Dz of the Pulmonary Parenchyma Flashcards
where does gas exchange occur in the lungs?
- alveolar airspaces
- capillary network
- supporting interstitial tissue
what inflammatory or infectious diseases of the parenchyma are there?
- pneumonitis/pneumonia
- eosinophilic bronchopneumopathy
non-cardiogenic pulmonary oedema (part of ARDS) occurs where?
lung parenchyma
What is an idiopathic disease of the lung parenchyma?
pulmonary fibrosis
What is pneumonitis?
Inflammation of the lung
What is pneumonia?
infectious inflammation of the lung
Infectious pneumonia/pneumitis is caused by…
Virus, bacteria, fungi, parasites
Can be hospital or community acq’d
Non-infectious causes of pneumonia/pneumitis include…
aspiration, smoke, allergy
pneumonia/pneumitis can be either focal or…
diffuse
What infecious agents can cause bacterial pneumonia?
- Primary - Bordetella, mycoplasma
- opportunists
- Mixed
What are common origins of bacterial pneumonia?
airways, hematogenous
What are clinical signs of bacterial pneumonia?
- cough - soft & productive
- tachypnea, dyspnea
- pyrexia
- non-specific signs (lethargy, dull, hypo/anorexia)
- restrictive breathing pattern, crackles
- other clinical signs associated w/ underlying cause
How do you diagnose bacterial pneumonia?
- hematology - Leukocytosis
- Rads, CT, U/S
- BAL for cytology & culture +/- mycoplasma PCR
How do you treat bacterial pneumonia?
- Antibiotics - Doxycycline or Amoxi-clav (IV or oral)
- Culture/susceptibility
- nebulisation & coupage
- Avoid anti-tussives, glucocorticoids
Fungal pneumonia is likely caused by what fungi?
- Aspergillus spp.
- Pneumocystis carini
- Histoplasma capsulatum
- Coccidoides immitis
- Bastomyces dermatitiditis
What are 2 common species that cause aspergillosis?
- Aspergillus tereus
- Aspergillus deflectus
What is unique about GSD’s and aspergillosis?
They have a mucosal immunity defect
Pulmonary lesions can commonly also be seen…
on bone, spine, other sites
Clinical signs for aspergillosis depend on…
affected organs
How do you diagnose aspergillosis?
- ID fungal agent
- Cytology & culture: FNA, BAL, urine
- Detection of galactomannan antigens
Pneumocystosis is caused by what organism?
Pneumocystis carini
Pneumocystosis commonly occurs in what breeds?
- dachshund, ckcs
- usually young
- mucosal immunity defect
What clinical signs are present in pneumocystosis?
- severe signs
- pyrexia absent
- similar to pneumonia
How do you diagnose pneumocystosis?
- BAL
- organisms are not easily recovered
- treat for pneumonia w/ no pyrexia
Parasitic Lung Disease has variable signs. What are they?
- exercise intolerance
- cough
How do you diagnose parasitic lung disease?
- fecal parasitology
- BAL
- specific testing
- response to therapy?
What clinical signs occur with Angiostrongylus vasorum infection?
- Direct inflammation of the lungs (C, dyspnea, exercise intolerance)
- Bleeding diathesis (coagulopathy - hyperfibrinolysis, multifactorial)
- Neurological (bleeding in CNS?)
What initial diagnostic tests can be used for diagnosing Angiostrongylus vasorum?
- Hematology (look for eosinophilia, anemia, thrombocytopenia)
- clotting times
- TEG
- rads/CT
How do you make a definitive diagnosis of Angiostrongylus vasorum?
- Modified Fecal (Baermann)
- Angiodetect
- Invasive tests (RARE to perform)
How do you treat Angiostrongylus vasorum?
- Deworming (Fenbendazole, Milbemycin oxime, Moxidectin)
- Plasma transfusion in bleeding dogs
What clinical signs are common with Aelurostrongylus abstrusus infection?
