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Pulmonary > Pleural > Flashcards

Pleural Flashcards

1
Q

Hydrostatic and oncotic pressure in pulmonary circulation favor fluid accumulation on _______ surfaces and absorption at _____ surfaces

A

Accumulation at parietal pleural surfaces, absorption at visceral.

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2
Q

Higher hydrostatic pressure in vessels does what to fluid

A

Pushes it out

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3
Q

Higher hydrostatic pressure outside vessels does what to fluid

A

Pushes it in

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4
Q

Oncotic pressure - lower causes what in vessels

A

Water leaves

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5
Q

Oncotic pressure- higher causes what in vessels

A

Water influx/stay

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6
Q

Higher oncotic pressure in insterstitial space leads to what

A

Water leaves vessels

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7
Q

Lower oncotic pressure in interstitial space leads to what

A

Water goes into vessels

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8
Q

Filtration coefficient/ permeability effect on vessel

A

More permeable= mild changes in starling forces have greater effect on fluid accumulation

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9
Q

Which vessels are more leaky pleural vessels vs lung vessels

A

Pleural not very leaky, lung leaky but oncotic pressures so narrow that they drive fluid resorption so hard to get fluid build up inside lung from oncotic pressure changes. More possible outside lung

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10
Q

When do clinical signs of fluid build up become apparent

A

> 60 mL/kg

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11
Q

What are the signs of fluid build up

A

Tachypnea (1st) –> inspiratory dyspnea, cyanosis, orthopnea

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12
Q

Why does fluid accumulation cause dyspnea

A

Inspiratory effort increased due to lack of ability to move negative pressure

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13
Q

What are the clinically auscultable signs of pleural effusion

A

Dull/absent lung sounds ventrally (lung sounds heard dorsally) - TAP THEM! Thoracocentesis- not radiographs

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14
Q

What drugs can be used in patients with respiratory distress

A

Anxiolytic, not sedative (unless needed for tap)

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15
Q

What does thoracocentesis cytology test for?

A

Total protein, cell count, differential cell count, cell morphology assessment - all to classify the fluid

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16
Q

What are the three differentials for types of pleural fluid

A

Transudate, modified transudate, exudate

17
Q

What are the characteristics of transudate

A

Low protein, low cell count! Primarily low number of mononuclear cell counts (macrophages, lymphocytes, mesothelial cells) - not eos, neuts, mast

18
Q

What are the characteristics of modified transudate

A

Fluid + protein, medium cell count, add neutrophils (non-degenerate, healthy)

19
Q

Rank fluid types by amount of protein from least to most

A

Trans- modified - exudate

20
Q

Rank fluid types by amount of cells from least to most

A

Trans- modified - exudate

21
Q

Changes in starling forces lead to what types of fluids

A

Trans and modified transudate

22
Q

Low oncotic pressure in blood, high hydrostatic, impermable vessels

A

Transudate

23
Q

What conditions may lead to modified transudate fluid

A

More permeable vessels, significant high hydrostatic, low oncotic pressure

24
Q

What are the causes of transudate and modified transudate pleural effusion in dogs and cats

A

Hydrostatic: Dogs- RHF, Cats- R or LHF; pericardial disease, volume overload; Severe hypoalbuminemia (oncotic); lymphatic draining, neoplasia, diaphragmatic hernia, lung lobe torsion

25
Q

What kind of lymphatic drain would cause pleural effusion

A

Draining out of chest

26
Q

Lymphatic draining into chest cause what kind of fluid

A

Chylous

27
Q

Describe non-septic exudate

A

Variable cells (neuts, macrophages, eos, lymphs): non-degenerative neuts but active macs and lymphs; no organisms seen

28
Q

Describe septic exudate

A

Exremely high cell count, degenerate neuts dominate, +/- bacteria (foul odor with anaerobes). BACTERIA IN NEUTS

29
Q

What would red fluid with white or yellow granules

A

Sulfur granules - nocardia, actinomyces

30
Q

Which neoplastic processes readily exfoliate into effusion

A

Lymphoma; others occasionally do

31
Q

What kind of cells can give false positive for neoplasia

A

Reactive dysplastic mesothelial cells from inflammation

32
Q

Describe chylous effusion

A

Moderate protein, moderate to high cell counts (with these could mistake with modified transudate or exudate); Cloudy or high lymphocytes- run serum triglycerides - if lower, chylous (lymphatic problem dumping into chest)

33
Q

What would serum triglycerides lower than blood triglycerides indicate

A

Chylous effusion from lymphatic obstruction dumping into chest

34
Q

Name differentials for chylous effusion

A

trauma, neoplasia, cardiac disease, dirofilariasis, lung lobe torsion, diaphragmatic hernia

Pulmonary (4 decks)

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