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Module 15 > Dyspnea in Small Animals: Diagnostic Approach > Flashcards

Dyspnea in Small Animals: Diagnostic Approach Flashcards

1
Q

what are inspiratory causes of dyspnea (6)

A
  1. nasopharyngeal mass
  2. stenosis
  3. foreign bodies
  4. laryngeal paralysis
  5. neoplasia
  6. tracheal mass
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2
Q

what are expiratory causes of dyspnea (3)

A
  1. dynamic airway collapse
  2. feline asthma
  3. pulmonary parenchymal disease (IPF; pneumonia; edema)
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3
Q

how is dyspnea investigated (10)

A
  1. history
  2. clincal features (signlament)
  3. physical exam (with supp oxygen)
  4. thoracic radiography (stable)
  5. thoracic and cardiac ultrasonography
  6. thoracocentesis
  7. blood/fecal tests
  8. rhinoscopy, laryngoscopy, bronchoscopy
  9. FNA of lungs
  10. CT
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4
Q

what are important considerations with history of dyspneic patients (10)

A
  1. acute vs chronic
  2. concurrent signs (cough)
  3. character: inspiratory/expiratory/mixed
  4. duration/frequency/timing
  5. relationship to activities (dust, exercise)
  6. vaccination/travel/worming
  7. respiratory noises; steror/stridor
  8. exercise tolerance/lethargy
  9. appetite
  10. response to prev treatment
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5
Q

what breeds of dogs are prone to tracheal collapse

A

toy breeds

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6
Q

what breeds of dogs are prone to lung fibrosis

A

terriers

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7
Q

what are cats prone to

A

asthma

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8
Q

what breeds of dogs are prone to laryngeal paralysis

A

large dogs

retrievers

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9
Q

what are older dogs prone to that can cause dyspnea

A

neoplasia

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10
Q

what are small breed dogs prone to

A

DMVD

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11
Q

what should be considered during clinical exam of dyspneic dogs (3)

A
  1. avoid excessive stress or struggling
  2. avoid dorsal recumbency for radiographs (esp if pleural disease suspected)
  3. give animal additional oxygen immediately
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12
Q

describe how you would clinically examinate a dyspneic dog (9)

A
  1. mucous membrane colour (pallour, cyanotic)
  2. respiratory rate
  3. resp pattern
  4. resp noises
  5. lymph nodes
  6. palpate cervical area
  7. pulse quality
  8. auscultation of heart and lungs and trachea
  9. percussion
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13
Q

what is dyspnea

A

sensation of difficult or laboured breathing

distress during severe resp disease (assume patient is experiencing discomfort)

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14
Q

what is tachypnea

A

increased resp rate (don’t confuse with panting)

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15
Q

what is orthopnea

A

inability to breath unless in an upright position

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16
Q

what is cyanosis

A

bluish to red-purple colour in the tissues due to increased amounts of deoyxgenated or reduced hemoglobin

arterial SaO2 (73-78%) on pulse oximetry before cyanosis is found with normal hematocrit

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17
Q

what is extrathoracic obstruction during inspiration (3)

A
  1. pharynx (stertor)
  2. laryngeal paralysis (stridor)
  3. tracheal collapse (honk)
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18
Q

what are intrathoracic obstructions during expiration (3)

A
  1. reactive airway disease –> asthma
  2. chronic bronchitis
  3. physical obstruction
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19
Q

how is thoracic percussion

A

percuss both sides of the chest

identify and asymmetry/areas of increased or decreased resonance

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20
Q

how does pleural effusion present with thoracic percussion

A

increased dullness ventrally

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21
Q

if dyspnea is caused by cardiac what will the heart rate and rhythm be

A

tachycardia +/- arrhythmia

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22
Q

what are the heart sounds if dyspnea is caused by cardiac reasons

A

usually murmurs +/- gallops

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23
Q

will there be inspiratory stridor if dyspnea is caused by cardiac reasons

A

not present

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24
Q

what will the response of cyanosis to O2 be if dyspnea is caused by cardiac reasons

A

none if R-L shunt

yes if severe pulmonary edema

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25
Q

if dsypnea is due to cardiac reasons then will the thorax be dull on percussion

A

yes if there is pleural effusion

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26
Q

if dyspnea is caused by respiratory reasons what will be the heart rate and rhythm

