked to?
upper airway obstruction (increased respiratory noises)
what is expiratory dyspnoea linked to?
dynamic lower airway obstruction (abnormal auscultation)
what is mixed dyspnoea linked to?
parenchymal disease
what is mixed dyspnoea with restrictive pattern linked to?
pleural space disease
how serious are pleural space diseases?
life threatening
how are pleural cavity diseases diagnosed?
chest radiographs if the patient is stable
thoracic ultrasound if not
thoracocentesis
fluid analysis
what may be seen on a chest radiograph which indicates pleural cavity diseases?
decreased details
cardiac silhouette is hard to see
what are the signs of chronic pleural effusion on chest x ray?
rounded lung margins
what are the tubes needed for analysis of fluid from the thoracocentesis?
EDTA tube for cytology
plain tube for culture and biochemistry
what is thoracocentesis?
aspiration of air or fluid from the pleural cavity by inserting a needle, catheter or drain via a caudal rib space
what area should be prepared for thoracocentesis?
around the 8th rib
what needle is usually required for thoracocentesis?
butterfly or simular
how should the area of skin be prepared for thoracocentesis?
clipped and aseptically prepped
what equipment is required for thoracocentesis?
needle 3 way tap extension set if needed sterile drapes sterile gloves surgical spirit LA blade if needed measuring drug if effusion
where should the needle for thoracentisis be placed?
cranial aspect of the rib
why shouldn’t the needle be placed on the caudal aspect of ribs during thoraentesis?
nerves and blood vessels on caudal side
when may a thoracic drain be placed?
if there is a large effusion present
how should thoracic drains be cared for?
aseptic
good hand hygiene - sterile equipment
how should thoracic drains be dressed?
sterile dressing, stocking and buster collar to prevent patient interference
what can be understood by analysing the fluid from thoracocentesis?
why the fluid accumulated
what are the 4 types of fluid that can be collected from thoracentesis?
pure transudate
modified transudate
exudate
miscellaneous
describe pure transudate
protein poor
clear fluid
what is the total protein of pure transudate?
<20 g/L
what is the total nucleated cell count of pure transudate?
<1.5x10^9
describe modified transudate
protein rich
yellow blood tinged fluid
what is the total protein of modified transudate?
> 20g/L
what is the total nucleated cell count of pure transudate?
<5x10^9/L
describe exudate
turbid fluid
what condition is associated with pure transudate?
hypoalbuminaemia
what are the main causes of hypoalbuminaemia?
liver failure
protein loosing enteropathy
protein loosing neuropathy
what diseases can lead to modified transudate within pleural fluid?
congestive heart failure
pericardial disease
neoplasia
diaphragmatic rupture
in what animals is modified transudate often found in pleural fluid during CHF?
cats
what cardiac marker may be used to detect cardiac related pleural effusion in cats?
NT pro-BNP
what can diagnose neoplasia from thoracentesis?
cytology of sample
what are the 2 types of exudate?
non-septic
septic
what cells will be seen in non-septic exudate?
neutrophils
marcophages
eosinophils
lymphocytes
is there any evidence of organisms in non-septic exudate?
no
what are the causes of non-septic exudate?
FIP neoplasia diaphragmatic hernia lung lobe torsion resolving pyothorax
what are the levels of TP and globulin seen in patients with FIP?
high total protein in effusion
high globulins in blood
what cells are seen in septic exudate?
degenerate neutrophils
what is the cause of septic exudate?
pyothorax
what bacteria may been seen in septic exudate?
intra or extracellular bacteria
anaerobic (foul smelling)
how is sepsis treated?
IVFT
antibiotics
what are the causes of septic exudate?
bite
foreign body
iatrogenic (thoracentesis)
parapneumonic
describe the appearance of chylothorax?
milky
what is the TP of chylothorax?
> 25 g/L
describe the total nucleated cell count of chylothorax
variable - small lymphocytes but may be some neutrophils id ongoing inflammation
is the triglyceride in chylothorax effusion higher or lower than plasma?
higher
what are the causes of chylothorax?
idiopathic cardiac disease cranial vena cava thrombosis/mass heartworm disease neoplasia
what is the haematocrit of haemothorax?
