Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Respiratory > Pleural Effusion and Pneumothorax > Flashcards

Pleural Effusion and Pneumothorax Flashcards

0
Q

Is pleural disease common in horses?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Is pleural disease common in SA?

A

YEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

FIndings associated with plerual disease?

A
  • dyspnoea
  • pyrexia with septic effusion
  • cause of hypoproteinaemia eg. chronic D+
  • trauma with pneumothorax, haemothorax, diaphragmatic hernia
  • history of coagulopathy
  • neoplasia and paraneoplastic disease
  • concurrent abdo abnormlaities (empty cranial abdo with diaphragmatic hernia, concurrent ascites (bicavity effusion indicates more systemic disease) )
  • RCHF (jugular distension, peropheral oedema, murmur) esp. seen in cats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PE findings with pleural disease?

A
  • ^ RR and effort
  • rapid and shallow
  • orthopnoea - reluctance to assume position other than standing and sternal
  • dullness on percussion of ventral thorax (v lung sounds)
  • resonance on percussion of dorsal thorax (v lung sounds)
  • displacement of apex beat may suggest mass lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where should the apex beat be?

A

Left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why are resp sounds not heard ventrally with plerual effusion?

A

Lung floats on fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

WHat is indicated as further investigation of pleural disease?

A
  • radiographs
  • ultrasound
  • do not stress!
  • thoracocentesis most important tx, may go straight to this if patient severely dyspnoeic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

WHat are the 2 aims of thoracocentesis?

A
  • therapeutic to relive discofort

- sample taken

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most important part of the thoracocentesis technique?

A
  • maintain a closed system to prevent air leakage into the pleural space
  • maintain sterility
  • cranial/caudal to heart
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why is ultrasound useful for thoracocentesis?

A
  • confirm presence of fluid

- choose optimum rib space to catheterise (Avoid heart!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How does thoracocentesis technique differ in horses cf sa?

A
  • use gravity and large bore catheter with valves to drain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which samples will be taken for analysis of pleural fluid?

A
  • EDTA for cytology
  • Plain tube for culture/biochem
    > cytology, total cell count, differential count
    > TP
    > bacterial culture and sense
    > Gram stain
    > TG and cholesterol levels (Chylous effusion)
  • Measure NT-proBNP in cats for cardiogenic v non-cardiogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Types of pleural fluid?

A

Transudate and modified transudate (hydrothorax) LOOK UP SLIDE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Causes of hypoproteinaemic?

A

transudatess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

causes of exudates?

A

septic/non-septic (eg. coronovirus FIP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

causes of modified transudates

A

venous obstruction

  • RCHF
  • neoplasia
  • lung lobe torsion
  • diaphragmatic hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

causes of chylothorax? appearance?

A
  • damage of thoracic duct - intestinal lymph drains into thoracic cavity
  • gross milky appearance
  • high in TG (fluid TG> plasma TG indicates chylous effusion)
  • cell count and SG similar to modified transudate but cells predominantly lymphocytes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

causes and appearance of haemothorax?

A
  • grossly haemorrhagic
  • indicates coagulopathy, trauma and neoplasia
  • usually defribrinated and SHOULD NOT CLOT! (does NOT indicate coagulopathy)
    > if it clots, you may have stabbed heart
  • protein and cell content similar to whole blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Is dyspnoea often caused by pure frank blood?

A

NO! Will present with hypovolaemia before dyspnoea (eg. 4kg cat 200ml fluid in thorax needed for dyspnoea - only has 300ml sirculating blood volulme!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pheumothorax caused by air leaking from where?

A
  • lung
  • mediastinum
  • through thoracic wall
    > small amount common after RTA
20
Q

Further diagnostic testss for pleural disease?

A 
BLOODS 
> hypoproteinaemia 
- hepatic, renal, GIT 
> Hyperglobulilnaemia
- FIP in cats
> Neutrophilia
- INflammaotry disease
> Cytopeania
- Bone marrow disease eg. lymphoma 
> serology 
- FIP, FelV, FIV
- Coronavirus poor
- FeLV and mediastinal lymphosarcoma link
> clotting times
- APTT and OSPT 
- platelet abnormalities less likely to cause cavity bleed
21
Q

What should be performed before and after thoracocentesis?

A 
> Radiographs for comparison 
- may reveal changes obscured by fluid 
- pneumothorax also seen 
- pneumomediastinum also seen 
> CT?
22
Q

Is US useful for pleural disease?

A

Not normally as air usually present

  • presence of fluid will enhance US utility and sometiems allows abnormalities to be seen eg. masses
  • US guidance useful for aspirating lesions or draining pocketed pleural fluid
23
Q

Are invasive techniques ever indicated for pleural disease?

A 
> exploratory thoracostomy 
- pleural biopsy
- detection of abnormlaities not detectable by other means
> Thoracoscopy
- minimally invasive surgical technique
24
Q

Tx pleural disease?

A 
- manage underlying disease
> lung lobe torsion Sx
> RCHF
> Neoplasia
> Hypoproteinaemia
> FIP
> DIaphragmatic hernia
25
Q

How does pleuropneumonia in horses differ from normal bacterial pneumonia?

A

Not pure respiratory pathogens - usually oropharyngeal contaminates

26
Q

Pathogens involved in pleuropneumonia in equines?

A
  • mixed bacterial infection of pharynx flora (ie. NOT pure resp pathogens)
  • B haemolytic streptococcus
  • E coli
  • Klebsiella spp.
  • Pasteurella
  • Bordatella
  • Bacteroides spp. NB: Anaerobes
27
Q

Most common predisposing factor of pleuropneumonia?

