Intro to Respiratory Flashcards
Localizing the problem
Need history from the client, and PE findings → defining the location of the lesion
Important questions for the owner
Coughing, sneezing, gagging, reverse sneezing, productive cough, nasal discharge?
Change in breathing pattern?
How long?
Housing/ environment
Timing and travel history
What is observed with nasal/ sinonasal disease
Sneezing, nasal discharge (small amount normal), stertor, facial/ nasal defects
Sneezing
Forceful expulsion of air and debris from the nasal cavity
Nasal discharge
Serous (clear watery)
Mucoid (clear thick)
Mucopurlulent (white to yellowish, thick)
Serosanguineous (blood tinged water to thick)
Epistaxis (frank blood/ hemorrhage)
Stertor
↑ noise occurring with air movement through the respiratory system
Associated with nasal and pharyngeal obstruction
Secondary problems to nasal/ sinonasal disease
Inability to retropulse eyes (mass)
Exophthalmos
Viral diseases of the nasal cavity
K9: distemper, parainfluenza, adenovirus t2, reovirus
Feline: herpes and calicivirus
Bacterial disease of the nasal cavity
K9- bordetella and non-commensal pathogens like pasterurella
Feline: Chlamydophilia, mycoplasma and bordetella
Fungal diseases of the nasal cavity
K9: aspergillosis, penicillosis, rhinosporidosis
Feline: cryptococcus, penicillosis, rhinosporidosis
Parasitic diseases of the nasal cavity
Pneumonyssoides caninum and Eucoleus boehmi in K9s
Inflammatory diseases of the nasal cavity
Nasopharyngeal polyps
Lymphoplasmacytic rhinitis (+/- overgrowth of commensal bacteria)
Allergic rhinitis (+/- overgrowth of commensal bacteria)
Neoplasia of the nasal cavity
Adenocarcinoma, carcinoma, sarcoma, lymphoma
Other diseases of the nasal cavity
FBs, trauma, dental disease, oronasal fistula, palatine defects and stenotic nares
Stertor is a common CS of _____________
Nasopharyngeal polyp in a cats
What is a disease of the nasopharynx?
Reverse sneezing: audible paroxysms of strong, inspiratory efforts made against a closed glottis
Response to irritation in the posterior nasal cavity/ nasopharynx
CS of laryngeal and tracheal diseases
Coughing
Stridor
Inspiratory dyspnea
Cyanosis if severe
Stridor
↑ noise occurring with air movement through the resp. system
Associated with cd. pharyngeal, laryngeal or tracheal obstruction
Laryngeal/ tracheal diseases
Brachycephalic airway syndrome
Infectious tracheobronchitis
Laryngeal paralysis
Collapsing trachea
Brachycephalic airway syndrome (congenital)
Stenotic nares
Elongated soft palate
Hypoplastic trachea
Brachycephalic airway syndrome (Acquired)
Everted laryngeal saccules and tonsils
Collapsed laryngeal vestibule
Dynamic bronchial collapse
What causes infectious tracheobronchitis
Bordatella bronchiseptica, parainfluenza virus and CAV2
Travel/ boarding/ grooming
Laryngeal paralysis
Unilateral or bilateral
Inspiratory stridor
Large breed dogs
if airway not protected could lead to lower resp. disease
Collapsing trachea
Collapsing process
Goose honk cough (elicited on tracheal palpation)
Middle-aged to older, toy and mini breed dogs
Locations of collapsing trachea
Cervical- inspiratory
Thoracic- expiratory
Bronchi- expiratory
CS of diseases of the lower respiratory tract
Coughing
Tachypnea (↑ rate of resp.)
Dyspnea (resp. distress)
Cyanosis
Causes of CS of the lower resp tract
Ventilatory failure, resp. failure or inadequate tissue oxygenation
Ventilatory failure
Inability to perform adequate ventilation
Due to airway obstruction, pleural cavity disease, chest wall disease, diaphragm disorders
Inadequate tissue oxygenation
Resp. causes: ventilatory/ resp. failure
Non-resp causes: anemia, methemglobinemia
Diseases of the lower resp. tract
K9 Chronic bronchitis and feline asthma/ bronchitis
K9 chronic bronchitis and Feline asthma/ bronchitis
Chronic multifactorial disease associated with chronic infamm. response in the airways →bronchoconstriction, bronchial thickening, ↑ mucus secretion, fibrosis and emphysema
Etiologies of K9 chronic bronchitis and Feline asthma/ bronchitis
Allergic
Infectious (K9), bacteria (feline)
Pulmonary parasites
Heartworms
Inhaled irritants
CS of K9 chronic bronchitis
Chronic coughing exacerbated by exercise or excitement
CS of feline asthma/ bronchitis
Mild to life threatening (open mouth breathing/ cyanosis)
Recurrent episodes of coughing and resp. disease
Primary expiratory dyspnea
Wheezing loudest @ the cervical trachea/ larynx
Inspiration: upper airway obstruction, laryngeal paralysis
Expiration: Attempt to keep small airways from closing early (rare)
Wheezing loudest @ the chest wall
Inspiration: Large airway obstruction
End of expiration/ cough: Intrathroacic, small airway obstruction
Bacterial pneumonia (parenchymal disease)
Common in dogs
Primary: lung → bordetella, strep zoo.