A

normal usually

sinus arrhythmia

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27
Q

will the heart sounds be normal if dyspnea is caused by respirtory

A

usually normal

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28
Q

will there be inspiratory stridor if there is resp causes of dyspnea

A

suggestive of URT obstruction

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29
Q

what will the repsonse of cyanosis to O2 if there resp causes

A

improves on O2

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30
Q

will the thorax be dull on percussion if dyspnea is caused by resp reasons

A

pleural effusion or mass

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31
Q

what are pleural space diseases that can cause dyspnea

A
  1. pleural effusion
  2. pneumothorax
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32
Q

what are the causes of pneumothorax (3)

A
  1. trauma
  2. spontaneous: secondary to bulla, necrosis, etc
  3. iatrogenic
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33
Q

what are the treatment of pneumothorax

A
  1. none/rest: minor trauma related tears often heal spontaneously in 2-3 days and need only monitoring
  2. thoracocentesis or thoracostomy tube
  3. surgery: if pneumothorax persists >72 hours; large lacerations and if cannot stabilize with a thoracostomy tube
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34
Q

what are mediastinal diseases that can cause dyspnea (5)

A
  1. masses: neoplasia/lymphadenomegaly/granulomas/brachial cysts
  2. megaesophagus
  3. pneumomediastinum
  4. mediastinitis
  5. mediastinal hemorrhage
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35
Q

what are the most common mediastinal neoplasia masses

A
  1. lymphoma
  2. thymoma
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36
Q

what are the differential diagnosis causes of neoplastic mediastinal masses (3)

A
  1. ectopic thyroid carcinoma
  2. chemodectoma
  3. neuroendocrine
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37
Q

how are mediastinal masses diagnosed

A

fine needle aspiration

flow cytometry may be helpful in distinguishing

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38
Q

what are the types of thymomas

A
  1. invasive
  2. non-invasive
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39
Q

what are the paraneoplastic effects of thymomas

A

hypercalcemia

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40
Q

what are other physical effects of mediastinal masses (6)

A
  1. venous obstruction: cranial vena cava can cause edema
  2. dysphagia: aspiration pnemonia
  3. horner’s sydrome: isruption of a nerve pathway from the brain to the face and eye on one side of the body
  4. hypertrophic osteopathy
  5. myasthenia gravis (thymoma)
  6. other paraneoplastic effect
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41
Q

how do mediastinal masses cause dyspnea (4)

A
  1. pleural effusion
  2. airway compression
  3. space occupying
  4. laryngeal paralysis
42
Q

what is hypertrophic osteopathy

A

unusual paraneoplastic syndrome: pallisades of sub-periosteal new bone on distal limbs (metapodial bones) usually secondary to a thoracic mass

causes limb thickening & lameness

43
Q

what are miscellaneous pulmonary diseases causing dyspnea (8)

A
  1. neoplasia (primary or secondary)
  2. idiopathic pulmonary fibrosis
  3. paraquat poisoning
  4. pneumonia
  5. parasitic
  6. hemorrhage
  7. edema
  8. pulmonary thromboembolism
44
Q

what breed is idiopathic pulmonary fibrosis seen in

A

west highland white terriers

“westies disease”

45
Q

what is the cause of idiopathic pulmonary fibrosis

A

unknown

may be non specific interstitial pneumonitis

46
Q

what is the onset of idiopathic pulmonary fibrosis

A

gradual

progressive deterioration

47
Q

what can idiopathic pulmonary fibrosis be secondary to

A

other resp conditions

48
Q

what are the signs of idiopathic pulmonary fibrosis (6)

A
  1. dyspnea
  2. tachypnea
  3. exercise intolerance
  4. cough (esp if also have CAD)

5. marked crackles on auscultation - very loud

  1. otherwise normal
49
Q

how is idiopathic pulmonary fibrosis diagnosed (3)

A

clinical presentation

imaging

bronchoscopy

50
Q

how is idiopathic pulmonary fibrosis treated (4)

A
  1. anti-inflammatory: glucocorticosteroids (oral or inhaled), mycophenolate
  2. bronchodilators (oral or inhaled)
  3. antibacterial therapy if secondary infection

4. sildenafil (or pimobendan) if pulmonary hypertension: most helpful

51
Q

how do cats present with idiopathic pulmonary fibrosis

A

cough and dyspnea

52
Q

how are cats with idiopathic pulmonary fibrosis treated (3)

