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Small Animal Medicine > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

Inflammatory Airway Disease

A
  1. Chronic Bronchitis
    • Dogs and cats
  2. Feline Asthma
    • “Feline lower airway disease”
      (often not differentiated clinically in cats, just called FLAD)
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2
Q

Airflow limitation

A

Impedance to air movement in the airways caused by inflammation, secretions, and smooth muscle contraction

  1. Chronic bronchitis
    • Little to no spontaneous bronchoconstriction
  2. Feline asthma
    • REVERSIBLE spontaneous bronchoconstriction
      • can be reverse w/ Beta-2 agonists
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3
Q

Inflammatory airway disease

A
  1. Canine Chronic Bronchitis
    • Middle aged to older
    • Small breeds over-represented
  2. Feline asthma and bronchitis
    • Young to middle-aged adult
    • Siamese
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4
Q

Inflammatory airway disease: clinical signs

A
  1. Chronic cough
    • Usually non-productive (initially)
  2. Expiratory WHEEZES
    • expiratory push (using abdominal effort)
  3. Tachypnea at rest
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5
Q

IAD: diagnostics

A
  1. CBC
  2. Parasite testing
  3. Bronchial lung patteran (donuts and railroad tracks for airways on radiographs)
    • +/- interstitial pattern
  4. TTW, ETW, or BAL*
    • Pre-med cats w/ bronchodilator
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6
Q

Feline Lungworm

A
  1. Aleurostrongylus abstrusus
    • Ingest L3 larva (snail, slug, reptile, bird, rodent)
    • Adult worms live in terminal bronchioles/alveolar ducts ==> inflammation
      • can be eosinophilic and look like feline asthma!
  2. Dx: identify L1 larvae in airway fluid or feces (Baermann or zinc sulfate)
  3. Tx: mild cases self-limiting; fenbendazole
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7
Q

“Classic” Feline Asthma Radiographs

A
  1. Bronchointerstitial lung pattern
  2. Pulmonary hyperinflation
    • increased lucency = air trapping (lungs look abnormally dark on rads)
    • flattened diaphragm
  3. Atelectasis of the RIGHT MIDDLE LUNG LOBE
    • mucous plugging
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8
Q

Feline IAD: bronchoscopy

A
  1. hyperemia
  2. irregularity in mucosa
  3. increased mucus
  4. lower airway collapse
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9
Q

Feline IAD: respiratory wash cytology

A
  1. Bronchitis ==> Neutrophilic

2. Asthma ==> Eosinophilic

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10
Q

Feline IAD: treatment

A
  1. Corticosteroids*
    • Cornerstone of treatment, taper to lowest effective dose
    • Oral (prednisone/prednisolone)
    • Inhaled (fluticasone)
  2. Bronchodilators
    • Decrease airway constriction in acute asthma attacks
    • NO effect on airway inflammation
  3. +/- cough suppressants (dogs)
    • break inflammatory cycle (dogs w/ a cough can develop into a quality of life issue, not really w/ cats)
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11
Q

Inhaled therapies

A

Delivered via metered dose inhaler into a spacer

- Fluticasone, albuterol

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12
Q

IAD: Treatment

A
  1. weight loss
  2. harness vs. a collar
  3. environmental trigger avoidance (smoke, perfume, etc.)
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13
Q

IAD: Treatment goals

A
  1. minimize clinical signs
  2. SLOW AIRWAY REMODELING
    • bronchiectasis
    • pulmonary fibrosis
    • pulmonary hypertension

Long-term management disease

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14
Q

Interstitial disease: eosinophilic bronchopneumopathy

A
  1. interstitial lung disease characterized by infiltration with eosinophils
    • peripheral eosinophilia common
  2. Most cases iodiopathic
    • Most commonly affects young dogs, arctic breeds, and Rottweilers predisposed*
    • MUST rule out other causes of eosinophilic lung inflammation: parasites, neoplasia
  3. Responds well to corticosteroids
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15
Q

Idiopathic Pulmonary Fibrosis

A
  1. West Highland White Terriers
  2. Diffuse inspiratory CRACKLES
  3. Diffuse broncho-interstitial lung pattern
  4. Dx: biopsy, rule out causes of secondary fibrosis
  5. Prognosis: poor long-term (it’s not reversible)

