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3. Cat & Dog 3 > Lower Airway Diseases in Small Animals > Flashcards

Lower Airway Diseases in Small Animals Flashcards

1
Q

Coughing Puppy Rule outs…

A
  • Canine infectious tracheo-bronchitis > “Kennel cough”
  • Tracheal foreign body
  • Tracheal collapse
    > Cons: usually older, seasonal
  • Bronchopneumonia
    > Cons: usually anorexia, lethargy, history of aspiration or exposure
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2
Q

Canine Infectious Tracheobronchitis
- what is this?

A

Infectious “complex”
* Bordetella bronchiseptica
* Canine adenovirus-2
* Canine parainfluenza virus
* Canine respiratory coronavirus
* +/- other secondary organisms

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3
Q

Canine Infectious Tracheobronchitis
- spread?
- disease course?

A
  • Highly contagious
    > Usually, history of contact with other dogs
  • Usually mild & self-limiting (within 1-2 weeks)
    > frustrating for client as dog is continuously coughing and may not be able to sleep
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4
Q

Canine Infectious Tracheobronchitis
* Clinical features

A
  • Dry, hacking, paroxysmal cough most common sign
  • May have nasal discharge (purulent)
  • Usually healthy otherwise
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5
Q

Diagnosing ITB

A
  • Diagnosis usually presumptive
    > History & clinical signs
    <><>
    Thoracic auscultation, radiographs, CBC
  • Usually normal
  • Diagnostic tests beyond the physical examination usually not performed in routine cases
    > Coughing induced on tracheal palpation
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6
Q

Treating ITB

A
  • Antibiotics have limited benefit in uncomplicated cases
    > Course of infection not shortened
    > Self-limiting disease
    <><><><>
  • Antibiotics rarely used
  • Antibiotics warranted only if:
  • Systemic signs or deeper respiratory involvement
    > E.g., fever, productive cough
  • Or if neonates (<8 weeks)
  • Empirical choices include Clavamox, doxycycline
    <><><><>
    Antivirals?
  • Not recommended
    <><><><>
    Glucocorticoids?
  • Not recommended
  • Does not shorten course of disease
  • May worsen illness if high dose used (immunosuppression)
    <><><><>
    Antitussives for dogs with dry cough
  • Hydrocodone, butorphanol
  • Contraindicated in cases of productive cough, systemic signs that may be reflective of pneumonia
    <><><><>
    Bronchodilators can help decrease bronchospasm
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7
Q

Treating ITB Antitussives
- which ones?
- what is their use?
- when not to use?

A

Antitussives for dogs with dry cough
* Hydrocodone, butorphanol
* Contraindicated in cases of productive cough, systemic signs that may be reflective of pneumonia
<><><><>
not recommended
- cough is cleaning the lungs, if we give this we can make things worse
- can give for the night if the puppy os not able to sleep, for example

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8
Q

ITB Prevention

A
  • B. bronchiseptica & Parainfluenza vaccine
  • ± Adenovirus
  • Recommended for at-risk dogs
  • Often required for boarding kennels
  • May lessen severity or prevent infections
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9
Q

ITB Prognosis

A
  • Excellent prognosis for recovery in uncomplicated cases
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10
Q

Complicated ITB
- what is this?
- what should we do?

A
  • Persisting (>1-2 weeks) or progressive clinical signs warrant the following diagnostics:
  • Thoracic radiographs
  • Airway sampling (transtracheal wash)
  • CBC
  • ± infectious disease testing (e.g., canine influenza)
    <><><><>
  • Pneumonia can result from ITB and requires further therapy
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11
Q

what radiographs do we need to diagnose tracheal collapse?

A

we need both inspiratory and expiratory views to see tracheal collapse - some are more visible in one view or the other

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12
Q

Tracheal Collapse, origins

A
  • Tracheal cartilage malacia
    > Dorsoventral collapse
  • Miniature and toy breeds
    > Yorkshire Terrier and Pomeranian
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13
Q

Clinical Signs of tracheal collapse

A
  • “Goose – honk” cough!!
  • Wheezing
  • Hacking
  • Exercise intolerance
  • Cyanosis +/- syncope
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14
Q

tracheal collapse dx? types and how to differentiate?

A

Radiography
* Dynamic condition
* Not overly sensitive
<><>
* Inspiration > cervical collapse
* Expiration > thoracic collapse
<><>
* also, fluoroscopy

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15
Q

Medical Management for tracheal collapse (broad, no drug names)

A

Initially
* Weight loss
* Environmental modifications
> Harness vs neck collar
> Removal of secondhand smoke
> Normal humidity
> Dental prophylaxis
* Pharmaceutical therapy

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16
Q

drugs we use for medical management of tracheal collapse

A
  • Doxycycline for a week > when severe signs, also has antiinflammatory properties
  • Corticosteroids > reduce inflammation
  • Bronchodilators > Open small airways and anti-inflammatory effect
  • Anti-tussives
  • Tracheal collapse elixir (0.22-0.44 ml/kg q8hr)
    > Phenobarbital, isoproterenol, theophylline, ephedrine
17
Q

possible issue with bronchodilators for tracheal collapse

A

questionable, as it can increase negative pressure > collapse

18
Q

Medical Management for tracheal collapse efficacy? when to go to surgery?