A

corticosteroids

sildenafil

bronchodilators

53
Q

what is the prognosis of idiopathic pulmonary fibrosis in cats

A

guarded

more rapidly progressive

54
Q

what is paraquat poisoning

A

herbicide

pneumotoxin

55
Q

what does paraquat poisoning result in (3)

A
  1. severe dyspnea initially with minimal radiographic findings
  2. initial alveolitis
  3. hemorrhagic progresses to severe pulmonary fibrosis
56
Q

what is the prognosis of paraquat poisoning

A

poor

57
Q

what can make paraquat poisoning worse

A

oxygen supplementation

formation of supraoxides in the lungs

58
Q

what are the causes of bacterial pneumonia (2)

A
  1. Bordatella spp
  2. Pasteurella spp
59
Q

when can bacterial pneumonia be caught

A

environmental (spontaneous) or hospital

60
Q

what is the signalment of bacterial pneumonia

A

dogs > cats

younger dogs

61
Q

what does bacterial pneumonia cause

A

venetral lobar alveolar pattern (early and recovery interstitial)

62
Q

what are the predispositions of bacterial pneumonia (4)

A
  1. prolonged recumbency (GA)
  2. foreign body
  3. dysphagia (megaesophagus, orally dosed for medication, feeding)
  4. damage to respiratory defences (CAD)
63
Q

what are the viral causes of pneumonia in cats and dogs

A
  1. canine distemper
  2. canine influenza
  3. feline calcicivirus
64
Q

what are the causes of pneumonia

A
  1. bacterial
  2. viral
  3. parasitic
  4. mycotic
65
Q

how does bacterial pneumonia present on radiograph (4)

A
  1. interstitial pattern early in disease
  2. alveolar pattern: air bronchograms are classical
  3. middle right lung lobe pathology or cranioventral distribution

4. look for foreign bodies, megaesophagus and other thoracic diseases

66
Q

describe the radiographic changes and ddx

A

consolidation of right middle lung lobe

bacterial pneumonia

67
Q

what are the radiographic changes and ddx

A

megaesophagus, depression of trachea

air filled bronchus surrounded by pneumonia lung

bacterial pneumonia

68
Q

how is bacterial pneumonia diagnosed (4)

A
  1. hematology
  2. transtracheal/endotracheal wash and cytology and culture
  3. bronchoscopy with bronchoalveolar lavage and culture and cytology
  4. cytology
69
Q

what are the hematologic signs of bacterial pneumonia (2)

A
  1. left shift neutrophilic leukocytosis
  2. monocytosis if more chronic
70
Q

what is seen on cytology in bacterial pneumonia

A

degenerative neutrophils/monocytes

intracellular bacteria

71
Q

what can bacterial pneumonia result in

A

sepsis which can lead to additional acute lung injury and ARDS (death)

72
Q

how is mild, stable bacterial pneumonia treated

A

amoxycillin-clavunate, trimethoprim-sulfonamide

73
Q

how is moderate and severe bacterial pneumonia treated

A

beta-lactam and fluroquinolone/aminoglycosides

broad coverage: four quadrants gram +, gram -, anaerobes, mycoplasma spp

IV injectable therapy then change to oral once its under control

long term is usually required 4-8 weeks

74
Q

how is bacterial pneumonia managed (3)

A
  1. supplementary O2
  2. nebulization: mobilizes airway secretions (sterile saline + gentamicin) + may need bronchodilator
  3. supportive care: IV, coupage, bronchodilators
75
Q

what are the symptoms of mycotic pneumonia (5)

A

similar for all pneumonias

  1. abnormal resp pattern
  2. tachypnea
  3. cough (pulmonary granulomas)
  4. exercise intolerance
  5. systemic signs: inappetance, weight loss, fever, lameness, lymphadenopathy, chorio-retinitis or anterior uveitis, draining fistula tracts
76
Q

what is the etiology of mycotic pneumonia

A
  1. Blastomycosis
  2. Histoplasmosis
  3. Coccidiomycosis
  4. Aspergillosis
77
Q

what can cause pulmonary edema (7)

A
  1. cardiogenic causes (heart failure)
  2. toxins (bacterial, smoke, paraquat, endogenous)
  3. anaphylaxis/shock
  4. near drowning
  5. neurogenic: seizures, electric shock
  6. over-perfusion(too much IV fluids): hypoalbuminemia
  7. negative pleural pressure in upper airway obstruction
78
Q

how is pulmonary edema treated (3)

