Lecture 15 10/23/24 Flashcards
What is pleuritis/pleuropneumonia?
inflammation of the lining of the thorax and covering of the thoracic organs with the eventual accumulation of excessive fluid in the thorax
What are the potential etiologies of pleuritis?
-extension of pulmonary infections
-trauma
-esophageal puncture
-congestive heart failure
-neoplasia
-hematogenous/septicemia
What are the oropharyngeal bacteria that can cause pleuritis?
-Strep. spp.
-Pasteurella spp.
-Actinobacillus spp.
-E. coli
-Enterobacter spp.
Which anaerobes can cause pleuritis?
-Bacteroides spp.
-Clostridium spp.
-Fusobacterium
What are the risk factors for pleuritis?
-long-distance transport
-strenuous exercise
-viral respiratory disease
-surgery/general anesthesia
-dysphagia
-systemic illness
What is the pathogenesis of pleuritis?
-parenchymal inflammation increases
-increased permeability of the capillaries in the overlying visceral pleura
-outpouring of protein and cells
-fluid accumulation within the pleural cavity
-bacteria may invade pleural fluid
What are the clinical signs of pleuritis?
-fever
-lethargy
-nasal discharge
-shallow breathing pattern
-guarded cough
-painful stilted gait
-tachycardia
-nostril flaring
-ventral edema
What are the signs of pleuritis on auscultation?
-pleural friction rubs
-ventral dullness
-cardiac sounds radiate
What are the signs of pleuritis on percussion?
-painful
-dullness
-decreased resonance ventrally
What are the signs of pleuritis on bloodwork?
-normal or toxic leukogram
-neutrophilia
-hyperfibrinogenemia
What are the signs of pleuritis on ultrasound?
-pleural fluid
-pulmonary abscesses
-consolidation
-gas echoes
What are the signs of pleuritis on radiography?
-fluid line
-pneumothorax
-deep abscesses
Which procedures can be used to diagnose pleuritis?
-thoracocentesis
-tracheal wash
-thoracoscopy
What are the goals of pleuritis treatment?
-remove excess pleural fluid
-inhibit bacterial growth
-provide anti-inflammatory and analgesic medications
-provide supportive care
What are the characteristics of pleuritis fluid draining?
-indwelling or intermittent
-use 24-32 French chest tubes for indwelling
-avoid rapid removal of large volumes of fluid
-use a heimlich valve or other one way valve
What are the indications for placing a chest tube?
-large volumes of fluid
-fluid has foul odor
-horse responds poorly to intermittent drainage
What are the complications that can occur with chest tube placement?
-localized swelling
-pneumothorax
-lung laceration
-hemothorax
-cardiac arrhythmias
-puncture of bowel, liver, or heart
What are the steps of antibiotic treatment for pleuritis?
-start with parenteral antibiotics that are based on culture/sensitivity or broad spectrum
-switch to oral antibiotics 10-14 days into therapy; animal dependent
-treat for a total of 2-4 months
What supportive care measures are taken when treating pleuritis?
-nasal oxygen
-anti-inflammatory meds
-bronchodilators
-fluid therapy
-nutrition
-laminitis prevention
What are the complications of pleuritis treatment?
-antibiotic resistance
-enteral or parenteral nutrition needs
-pleural adhesions
-bronchopleural fistulae and pneumothorax
-abscesses requiring drainage via rib resection
What are the complications of pleuritis?
-constrictive pericarditis
-laminitis
-jugular phlebitis/thrombosis
-colitis
What is the prognosis of pleuritis?
-favorable if treated early
-anaerobic infections have decreased prognosis
What are the causes of pleural effusion?
-bacterial pneumonia
-thoracic neoplasia
-thoracic trauma
-pericarditis
-hypoproteinemia
-congestive heart failure
-liver disease
-diaphragmatic herniation
-equine infectious anemia
-damage of thoracic duct
What is the pathogenesis of pleural effusion?
-elevation of the hydrostatic pressure gradient
-decrease in the colloid osmotic pressure
-increased permeability of capillary vessels
-decreased removal of fluid due to impaired lymphatic drainage
What is the treatment for pleural effusion?
-treat primary cause
-removal of pleural fluid
