Lecture 12: Tracheal Collapse (Exam 2) Flashcards
What is a tracheal collapse (congenital tracheal stenosis)
Form of tracheal obstruction caused by cartilage flaccidity & flattening
What is the cause of tracheal collapse
- Unknown & probs multifactorial
- Genetic factors
- Nutrition
- Allergens
- Neuro def
- Small airway dx
- Degen of cartilage matrices
What becomes an impt tracheobronchial clearing mechanism
Coughing
Describe the common signalment
- Mostly common in toy & min breed dogs
- Males & females are affected equally
- Larger dogs usually assoc w/ trauma, deformity, or intraluminal/extraluminal masses & should not be equated w/ tracheal collapse in toy breed dogs
- Middle or old aged
Describe the hx of px
- Onset of clinical sx often before a year
- Can have abnorm resp noise, dyspnea, exercise intolerance, cyanosis, & syncope
- “goose honk” cough
- Gagging after coughing may occur in as many as 50% of cases
What are some concurrent probs
- 50% are obese
- Laryngeal paresis or paralysis in 20 to 30%
- > 40% of dogs thought to have dental or periodontal dx
- Hepatomegaly & hepatopathy are common
What will be seen during PE
- Flaccid tracheal cartilages w/ prominent lateral borders on palpation
- Paroxysmal coughing on palpation
- Abnorm resp noises
- Mitral valve dx
What can be noted w/ Dx imaging on a px
- Cervical trachea expected to collapse on inspiration
- Thoracic trachea expected to collapse on expiration
T/F: Dx imaging may req multiple imaging modalities as well as bronchoscopy
True
What does a tracheoscopy/bronchoscopy do
- Confirm & grade the severity
- Eval the entire tracheobronchial tree
- Collect air way samples
- Confirm location of the collapse
Describe the different grades of collapse
Describe medical management for a tracheal collapse
- Rec for animals w/ mild clinical sx & for those w/ < 50% collapse
- Weight loss is critical
- Environmental modifications
- Antitussives, antibiotics, bronchodilators, +/- anti inflammatories
- Response is usually transient & the dx typically progresses
Who is surgical tx recommended for
- Dogs w/ mod to severe clinical sx
- > 50% reductio of the tracheal lumen
- Refractory to medical therapy
Describe poor surgical candidates
- Laryngeal paralysis or collapse
- Generalized cardiomegaly
- Bronchial collapse
- Chronic pulmonary dx
- Collapsed mainstem bronchi
What is the goal of sx
To support the tracheal cartilages & trachealis muscle while preserving as much of the segmental blood & nerve supply to the trachea as possible
List the two surgical tech
- Extraluminal ring prostheses
- Endoluminal stenting
How is a extraluminal ring prosthesis performed
- Dissect a tunnel around the trachea @ each implantation site
- Guide the prosthesis through the tunnel
- Rotate the prosthesis around the trachea
- Secure the prosthesis w/ several sutures
Describe an endoluminal stent placement
- Min invasive tech used for intraluminal prosthesis placement varies w/ the type of self expanding elastic implant selected
- Stents are place under general ax using tracheoscopy or fluoroscopy
- Implant should remain 10 mm from the larynx & carina to prevent excess irritation & granulation
- Open looped or knitted implants are preferred b/c they promote coverage of the stent w/ tracheal epithelium
T/F: The quality of life is improved for most px & surgery or stents cure the condition
False; neither surgery nor stents cure the condition
What are some complications that can occur
- Death
- Coughing bruising
- Swelling
- Recurrent laryngeal nerve damage
- Tracheal necrosis
- Stent migration
- Granuloma formation
- Hemorrhage
- Emphysema
- And may more
what does the prognosis dep on
More dep on concurrent resp probs such as laryngeal paralysis or collapse & bronchial dx than on the location or severity of tracheal collapse
What is the presence of mainstem bronchi collapse associated w/ regardless of the tx type
Shorter survival times