A
  1. diuretics
  2. oxygen
  3. specific treatment for underlying cause
79
Q

what are the causes of pulmonary hemorrhage (4)

A
  1. trauma (RTA)
  2. coagulopathies (coumarin rodenticides)
  3. pulmonary thromboembolism
  4. Angiostrongylus vasorum
80
Q

what are the causes of pulmonary thromboembolism (7)

A
  1. heartworm
  2. nephrotic syndrome (loss of antithrombin III)
  3. hyperadrenocorticism
  4. bacterial endocarditis
  5. immune mediated hemolytic anemia
  6. corticosteroid therapy
  7. iatrogenic
81
Q

what are the signs of pulmonary thromboembolisms

A
  1. profound dyspnea/distress
  2. hypoxemia
  3. sudden death
82
Q

how are pulmonary thromboembolisms diagnosed (4)

A
  1. minimal radiographic changes but may have right sided cardiomegaly +/- vascular attenuation or tortuosity
  2. contrast angiography; CT
  3. hematology/coagulation profile
  4. pulmonary hypertension on echo
83
Q

what are the radiographic changes seen

A

inverted D shape: right sided enlargement (RV)

hypovascular lung field

attenuation of caudal lobe pulmonary arteries

84
Q

how is pulmonary thromboembolism treated

A
  1. heparin
  2. aspirin or cloidogrel
  3. sildenafil where PH present
  4. thrombolysis?

treat underlying cause

85
Q

what are airway diseases that cause dyspnea (4)

A
  1. laryngeal paralysis
  2. tracheal collapse
  3. foreign bodies
  4. feline asthma
86
Q

what are the clinical features of feline asthma

A
  1. any age commonly in young to middle aged cats (1-3 yo)
  2. siamese appear predisposed
87
Q

what are the clinical signs of feline asthma (3)

A
  1. variable
  2. chronic or intermittent cough
  3. acute respiratory distress: open mouth breathing, audbile wheezing
88
Q

what are the main differentials for acute dyspnea in cats (7)

A
  1. feline bronchial asthma
  2. congestive heart failure (pleural effusion, pulmonary edema)
  3. lung contusion
  4. pneumonia
  5. hydrothorax or pneumothorax
  6. diaphragmatic and pericardioperitoneal diaphragmatic hernia
  7. upper airway obstruction
89
Q

what are the radiographic changes seen in feline asthma (5)

A
  1. hyperlucency and hyperinflation
  2. flattened diagphragm indicating air-trapping
  3. broncho-interstitial to bronchial patterns
  4. abnormal soft tissue opacities: granulomas, mucoid plugs
  5. erophagia (swallow air)
90
Q

what radiographic changes are seen here

A

patchy infiltrates

feline asthma

91
Q

what radiographic change is seen here

A

gas in stomach due to feline asthma

92
Q

what change is seen here

A

flattened diaphragm

feline asthma

93
Q

what is the changes seen here

A

bronchial pattern

middle lung lobe collapse

air trapping

94
Q

how is feline asthma diagnosed (4)

A

dyspnea

cough

BALF cytology - eosinophilia

radiograph: bronchial pattern, middle lung lobe collapse, air trapping

95
Q

what is the acute treatment of feline asthma

A
  1. oxygen
  2. cage rest
  3. bronchodilator
  4. corticosteroids
96
Q

what bronchodilators used in feline asthma (5)

A
  1. terbutaline
  2. aminophylline

3. salbutamol - inhaled

  1. adrenaline
  2. atropine
97
Q

what corticosteroids are used to treat feline asthma (3)

A
  1. methylprednisolone
  2. dexamethaonse

3. inhaled futicasone

98
Q

what is the long term treatment of feline asthma (5)

A
  1. control environment
  2. control endoparasites (fenbendazole)
  3. bronchodilators (acute or high grade)
  4. antibiotics - doxycycline
  5. corticosteroids (chronic)
99
Q

what long term bronchodilators are used to treat feline asthma

A
  1. salbutamol (albuterol) inhaled
  2. salmeterol (serevent) inhaled
  3. terbutaline: 0.625 mg-1.25 mg per os 12 h
  4. theophylline 20mg/kg per os 24h
100
Q

what long term corticosteroids are used to treat feline asthma

A
  1. prednisolone 0.5mg/kg po q 24 hours for 7-14 days and then taper
  2. futicasone, budesonide, beclomethasone inhaled

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