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Clinical Respiratory > Dz of the Pulmonary Artery & the Pleural Space > Flashcards

Dz of the Pulmonary Artery & the Pleural Space Flashcards

1
Q

Pulmonary Hypertension occurs if

A

> 30 mm Hg

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2
Q

Mild hypertension is considered…

A

30-55 mmHg

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3
Q

Moderate hypertension is considered

A

56-79 mmHg

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4
Q

Severe pulmonary hypertension is considered when…

A

> 80 mmHg

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5
Q

Explain the pathogenesis of pulmonary hypertension.

A
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6
Q

What are the 6 main groups used to classify pulmonary hypertension?

A
  • Arterial dz (idiopathic pulm hypertension, congenital L-R shunts)
  • L Heart dz (L-sided valvular heart dz, L-sided cardiomyopathy)
  • Resp Dz/Hypoxia (chronic obstructive pulm dz, interstitial lund dz, alveolar hypoventilation disorders)
  • Pulmonary thromboembolism (pulm thromboembolism, neoplasia)
  • Parasitic (Dirofilaria, Angiostrongylus)
  • Multifactorial
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7
Q

What are clinical signs of pulmonary hypertension?

A
  • secondary to underlying dz
  • secondary to pulmonary hypertension –> resp distress, exercise intolerance
  • heart sounds (+/- tricuspid murmur or split S2)
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8
Q

What clinical findings are secondary to and strongly suggestive of pulmonary hypertension?

A
  • syncope w/o any other identifiable cause
  • respiratory distress at rest
  • activity or exercise terminating in respiratory distress
  • R-sided heart failure - cardiogenic ascites
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9
Q

What clinical findings are secondary to and possibly suggestive of pulmonary hypertension?

A
  • tachypnea at rest
  • increased respiratory effort at rest
  • prolonged exercise or post-activity tachypnea
  • cyanotic or pale MMs
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10
Q

How does an echocardiogram help diagnose pulmonary hypertension?

A
  • Looks for tricuspid regurgitation to estimate systolic pressure
  • Pulmonic regurgitation to estimate diastolic pressure
  • modified bernoulli equation +/- RV remodeling
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11
Q

What additional tests can be used to diagnose pulmonary hypertension?

A
  • Rads/CT
  • Haematology & biochemistry
  • Heartworm/F. Heartworm
  • Bronchoscopy
  • BAL
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12
Q

What txt is there for pulmonary hypertension?

A
  • exercise restriction
  • treat underlying cause
  • phosphodiesterase inhibitor - Sildenafil
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13
Q

Pulmonary thromboembolism is the obstruction of…

A

pulmonary vessel (s) by a blood clot

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14
Q

Explain Virchow’s Triad and how it relates to pulmonary thromboembolism.

A
  • Endothelial injury: Neoplasia, sepsis, indwelling venous catheters, pancreatitis, other inflammatory diseases
  • Hypercoagulability: protein-losing nephropathy, protein-losing enteropathy, hyperadrenocorticism, dirofilariasis, IMHA
  • Abnormal blood flow: cardiac dz, trauma w/ crush injury, neoplasia
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15
Q

What clinical signs may occur with pulmonary thromboembolism?

A

Acute on initial presentation, dyspnoea, tachypnea, lethargy, C, haemoptysis, cyanosis, death

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16
Q

Clinical signs are dependent upon…

A

degree of thrombosis
underlying cause

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17
Q

What tests could you do to diagnose pulmonary thromboembolism?

A
  • Blood gas analysis
  • Rads
  • PT/PTT
  • TEG
  • D-dimers
  • CT
  • Echo
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18
Q

Txt is critical for pulmonary thromboembolisms because…

A

it has a high mortality rate because p will continue to throw clots around the body, including to critical organs

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19
Q

What txt should be used for supportive txt of pulmonary thromboembolism?

A
  • Oxygen therapy
  • pulmonary hypertension –> Sildenafil
  • Bronchodilators –> Methylxanthines
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20
Q

What drugs are used to prevent further thrombus?

A

Anticoagulants - Clopidogrel, LMWH

Thrombolytic agents are not recommended because o the risk of bleeding

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21
Q

Where do the adult stages of Dirofilaria immitis live?

A

Heart & pulmonary artery

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22
Q

Adult worms of Dirofilaria immitis cause…

A

inflammation, vascular dysfxn, pulmonary hypertension, pulmonary thromboembolism

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23
Q

What is Wolbachia?

A

A symbiotic bacteria with Dirofilaria immitis

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24
Q

Describe the clinical signs for Dirofilaria immitis in mild, moderate, severe, and caval syndrome cases.

A
  • Mild: Asymptomatic or C
  • Moderate: C, exercise intolerance, abnormal lung sounds
  • Severe: C, exercise intolerance, dyspnea, abnormal heart & lung sounds, hepatomegaly, syncope, ascites, death
  • Caval syndrome: Sudden onset of severe lethargy & weakness accompanied by hemoglobinemia & hemoglobinuria
25
Q

How would you diagnose Dirofilaria immitis infection with bloods?

A

Antigen, Mod Knott or Filtration test, Antibody test

26
Q

What are the pros/cons of the bloods tests for heartworm?

A
  • Antigen: For female adults only, False + rare, False - if low burden/ male only/ immature females/ antigen-antibody complexes
  • Mod Knott or Filtration Test: For microfilaria, 20% of afilaremic dogs which is higher if preventative txt given
  • Antibody test: only confirm exposure, 85% sensitivity, mostly for cats
27
Q

What further diagnostic tests could be used to assist with diagnosing Dirofilaria immitis and what would you expect to find on those tests if positive?

