Lecture 13 Flashcards
Tracheal wash- how invasive?
What are you sampling?
Minimally invasive
Samples fluid and cells from trachea and primary bronchi
What technique do small dogs and cats receive for tracheal washes?
Large dogs?
Endotracheal wash
Transtracheal wash
What are indications that you should do a tracheal wash?
Large airway disease Persistent cough Wheezing Radiographic evidence of respiratory disease Bacterial pneumonia
Do you need anesthesia for tracheal wash?
No!
Contraindications for transtracheal wash
Fractious/uncooperative
Hypocoaguable/ throbocytopenic patients
Patients with severe skin disease
Side effects of transtracheal wash
Transient worsening of respiratory status
Airway irritation and bronchoconstriction
Subcutaneous emphysema and pneumomediastinum
Do you need anesthesia for endotracheal wash?
Yes!
Difference between tracheal wash and BAL
Tracheal wash collects material from large airways
BAL collects material from deep within lung (alveoli)
How do you know you have a good sample from BAL?
Layer of foam on top of fluid (indicates surfactant)
Describe BAL
Requires anesthesia
Detects diseases of small airways and alveoli
Two techniques- bronchoscopy guided; endotracheal
When is BAL indicated?
Patients without resp distress
Small airway lung disease
Used in combination with bronchoscopy
How should samples be handled?
Quickly! Need to make slides yourself
What are significant findings in samples?
Increased neutrophils or eosinophils
Pathogens inside phagocytes
Parasitic ova, larval fungus, neoplastic cells
What should you culture?
Definitely aerobes minimally
Not anaerobes usually
Mycoplasma and fungi in chronic diseases
Is it normal to find bacteria in your samples?
Yes! As long as they are low numbers
What is a cushman spirals
Has brush like appearance
Mucus casts of small bronchioles
Sign of chronic disease
Canine chronic bronchitis- what is it?
Clinical characteristics?
Chronic airway inflammation- irreversible
Unknown etiology- inhaled irritants, recurrent infection, allergic disease, immune deficiency, small/medium breeds, older than five years old, overweight
Clinical signs of canine chronic bronchitis
Progressive chronic dry hacking cough
Expiratory wheeze
Tachypnea
Cyanosis
How to diagnose canine chronic bronchitis
History/ physical exam
Rads
Tracheal wash
Bronchoscopy
How to treat canine chronic bronchitis
No cure, but can relieve clinical signs
Change environmental factors
Glucocorticoids
Bronchodilators
Two bronchial diseases in cats
Chronic bronchitis
Asthma
*both have same clinical signs but asthma have eosinophilia and bronchitis has neutrophils
How to diagnose asthma/chronic bronchitis
History/physical exam
Thoracic radiograph (atelectasis of R. Middle lung lobe)
Tracheal wash/BAL
Ancillary tests (HW, fecal float)
How to treat asthma/ chronic bronchitis
No cure
Emergency treatment= oxygen, bronchodilator, anti-inflammatory
Long term treatment= environmental modification, corticosteroids, bronchodilators
What is eosinophilic bronchopneumopathy
Variety of conditions characterized by eosinophilic infiltration of lung and bronchial mucosa
Usually idiopathic
Signalment and clinical signs of eosinophilic bronchopneumonia
Young adults, female, harsh cough followed by gag/retch
Wheezes and crackles
Other resp signs
How to diagnose eosinophilic bronchopneumonia
Rads and bronchoscopic findings
Eosinophilia
Must rule out known causes (HWs, parasites, lymphoma)
How to treat eosinophilic bronchopneumonia
Corticosteroids
What is bronchiectasis
Irreversible dilation of diseased bronchi (loses elasticity from cycle of inflammation and infection)
