Lung Edema

Question 1

pathophysiology

Answer 1

Interstitial and alveolar accumulation of fluids
Edema is the result of 
Increased hydrostatic pressures
Decreased colloid- oncotic pressure
Increased vascular permeability
Impaired lymphatic drainage

Question 2

Cardiogenic edema

Answer 2

is the result of increased venous pulmonary hydrostatic pressures secondary to left-CHF
Alveolar epithelium is intact האפיתל נשמר
Fluid is protein-poor
Severe cases may cause leakage of protein rich fluids
The condition is highly responsive to treatment:
Diuretics to reduce pre-load to left heart

פרוגנוזה טובה יותר מלא קרדיוגנית

Question 3

Non-cardiogenic edema

Answer 3

often involves increased vascular permeability and impaired alveolar epithelium integrity
Fluid is protein-rich
The condition is poorly responsive to diuretic treatment
Alveolar fluid absorption requires intact functioning epithelium
Injury to alveolar epithelial cells impairs fluid reabsorption

Question 4

עלייה בחדירות הוסקולרית יכולה לנבוע מ

Answer 4

Neurogenic lung edema (electrocution, head trauma, seizures)

Post-obstructive lung edema (re-expansion, strangulation)

Direct pulmonary damage (aspiration pneumonia, paraquat poisoning, near drowning, PTE)

ALI/ARDS (infection, sepsis, heat stroke, IMHA, snake bite, pancreatitis, uremia, vasculitis, TRALI, oxygen toxicity, smoke inhalation)

Question 5

סימנים קלינים

Answer 5

הסימנים הקליניים הינם דומים, ללא קשר למקור הבצקת. בינהם - טאכיפנאה, דיספנאיה, שיעול
– לעיתים שיעול דמי, ציאנוזיס, קרקלס, באי ספיקה שמאלית תשמע אוושה. צילומי בית חזה
תמיד יראו שינויים, במיוחד בבצקות לא קרדיוגניות. השינויים יכולים להיות כתמיים או דיפוזיים.
הדפוס יכול להתחיל אינטרסטיציאלי, ולהמשיך כדפוס אלבאולרי ככל שהמצב מחמיר

Clinical signs are similar
Tachypnea, dyspnea, cough and hemoptysis, cyanosis, orthopnea
Crackles
Heart murmur in dogs with L-CHF

Question 6

CXR (non-cardiogenic edema)

Answer 6

Patchy to diffuse
Interstitial to alveolar
Care with dyspneic animals!

Question 7

treat

Answer 7

Treatment in non-cardiogenic edema is aimed at oxygenation while the lungs heal
Oxygen supplementation
Positive pressure ventilation when PaO2=60/SpO2=90% despite oxygen supplementation, or when respiratory effort leads to muscle fatigue
Diuretic as a rule of thumb are not as effective as in cardiogenic edema
May be of benefit in neurogenic edema
Improve lymphatic flow in ALI/ARDS- only in well-hydrated animals
Addressing primary cause (e.g., sepsis) if possible
Beta-2 agonists (and phosphodiesterase inhibitoris) may accelerate alveolar fluid reabsorption