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FA2 Respiratory > Lecture 30 11/21/24 > Flashcards

Lecture 30 11/21/24 Flashcards

1
Q

What is pulmonary edema?

A

abnormal accumulation of liquid and solute in the interstitial tissues, airways, and alveoli of the lung

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2
Q

What are the characteristics of pulmonary edema?

A

-not a disease, but a consequence
-can be cardiogenic or non-cardiogenic

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3
Q

What is the sequence of edema accumulation?

A

-fluid accumulates faster than it can be absorbed
-fluid in the alveoli leads to V/Q mismatch and hypoxemia

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4
Q

What are the pathophysiologic causes of pulmonary edema?

A

-increased pulmonary capillary hydrostatic pressure
-decreased plasma oncotic pressure
-decreased capillary wall integrity
-impaired lymphatic functions

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5
Q

What can cause increased hydrostatic pressure?

A

-left heart failure
-overhydration
-venous obstruction and compression

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6
Q

What can cause decreased plasma oncotic pressure?

A

-hypoalbuminemia
-overhydration

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7
Q

What can cause altered lymphatic drainage?

A

-cancer
-lymphatic hypoplasia/aplasia
-lymphangitis (from tick-borne disease)

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8
Q

What can cause altered capillary membrane permeability?

A

-electric cord shock
-infection/sepsis
-smoke/irritants
-gastric fluid aspiration

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9
Q

What are the predisposing factors for non-cardiogenic edema development?

A

-neurogenic pulmonary edema
-post-obstructive pulmonary edema
-systemic disease leading to ARDS
-direct pulmonary injury
-profound hypoalbuminemia
-impaired lympahtic drainage
-drowning
-transfusion-related
-pulmonary thromboembolism
-high altitude

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10
Q

What are the consequences of edema?

A

-pulmonary fluid accumulation
-atelectasis
-decreased compliance
-V/Q inequality
-hypoxemia

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11
Q

What are the clinical signs of pulmonary edema?

A

-crackles/harsh bronchovesicular sounds
-moist cough that may produce foam
-tachypnea
-orthopnea
-dyspnea
-open mouth breathing
-cyanosis
-hemoptysis

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12
Q

How is pulmonary edema diagnosed?

A

-history
-physical exam
-blood work
-blood gas
-radiology

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13
Q

Which signs of radiology are indicative of pulmonary edema?

A

-unstructured interstitial or peribronchial pattern
-patchy infiltrates
-caudodorsal fields affected

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14
Q

Which diagnostics are used to determine whether or not pulmonary edema results from heart disease?

A

-auscultation
-ECG
-TFAST
-echo
-NT-proBNP

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15
Q

What are the treatment steps for pulmonary edema?

A

-cage rest/reduce stress; use sedatives PRN
-improve oxygen with supplemental O2 and bronchodilators
-decrease hydrostatic pressure with diuretics and vasodilators
-identify and treat underlying disease
-supportive care
-intubation and ventilation for severe cases

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16
Q

What is ARDS?

A

acute respiratory failure due to non-cardiogenic edema and inflammation

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17
Q

How does ARDS differ from acute lung injury?

A

acute lung injury is a less severe version of ARDS

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18
Q

What are the risk factors for ARDS?

A

-risk factors for non-cardiogenic pulmonary edema
-injury to vascular endothelium
–aspiration pneumonia
–bacterial pneumonia
–sepsis
–trauma
–shock

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19
Q

What are the clinical signs of ARDS/ALI?

A

-rapid onset of resp. signs
-bilateral pulmonary infiltrates on rads
-no evidence of left atrial hypertension

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20
Q

What are the characteristics of PaO2:FiO2 ratio?

A

-ratio between arterial O2 and inspired O2
-PaO2 measured on blood gas
-severe ARDS ratio = <100 mmHg
-moderate ARDS ratio = 100-200 mmHg
-mild ARDS/ALI ratio = 200-300 mmHg

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21
Q

How is ARDS/ALI treated?

A

-treat underlying disease
-supplemental O2
-ventilator for resp. support
-supportive care
-refer case to emergency/critical care facility

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22
Q

What are the characteristics of the pleural space?

A

-serous membrane
-mediastinum is incomplete
-normal pleural fluid is produced by transudation

23
Q

Why is it important that normal intrathoracic pressure is negative?

A

negative intrathoracic pressure keeps the alveoli open in health

24
Q

What can cause pneumothorax?

A

-leakage from inside airway
-air from the outside
-trauma
-bullae in the lung
-iatrogenic
-neoplasia
-spontaneous pneumothorax

25
Q

What is the treatment for pneumothorax?

