Examination of the respiratory system Flashcards
Exam of the resp system: History
Signs Vaccination Deworming Medications Type of housing/ environment Health of other animals Age (old=tumours, young=infections)
Signs
Get the exact complaint, duration and progression Nasal discharge Coughing Abnormal breathing sounds Abnormal vocalization Dyspnoea Sneezing Stridor Epistaxis
General impression
Level of consciousness Behaviour Posture Locomotion Nutritional condition Grooming state Abnormal sounds Abnormal resp
Nose and paranasal sinuses: exam methods
Inspection- internal and external
Palpation
Percussion
Smelling
Nose and paranasal sinuses: further exams
Nasal discharge- cytology, bacto, mycology, para X-ray Endoscopy and rhinoscopy! Diagnostic punction Biopsy Diagnostic rhinotomy CT MRI Nasogastric tubing
Parameters to examine
Shape/form of nose Occurrence of Nasal stridor Expired air Any discharge Nasal plane Nostrils and mucus membranes Palate and nasopharynx Paranasal and frontal sinuses
Occurrence of nasal stridor: normal
Faint during expiration- more pronounced in brachycephalic
Occurrence of nasal stridor: abnormal
Stridor Sneezing Reverse sneezing Snoring Singulation Purring Groaning Howling
Causes of abnormal stridor
Can be during insp or exp or both
Localization: one-sided, on both sides, from pharynx or larynx etc
Narrowed air passages
Nasal stridor:
Sniffling sound
Pharyngeal stridor
Snoring sound
Laryngeal
Soft “sawing”
Collapsed trachea
Expiratory!!
Tooting sound
Larynx paralysis
Inspiratory stridor
Narrow trachea/bronchus
Mixed stridor
Expired air
Strength- lung capacity
Temp- will increase with fever, will decrease with hypovolaemic shock
Symmetry- both nostrils
Odour
Nasal discharge
Continuity (frequency) Symmetry Quantity Quality/ consistency Colour Odour
Nasal discharge: continuity
Permanent vs periodic
Nasal discharge: side
Unilateral is possible until the choana bilateral is after
Nasal discharge: quality/ consistency
Watery Mucous Mucopurulent Haemorrhagic Foamy Food particles
Nasal plane
Surface- intact
Colour
Moisture
Nostrils and mucus membranes
Shape Width Movability of nasal alae (very in horse) Symmetry Internal exam of the mucus membranes
Paranasal and frontal sinuses
Inspection Palpation Percussion Endoscopy X-ray, CT, MRI
*all the sinuses
Examples of diseases infecting the nose and paranasal sinuses
Distemper- hyperkeratosis of nasal plane and foot pads Rhinitis/ nasal discharge Canine leishmaniosis Discoid lupus erythematosus Sinusitis
Physio findings of nose and paranasal sinuses
Temp same as surroundings
Palpation not painful
Percussion sound is sharp, bone-like
Faint, regular noise during expiration
Nostrils have regular shape and symmetrica width
Nasal alae don’t move during insp and exp
Percussion sound of paranasal sinuses is sharp, bone-like
Nasal plane is moist, intact, pigmented and no discharge
Soft and hard-palate are intact, moist and are pinkish-red
Mucus membrane of nose is light pink, smooth, shiny and intact
Coughing: parameters to examine
Origin Frequency Strength Tone Occurrence Duration Secretion Any pain Depth Localization of origin Quality of sputum- if productive vs non-productive
Location of coughing
Larynx Trachea Bronchi Lung emphysema, chronic bronchitis Pneumonia Cardiac Disease
Coughing from larynx
gagging, tendency to vomit
Larynx paralysis- deep and long hoars
Coughing from trachea
Tracheitis- bark like
Tracheal collapse: goose-honking cough
Coughing from bronchi
Acute is like tracheitis
Chronic is wet! mucus and pus
Cardiac disease
Wet, hacking cough
How to stimulate coughing
Press the tracheal rings or press the thorax very rapidly during expiration
Characteristics of an induced cough
Medium held Medium intensive Medium deep Unsnapping Dry Sharp Painless Does not recur
Larynx and pharynx examination methods
External: inspection, palpation, auscultation
Internal: inspection
Additional: X-ray, endoscopy, CT and MR
Examination of the tonsils
Shape size: half peanut Covered by semilunar fold Colour Surface Symmetricity
Examination of the trachea
External: inspection, palpation, auscultation
Additional
What are the additional exams of the trachea
X-ray
Endoscopy
CT, MRI
Tracheal fluids- sampling and analysis- cytology etc…
Examination of the thorax
Inspection Palpation Auscultation Percussion Additional
Inspection of thorax
Chest
Resp movements
Dyspnea
Inspection of thorax: chest
Skin
Shape and size
Bilateral symmetry
Local deformities
Inspection of thorax: resp movements
Frequency
Rhythm
Type
Depth
Inspection of thorax: resp movements: rhythm
Normal- insp is a bit longer Held insp- narrowing upper airways or abd P Held exp- decreased lung elasticity Shorter insp or expiration- usually pain Assymetric- bronchus obstruction Intermittent
