Exam 2 - Pulmonary Parenchymal Disease Flashcards
what are some differentials for canine eosinophilic airway/pulmonary disease?
allergic bronchitis/eosinophilic bronchopneumopathy
parasites/heartworms
fungal
rarely neoplasia
what are the anatomic components that are commonly affected in pulmonary parenchymal disease?
alveoli. interstitium, & sometimes pulmonary vasculature
what was eosinophilic bronchopneumopathy formerly called?
pulmonary infiltrate with eosinophils
what is included in the syndrome of idiopathic eosinophilic lung disease?
allergic bronchitis
eosinophilic bronchopneumopathy
eosinophilic granulomatosis - intraluminal mass lesions
what is the underlying cause of eosinophilic bronchopneumopathy?
unknown
how is eosinophilic bronchopneumopathy characterized?
eosinophilic infiltration of lung & bronchial mucosa
what are the common clinical signs associated with eosinophilic bronchopneumopathy?
cough, exercise intolerance, tachypnea, & dyspnea
less commonly - nasal discharge & systemic signs such as lethargy & inappetance
what may owners mistake eosinophilic bronchopneumopathy for?
gagging/retching problem
what dogs are typically affected by eosinophilic bronchopneumopathy?
wide age range, but often young adult dogs
are signs of eosinophilic bronchopneumopathy often progressive or static?
progressive
T/F: in animals with eosinophilic bronchopneumopathy, 50% of cases will have a peripheral eosinophilia
true
what may be seen on thoracic radiographs on a dog with suspected eosinophilic bronchopneumopathy?
bronchointerstitial pattern, diffuse interstitial pattern, patchy alveolar pattern, & rare nodular pattern
how is eosinophilic bronchopneumopathy diagnosed?
cytology & excluding other differentials
what may be heard on auscultation of a patient with suspected eosinophilic bronchopneumopathy?
normal or may have crackles
T/F: radiographic changes associated with eosinophilic bronchopneumopathy are often more severe in pattern when compared to chronic bronchitits
true
T/F: eosinophilic bronchopneumopathy is a diagnosis of exclusion
true
what diagnostics may be run when trying to rule out eosinophilic bronchopneumopathy?
fecal float, baermann test, culture of airway wash fluid, heartworm test, histoplasma antigen EIA test
what is the general treatment used when treating eosinophilic bronchopneumopathy?
prednisone 1mg/kg PO every 12 hours for 2 weeks then tapered off over 3 months
what medication is avoided when treating eosinophilic bronchopneumopathy?
cough suppressants
what is the prognosis of eosinophilic bronchopneumopathy dependent on?
severity of the disease
T/F: many patients with eosinophilic bronchopneumopathy may require lifelong therapy
true
what are 4 host defenses against bacterial pneumonia?
- nasoturbinate filtration
- protective airway reflexes (sneezing, coughing, bronchoconstriction)
- mucociliary clearance
- phagocytosis & killing by macrophages
what are some common causes of aspiration pneumonia?
vomiting, swallowing disorder, regurgitation, or iatrogenic causes
what are the main ways bacterial pneumonia occurs?
hematogenous or secondary
what are some rare funguses that can cause fungal pneumonia?
cryptococcus, aspergillus, & sporothrix
what are some common fungal causes of fungal pneumonia?
histo, blasto, & coccidioides
what is a causative organism of protozoal pneumonia?
toxoplasmosis
what are some organisms that commonly cause viral pneumonia?
kennel cough, distemper, FIP, & rare calicivirus
what are some organisms that commonly cause parasitic infections leading to pneumonia?
heart worms, lung worms, & aberrant migration
what is bacterial bronchitis?
infection is limited to airways & peribronchial tissues
what is bronchopneumonia?
infection of airways, peribronchial tissue, & lung
what is hematogenous pneumonia?
infection that spreads to the lungs via the bloodstream
what is aspiration pneumonia?
infectious and/or chemical pneumonia resulting from aspiration of material into the lungs
about 1/2 of the cases of bacterial pneumonia seen in puppies are caused by what agent? what other 2 agents are also common?
bordetella bronchiseptica
streptococcus species & mycoplasma
what are some examples of underlying causes of bacterial pneumonia?
kennel cough, bronchiectasis, foreign material, neoplasia, or ciliary dyskinesis
what are the common clinical signs seen with bacterial pneumonia?
soft cough, purulent nasal discharge, tachypnea/dyspnea, crackles on auscultation, & sometimes fever
SIRS may occur
what diagnostic test is commonly used when bacterial pneumonia is suspected?
transtracheal wash - run cytology
what is the classic distribution of hematogenous pneumonia?
caudodorsal - increased blood flow to these lung lobes
hematogenously-borne pneumonia typically involves what?
alveolar infiltrates
what may be seen on cytology with a hematogenous pneumonia?
neutrophils, may be degenerate
bacteria found in <50% of samples
what additional diagnostic should be run in suspected cases of hematogenous pneumonia?
culture & susceptibility testing
what is the treatment used for hematogenous pneumonia?
supportive therapy based off of severity of symptoms, & antibiotics for 1-2 weeks beyond clinical & radiographic remission
what are some common causes of bacterial pneumonia from immune dysfunction?
congenital immunodeficiency disorders
FeLV/FIV
primary ciliary dyskinesis
what causes aspiration pneumonia?
inhalation of liquid or solid material into the lungs
aspiration pneumonia may lead to what other 2 pneumonias?
bacterial and/or chemical
why can aspirated gastric contents be problematic?
the acid causes tissue necrosis, edema, & hemorrhage
what pattern is almost pathognomic for aspiration pneumonia?
cranioventral distribution
T/F: bronchoconstriction can occur as a result of aspiration pneumonia
true
what are the clinical signs associated with aspiration pneumonia?
acute severe signs
may be coughing/systemically sick
crackles may be heard upon auscultation
how is aspiration pneumonia diagnosed?
usually presumptive based on radiographic changes
when may radiographic changes be seen in patients with aspiration pneumonia?