A

-remove air
-continuous drainage if needed
-possibly surgery

26
Q

What are the potential etiologies of pleural effusion?

A

-increased hydrostatic pressure
-decreased oncotic pressure
-increased capillary membrane permeability
-lymphatic obstruction

27
Q

What happens as pleural effusion forms?

A

there is a gradual collapse of lung parenchyma and an increase in intrathoracic pressure

28
Q

What can cause pleural effusion?

A

-CHF
-pneumonia
-malignancy
-atelectasis
-hypoalbuminemia
-diaphragmatic defect
-thoracic duct rupture/disease
-idiopathic chylothorax

29
Q

What are the clinical signs of pleural effusion?

A

-restrictive breathing pattern
-rapid, shallow breathing
-resp. distress
-strong abdominal component to breathing
-muffled lung sounds

30
Q

Which aspects of the physical exam are most important when dealing with pleural effusion?

A

-breathing pattern
-percussion
-auscultation

31
Q

What are the characteristics of diagnostic thoracocentesis?

A

-often done before rads to stabilize patient
-not a benign procedure
-down with aseptic technique
-should provide supplemental oxygen
-insert needle anterior to rib
-remove air or fluid

32
Q

What is the diagnostic approach to pleural effusion?

A

-do not stress animal
-TFAST/ultrasound
-radiology
-thoracocentesis before or after rads

33
Q

What should be done after removing air/fluid via thoracocentesis?

A

-re-radiograph
-remove remaining fluid if present
-determine underlying disease

34
Q

What is the therapy for pleural effusion patients?

A

-oxygen
-temporary thoracocentesis/repeated as necessary
-chest tubes in severe patients

35
Q

Which conditions are responsible for the majority of pleural effusion in cats?

A

cardiac disease and neoplasia

36
Q

What are the causes of hemothorax?

A

-coagulopathy
-trauma/rib fracture
-cancer

37
Q

How does hematocrit help to indicate hemothorax?

A

-pleural effusion has HCT greater than 20%
-HCT of pleural effusion is greater than 50% of patient’s peripheral HCT

38
Q

What are the causes of pure transudates?

A

-hypoproteinemia
-early heart failure

39
Q

What are the causes of modified transudates?

A

-feline cardiomyopathy
-diaphragmatic hernia

40
Q

What are the causes of non-septic exudates?

A

-neoplasia
-lung lobe torsion
-FIP
-pancreatitis

41
Q

What clinical signs are seen in patients with septic exudate?

A

-systemic signs of illness
-inflammatory leukogram
-fever
-degenerative neutrophils and bacteria on cytology

42
Q

What are the characteristics of pyothorax?

A

-purulent exudate in pleural cavity
-result of bacterial invasion

43
Q

What are the potential etiologies of pyothorax?

A

-migrating foreign bodies
-bite wounds
-extension from lungs
-esophageal perforation
-parasitic migration
-hematogenous spread
-iatrogenic

44
Q

Which organisms are typically involved in pyothorax?

A

-anaerobes
-Actinomyces
-Norcardia
-Pasteurella

45
Q

How is pyothorax diagnosed?

A

-ultrasound
-radiology
-thoracocentesis
-cytology
-culture and sensitivity
-blood work
-CT scan

46
Q

What is the treatment for pyothorax?

A

-oxygen
-IV fluids
-nutrition
-systemic antibiotics
-drainage
-thoracotomy tubes
-surgery

47
Q

What are the sequelae of of pyothorax?

A

-constrictive pleuritis
-adhesions
-abscessation

48
Q

What are the characteristics of chylothorax?

A

-contains chyle/lymphatic fluid from the gut
-effusion is a mixture of intestinal and thoracic lymph

49
Q

What are the causes of chylothorax?

A

-congenital abnormalities of thoracic duct
-cranial mediastinal masses/neoplasia
-fungal granulomas
-heart disease
-trauma
-lung lobe torsion
-thrombosis
-idiopathic

50
Q

How is chylothorax diagnosed?

A

-pleural disease signs
-radiology
-thoracocentesis
-fluid analysis; cytology and triglyceride on fluid and serum

51
Q

What is the treatment for chylothorax?

A

-drainage
-low fat diet
-rutin/octreotide medications
-surgery

52
Q

What are the surgical options to treat chylothorax?

A

-ligation of thoracic duct
-shunts
-omental drainage
-pericardectomy

53
Q

What are the long term sequelae of chylothorax?

A

-loss of fluids, proteins, vitamins, and electrolytes when drained
-constrictive pleuritis
-pneumothorax from constant draining
-patient stress from constant draining

FA2 Respiratory (33 decks)

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