A
  • travel (head tied up, mucociliary escalator imparied)
  • surgery - anaesthesia
  • intense excercise
  • respiratory viral infection1*
  • stress eg. foaling
28
Q

Where is equine pleuropnumonia commonly seen?

A

Cranioventral lung (organisms inhaled, this is the first place they go)

29
Q

Clinical signs of acute, longterm and chronic pleuropneumonia?

A
  • pyrexia, lethargy, slight nasal discahrge, shallow breathing, guarded cough, painful stilted gait, pleurodynia
  • nostril flare, tachycardia, ^ jugulr pulse height (>1/3), toxic mm, guarded, soft, moist cough, foetid nasal discharge
  • chronic: intermittent fever, weight loss, ventral and limb oedema (will have abcesses walled off in chest)
30
Q

DIagnosis of pleuropneumonia in equines

A
  • history
  • clinical signs
  • PE
  • haem/US
  • thoracocentesis
  • radiography
  • transtracheal aspirate
31
Q

PE findings of equine pleuropneumonia?

A 
> auscultation
- ventral dullness (But may not be heard noramlly anyway!) 
- fluid in trachea
- pleural friction rubs? 
- cardiac sounds radiate? 
> percussion
- ventral dullness
32
Q

What is the best diagnostic test for pleural disease in horses?

A

Ultrasound

  • chalaracterise fluid (volume , location, how high the fluid comes up, gas bubbles indicate anaerobic bacteria)
  • lungs consolidation, abscessation
33
Q

WHat should be performed as well as thoracocentesis when diagnosing pleural effusion in horses? What are you looking for on thoracocentesis?

A
  • Transtracheal aspirate (important to not have contamination from upper airway)
  • Thoracocentesis: physical characteristics, cytology, bacteriology
34
Q

Aims of Tx in equine pleuropneumonia?

A
  • remove pleural fluid
  • ABx
  • nti-inflammatory and analgesic tx
  • supportive care
35
Q

Why is drainage useful for tx fo pleural fluid in horses? How is this performed differently to SA?

A
  • removes debris, inflam mediators, toxins
  • improves pulmonary clearance
  • removes restrictive forces
    > Drain both sides as fenestrated mediastinum often blocked with inflam mediators
    > indwelling cannula, repeated intermittent drainage
36
Q

What can pleurscopy be used for? Is this common?

A

NOt common

  • excellent drainage
  • visualisation
  • break down adhesions
37
Q

Medical and supportive care for equine pleuropneumonia?

A 
> Anti-inflams and analgesics
- NSAIDS, opiates 
> Abx
- broad spec
- anaerobes
- culture and sensitivity 
> Supportive care
- oxygen
- bronchodilators
- fluids
- nutrition
38
Q

Tx of chronic pleuropneumonia in the horse?

A
  • pleural and pulmonary abscesses may be drained via resection of intercostal mm. and rib (providing they are walled off from the rest of the pleural cavity)
39
Q

Prognosis of equine pleuropnemonia?

A
  • mild cases diagnosed early 50% - 100% success (can return to original career)
  • later severe cases: salvage attempts for breeding, $$$$
40
Q

Complications of pleuropneumonia in horses?

A
  • pulmonary abscess (cranial mediastinal masses)
  • pleural adhesions
  • bronchopleural fistula
  • constrictive pericarditis
  • thrombophlebitis
  • laminitis
  • diarrhoea
41
Q

Principles of Tx of pyothorax in SA?

A
  • remove infected material
  • remove causative agent
  • risk of less aggressive Tx is that a nidus of infection will remain and problem will recur
42
Q

Why may single thoracocentesis followed by systemic ABx not be effective?

A
  • remove insufficient infection material
  • systemic ABx unlikely to penetrate inspissated purulent material in pleural space
  • high likelyhood of recrudescence
43
Q

What is a better Tx plan than single thoracocentesis with ABx?

A
  • implant indwelling drain, pleural lavage
  • leave in situ for 5-7d
  • systemic ABx (lavage facilitates ABx penetration)
  • NB. will still recur if FB present to act as nidus, PLUS risk of infection via indwelling drain and potential for pneumothorax if dog chews out drain
44
Q

What is the more aggressive form of pyothorx tx?

A

> exploratory thoracotomy
- debridement and lavage of thoracic cavity
- placement of indwelling drains
+ greatest likelihood of success at resolving pyothorax
- perioperative morbidity and mortality

45
Q

Is Tx of chylothorx often successfully treated? What tx are available?

A

Not really
- surgical
> ID and ligate thoracic duct
> redistribute pleural fluid
> enhance absorption of pleural fluid
> SALVAGE: Pleurodesis to get pleura to adhere and eradicate space where fluid forms)
- medical
> detect underlying cause (lymphoma, RCHF) though usually idiopathic
> reduce formation of intestinal lymph (low fat diet, MCTO, diuresis)
> enhance resorption of fluid from pleura (Rutin = Benzopyrone)

46
Q

Most common cause of chylothorax?

A

Idiopathic

47
Q

Tx of small, moderate and large volume pneumothorax?

A

Small
- rest and check for resolution
Medium
- Drain air, rest patient, manage conservatively
Large
- place indwelling drain, drain repeatedly, exploratory thoracotomy likely indicated to ID and correct underlying cause

Respiratory (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions