Pericardial, pleural and abdominal effusions in SA

Question 1

List causes of pericardial effusions

Answer 1

Congenital pericardial disease
Idiopathic haemorrhagic effusion
Neoplasia
Congestive heart failure – usually small effusions & not functionally significant
Left atrial rupture - RARE
Haemorrhage – trauma, coagulopathy, haemangiosarcoma
Hypoproteinaemia
Pericarditis – migrating FBs? -RARE

Question 2

What happens in Pericardio-peritoneal diaphragmatic hernia

Answer 2

Abdominal contents are herniated into the pericardial sac because of direct communication between the peritoneal and the pericardial cavities.

Question 3

Signs and treatment of pericardio peritoneal diaphragmatic hernia

Answer 3

None, gastro-intestinal, cough, ascites
Surgery if symptomatic

Question 4

Pericardio-peritoneal diaphragmatic hernia (PPDH): Diagnostic Imaging

Answer 4

Marked cardiomegaly
Intestines, spleen, liver may be in the pericardial space
Frequently an incidental finding

Question 5

Define cardiac tamponade

Answer 5

Compression of the heart by an accumulation of fluid in the pericardial sac

Question 6

How does cardiac tamponade occur

Answer 6

If the pressure of effusion is greater than right atrial/ventricular pressure

Question 7

Why can tamponade occur at lower volumes when pericardium is thickened

Answer 7

Because there is less compliance of the pericardium.

Question 8

Pathophysiology of pericardial effusion

Answer 8

1. Pericardial effusion
2. Compresses right heart
3. Decreases filling of right side
4. Increased venous pressure causing RCHF
5. Decreases CO
6. Forward failure

Question 9

Clinical presentation of pericardial effusion with tamponade

Answer 9

Abdominal distension
Exercise intolerance
Lethargy
Weakness

Question 10

Breeds of dogs predisposed to pericardial effusion with tamponade

Answer 10

Idiopathic: Golden retrievers, Labradors, St. Bernards
Neoplastic: Boxers, German Shepherd

Question 11

Physical examination findings of pericardial effusion with tamponade

Answer 11

Poor cardiac output
- Pallor
- Prolonged capillary refill time
- Weak pulse
- Tachycardia
- Muffled heart sound
Right sided congestive heart failure
- Jugular distension
- Ascites
- Hepatomegaly
Pulsus paradoxus

Question 12

What is pulsus paradoxus

Answer 12

Weaker pulse during inspiration

Question 13

What is the name of the technique used in pericardiocentesis

Answer 13

Seldinger technique

Question 14

Progonosis of pericardial effusion

Answer 14

Recurrence occurs in 50% of case following pericardiocentesis
Pericardiectomy is recommended if the effusion recurs and carries a good prognosis in idiopathic cases
If the effusion recurs quickly, neoplasia is likely and prognosis is guarded
Surgery may be an option in some cases with tumours

Question 15

Small volume pericardial effusions are seen with what conditions in cats?

Answer 15

Congestive heart failure (main cause of pericardial effusions seen on echo in cats)
Hypoproteinemia
Feline infectious peritonitis

Question 16

T/F Feline Infectious Peritonitis can cause pericardial effusion

Answer 16

True!

Question 17

Difference between Exudates and Transudates

Answer 17

Exudates are fluids, CELLS, or other cellular substances that are slowly discharged from BLOOD VESSELS usually from inflamed tissues.

Transudates are fluids that pass through a membrane or squeeze through tissue or into the EXTRACELLULAR SPACE of TISSUES.

Question 18

List some causes of abdominal effusions in dogs

Answer 18

Liver disease
Cardiac disease
Neoplastic (Haemangiosarcoma)
Hypoalbuminaemia

Question 19

List some causes of abdominal effusions in cats

Answer 19

Infectious disease- Feline infectious peritonitis
Neoplastic (Abdominal carcinomas)
Liver disease
Heart disease (uncommon)
Hypoalbuminemia

Question 20

Physical examination of patient with abdominal effusion

Answer 20

Abdominal distension
Abdominal Fluid thrill/wave
Tachypnoea/dyspnoea: If large effusion (pressure on diaphragm)
Abdominal discomfort: Particularly when lifted

Question 21

Differentiate between abdominal effusion from Thoracic vs Non thoracic

Answer 21

Look for evidence of cardiac disease and right sided congestive heart failure
Jugular distension
Jugular pulsation
Murmur
Arrhythmias

Question 22

List some causes of pleural effusions in dogs and cats

Answer 22

Neoplastic diseases (Lymphoma, Carcinoma, Mesothelioma)
Hypoalbuminaemia
Protein losing enteropathy
Protein losing nephropathy

Question 23

Define carcinoma

Answer 23

Carcinoma is a malignancy that develops from epithelial cells.

Question 24

Clinical examination of patient with pleural effusion

Answer 24

Dyspnoea
Tachypnoea
Muffled heart sounds
Ventral dullness on thoracic percussion

Question 25

How would transudate look like on ultrasound

Answer 25

Hypoechogenic

Question 26

How would exudate look like on ultrasound

Answer 26

Hyperechoic

Question 27

Which intercostal space do you perform a thoracocentesis

Answer 27

7-9th

Question 28

Pyothorax is a sign of what infection

Answer 28

Intrapleural bacterial infection

Question 29

T/F Pyothorax is more common in cats

Answer 29

True!

Question 30

Clinical signs of patient with pyothorax

Answer 30

Dyspnoea ± acute onset, lethargy, inappetence, pyrexia, anorexia Ventral thoracic dullness - percussion, auscultation Haematology ± leucocytosis, ± anaemia

Question 31

Aetiology of pyothorax

Answer 31

Consider FeLV/FIV Penetrating bite Perforation of respiratory tract or oesophagus Pneumonia with lung necrosis Haematogenous/lymphatic spread Migrating foreign body Iatrogenic Unknown/idiopathic

Question 32

FeLV

Answer 32

Feline Leukemia virus

Question 33

FIV

Answer 33

Feline immunodeficiency virus

Question 34

FIP

Answer 34

Feline Infectious peritonitis

Question 35

Chyle

Answer 35

Milky bodily fluid formed in the lacteal system of the intestine High triglycerides Lymphocytes

Question 36

Difference between Chyle and pseudochyle

Answer 36

Chyle: cholesterol: triglyceride in fluid < 1, lymphocytes Psudochyle: cholesterol: triglyceride in fluid >1, neutrophils, lymphocytes

Question 37

Causes of Chyle

Answer 37

Congestive heart failure Neoplasia Trauma Congenital Idiopathic (Afghans, bull mastiffs)

Question 38

Chylothorax: Management

Answer 38

Conservative: Thoracocentesis Low fat diet Diuretics especially if CHF present Rutin (nutraceutical)- aids fluid absorption Surgical: thoracic duct ligation + pericardectomy + cysterna chyli ablation + thoracic omentalization

Question 39

Where does heart worm live

Answer 39

Adults live in the pulmonary arteries and right ventricle

Question 40

What can one expect to see on a thoracic radiograph of a dog with heartworm

Answer 40

Interstitial lung pattern Pulmonary artery dilation Tortuous pulmonary vessels

Question 41

Diagnostic testing for heartworm

Answer 41

Blood smear for microfilaraemia Knott’s/filter test – to concentrate microfilariae Microfilarial antibody test Adult female worm antigen test

Question 42

Name of drug to treat heartworm

Answer 42

Macrocyclic Lactone (milbemycin, avermectins) and Doxycycline prior to adulticide therapy Deep intramuscular injection Melarsomine