Lung Disease Flashcards
What clinical signs are associated with aspiration pneumonia? How can you diagnose it? How do you treat it?
Signs
- cough, harsh/reduced lung sounds, tachypnoea, pyrexia
Diagnosis
- Radiographs alveolar infiltrate (patchy/focal): Most common affected lobes are right middle, right cranial and left cranial
- BAL to confirm diagnosis
Treatment
Supportive – oxygen therapy, antibiotics
Treat any underlying cause
Consider anti-acid medication if frequent occurrence
May increase gastric bacterial load therefore caution…
Metoclopramide to improve motilty and increase LOS tone
What causes pulmonary oedema?
- Increased hydrostatic pressure
- Reduced oncotic pressure
- Increased vascular permeability
- Impaired lymphatic drainage
What are the 2 types of pulmonary oedoma?
- cardiogenic - low protein due to increased hydrostatic pressure without increased vascular permeability
- non-cardiogenic - result of lung damage which increases vascular permeability and causes hypoxaemia and high protein fluid in the lung parenchyma
What is the common presentation of pulmonary oedema? How do we diagnose it? How do we treat it?
**Presentation **
- signs may be delayed after insult for up to 72 hours
- Moist cough (may produce froth), orthopnoea, cyanosis
- Harsh BV lung sounds with crackles are typical
Diagnosis
- Radiographs – unstructured interstitial pattern and peri-bronchial can progress to alveolar, often caudo-dorsal
Therapy caution as animals clinically fragile
- Address underlying cause, treat ARDS/ALI
- Oxygen supplementation
- Sedation may be required (caution with resp depression)
- Support – keep affected lung dependent
- Diuretics less effective for non-cardiogenic oedema but still indicated
What is the common presentation of physical lung injury? How do you diagnose it? How do you treat it?
Thoracic trauma
Pulmonary contusion - ventilation perfusion mismatch
Chest wall damage and pain
Thoracic radiographs to evaluate all thoracic structures
Lag phase
Supportive care with supplemental oxygen ASAP
Other treatment as required – e.g. stabilisation of the thoracic wall, analgesia
What is common presentation of drowned patients? How can you diagnose it? How can you treat it?
Resp. distress, arrest, cough, unconscious
Auscultation – increased or decreased lung sounds
Radiographs varied but interstitial to alveolar pattern
This can progress to ARDS and so the appearance may underestimate the extent of the pathology
Sand bronchograms are a negative prognostic indicator
Radio-opaque material in the airways
Oxygen therapy, may need ventilation if unable to keep saturation PaO2>60mmHg with FiO2 >50%.
Care with fluid therapy – over perfusion in the face of lung injury
No evidence for antibiotics or corticosteroids improving outcomes
What clinical signs are associated with canine chronic bronchitis?
- Persistent, productive or nonproductive cough
- Exercise intolerance,
- increased expiratory effort,
- prolonged expiratory phase,
- wheezing.
- Acute exacerbation of disease can occur during excitement, stress, or when a secondary, complicating factor (e.g. pneumonia) occurs.
- Acute respiratory distress can occur
What clinical signs are associated with feline asthma?
episodic respiratory distress and dyspnoea, coughing
What clinical sign is the key feature in feline chronic bronchitis?
Cough
What investigations can you undertake in chrinic inflammatory airway disease? How can you treat it?
Investigations
* Bloods
* Pulse oximetry
* Radiographs – lateral recumb. or standing
* CT
* BAL (TTW?) – culture and PCRs?
* Bronchoscopy
Treatment
* Anti-inflammatories - Glucorocorticoids
* Bronchodilators - Licensed vs. unlicensed
* Antibiotics
* Antitussives
* Supportive therapy
* Regular reassessments – e.g. development of dynamic airway disease or nosocomial infections.
What is the common presentation of eosinophilic lung disease? How is it diagnosed? How is it treated?
Acute or chronic presentation
* usually coughing
* Can also see weight loss
Diagnosis
* Radiographs show diffuse bronchointerstitial pattern although can see alveolar patterns (can be dense infiltrates)
* Circulating eosinophilia in ~50% dogs – some will have hypereosinophilic syndrome
* BAL for diagnosis – caution to look for parasites, neoplasia and fungal disease
Treatment
* prednisolone 1-2mg/kg daily
* Outcome often very good unless other organs involved in which case prognosis guarded
What kind of history is associated with interstitial pulmonary fibrosis? What can you see on clinical exam? How woud you diagnose it?
History
* Insidious onset
* Chronic breathlessness which is slowly progressive
* Coughing can be a feature
* Exercise intolerance
* Owner may notice cyanosis
* Can cause syncope
Clinical examination
* Crackles throughout the lung fields
* Prolonged expiratory phase with expiratory effort.
Diagnosis
* Suggestive clinical signs
* Diffuse crackles on auscultation, dyspnoea, coughing
* Thoracic radiographs
* Generalised interstitial lung pattern
* +/- right sided cardiomegaly, +/- pulmonary hypertension
* CT – method of choice in humans
* Typical ground glass appearance – diffuse increase opacity without loss appearance of blood vessels.
* Bronchoscopy
* BAL samples are either normal or show low cellularity
* Rules out other inflammatory conditions – primarily CB
* Lung biopsy is the only method of definitive diagnosis
* Relatively poorly understood compared with human fibrotic lung diseases
* In absence of biopsies, efficacy of treatment difficult to determine
How would you treat interstitial pulmonary fibrosis?
Symptomatic treatment
- Avoid collars, harness only, avoid smoke inhalation
Inhaled therapy
- Bronchodilator, corticosteroids
Oral therapy
- Bronchodilators - especially if concurrent airway collapse
- Corticosteroids
Additional immunosuppressive medication
- Azathioprine and cyclosporin - No evidence of clinical efficacy
Antibiotics as necessary
Anti-fibrotics (e.g. colchicine)
- Theoretically slows collagen deposition and reduces production of profibrotic cytokines
- No evidence for efficacy of these
Management of pulmonary hypertension
- Phosphodiesterase inhibitors: Sildenafil, tadalafil, pimobendan
What conditions are associated with pulmonary parasites?
- coagulopathies
- neurological dysfunction
What clinical signs are associated with a. vasorum? How can you diagnose it?
- anaemia, subcutaneous haematomas, internal haemorrhages, prolonged bleeding from wounds or after surgery
- Paresis, depression, seizures, spinal pain, behavioural changes, ataxia and loss of vision have been described
BAL, faecal sample (intermittent shedding)
SNAP test
PCR test (pharynx swab, BAL)
Radiography
