Pericardial, Pleural and Abdominal Effusions Flashcards
what are congenital pericardial disorders (3)
- pericardio-peritoneal diaphragmatic hernia (PPDH)
- complete/partial defects
- cysts
what are the causes of pericardial effusions (7)
- idiopathic hemorrhagic effusion
- neoplastic (also usually hemorrhagic)
- CHF: usually small & functionally signficant
- left atrial rupture (rare): secondary to severe/chronic mitral regurgitation & jet lesions
- hemorrhage: trauma, coagulopathy, hemangiosarcoma
- hypoproteinemia
- pericarditis very rare (migrating FBs?)
what is a cardiac tamponade
occurs if the volume &/or pressure of effusion is high enough
if pericardial fluid pressure > RV/RA pressure
what would cardiac tamponade appear on echo
what is the pathophysiology of cardiac tamponade
what are the clinical features of pericardial effusions
- idiopathic: large breed dogs, including german
what are the presenting signs of pericardial effusions in dogs (4)
- exercise intolerance
- lethargy
- abdominal distension
- weakness
what are the physical findings of tamponade (5)
- pallor
- prolonged capillary refill time
- weak pulse
- tachycardia
- muffled heart sounds
what are the signs of right sided congestive heart failure (4)
- jugular distension
- ascites
- hepatomegaly
- pulsus paradoxus –> weaker pulse during inspiration
what are the radiographic signs of pleural effusions (3)
- cardiomegaly
- rounded cardiac silhouette (esp. DV)
- wide caudal vena cava
what is seen on ECG with pericardial effusion (2)
- small QRS complexes
- electrical alternans (also seen with SVTs)
what is seen on echo with pericardial effusions
effusion with potential cardiac tamponade
how is pericardial effusion treated
pericardiocentesis – therapeutic and diagnostic
how is pericardiocentesis performed (10)
- left lateral recumbency
- clip right thorax over the heart
- infiltrate 5-6th intercostal space at costo-chondral junction with local anesthetic
- aseptically prepare skin
- use pericardiocentesis catheter or large gauge IV catheter
- advance to and through pericardium
- ECG will detect arrythmias if touch myocardium
- drain pericardium as completely as possible
- pericardial effusion almost always hemorrhagic but doesn’t clot – if it does, stop draining
- send fluid for cytology +/- culture
what is the prognosis of pericardial effusions
recurrence occurs in 50% of cases
pericardiectomy is recommended if the effusion recurs and carries a good prognosis in idiopathic cases
if effusion recurs quickly neoplasia is likely and prognosis is guarded
do pericaridal effusions always lead to tamponade
no not always
what are small volume effusions seen with (4)
- congestive heart failure (main cause of pericardial effusions seen on echo in cats)
- hypoproteinemia
- feline infectious peritonitis
- infection - very uncommon
what are the types of effusions (7)
- transudate (non-inflammatory)
- modified transudate (higher cell or protein content)
- exudate (inflammatory) –> septic and non-septic
- hemorrhage
- chyle (lymphatic)
- bile (biliary tract trauma)
- urine (trauma or ureter, bladder, urethra)
what are causes of abdominal effusions in dogs (4)
- liver diseases: chronic hepatopathies
- cardiac diseases: pericaridal effusions, dilated cardiomyopathym mitral valve disease, pulmonary stenosis, dirofilariasis (heartworm)
- neoplastic diseases: hemangiosarcoma, various others
- hypoalbuminemia: protein losing enteropathy, protein losing nephropathy
what are the abdominal effusions in cats (5)
- infectious disease: feline infectious peritonitis
- neoplastic diseases: abdominal carcionmas
- liver diseases: chronic hepatopathies
- heart disease (uncommon): cardiomyopathy
- hypoalbuminemia: protein losing enteropathy, protein losing nephropathy
what is the basic approach to abdominal effusions (7)
- history
- clinical exam
- ascitic fluid analysis
- blood biochemistry
- hematology
- urinanalysis
- diagnostic imaging (radiography, echocardiography, abdominal ultrasonography, CT)
what are the signs of abdominal effusion (3)
- abdominal distention: fluid thrill/wave
- tachypnea/dyspnea: if large effusion (pressure on diaphragm)
- abdominal discomfort: particularly when lifted
how do you tell the difference between thoracic and non-thoracic causes
look for evidence of cardiac disease and right sided congestive heart failure
if cardiac/intrathoracic etiology for ascites: jugular distension &/or pulsation, murmur, arrhythmias