Secondary: pneumonia→ E. coli, pasteurella, strep, staph, pseudomonas, klebs
CS of Bacterial pneumonia
Nonspecific: depression, anorexia, WL and fever
Cough, nasal discharge, dyspnea and crackles
How do you diagnose bacterial pneumonia
Thoracic rads:
FB: focal
Dependent: secondary to airway disease of aspiration
Caudodorsal: hematogenous spread
What causes fungal pneumonia (parenchyma disease)
Blastomycosis, histoplasmosis, coccidiomycosis, cryptococcus, aspergillosis
Hypersensitivity/ immune mediated parenchymal diseases
Eosinophilic pneumonitis
Eosinophilic pulmonary granulomatosis
Pulmonary edema (parenchyma)
Syndrome not disease:
↓ plasma colloid osmotic pressure → hypoalbuminemia
↑ hydrostatic pressure/ vascular overload → cardiac disease/ CHF, fluid overload, obstruction of pulmonary veins
↑ vascular permeability (stroke, trauma, near drowning, pulmonary contusions)
Systemic (DIC, sepsis, uremia, electrocution, etc)
Lymphatic obstruction
Unknown mechanisms that cause pulmonary edema
Thromboembolism
Severe upper airway obstruction
Neurogenic
Hepatic failure
Pulmonary hypertension
CS of diseases of the thoracic wall, pleural space and mediastinum
Dyspnea, cough, pleural effusion, mediastinal mass
Diseases of the thoracic wall, pleural space and mediastinum
Pneumothorax
Pleural effusion
Diaphragmatic hernia
PPDH, diaphragmatic paralysis, blunt chest trauma, thoracic wall deformities
Pneumothorax
Movement of air into the pleural space
Loss of chest wall integrity, puncture of the pulmonary pleura, rupture of the airway and mediastinum and rupture of the diaphragm with free abdominal air
Tension pneumothorax
Respiratory movements pulls air into pleural space but prevent escape
Difficult to hear lung sounds, resonates percussion
Etiologies of pneumothorax
Traumatic
Pulmonary disease (rupture of cysts, cavitations, emphysema)
Iatrogenic (thoracocentesis, needle aspirate, catheters, surgery, etc.)
Parasitic
Pleural effusion
Pathologic accumulation of fluid
Inspiratory dyspnea with expanded chest wall
Dullness on thoracic percussion
↓ bronchovesicular and heart sounds
Classifications of pleural effusions
Transudate protein
Modified transudate (obstructive)
Exudate protein
Chylous/ pseudochylous
Diaphragmatic hernia
Congenital and acquired (blunt abdominal trauma against a close glottis)
CS of a diaphragmatic hernia
Acute v chronic
Maybe no CS
Resp. signs (space occupying organs, pleural adhesions atelectasis)
Organ entrapment (bowel, liver, gastric, etc)
CS of mediastinal diseases
Resp: airway/ parenchymal compression
Dysphagia: esophageal obstruction
Horner’s syndrome
Cr. vena cava syndrome
Mediastinal diseases
Mediastinitis
Medastinal hemorrhage
Pneumomediastinum
Lymphadenopathy
Neoplasia (thymoma, lymphosarcoma)
Dx tools for resp. cases
CBC with side evaluation and full WBC differential
Chemistry panel (for systemic disease)
Urinalysis (proteinuria, urine conc.)
Fecal
Basic infectious tests
Dx rads aren’t useful for ________________
Sinonasal disease
Dx rads
3 views: R, L and VD
Include lateral of the cervical trachea and larynx/ pharynx
Prefer inspiratory views
Dx for nasal/ sinonasal diseases
Cytology- exudates/ discharge
Culture- tissue samples for fungal/ bacteria
Virus isolation/ resp. PCR
CT scan (nasal passages, sinuses, turbinate, masses, bone destruction)
Rhinoscopy/ pharyngoscopy
Dx tools for pharynx, larynx and trachea
CT scan, fluoroscopy, bronchoscopy/ pharyngoscopy, sedated laryngeal exam
Dx tools for lower resp tract/ parenchymal
Ct scan, blood gases, pulse oximetry, ultrasound, borchoscopy, fine needle aspiration, histopathology, ECG
Dx tools for pleural space
CT scan, ultrasound, thoracocentesis (fluid analysis, cytology, culture)
Dx tools for thoracic wall/ cage
CT scan, ultrasound, contrast studies (barium)
Dx tools for mediastinum
Fine needle aspirate, histopathology, bronchoscopy