A
  • Rads: look for enlarged tortuous pulmonary vessels, parenchymal changes, R-heart enlargement
  • Echo: worms, remodelling, pulmonary hypertension
28
Q

Adjunct Txt has a risk of complications during adulticide txt in Dirofilaria infection. What is it?

A

Dead worm reaction which can lead to pulmonary embolism and inflammation

29
Q

How do you minimise the risk of the dead worm rxn in Adjunct txt of Dirofilaria infection?

A

Minimise risk by strict rest and glucocorticoids to reduce clinical signs

30
Q

Prior to Adulticide txt of Dirofilaria immitis, what should be administered and why?

A
  • Macrocytic lactones as a filaricide
  • Doxycycline for Wolbachia bacterial infection & release from the worms
31
Q

Explain adulticide treatment of Dirofilaria.

A
  • Melarsomine on Day 60, 90, and 91 after adjunct txt.
  • Strict rest for 6-8 wks following last Melarsomine
  • Glucocorticoids to reduce clinical signs
  • Retest with antigen test 9 months after treatment
  • Sx removal if heavy burdens or caval syndrome
32
Q

You live an an endemic area for Dirofilaria immitis. How should you prevent infection with this worm in your dog?

A
  • Macrocytic lactones (Ivermection, Selamectin, Moxidectin, Milbemycin oxime) q 30 days, 12 months/yr, starting from 8 wks of age and perform annual testing
33
Q

Macrocytic lactones kill what stages of Dirofilaria immitis?

A

Microfilaria, 3rd & 4th stage larvae

34
Q

Explain Dirofilaria immitis in cats

A
  • often low worm burden
  • 1/3 single sex population
  • signs relate to the arrival of worms in the pulmonary vessels or death of worms
  • Prevent the same way as dogs
  • Dx: Antibody test
  • Txt: Prednisolone, No Melarsomine
34
Q

What is pleural effusion?

A

build-up of fluid btw layers of tissue that line lungs & chest cavity

35
Q

Transudate pleural effusion is…

A

pure or modified

36
Q

exudate pleural effusion is…

A

septic or aseptic

37
Q

What are clinical signs of pleural effusion dependent on?

A
  • rate of accumulation
  • volume
  • type of fluid
  • cause
  • concurrent dz
38
Q

What are clinical signs of pleural effusion?

A

tachypnea, dyspnea, cyanosis, open-mouth breathing
restrictive breathing pattern, dull lung sounds in ventral thx, dull percussion

39
Q

What is the initial mgmt of pleural effusion?

A
  • minimise stress –> mild sedation (butorphanol)
  • oxygen
  • ultrasound & thoracocentesis (Dx & therapeutic)
40
Q

How would you analyse fluid from pleural effusion?

A

Macroscopic eval: Blood (coag test, trauma, neoplasia), white & opaque (chylothx), others: transudate or exudate

41
Q

Pure transudate from pleural effusion would have what cytological findings?

A

macrophages, mesothelial cells, non-degenerate neuts

42
Q

Modified transudate from pleural effusion would have what findings on cytology?

A

macrophages, mesothelial cells, & increasing numbers of lymphocytes, & non-degenerate neuts

43
Q

What would non-septic exudate from pleural effusion have on cytology?

A

neutrophils & macrophages

44
Q

What would septic exudate from pleural effusion have on cytology?

A

degenerate neutrophils, intracellular & extracellular bacteria, macrophages

45
Q

Decreased oncotic pressure with a pure transudate in pleural effusion means…

A

Hypoalbiminemia (protein-losing nephropathy/enteropathy, liver failure, etc)

46
Q

Increased hydrostatic pressure from modified transudate in pleural effusion means…

A

congestive heart failure, pulmonary thromboembolism, lung lobe torsion, neoplasia

47
Q

Increased vascular permeability in exudate from pleural effusion is a sign of…

A

systemic inflammation, local infection (pyothx), systemic infection, neoplasia

48
Q

What further tests can be used to diagnose pleural effusion?

A

ultrasound & -centesis
fluid analysis
blood tests (hematology, biochemistry, coagulation testing)
Rads, Echo CT

49
Q

How would you treat pleural effusion?

A
  • drainage
  • treat underlying dz
50
Q

What is pyothorax and what is it typically caused by?

A

Infection of pleural space
Causes: FB, perforating wound, pneumonia, translocation

51
Q

How do you treat pyothorax?

A
  • drain placement +/- lavage
  • antibiotics, empirical or based on C&S
  • Supportive care
  • +/- Sx
52
Q

What is chylothorax and what is it often caused by?

A

Build up of chyle
Causes: idiopathic, R-sided heart failure, neoplasia/mass, thromboembolism, lung lobe torsion

53
Q

how would you medically manage chylothorax?

A

Thoracocentesis
Meds: Rutin, Octreotide (EH…)
Diet: low-fat
spontaneous resolution may occur

54
Q

When would you do surgical management of chylothorax? And what options for procedures are open to you?

A
  • In idiopathic dz
  • Thx duct ligation, subtotal pericardiectomy, pleuroperitoneal shunting, pleurodesis
55
Q

What is Pneumothorax? What often causes it?

A

Air build up
Causes: trauma (open or closed), iatrogenic, spontaneous (idiopathic, bulla, pneumonia)

56
Q

How might you diagnose pneumothorax?

A

Imaging: rads, ultrasound (EMERGENCY), CT

57
Q

What are the two types pneumothorax that you need to be able to differentiate?

A

Tension vs non-tension

58
Q

What txt is used for pneumothorax?

A

drainage, sx, pleurodesis

Clinical Respiratory (7 decks)

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