what is shown on thoracic radiography with cardiac causes of ascites
cardiomegaly with enlargement of caudal vena cava
what are acquired heart disease causes of ascites (3)
- pericardial disease
- biventricular CHF secondary to DCM or degenerative valve disease in dogs & cardiomyopathy in cats (esp if pulmonary hypertension)
- dirofilaria immitis – caval syndrome
what are congenital heart disease causes of ascites (3)
- pulmonary stenosis
- tricuspid valve dysplasia
- biventricular CHF secondary to end-stage left-to-right shunts
what are the causes of pleural effusions in cats and dogs (6)
- infectious diseases: pyothorax (exudative pleurisy), feline infectious peritonitis
- neoplastic diseases: lymphoma, carcinomas, mesthelioma
- heart disease – CHF
- chylothorax
- hemorrhage
- hypoalbuminemia: protein losing enteropathy, protein losing nephropathy
what is seen on history with pleural effusions (3)
- inspiratory and expiratory dyspnea
- tachypnea
- +/- cough
what is seen on clinical exam with pleural effusions (4)
- dyspnea
- tachypnea
- muffled heart sounds
- ventral dullness on thoracic percussion
what is the diagnosis of pleural diseases (6)
- radiography pre/post drainage
- ultrasonography
- pleural fluid biochemistry, cytology and culture
- biopsy if mass identified
- CT/MRI
- exploratory thoracotomy/thoracoscopy
how does transudate, modified transudate, FIP, exudate, chylous
how are pleural effusions investigated by laboratory (3)
- hematology: evidence of anemia
- biochemistry: blood protein concentration, fluid protein, lipid, glucose, renal function, hepatic function
- urine analysis: protein:creatinine ratio
how are pleural effusions seen on radiograph
separation of lung lobes with pleural fissure lines
shows presence and extent of effusion
what are the clinical signs of pyothorax
dyspnea +/- acute onset of lethargy, inappetence, pyrexia, anorexia, pain?
ventral thoracic dullness, percussion and auscultation
what is seen on hematomology with pyothorax (2)
- +/- leukocytosis
- +/- anemia
what is the etiology of pyothorax (6)
- penetrating bite; perforation of respiratory tract or esophagus
- pneumonia + lung necrosis
- hematogenous/lymphatic
- foreign body (farm dogs)
- iatrogenic
- unknown/idiopathic
what is a common cause of pyothorax in cats
FeLV/FIV
what is the bacteriology of pyothorax (2)
anaerobes predominate
- close to oral flora in cats: Bacteroides, Fusobacterium, Clostridia, Pasteurella, Streps, Staphs
- different spectrum in dogs: Actinomyces, Nocardia, Bacteroides
how is pyothorax managed
- thoracic drainage: needle, catheter, or indwelling chest drain
- systemic +/- local antibiotics: broad spectrum + anaerobes
- +/ pleural lavage
- +/- thoracotomy
success rate 70-80%
what are the types of chylothorax
- chyle (triglycerides, chylomircons, lymphocytes, lactescence clears with ether)
- pseudochyle (ether -ve, neutrophils, cholesterol) – usually inflammatory (uncommon)
what are the causes of chylothorax
- CHF (cats)
- neoplasia, trauma, congenital, idiopathic (Afghans, bull mastiffs)
what is the management of chylothorax (5)
- drainage
- low fat diet
- diuretics esp for CHF
- rutin - aids fluid absorption
- surgery: thoracic duct ligation + pericardiectomy
what is Dirofilaria immitis
mosquito borne
adults live in pulmonary arteries and RV
what does Dirofilaria immitis cause
- pulmonary hypertension (cor pulmonale)
- weight loss
- fatigue
- cough
- dyspnea
- caval syndrome
what are the signs of Dirofilaria immitis in dogs (7)
- cough
- exercise intolerance
- dyspnea
- syncope
- hepatomegaly
- ascites - caval syndrome
- death
what are the signs of Dirofilaria immitis in cats (3)
signs often vague and diagnosis more difficult
- tachypnea
- cough
- emesis
what is seen on radiography with Dirofilaria immitis
right sided cardiomegaly
tortuous pulmonary arteries
interstitial changes in the lung fields
what is the diagnosis of Dirofilaria immitis (4)
- blood smear for direct detection of microfilaremia
- knott’s/filter test: RBC lysed and blood centrifuged or filtered to concentrate microfilariae
- microfilarial antibody test
- adult female worm antigen test
what is the treatment of Dirofilaria immitis (3)
- stabilize first (CHF, glucocorticosteroids)
- melarsomine dihydrochloride
- doxycycline to eliminate Wolbachia (endosymbiont bacterium) - reduces pathological changes associated with dead heartworms
how is Dirofilaria immitis prevented (3)
- Avermectins (moxidectin, selamectin)
- Milbemycin oxime
- mosquito repellents
