PE and Investigation Respiratory Disease Flashcards
What can be noted from distance observation?
- behaviour and demeanor
- resp rate, effort and pattern
- inspiratory and expiratory noise
- nostril flare
What can be determined through history and signalment?
- individual v herd/ infectious problem
- neonate, juvenile or adult
- performance, pleasure or production animal
- gneral management and environment
- disease course and features
- response to tx
WHat can be noted on PE?
- BCS
- posture
- abdominal effort
- hypertrophy of abdo muscles
- mm
- eyes (ocular discharge seen with resp infection)
- jugular veins (^ jugular pulse height)
- pectoral oedema
What are the landmarks of the maxillary paranasal sinus?
- dorsal line from medial canthus to nasoincisive notch
- rostral line at right angles to the rostral part of the facial crest
- floor parallell and slightly below facial crest
- caudal middle of orbit to facial crest
Landmarks of frontal paranasal sinus?
- caudal line rostral to the TMJ
- lateral line form the medial canthus to nasoincisive notch
- rostral line 2/3 distance from medial canthus to rostral end of facial crest
What are you looking for for serious sinus problems?
- facial asymmetry (only seen with very serious disease)
What structures are present in the pharyngeal area?
- gutteral pouches (look for swelling)
- lymph nodes (looking for enlargement and discharges if abscessated)
- larynx (looking for assymmetry of cricoarytenoideus dorsalis muscle [RLN], can assess movement in repsonse to a slap over the withers- though probably cant feel this)
What can be heard on equine thoracic Ausculatation and percussion?
- only just audible in adult, louder in foals and thin animals
- abscence of noise does not indicate lack of disease!!
- radiating heart sounds with pleural effusion
Where are the borders for thoracic auscultation in the ruminant?
- 6th intercostal space (point of elbow)
- 9th intercostal space (midway)
- 11th (level with tuber coxae)
- diaphragmatic border straight dorsoventral
(horses triangular region of auscultation)
What do crackles and wheezes indicate?
- crackle: small airways and alveoli problems
- wheeze: partial obstruction larger airways
What may shift of apex beat indicate?
displacement of heart due to scpae occupying lesion (only in small animals?)
What should further diagnostic testing decisions be based on?
- whether it will change tx or management of case
- specific advantages and disadvantages of each test
What can be examined on endoscopy of the equine?
- nasal passages
- gutteral pouches
- nasopharynx
- soft palate
- larynx
- trachea
What can be examined on endoscopy of small animals? How is it performed?
- trachea, mainstem bronchi and larger divisions or main bronchi
- must be performed under GA and trachea must be of sufficient diameter
> patient in sternal, radiographs taken prior
Strengths and weaknesses of enodscopy?
+ diseases of major airways
+ dynamic disease of URT
- unable ot visualise smaller airways or parenchymal lesions
What further techniques can be performed via endoscopy?
- aspiratio nof samples
- biopsy of discrete lesions
- retrieval of FB
What tests can be carried out if a viral cause is suspected?
- paired serology
- virus isolation from bubffy coat
- virus iolation from nasopharyngeal swabs
- vrial antigen detection by FAT from nasopharyngeal swabs and PCR to identify RNA/DNA of specific viruses
What samples of respiratory tract can be collected?
- nasopharyngeal swabs
- endoscopically guided tracheal aspirate
- transtracheal aspirate
- bronchoalveolar lavage
- pleural fluid
- lung biopsy
- gutteral pouch lavage
When is nasopharyngeal swab suitable?
- bacterial culture of specific orgnaism NOT normal commensals of the pharynx
> eg. in horses only bacteria in horses STREP EQUI EQUI as all others found will be normal commensals
> culture and PCR
What is endoscopically guided tracheal aspirate in equines also known as? What does this provide information on?
- tracheal wash
- secretions from ALL of lungs that pooled at the thoracic inlet
Pros and cons of tracheal aspirate/wash?
\+ easy to perform \+ sample representative of whole lung - contamination by equipment and pharyngeal flora - wide range normal cell populations - cells poorly preserved
Which procedure helps avoid oropharyngeal contamination? Outline how this is carried out?
> transtracheal aspirate
- surgically prepare site in lower 1/3 trachea
- instil local and insert catheter or needle between tracheal rings
- instilll saline and withdraw sample
- remove sample catheter first and guide catheter last to avoid contamination
Pros and cons or transtracheal aspirate?
+ no pharyngeal contamination
+ no specialised equipment required
+ useful in young foals (endoscopes too large)
- horse may cough catheter into pharynx anyway
- invasive
- cellulitits and subcut emphysema possible side effects
How is endoscopically guided tracheal aspirate performed in SA?
- GA
- go in through ET tube (NOT in cats as wont fit, pull ET tube first)
- blind wash and suck out
Transtracheal aspirate in equine common?
No unless 100% accuracy required eg. pleuropnuemonia caused by inhaling oro-pharyngeal pathogens
Indications for transtracheal aspirates in smallies? What must be punctured during this procedure?
Endoscopy not available (eg. if GA contraindicated)
- direct access in the concious pateint
> puncture cricothyroid ligament
What is the downside to bronchoalveolar lavage?
horse will cough throughout procedure!
Method of BAL?
- guide catheter inserted
- BAL tube into bronchus until it will not advance further
- inflate balloon and insert saline 120-200ml
- withdraw
ADVANTAGES AND DISADVANTAGES OF BAL?
+ sample is from area of tract most liekly affected eg. EIPH, COPD
+ narrow cell population aids interpretation
+ equipment required cheap and accessible (good for all LA)
- site sampled may not be appropriate in animals with loalised pulmonary abscesses or pnumonias (caudodorsal lung lobes most commonly sampled)
How is thoracocentesis often performed in horses?
Under ultrasound guidance
- select site in 7/8th intercostal spac, above lateral thoracic vein, prepare surgically, instill local, make stab incision, blunt teat cannula or drain CLOSED FROM ATMOSPHERE
What is analysed from a thoracocentesis sample?
- cytology (ID type of cells)
- protein (differentiate transudate, modified transudate, exudate)
- TG:cholesterol ratio (ID chylothorax in SA only not large)
- culture and sensitivty
When is lung aspiration indicated?
Discrete intrapulmonary lesion exists which cannot be accessed in any other way
- ultrasound or fluoroscopic guidance
- only in severely ill patients
When is lung biopsy indicated? Pros and cons?
- not frequently performed
- ID specific forms of pathology eg. interstitial pneumonia and neoplaisa
- very invasive (potential complications include uncontrollable haemorrhage and pneumothorax)
Why may feacal examination be indicated?
Angiostrongylus vasorum larvae in small animals
WHa is radiography useful for?
visualising pulmonary structures, pleural cavity, mediastinum
What is CT useful for?
- not horse!
- pleural, mediastinal and parenchymal areas
- high quality image, more detailed anatomical structure
- cheaper, quicker and better detail of lungs than MRI
What is thoracic US useful for?
Pleural effusion
- taking smaples eg. pleurocentesis, lung biopsy
What are pulmonary function tests?
- track excercise tests, treadmill excercise tests, oesophageal manometry, flow-volume loops, oxygen uptake and blood gas analysis
- rarely used
