Pericardial, pleural and abdominal effusions in SA Flashcards
List causes of pericardial effusions
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
What happens in Pericardio-peritoneal diaphragmatic hernia
Abdominal contents are herniated into the pericardial sac because of direct communication between the peritoneal and the pericardial cavities.
Signs and treatment of pericardio peritoneal diaphragmatic hernia
None, gastro-intestinal, cough, ascites
Surgery if symptomatic
Pericardio-peritoneal diaphragmatic hernia (PPDH): Diagnostic Imaging
Marked cardiomegaly
Intestines, spleen, liver may be in the pericardial space
Frequently an incidental finding
Define cardiac tamponade
Compression of the heart by an accumulation of fluid in the pericardial sac
How does cardiac tamponade occur
If the pressure of effusion is greater than right atrial/ventricular pressure
Why can tamponade occur at lower volumes when pericardium is thickened
Because there is less compliance of the pericardium.
Pathophysiology of pericardial effusion
- Pericardial effusion
- Compresses right heart
- Decreases filling of right side
- Increased venous pressure causing RCHF
- Decreases CO
- Forward failure
Clinical presentation of pericardial effusion with tamponade
Abdominal distension
Exercise intolerance
Lethargy
Weakness
Breeds of dogs predisposed to pericardial effusion with tamponade
Idiopathic: Golden retrievers, Labradors, St. Bernards
Neoplastic: Boxers, German Shepherd
Physical examination findings of pericardial effusion with tamponade
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
What is pulsus paradoxus
Weaker pulse during inspiration
What is the name of the technique used in pericardiocentesis
Seldinger technique
Progonosis of pericardial effusion
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
Small volume pericardial effusions are seen with what conditions in cats?
Congestive heart failure (main cause of pericardial effusions seen on echo in cats)
Hypoproteinemia
Feline infectious peritonitis
T/F Feline Infectious Peritonitis can cause pericardial effusion
True!
Difference between Exudates and Transudates
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.
List some causes of abdominal effusions in dogs
Liver disease
Cardiac disease
Neoplastic (Haemangiosarcoma)
Hypoalbuminaemia
List some causes of abdominal effusions in cats
Infectious disease- Feline infectious peritonitis
Neoplastic (Abdominal carcinomas)
Liver disease
Heart disease (uncommon)
Hypoalbuminemia
Physical examination of patient with abdominal effusion
Abdominal distension
Abdominal Fluid thrill/wave
Tachypnoea/dyspnoea: If large effusion (pressure on diaphragm)
Abdominal discomfort: Particularly when lifted
Differentiate between abdominal effusion from Thoracic vs Non thoracic
Look for evidence of cardiac disease and right sided congestive heart failure
Jugular distension
Jugular pulsation
Murmur
Arrhythmias
List some causes of pleural effusions in dogs and cats
Neoplastic diseases (Lymphoma, Carcinoma, Mesothelioma)
Hypoalbuminaemia
Protein losing enteropathy
Protein losing nephropathy
Define carcinoma
Carcinoma is a malignancy that develops from epithelial cells.
Clinical examination of patient with pleural effusion
Dyspnoea
Tachypnoea
Muffled heart sounds
Ventral dullness on thoracic percussion
How would transudate look like on ultrasound
Hypoechogenic
How would exudate look like on ultrasound
Hyperechoic
Which intercostal space do you perform a thoracocentesis
7-9th
Pyothorax is a sign of what infection
Intrapleural bacterial infection
T/F Pyothorax is more common in cats
True!
Clinical signs of patient with pyothorax
Dyspnoea ± acute onset, lethargy, inappetence, pyrexia, anorexia
Ventral thoracic dullness - percussion, auscultation
Haematology ± leucocytosis, ± anaemia
Aetiology of pyothorax
Consider FeLV/FIV
Penetrating bite
Perforation of respiratory tract or oesophagus
Pneumonia with lung necrosis
Haematogenous/lymphatic spread
Migrating foreign body
Iatrogenic
Unknown/idiopathic
FeLV
Feline Leukemia virus
FIV
Feline immunodeficiency virus
FIP
Feline Infectious peritonitis
Chyle
Milky bodily fluid formed in the lacteal system of the intestine
High triglycerides
Lymphocytes
Difference between Chyle and pseudochyle
Chyle: cholesterol: triglyceride in fluid < 1, lymphocytes
Psudochyle: cholesterol: triglyceride in fluid >1, neutrophils, lymphocytes
Causes of Chyle
Congestive heart failure
Neoplasia
Trauma
Congenital
Idiopathic (Afghans, bull mastiffs)
Chylothorax: Management
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
Where does heart worm live
Adults live in the pulmonary arteries and right ventricle
What can one expect to see on a thoracic radiograph of a dog with heartworm
Interstitial lung pattern
Pulmonary artery dilation
Tortuous pulmonary vessels
Diagnostic testing for heartworm
Blood smear for microfilaraemia
Knott’s/filter test – to concentrate microfilariae
Microfilarial antibody test
Adult female worm antigen test
Name of drug to treat heartworm
Macrocyclic Lactone (milbemycin, avermectins) and Doxycycline prior to adulticide therapy
Deep intramuscular injection Melarsomine
