Effusions and Ascites

Question 1

Causes of pericardial effusions

Answer 1

• Idiopathic
• Neoplastic (haemangiosarcoma, lymphosarcoma)
• Left atrial rupture
• Hypoproteinemia
• Haemorrhage
• CHF

Question 2

pathophysiology of pericardial effsion

Answer 2

Pericardial effusion

Compresses right heart

Decreases filling : right sided CHF

Decrease CO

Forward Failure

Question 3

Pericardial effusion

• presenting signs
• physical findings
• DDX
• Diagnostics
• Treatment

Answer 3

Presenting signs:

• Exercise intolerance
• Lethargy
• Abdominal distension
• Weakness

Physical findings:
-Poor cardiac output
         Pallor
         Prolonged capillary refill time
         Weak pulse
         Tachycardia
-Right sided congestive heart failure
          Jugular distension
          Ascites
          Hepatomegaly
-Pulsus paradoxus – weaker pulse during inspiration
-heart sounds are muffled by fluid 

DDX = DCM

Diagnostics:

• radiograph: rounding of cardiac silhouette
• ECG: small QRS complex, different heights (swings in fluid)
• echo: compressed RHS (RA) due to fluid

Treatment:

• pericardicentesis
• pericariectomy if reoccurs

Question 4

Pleural effusions

• types
• treatment

Answer 4

Transudates
Modified transudates
Exudates
Haemorrhage
Chylous effusions

Diagnosis/Treatment: thoracocentesis

Question 5

Abdominal effusions causes

• Dog
• Cat

Answer 5

Dog:
-Liver diseases: Chronic hepatopathies
-Cardiac diseases
        Pericardial effusions
        Dilated cardiomyopathy 
        Mitral valve diseases
        Pulmonic stenosis
        Dirofilaria
-Neoplastic diseases
        Haemangiosarcoma
        Various others
-Hypoalbuminaemia
        Protein losing enteropathy
        Protein losing nephropathy

Cat:
-Infectious diseases
          Feline infectious peritonitis
-Neoplastic diseases
          Abdominal carcinomas
-Liver diseases
           Chronic hepatopathies
- Heart diseases
           Cardiomyopathy
-Hypoalbuminaemia
           Protein losing enteropathy
           Protein losing nephropathy

Question 6

Abdominal effusions:

• signs
• clinical exam
• diagnostics
• tests

Answer 6

signs:

• abdominal distension
• tachypnoea/dyspnoea
• abdominal fluid

Clinical exam
-RHS CHF (jugular distension, murmurs, arrhythmias)

Diagnostics:
-radiographys: thoracic-cardiomegaly & distension of caudal vena cava

Tests:
-Haematology
	Infection
-Biochemistry
	Protein levels
	Renal function
	Hepatic function
-Urine analysis
	Protein: creatinine ratio

Question 7

Abdominal effusions

-types and their make up and causes

Answer 7

Transudate: clear, non viscous fluid (low protein, low cells)
-mainly mesothelial cells
-neutrophils and lymphocytes
causes:
-Hypoalbuminaemia
          PLN, PLE, liver disease
-Pre-sinusoidal obstruction
          Portal hypertension
          Hepatic fibrosis
-Early bladder rupture
         Fluid is high in urea and creatinine

Modified Transudate: clear/straw coloured, non-viscous fluid (high protein, low cells)
-predominantly mesothelial cells
-few neutrophils and lymphocytes
causes:
-Altered vascular permeability
          Chronic transudates
          Some tumours
-Altered hydrostatic pressure
          Congestive heart failure
           Sinusoidal and post - sinusoidal obstruction
           Budd-Chiari like syndrome

Exudate: straw-coloured, purulent, viscous fluid (high protein, high cells)
-reactive mesothelial cells
-many neutrophils
causes:
-Non-septic
        Feline Infectious Peritonitis (FIP)
        Ruptured gall bladder
        Rupture urinary bladder
        Severe accumulations of neutrophils = pseudochylous
-Septic
        Bacterial peritonitis 
        Rupture of abdominal viscera
        Surgery
        Nocardiosis

Question 8

Neoplastic effusions

Answer 8

Sero-haemorrhagic: Carcinomas
Chylous: Lymphoma
Pseudochylous: Necrotic tumours
Haemorrhagic: Haemangiosarcoma

Question 9

Dirofilaria Immitis

• dog CS
• cat CS
• haematology
• diagnostics
• tests
• dog treatment
• cat treatment

Answer 9

dogs CS:

• Cough
• Exercise intolerance
• Dyspnoea
• Syncope
• Hepatomegaly
• Ascites
• Death

Cat CS:

• Sudden death
• Vomiting
• Coughing
• Dyspnoea
• Lethargy
• Anorexia
• Weight loss
• Chylothorax

Haematology:

• eosinophilia
• neutrophilia
• basophilia
• anaemia
• lymphopenia

Radiography: RHS cardiomegaly, interstitial changes in lung fields
US: may see worms in RV

Tests:

• bloods smear
• antibody test
• antigen test
• knotts/filter test

Treatment:
DOGS
-Thiacetarsamide sodium
-Melarsomine dihydrochloride
-surgical removal
-avermectins
-milbemycine oxime
CATS
-avermectins
-mylbemycine oxime
-Diethylcarbamazine