Pleural Diseases Flashcards
What is the most common finding consistent with pleural disease?
Dyspnoea
Why do patients with pleural disease show increased resp rate and effort?
Breathing on a small volume of remaining lung function
What is orthopnoea?
Sternal position assumed to ease breathing
Suggest some historical and clinical signs that might indicate pleural disease..
Pyrexia with septic effusion Clinical signs associated with hypoproteinaemia (e.g. chronic diarrhoea) Trauma Bleeding with coagulopathy Signs associated with neoplasia
Describe a physical examination of a patient with pleural disease…
Increased resp rate and effort May have rapid, shallow resp Orthopnoea Dullness on percussion of ventral thorax REsonance of percussion of dorsal thorax Displacement of the apex beat
What is the most important diagnostic procedure once presence of a pleural effusion have been confirmed?
Thoracocentesis
Outline the key technical aspects of thoracocentesis…
Maintain a closed system
Maintain sterility
Avoid damage to the heart
By what are pleural transudates caused?
Hypoproteinaemia
By what are pleural modified transudates caused by?
Venous obstruction RSHF Neoplasia Lung lobe torsion Diaphragmatic hernia
How does chylothorax arise?
Damage to the thoracic duct results in drainage of intestinal lymph into thoracic cavity
Why does chylothorax appear grossly milky?
High triglycerides
What is the predominant cell type in chylothorax?
Lymphocyte
What does a haemothorax indicate?
Coagulopathy
Trauma
Neoplasia
What is a pneumothorax, how does it occur?
Air in the pleural cavity, usually spontaneous or secondary to trauma
Describe the effect of pleural fluid on radiography…
Obscures detail
Outline the pathogenesis of equine pleuropneumonia…
Mixed bacterial infection
Organisms usually normal pharynx flora
Inhalation of bacterial with subsequent extension into pleural space
Suppression of pulmonary mechanisms (e.g. MCE, macrophages)
Outline the major organisms responsible for equine pleuropneumonia…
Beta-haemolytic streps E. coli Klebsiella Pasteurella Bordetella
On what are the clinical signs of equine pleuropneumonia dependent?
Amount of fluid
Pathogen
Extent of parenchymal disease
Chronicity
Outline the clinical signs associated with early acute equine pleuropneumonia
Pyrexia Lethargy Slight nasal discharge Shallow breathing Guarded cough Painful, stilted gait Pleurodynia
What is pleurodynia?
Pleuritic pain in the chest
Outline the clinical signs associated with late-stage acute equine pleuropneumonia..
Nostril flare Tachycardia Increased jugular pulse height Toxic mm Guarded, soft, moist cough Foetid nasal dischargw
Outline the clinical signs associated with chronic equine pleuropneumonia…
Intermittent fever
Weight loss
Ventral and limb oedema
Outline diagnostics for equine pleuropneumonia
History, CS and PE Haemotology Ultrasonography Thoracocentesis TTA
Outline the aims of treatment for equine pleuropneumonia
Remove excess pleural fluid (surgical)
AB therapy - Pen & gent, metronidazole
NSAIDS/analgesia opiates
Supportive care - oxygen, bronchodilators, fluids, nutrition
