Lecture 15 10/23/24

Question 1

What is pleuritis/pleuropneumonia?

Answer 1

inflammation of the lining of the thorax and covering of the thoracic organs with the eventual accumulation of excessive fluid in the thorax

Question 2

What are the potential etiologies of pleuritis?

Answer 2

-extension of pulmonary infections
-trauma
-esophageal puncture
-congestive heart failure
-neoplasia
-hematogenous/septicemia

Question 3

What are the oropharyngeal bacteria that can cause pleuritis?

Answer 3

-Strep. spp.
-Pasteurella spp.
-Actinobacillus spp.
-E. coli
-Enterobacter spp.

Question 4

Which anaerobes can cause pleuritis?

Answer 4

-Bacteroides spp.
-Clostridium spp.
-Fusobacterium

Question 5

What are the risk factors for pleuritis?

Answer 5

-long-distance transport
-strenuous exercise
-viral respiratory disease
-surgery/general anesthesia
-dysphagia
-systemic illness

Question 6

What is the pathogenesis of pleuritis?

Answer 6

-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

Question 7

What are the clinical signs of pleuritis?

Answer 7

-fever
-lethargy
-nasal discharge
-shallow breathing pattern
-guarded cough
-painful stilted gait
-tachycardia
-nostril flaring
-ventral edema

Question 8

What are the signs of pleuritis on auscultation?

Answer 8

-pleural friction rubs
-ventral dullness
-cardiac sounds radiate

Question 9

What are the signs of pleuritis on percussion?

Answer 9

-painful
-dullness
-decreased resonance ventrally

Question 10

What are the signs of pleuritis on bloodwork?

Answer 10

-normal or toxic leukogram
-neutrophilia
-hyperfibrinogenemia

Question 11

What are the signs of pleuritis on ultrasound?

Answer 11

-pleural fluid
-pulmonary abscesses
-consolidation
-gas echoes

Question 12

What are the signs of pleuritis on radiography?

Answer 12

-fluid line
-pneumothorax
-deep abscesses

Question 13

Which procedures can be used to diagnose pleuritis?

Answer 13

-thoracocentesis
-tracheal wash
-thoracoscopy

Question 14

What are the goals of pleuritis treatment?

Answer 14

-remove excess pleural fluid
-inhibit bacterial growth
-provide anti-inflammatory and analgesic medications
-provide supportive care

Question 15

What are the characteristics of pleuritis fluid draining?

Answer 15

-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

Question 16

What are the indications for placing a chest tube?

Answer 16

-large volumes of fluid
-fluid has foul odor
-horse responds poorly to intermittent drainage

Question 17

What are the complications that can occur with chest tube placement?

Answer 17

-localized swelling
-pneumothorax
-lung laceration
-hemothorax
-cardiac arrhythmias
-puncture of bowel, liver, or heart

Question 18

What are the steps of antibiotic treatment for pleuritis?

Answer 18

-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

Question 19

What supportive care measures are taken when treating pleuritis?

Answer 19

-nasal oxygen
-anti-inflammatory meds
-bronchodilators
-fluid therapy
-nutrition
-laminitis prevention

Question 20

What are the complications of pleuritis treatment?

Answer 20

-antibiotic resistance
-enteral or parenteral nutrition needs
-pleural adhesions
-bronchopleural fistulae and pneumothorax
-abscesses requiring drainage via rib resection

Question 21

What are the complications of pleuritis?

Answer 21

-constrictive pericarditis
-laminitis
-jugular phlebitis/thrombosis
-colitis

Question 22

What is the prognosis of pleuritis?

Answer 22

-favorable if treated early
-anaerobic infections have decreased prognosis

Question 23

What are the causes of pleural effusion?

Answer 23

-bacterial pneumonia
-thoracic neoplasia
-thoracic trauma
-pericarditis
-hypoproteinemia
-congestive heart failure
-liver disease
-diaphragmatic herniation
-equine infectious anemia
-damage of thoracic duct

Question 24

What is the pathogenesis of pleural effusion?

Answer 24

-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

Question 25

What is the treatment for pleural effusion?

Answer 25

-treat primary cause
-removal of pleural fluid