> 20%
or >50% of patient haematocrit
what does haemothorax lead to?
hypovolaemia
what are the causes of haemothorax?
anticoagulant rodenticide coagulopathy lung lobe torsion trauma neoplasia (rib)
what are the complications of thoracocentesis?
particularly with chronic effusion
pyothorax
pneumothorax
how are pleural effusions diagnosed and treated?
thoracocentesis (with drain)
treatment of underlying disease
how is lung neoplasia treated?
depends on tumor type - chemo or surgery
how is lung lobe torsion treated?
lobectomy
in what animals is lung lobe torsion the most common?
narrow, deep chested dogs
also reported in pugs
what may lung lobe torsion occur secondary to?
other causes of effusion
how is diaphragmatic rupture treated?
surgrey
how is pyothorax treated?
IV fluroquinolone and penacillin or clindamycin
de-escalate antimicrobials where possible
therapeutic drain
lavage if drain present
surgery
how is chylothorax treated?
manage underlying disease
Rutin to stiulate macrophages to remove lipids from effusion
surgery if idiopathic
spontaneous heal if traumatic rupture of thoracic duct
what surgery is used to treat chylothorax?
thoracic duct ligation
+/- pericardiectomy
what is pneumothorax?
accumulation of air in the pleural space
what are the causes of pneumothorax?
trauma
spontaneous
iatrogenic
what are the spontaneous causes of pneumothorax?
blebs and bullae
chronic airway disease (asthma in cats)
what are blebs and bullae?
blistered lesions of the lungs
what are the signs of pneumothorax seen on physical exam?
no lung sounds audible on dorsal aspect
hyper-resonant percussion
how is pneumothorax diagnosed?
radiography
ultrasound
how is pneumothorax treated?
rest thoracocentesis as required chest drain (rapid accumulation) O2 therapy continuous drainage and exploratory thoracotomy may be required
what are the main nursing considerations associated with pneumothorax?
delay diagnostics until stable low stress SpO2 monitoring supplement O2 if hypoxaemia (<95%) consider sedation if needed thoracocentesis prep (e.g. clipping) cover any obvious chest wounds to prevent entry of air
what is the role of the VN in caring for pleural space disease patients?
chest drain care O2 therapy obs and monitoring medication including analgesia care of wounds and drains fluid therapy shock treatment recumbent patient care feeding and exercise adjustments
describe how to perform thoracocentesis
7th to 8th intercostal space
costochondral junction for fluid, higher for air
enter chest cranial to rib then redirect caudally
what are the 2 main functions of the liver?
synthesis
clearance / detoxification
what is synthesised in the liver?
proteins (albumin, globulin, clotting factors)
glucose
cholesterol
what substances are cleared or detoxified by the liver?
encephalopathic toxins
bilirubin
bile acids
enterically absorbed drugs
what does the liver convert ammonia to?
urea
what do encephalopathic toxins do to the body?
affect brain function
what effect will liver dysfunction have on synthesis?
reduction in production of normal substances
what is the effect of reduced hepatic function on clearance and detoxification?
failure to clear toxins from the body
what are the clinical signs of hepatic dysfunction?
variable - a combination of: inappetance lethargy vomiting diarrhoea jaundice ascites hepatic synthetic failure hepatic detoxification failure
what are the signs of hepatic synthetic failure?
reduction in proteins, carbohydrates, fats and clotting factors
what are the signs of hepatic detoxification failure?
hepatic encepalopathy
persistent drug activity
what is icterus?
jaundice
what is jaundice?
yellow discoloration
when can hyperbilirubinaemia be detected?
> 10 umol/L
when is tissue deposition of bile pigment visible?
> 40 umol/L
is jaundice generally harmful?
no
what is jaundice a marker of?
possible hepatic disease
what is the overarching cause of jaundice?
failure of routine clearence or bilirubin
what are the 3 main causes of jaundice?
pre-hepatic
hepatic
post hepatic
what is the reason for pre-hepatic jaundice?
too much bilirubin produced for the liver to break down - usually due to haemolysis
what is the cause of hepatic jaundice?
liver is failing to breakdown bilirubin due to failure of uptake, conjugation or transport
what are the post hepatic causes of jaundice?
issues with bile flow
failure of excretion of bile (through the gall bladder to duodenum)
cholestatic disease
biliary rupture
what is ascites?
watery (low protein, low cellularity) fluid accumulation in the abdomen
what are the reasons for ascites?
hypoalbuminaemia
portal hypertension
sodium and water retention
what is happening during portal hypertension?
damaged liver has reduced compliance and increased resistance to flow which causes blood to back up into portal vein