24-48 hours after the event
if the patient is stable, what diagnostic test may be used?
tracheal wash - help guide antibiotic therapy
what should be apart of your evaluation when looking for a cause of aspiration pneumonia?
history of vomiting, seizures, regurgitation
neurological problems
esophagus problems
T/F: bronchoscopy is used for diagnosing aspiration pneumonia
false - usually avoided
what are some examples of a systemic neuromuscular disorders causing aspiration?
myasthenia gravis, polyneuropathy
what are some examples of a iatrogenic mechanisms causing aspiration?
force-feeding or misplaced feeding tube
what are some examples of decreased mentation causing aspiration?
post-anesthesia/sedation
post-seizure
CNS disease
metabolic disease
what are some examples of oropharyngeal disorders causing aspiration?
cricopharyngeal dyssynchrony
pharyngeal mass
BOAS
what are some examples of laryngeal disorders causing aspiration?
laryngeal paralysis & laryngoplasty
what are some examples of esophageal disorders causing aspiration?
megaesophagus, dysmotility, & obstruction
what is included in emergency management of a patient with aspiration pneumonia?
if under anesthesia - suction airway
oxygen supplementation, treat shock if present, & can try bronchodilators
how are antibiotics used in treating aspiration pneumonia?
IV - immediately if severe respiratory distress or sepsis
IV fluids to maintain hydration - don’t over-hydrate patients, can cause pulmonary edema
nebulize & coupage, turn recumbent patients
what medications should be avoided in aspiration pneumonia patients?
diuretics - would dry up lungs
cough suppressants - don’t want to suppress the patient’s ability to cough
how is aspiration pneumonia monitored?
clinical status, radiographic improvement, recheck rads after 1 week, & treat for 1 week beyond radiographic/clinical resolution
how is non-cardiogenic pulmonary edema determined to be non-cardiogenic?
physical exam, thoracic rads, & +/- echo
what is the mechanism of non-cardiogenic pulmonary edema?
increased capillary permeability & changes in hydrostatic & oncotic pressure
what are some underlying diseases associated with non-cardiogenic pulmonary edema?
post-seizures, head trauma, upper airway obstruction, near-drowning, electrocution, smoke inhalation, & pulmonary thromboembolisms
what is acute respiratory distress syndrome?
form of non-cardiogenic pulmonary edema with a peracute onset that is associated with severe underlying inflammatory processes
T/F: acute respiratory distress syndrome affects cats more than dogs
false - dogs more than cats
what are the components involved in possible causes of SIRS?
sepsis, pneumonia, aspiration, pancreatitis, heatstroke, or multi-systemic trauma
what is the diagnostic criteria for acute respiratory distress syndrome?
acute onset of <72 hours of tachypnea & labored breathing
known risk factors
evidence of pulmonary capillary leakage without increased pulmonary capillary pressure
evidence of hypoxemia
evidence of pulmonary inflammation - neutrophilic inflammation on airway wash
what is the common pattern of non-cardiogenic pulmonary edema?
interstitial to alveolar lung pattern in caudodorsal lung fields
T/F: neurogenic pulmonary edema occurs within minutes of the inciting incident
true
how is acute respiratory distress syndrome managed?
treat underlying disorders, fluid therapy to avoid hypotension, oxygen therapy, early nutritional support, & mechanical ventilation
what are the conditions that cause a hypercoagulable state?
- activation of vascular endothelium - vessel wall injury
- procoagulant states - hypercoagulability
- stasis of blood flow
what diseases are associated with pulmonary thromboembolism?
PLN, HAC, IMHA, HW disease, sepsis, pancreatitis, SIRS, surgery, & neoplasia
what is the mechanism of pulmonary thromboembolism?
occlusion of pulmonary vasculature by a clot
impairs oxygen transport from the lungs - ventilation perfusion mismatch
how are pulmonary thromboembolisms diagnosed?
usually presumptive & difficult to confirm
what clinical signs are associated with pulmonary thromboembolism?
acute onset of tachypnea/dyspnea, can develop cough/hemoptysis/cyanosis, or collapse, may hear crackles
hypoxemia seen on arterial blood gas & hyperventilation (low PaCO2)
if you have a low d-dimers results, are you more or less likely to have a pulmonary thromboembolism?
less likely
what is the test of choice for diagnosing pulmonary thromboembolism?
CT angiogram
how is a patient with a suspected pulmonary thromboembolism managed?
supportive care, treating underlying condition, & inhibit further clot formation
what platelet inhibitor can be used for treating PTE?
clopidogrel
how to anticoagulant drugs work in treating PTE?
inactivate factors IIa & Xa by competing with antithrombin
what is the most common cause of bacterial pneumonia?
aspiration
neurogenic non-cardiogenic pulmonary edema most commonly occurs with what?
seizures, head trauma, upper airway obstruction, or electrocution
what is it called when acute respiratory distress syndrome occurs as an adverse reaction to a blood transfusion?
tranfusion-related lung injury
