Disorders of the respiratory system Flashcards
What groups can respiratory disorders be split into and what are they associated with?
- Upper respiratory tract = associated with inspiratory dyspnoea and an externally audible noise
- Lower respiratory tract = associated with expiratory dyspnoea and wheeze generally audible on thoracic auscultation
- Extrapulmonary disease
What are the components of the upper respiratory tract?
- Nasal cavity
- Pharynx
- Larynx
- Trachea
What are some clinical signs associated with nasal disease?
- Sneezing
- Snorting
- Facial swelling
- Facial rubbing
- Dyspnoea
- Nasal discharge
What could nasal discharge possible look like?
- Serous
- Mucoid
- Mucopurulent (green)
- Bloody
What are some possible causes for nasal disease?
- Viral/bacterial/fungal
- Allergies
- Neoplasia
- Ethmoid haematoma
- FB
- Polyp/cysts
- Trauma
- Coagulopathy
- Dental disease
- Sinusitis
- Dacryocystitis (infection of the nasolacrimal sac)
What diagnostics can be done for a patient with suspected nasal disease?
- History and clinical examination
- Blood tests (haematology, biochemistry, clotting profile)
- Imaging (X-rays/CT/MRI/Rhinoscopy/Endoscopy)
- Bacteria and fungal culture
- Nasal flush for cytology
- Biopsy and histopathology
What treatment and nursing care can be done for a patient with nasal disease?
Dependent on cause
- Barrier nurse and isolate (if infectious)
- Monitor vitals and clinical signs including comfort
- Cleaning/grooming including nasal orifices (apply vaseline)
- Assist with feeding
- Humidifier may be required
- Medication under VS direction (ABs for bacterial infections and antifungals for fungal infections)
- Assist with surgical procedure/removing FB
What are some common causes of laryngeal disease?
- Persistant barking
- Respiratory tract infections
- Paralysis of arytenoid cartilage
What are some clinical signs of laryngeal disease?
- Change in vocal ability
- Coughing/gagging
- Stridor (audible whistling noise) on inspiration
- Exercise intolerance
- Cyanosis
- Hyperthermia
- Dyspnoea (often with paradoxical abdominal movement)
What diagnostics can be done for a patient with suspected laryngeal disease?
- History
- Clinical examination
- Endoscopy
What stabilisation and management his required for a patient with laryngeal disease?
- O2 therapy
- Sedation and rest (reduce stress and inspiratory effort)
- Cooling
- Tracheostomy (severe cases)
- Hobday in mild cases
- Tie-back in severe cases
- Swap collar for harness
What is epiglottic entrapment?
Aryepiglottic folds become abnormal and envelopes the apex and lateral margins of the epiglottis
What clinical signs may be seen with epiglottic entrapment?
- Stridor (audible whistling noise) on inspiration
- Dyspnoea
- Coughing
- Cyanosis
What diagnostics can be done for a patient with suspected epiglottic entrapment?
- History
- Endoscopy
What stabilisation and management is required for a patient with epiglottic entrapment?
- Surgical correction
- Systemic anti-inflammatories
- ABs
What does the lower respiratory tract consist of?
- Bronchi
- Bronochioles
- Alveoli
Orthopnoea
dyspnoea or shortness of breathing in lateral recumbency (usually improves in sternal recumbency)
What is acute respiratory disease?
- Interruption or failure of normal respiratory function
- Reduced O2 to the circulation
- Increased CO2
What are some possible causes of acute respiratory disease?
- Trauma (ruptured diaphragm and flail chest)
- Pneomothorax/haemothorax/pyothorax/chylothorax (lymphatic fluid build up in thorax)
- Neoplasia
- Obstruction (FBV/tracheal collapse)
- Infections
- Pulmonary oedema
- Pulmonary haemorrhage
- Paraquat poisoning (plantkiller)
- Gastric torsion
What clinical signs are associated acute respiratory disease?
- Tachypnoea/dyspnoea/orthopnoea
- Mouth breeding
- Cyanosis
- Tachycardia
- Collapse
What treatment and nursing care can be done for a patient with acute respiratory disease?
- Inform VS and set up O2
- Keep patient calm and in quiet area
- Minimal restraint
- Replace collar with harness
- Support in sternal if recumbent
- Have crash box ready
- Monitor closely
What is flail chest?
Destabilisation of a portion of the ribs (often multiple)
What clinical signs are associated with flail chest?
- Tachypnoea/dyspnoea
- Thoracic pain
- Paradoxical inward displacement during inhalation and outward displacement during exhalation
- Sub-cut emphysema
- Hypoxaemia
What diagnostics can be done for a patient with suspected flail chest?
- Usually visually obvious
- Radiograph to confirm nature of the ribs
What stabilisation and management is required for a patient with flail chest?
- O2 support
- Analgesia
- Sensible positioning
- Bandage chest to reduce movement of the segment
- Surgery (only with penetrating wound)
What is chronic pulmonary disease?