NOTE: pulmonary fibrosis can occur with any untreated lung disease

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16
Q

Bacterial Pneumonia

A

RARELY A PRIMARY DISEASE

  1. Immunocompromised host
    • young/old patient
    • therapeutic steroids
    • systemic disease (diabetes, Cushing’s, FeLV/FIV)
    • Lung disease (bronchitis, viral infection)
  2. Recombency (can’t protect their airway or cough)
    • illness/sedation
  3. Impaired host defenses
    • congenital/acquired
17
Q

Bacterial Pneumonia: causes

A
  1. Respiratory tract not sterile to level of carina!!
    • may be some normal flora past the carina too
  2. Route of infection
    • ASPIRATION*
    • Hematogenous
    • Traumatic/penetrating

Bacterial isolates:
#1 = E. coli* (then Pasteurella)
Aerobes > Anaerobes
Mycoplasma sp. common

Diagnose: airway wash w/ culture (look for bacteria, may be in PMN’s, along w/ septic inflammation)

18
Q

Bordetella Bronchiseptica

A

1 cause of community acquired infectious pneumonia in dogs <1 YEAR OF AGE

Bordetella is contagious!!!

19
Q

Pneumonia Radiographs

A

INTERSTITIAL TO ALVEOLAR PATTERN
- Only interstitial = early or less severe disease

Distribution:
 1. Aspiration: cranioventral*
 2. Hematogenous: dorsal-diffuse
    - Viral pneumonias
 (but it's not clear cut..)
20
Q

Aspiration pneumonia

A

MOST COMMON CAUSE OF BACTERIAL PNEUMONIA IN ADULT* DOGS

Initial problem = airway irritation/injury (ie. pneumonitis, NOT infection)
==> injury allows for bacterial colonization

21
Q

Aspiration pneumonia

A

Out of 125 dogs, history of:

- Vomiting (64%)
- Recent anesthesia (16%)
         - causes laxity of esophagus and LES

Commonly associated w/ regurgitation, megaesophagus, largyngeal paralysis (glottis can’t always close properly), myastenia gravis

22
Q

Localization trend of Aspiration Pneumonia

A
  1. Right Middle Lung Lobe
  2. Right Cranial Lung Lobe
  3. Caudal segment of Left Cranial lobe

BUT, normal rads in a suspicious patient does not rule aspiration pneumonia out

23
Q

Bacterial Pneumonia - Empiric treatment

A
  1. Uncomplicated disease
    • NARROW spectrum, SINGLE therapy

Duration: 1-2 weeks post radiographic resolution (3-4 weeks)

  1. Complicated/severe disease
    • BROAD spectrum, combination therapy
      • aerobic and anaerobic coverage, G+ and G- coverage
    • Parenteral administration initially

Duration: 1-2 weeks post radiographic resolution (4-6weeks)

24
Q

Nebulization

A
  1. Loosens and moistens airway secretions

2. Improves expectoration

25
Q

Fungal Pneumonia

A 
#1 cause: Blastomyces dermatidis*
#2 cause: Histoplasma capsulatum
  • Coccidiodes immitis
  • Cryptococcus neoformans
    • feline
    • nasal infection more common than true pneumonia (doesn’t cause true pneumonia often)
26
Q

Fungal Pneumonia: Dx and Tx

A

Diagnosis:

  • CYTOLOGY
    • Wash (TTW/BAL)
    • LN/Lung FNA
    • Look elsewhere for lesions (skin, LN)
  • Urine antigen
    • Blasto/Histo
    • Sensitive! Doesn’t differentiate between the two..
  • Rads: may appear as a “snowy” pattern in lungs - very suggestive of fungal pneumonia, but neoplasia and bacterial pneumonia CAN look like this too (if have snowy pattern => guarded prognosis)

Treatment:

  • LONG-TERM antifungals (itraconazole/fluconazole)
  • +/- anti-inflammatory steroids
27
Q

Pulmonary Neoplasia

A
  1. Metastatic*: most common!
  2. Primary
    • Commonly solitary/large nodule
    • Tx: surgical excision +/- chemotherapy

Small Animal Medicine (31 decks)

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