A
  • Majority of dogs respond well
    to medical management
  • However… progressive disease and still guarded long- term prognosis
  • Surgery/stent is palliative, performed when medical treatment fails
19
Q

Extra-luminal Tracheal Prosthesis - what is this? disadvantages?

A
  • External rings around trachea
    <><>
  • Disadvantages:
  • Only for cervical collapse
  • Collapse can occur beyond rings
  • 40% complication rate
20
Q

Endo-Luminal Tracheal Stent - when do we use this? what is it? complications?

A

more common, generally better
> for cases that are not improving with medical manamgement
<><><><>
* Minimally-invasive insertion
> Fluoroscopy +/- scoping
<><>
* Complications:
* Stent migration or fracture
* Granulation tissue formation
* Progressive collapse
* Costly

21
Q

Endo-Luminal Tracheal Stent - at what point should we consider this treatment? goal? results? what else do we need?

A
  • LAST RESORT ONLY
  • Goal: allow breathing and better quality of life
  • Dogs won’t stop coughing !!!!!
  • 100% need medical management
22
Q

Tracheal Collapse Prognosis

A
  • Life-long condition, progressive
  • Depends on grade of collapse
  • More severe collapse = guarded prognosis
23
Q

Bacterial Pneumonia Predisposing causes

A

Aspiration of GI contents
* Megaesophagus, recent anesthesia, chronic vomiting, seizures, force feeding, dysphagia, etc
<><>
Systemic immunosuppression
* Drugs
* Endocrine dz (hyperadrenocorticism, diabetes mellitus)
* Infection (FeLV, FIV)
<><>
Defective respiratory defenses/damage to
respiratory epithelium
* Bronchiectasia
* Smoke inhalation
<><>
* Sepsis (hematogenous spread of bacteria)

24
Q

Aspiration Pneumonia - pathogenesis?

A
  • Low bacterial content of aspirated GI material
  • Gastric pH kills most bacteria – contents may
    be sterile
  • Material may be contaminated by oral bacteria
    <><><><>
  • Acid injury to pulmonary parenchyma
  • Induces lung inflammation, bronchoconstriction
  • Predisposes to secondary (opportunistic) bacterial invaders
25
Q

Aspiration and bacterial pneumonia share several historical & PE findings, and may include:

A
  • **Anorexia
  • Lethargy**
  • Exercise intolerance
  • Tachypnea
  • Cough (more than 50% do not cough)!!!
  • Dyspnea
  • Cyanosis if severe lung involvement
  • Fever
  • Nasal discharge
  • Inspiratory crackles
  • Increased bronchovesicular sounds
26
Q

Pneumonia Thoracic Radiographs

A
  • Interstitial to alveolar radiographic pattern common * Typical distribution is ventral
  • May only affect one lung lobe
    > Often right middle lung lobe with aspiration pneumonia
    > Right cranial or caudal portion of left cranial
27
Q

Pneumonia CBC and pulse ox diagnostics?

A
  • CBC – neutrophilia common
  • Hypoxemia common
    > Pulse oximetry, blood gas analysis
    > Depends on how much lung is affected
28
Q

Airway Sampling for pneumonia use?
* Most common bacterial pathogens in canine pneumonia:

A
  • Culture & sensitivity helpful in guiding treatment
    <><><><>
    Most common bacterial pathogens in canine pneumonia:
  • E. coli
  • Pasteurella spp.
  • Bordetella bronchiseptica (especially in young dogs)
  • Streptococcus spp.
  • Staphylococcus spp.
29
Q

Empirical Antibiotic Selection for pneumonia?
mild vs severe cases

A

Dogs with mild to moderate clinical signs:
* Ampicillin, amoxicillin, amoxicillin-clavulanic
acid
* Cephalexin, cefazolin
<><>
Dogs with severe clinical signs or sepsis:
* IV route
* Add a fluoroquinolone or aminoglycoside

30
Q

pneumonia treatment, other than antibiotics

A
  • Oxygen support (nasal canula)
  • Maintain adequate airway hydration > IV fluids, nebulization with saline and coupage
31
Q

should we monitor pneumonia with radiographs? what should we do?
how long should we treat?

A
  • Paradigm shift in monitoring resolution: skip the x-rays, consider C-Reactive Protein to monitor resolution
  • Shortest course of antimicrobials
    <><><><>
  • Recurrent pneumonia is challenging
  • Underlying causes often hard to treat
32
Q

pneumonia prognosis? how can radiographs predict?

A

Prognosis for recovery is good
* Depends on underlying cause
* Relapse may occur if underlying cause not able to be corrected
<><><><>
* Severity of radiographic involvement does not appear to predict prognosis

33
Q

what should we do if there is pneumonia recurrence?

A

CT-scanner recommended to look for FB

3. Cat & Dog 3 (26 decks)

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