Lecture 17: Disease of the Lower RT (Specht) Flashcards
Bacterial pneumonia more common in dogs/cats?
dogs
routes on infection for bacterial pneumonia
inhalation
aspiration
hematogenous spread
bacterial pneumonia CS
Can be acute/chronic/mild/severe
- coughing and dyspnea*
- fever
- nasal d/c
- cyanosis
- crackles
- non-specific anorexia, dehydration, weight loss
Dx of bacterial pneumonia
- inflammatroy leukogram
- interstitial or alveolar pattern in rads
- TTW/BAL/pulmonary aspirate positive culture***
Tx of bacterial pneumonia
- Abx (based on culture/sensitivity!) until at least 2 weeks after complete resolution of all clinical/rad signs
- supportive care (hydration, nutrition, turning)
- O2
- nebulization, coupage, mild exercse to loosen phlegm
prog. of bacterial pneumonia
- fair to good
- affected by severity, underlying conditions, complications
2 main causes of viral pneumonia
canine distemper, flu
tx of viral pneumonia
supportive care
tx of 2ary bacterial infections
route of infect./CS of fungal pneumonia
inhalation, hematogenous
CS: cough, dyspnea, lethargy, weight loss, anorexia
dx of fungal pneumonia
- rads show diffuse interstitial pattern or hilar lymphadenopathy
- cytology/culture/histo (i.e. TTW, BAL, pulmonary aspirate) have pyogranulomatous/eosinophilic inflamm. + organisms assoc. with macs**
- serology possible
tx/prog. of fungal pneumonia
Tx: antifungals 1-2 mo. after resolution, oxygen therapy, +/- steroids
Prog: fair to poor, requires long-term tx
aspiration pneumonitis
- occurs when foreign material enters the lungs
- can be 2ary to v, dysphagia, megaesophagus, force-feeding, feeding tubes, etc.
- can be followed by 2ary bact. infection
dx of aspiration pneumonia
classic: alveolar pattern in R middle lung lobe on rads**
+/- megaesophagus
-cytology/cutlure
tx of aspiration pneumonia
- symptomatic care (O2, nebulization, coupage, exercise)
- abx only if no improvement, inflammatory leukogram worsens, fever develops, or animal has been on H2 blockers or proton pump inhibitors
prog. of aspiration pneumonia
depends…mild to fatal
number 1 differential for asthma**
pronounced expiratory effort
feline bronchitis (asthma)
dz char. by wheezing, coughing, dyspnea due to spontaneous bronchoconstriction
contributing factors of asthma
- bronchospasm
- bronchial smooth m./epithelial hypertrophy
- inc. mucus prod. or dec. clearance
- inflamm. exudate w/n lumen or of airway walls
- fibrosis
- emphysema
- airway hypersensitivity
only potential difference between asthma and bronchitis
asthma may have more eos in wash than bronchitis
CS of feline bronchitis
- young/middle aged
- small airway obstruction –> sudden dyspnea; cough/wheezing/crackles, inc. expiratory effort
- slowly progressive pathology
- exacerbated by env. changes
Dx of feline bronchitis (asthma)
- history, CS, PE**
- TXR: bronchial wall thickening/pulm. hyperinflation
- TW/BAL cytology (inflammaotry, cultures usually negative)
- HW Ag and Ab tests
- Fecal
Tx of feline bronchitis
- airway management
- env. mod.
- long-term corticosteroids
- bronchodilators
Prog. of feline bronchitis
- poor for complete cure
- fair to good for control of CS
- sudden death possible
canine chronic bronchitis
long-term airway inflamm. probably assoc. with irritants, recurrent infection, allergies. Targets overweight, small to medium breedsover 5 yo
CS of canine chronic bronchitis
-progressively worsening dry cough exacerbated by excitement
+/- wheezes, crackles
Dx of canine chronic bronchitis
TXR:
-prominent bronchial pattern +/- interstitial
-bronchiectasis if severe
-R sided cardiomegaly if severe (cor pulmonale)
Tracheal wash:
-cytology: nonspecific inflamm., excess mucous
-culture: generally negative
Bronchoscopy:
-membranes hyperemic, edematous, excess mucous, small airway collapse
Tx of canine chronic bronchitis
focused on relieving CS, not curing**
- glucocorticoids
- bronchodilators
- cough suppressants
- antibiotics
Pulmonary Thromboembolism
thrombosis or embolism causes perfusion/ventilation mismatch (increased V/Q)**
- dec. cardiac output, inc. pulmonary resistance, bronchoconstriction
- loss of surfactant, infarction
virchow’s triad
describes the three broad categories of factors that are thought to contribute to thrombosis:
Hypercoagulability Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction
Dz assoc. with pulmonary thromboembolism
- hyperadrenocorticism
- pancreatitis
- sepsis
- IMHA
- trauma/surgery
- DIC
- Protein-losing nephropathy
CS of pulmonary thromboembolism
SUDDEN ONSET** of resp. distress, dyspnea, tachypnea
+/- increased breath sounds
tachycardia
shock, hemoptysis, syncope, collapse, death
Dx of pulmonary thromboembolism
- presumptive
- coag. panels
- TXR: usually do NOT rule out PTE***, but may wee hypovascular regions/blunted pulmonary vessels
- angiography, scintigraphy
Tx of PTE
- supportive care
- anticoagulants
- fibrinolytic meds (streptokinase, TPA)
Prog. of PTE
- guarded/poor
- depends on severity
- risk of sudden death
Chars. of pulmonary/bronchial neoplasia
- 1ary neoplasia RARE
- common site of mets
- older animals
- variable CS: cough, tachypnea, dyspnea, pleural space problems, hypertrophic osteodystrophy
Dx/Tx/Prog. of pulmonary/bronchial neoplasia
Dx: imaging for localization (rads, CT, bronchoscopy), cytology/biopsy for defin. dx
Tx: sx, chemo, radiation, palliative tx (alleviating pain)
Prog: complete excision possible
eosinophilic bronchopneumonopathy
- wide spectrum of disorders char. by severe eosinophilic infiltration
- variable CS
eosinophilic bronchopneumonopathy Dx/Tx/Prog.
Dx: R/O other causes, +/-eosinophilia in peripheral blood, cytology/biopsy with eos infiltration
Tx: steroids
Prog: variable
bronchiectasis
- permanent dilation of bronchi
- complication of chronic resp. dz such as chronic bronchitis
- extremely susceptible to infection
- sx removal possible
- prognosis guarded to poor