Associated with a narrowed bronchial lumen
What are some possible causes chronic pulmonary disease?
- Bronchial inflammation with oedema and hyperaemia of bronchial mucosa
- Bronchospasm
- Bronchomalacia
- Mucous accumulation
- Acute anaphylactic reaction (uncommon)
- Infection
- FB
- Trauma
- Collapsed lung
- Tumour
What specific diseases are related to chronic pulmonary disease?
- Asthma
- Chronic bronchitis
- Pneumonia
- Pulmonary haemorrhage
- Pulmonary oedema (eg cardiac failure)
- Lungworm
- Neoplasia
What clinical signs are associated with chronic pulmonary disease?
- Coughing
- Wheezing
- Tachypnoea
- Exercise intolerance
- Lethargy
What diagnostics can be done for a patient with suspected chronic pulmonary disease?
- Thoracic X-rays (bronchial or bronchointerstitial pattern on X-rays, pulmonary hyperinflation and a flattened diaphragm)
- Lower airway cytology (eosinophilic inflammation >17% eosinophils for feline asthma, neutrophilic inflammation evident for chronic bronchitis)
- Heartworm test (ideally both antigen and antibody test)
- Baermann faecal test
What management and nursing care is required for a patient with chronic pulmonary disease?
- Bronchodilators, corticosteroids, potential parasite control
- O2 support
- Rest/avoid stress
- Monitor vitals
- Medication under VS direction
What clinical signs are associated with BOAS?
- Stertor
- Stridor
- Exercise intolerance/collapse
- Cyanosis
- Syncope
- Gastro-oesophageal reflux/vomiting/regurgitation
What diagnostics can be done for a patient with suspected BOAS?
- Observe clinical signs
- Breed disposition
- Examination of upper airway under GA
What stabilisation and management is required for a patient with BOAS?
- O2 support
- Sedation to reduce stress and inspiratory effort
- Cooling
- Tracheostomy in severe cases
- Surgical correction of anatomy in severe cases
What is tracheal disease?
- Cartilaginous rings are abnormal or degenerate
- Usually seen in small-breed dogs
What clinical signs are associated with tracheal disease?
- Cough like a goose-honk and dyspnoea with stress or excitement
- Cyanosis
- Collapse
What diagnostics can be done for a patient with suspected tracheal disease?
- Clinical history and exam
- Clinical signs
- Thoracic x-rays
- Tracheal endoscope
- Tracheal wash
What treatment and nursing care can be done for a patient with tracheal disease?
- O2 support
- Intubation if emergency (risk further irritation)
- Quiet environment
- Long term weight management
- Restrict exercise
- Avoid dry, smokey and dusty atmospheres
- Tracheal stent placed (specialist)
- Swap collar for harness
What is a tracheotomy?
- Temporary or permanent procedure
- Most often used as a life-saving procedure in an emergency situation to bypass an upper airway obstruction
- Done under GA or sedation and local anaesthetic
- Area below larynx on ventral midline neck is clipped and prepared
- Incision made along midline and between the rings of the trachea
- Tube inserted and secured in place
What is a tracheotomy?
- Temporary or permanent procedure
- Most often used as a life-saving procedure in an emergency situation to bypass an upper airway obstruction
- Done under GA or sedation and local anaesthetic
- Area below larynx on ventral midline neck is clipped and prepared
- Incision made along midline and between the rings of the trachea
- Tube inserted and secured in place
What is the reason for performing a bronchoalveolar lavage (BAL)?
- Investigate coughing and suspected bronchial or alveolar disease
- Obtain sample for cytology and bacteriology from lower airways
What equipment is required for a bronco alveolar lavage (BAL)?
- Bronchoalveolar lavage catheter or a soft urinary catheter
- Syringes (5-30ml)
- Warm sterile saline
- Sample pots (EDTA for cytology and plain for culture)
- Microscope slides for smears of any monoid material present
How is a tracheal wash performed?
- Using an endoscope
- Long narrow sterile tube passed through the endoscope lumen
- Sterile water flushed through into the trachea
- Sucked back into the syringe
- Sample sent for cytology and bacteriology
What equipment is required for a thoracocentesis?
- Sedation (if necessary)
- Ultrasound
- Clippers
- Cotton wool/swabs and skin disinfectant
- Local anaesthetic
- Sterile gloves
- Blade (number 15)
- IV catheter (butterfly catheter for cats)
- Extension set
- 3-way tap
- Syringe
- Bowl
- Sample pots (EDTA and plain for culture)
What is required for a chest drain and how is it performed?
- Use of a fenestrated drain and a trocar
- Insertion can be carried out under GA or local
- Skin incision made between 9th and 12th ribs and a subcutaneous tunnel made to the level off the 7th/8th intercostal space
- Drain is pushed through the intercostal muscles
- Once in place needs to be secured and sealed
- Mechanical suction can be applied as necessary to drain the thorax