Inspection of thorax: resp movements: Type
Normal is costo-abdominal
Costal- function of diaphragm lost or increased abdominal P
Abdominal: painful chest diseases, paralysis of intercostal muscles
Inspection of thorax: Dyspnea types
Insp
Exp
Mixed
Inspiratory dyspnea
Narrowed upper airways
Pneumothorax
Pleural effusion
Proloned insp
Extension of head and neck, dilated nostrils, sagging belly
Expiratory dyspnea
Compression/ obstruction of lower airways
Microbronchitis
Fibrous pleuritis
Prolonged and laboured exp
Work of abd muscles more severe, extension of head and neck
Mixed dyspnea
Decreased compliance
Pulmonary edema, emphysema
Neoplasm
Forced inspiration and expiration
Inspection of thorax: Dyspnea paradoxical breathing
Normally: abdomen and chest move in and out together
Diaphragm moves downwards during insp and upwards during exp
During paradoxical- the diaphragm and abdominal wall moves opposite to expected
Chest movements are restricted
Causes of paradoxical breathing
Pleural fluid
Pneumothorax
Diaphragm paralysis
Broken ribs
Palpation of thorax
Temp- intercostal spaces from dors to ventral
Fremitus pectoalis- bronchitis, valve insufficiency
Pain
Deformities
Auscultation of thorax, what are we trying to measure
Spontaneous or artificially induced sounds
Indirect= mediate
Direct= immediate
Auscultation of thorax: normal sound
Blow-like, develops in upper airways
Stronger during insp
Resp sounds do not originate from alveoli or small bronchi
Auscultation of thorax: exam order
Directly audible with ear: nose, larynx, trachea
Indirect: use stethoscope: larynx, trachea, thorax
Brachycephalic airway syndrome
Elongated soft palate and laryngeal collapse, stenosis of nares— this all leads to dyspnoea
Auscultation of thorax: Bronchial resp sound
Physio: above larynx and trachea
Blowing character and prolonged syllable ‘ch’
normal during inhalation in cow, dog, cat, sus
ALWAYS abnormal during exhalation
Best heard at anterior resp area over the larger bronchi close to the surface of the body
Abnormal when peribronchial lung tissue contains less air e.g bronchitis, pneumonia and pneuomothorax
Auscultation of thorax: additional/adventitious resp sounds (rhonchi)
NEVER physio Need to describe place strength type resp phase when heard if temp or permanent
Classification of rhonchi
Non-musical and musical
Non-musical rhonchi
Sudden arising and stopping
Because of areas infiltrated with fluid
Caused by abrupt opening of previously closed bronchi and the vibration of the small bronchial wall
Crepitation, crackling, rattling, stertor
Early insp: obstruction of bronchi >2mm in diameter
Bronchopneumonia, COPD
Late insp: compression of bronchi <2mm in diameter
Pulm edema, interstitial pneumonia
Musical rhonchi
Continuous regarding the phase of the resp cycle
Obstructive lung disease- results in active expiration
Venturi effect: smaller diameter, quicker airflow
Walls vibrate between insp and exp
Whistling- higher monophon
Wheezing- lower monophon
Types of musical rhonchi
During inspiration- extrathoracal
Caused by upper airway obstruction e.g laryngeal paralysis
During late insp- intrathoracal resonant sound- originates from bronchial compression caused by enlarged lung parenchyma
During expiration-intrathoracal resonant sound- from obstruction of bronchi and bronchiole e.g COPD
Percussion- lung borders
Abnormal shift of lung borders
Elevation of caudoventral border
Altered percussion sound of the lung borders
Abnormal shift of lung borders- causes
Caudal borders- backwards and downwards
Alveolar and interstitial lung emphysema
Decreased percussion area of lungs- caused by abdominal distension- ascites, pregnancy
Elevation of caudoventral border causes
Increased cardiac dullness- cardiomegaly, pericardial effusion
Altered percussion sounds within the lung borders
Relative dullness
Absolute dullness- thickened thoracic wall, pleural effusion
Tympanic- atelactic parenchyma around lung
Hollow/box sound- lung emphysema
Metallic- penumothorax
Diernhofer triangle
Enlarged cardiac dullness
Additional exams
X-ray US Endoscopy- rigid or flexible endoscope BAL Bronchial fluid ananlysis Thoracocentesis CT, MR Lung function tests Blood acid base analysis
Rhincoscopy- indications and diseases
Sneezing, reverse sneezing
Nasal discharge
Epistaxis
Stridor
Diseases:
Rhinitis
Neoplasia
Foreign body
Laryngoscopy/pharyngoscopy- indications and diseases
Laryngeal disfunction causing obstruction of the epiglottis – need to first rule out rabies!!!
Difficulty swallowing
Regurgitation
Diseases: Foreign body Elongated soft palate Tonsilitis/ laryngitis Laryngeal paralysis/ collapse
Tracheo-bronchoscopy
Bronchopneumonia
Chronic bronchitis
Pulmonary parasites
Tracheal collapse