- Asymptomatic
- mild C
- severe - bronchopneumonia, pleural effusion, pneumothorax, death
What diagnostic tests can be used to diagnose Aelurostrongylus abstrusus?
- Rads - miliary interstitial pattern, alveolar pattern if severe
- Definitive parasite ID –> fecal analysis, PCR on BAL
- BAL - eosinophilic, larvae may be present
How do you treat Aelurostrongylus abstrusus?
Txt: Fenbendazole, Milbemycin oxime, Moxidectin
Eosinophilic bronchopneumopathy is due to
eosinophilic infiltrate in the lungs causing an autoimmune infection in dogs
What are clinical signs of eosinophilic bronchopneumopathy?
- Harsh cough
- dyspnea
- tachypnea
- exercise intolerance
- nasal discharge - concomitant eosinophilic rhinitis
- crackles & wheezes
How do you diagnose eosinophilic bronchopneumopathy?
- Signalment (Siberian huskies, Alaskan malamutes, Rotties), often young females
- hematology: +/- eosinophilia
- Imaging: Rads/CT
- bronchoscopy
- BAL
- Absence of parasites or neoplasia –> imaging, fecal, other parasite tests
How do you treat eosinophilic bronchopneumopathy?
- Glucocorticoids (IC, long-term)
- Fenbendazole to exclude parasites
- May need to treat a secondary bacterial infection
Cardiogenic pulmonary oedema causes an increase in…
hydrostatic pressure
Non-cardiogenic pulmonary oedema causes
- increased vascular permeability
- pulmonary vasoconstriction
- less likely: reduced oncotic pressure
ARDS is a complication of…
other systemic dz
ARDS has what prognosis?
Poor
It is an EMERGENCY
What clinical signs are present in ARDS?
- Acute respiratory distress: restrictive breathing pattern, tachypnea, dyspnea
- Crackles - caudodorsal aspect
- Signs of underlying cause
How do you diagnose ARDS?
- Pulmonary oedema (do rads)
- exclude cardiac dz (do echo)
- ID underlying cause (Hx, blood analysis, Dx imaging)
What treatment is required for ARDS?
- supportive txt (Oxygen therapy, positive pressure ventilation, avoid stress - sedate)
- treat underlying condition
- furosemide –> limited benefits
What is the most common primary lung tumour?
Adenocarcinoma
What paraneoplastic signs are present in primary lung tumours?
- +/- hypertrophic osteopathy
- +/- lung-digit syndrome (cats)
Metastatic lung tumours usually consist of…
multiple nodules
The lung tumours are common sites for…
metastasis
What clinical signs are common in metastatic lung tumours?
- weight loss, lethargy, panting, +/- signs related to primary site, C is rare, some asymptomatic
How do you diagnose metastatic lung tumours?
- imaging: rads/ct
- cytology, Bx for Definitive Dx
If there is a primary tumour, how do you treat?
- Sx removal
If there is mets, how do you treat?
- depends on primary tumour
- Sx if a single mass is involved
- Chemo depending on types of neoplasia
Idiopathic pulmonary fibrosis occurs in which breeds most commonly?
Westies
Staffies
What clinical signs are part of idiopathic pulmonary fibrosis?
- advanced dz at diagnosis usually
- slow progression
- exercise intolerance
- cough
- panting
- Dyspnoea
- cyanosis
- Cardiopulmonary auscultation (crackles, R-sided apical systolic murmur leading to pulmonary hypertension)
How do you diagnose idiopathic pulmonary fibrosis?
- Signalment: Westies, Staffies
- Imaging
- BAL
- Echo
- Bx - rarely done
How do you treat idiopathic pulmonary fibrosis?
- Progressive & not curable (symptomatic & complications)
- Prednisone –> suspected concurrent inflammation
- antitussives, bronchodilators (Theophylline)
- Sildenafil (pulmonary hypertension)
- No anti-fibrotic drugs shown to be effective
What is the prognosis of idiopathic pulmonary disease?
Poor, Death w/i 11 months from Dx
