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1- SA- Respiratory Disease > pleural space disease > Flashcards

pleural space disease Flashcards

1
Q

List 6 conditions which lead to the loss of thoracic capacity +/- cyanosis

A

pleural effusion
pneumothorax
Neoplasia (pleural or mediastinal)
Ruptured diaphragm
Abdominal abnormality e.g. severe ascites/ mass
Gross cardiomegaly

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2
Q

What is the pleural space

A

the narrow space between the parietal and visceral pleura
contains a small amount of serous fluid spread over the surface of the pleural

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3
Q

What is pleural space disease

A

accumulation of:
- fluid (pleural effusion)
- air (pnuemonthorax)
- soft tissue mass
in the pleural space

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4
Q

How does pleural space disease lead to difficulty breathing

A

there is direct compression of the lungs by fluid/air/mass
There is loss of negative pressure leading to lung collapse
If fluid –>this restricts the ability of the lungs to inflate so is known as restrictive lung disease

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5
Q

List 6 clinical signs of pleural space disease

A

‘restrictive’ breathing pattern= short shallow breaths
tachypnoea
open mouth breathing
dyspnoea, respiratory distress
orthopnoea
cyanosis

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6
Q

what is orthopnoea

A

the animal uses their entire body to breath - e.g. elbow adduction, sternal recumbency

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7
Q

List 3 findings on clinical exam that you might expect from a patient with pleural space disease

A

Observe the characteristic restrictive respiratory pattern
muffled heart/lung sounds
percussion of chest - dull ‘thud’ when there is a pleural effusion

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8
Q

Why might a pleural effusion form

A

If there is
- Decreased pleural fluid absorption into lymphatics
OR
- Increased fluid formation

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9
Q

List 6 reasons for increased fluid formation during a pleural effusion

A

‘leaky’ capillaries
Increase in intravascular pressure
Increase in lung interstitial fluid
Decrease in pleural pressure
Increase in pleural fluid protein
Disruption of thoracic duct or blood vessels

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10
Q

List 3 reasons for decreased fluid absorption in the pleural space during pleural effusion

A

Obstruction of draining lymphatics
Increased systemic vascular pressures
Reduced vascular oncotic pressure

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11
Q

T/F lung lobe torsion could cause chylothorax or haemothorax

A

True
Chylothorax -> occurs if there is disruption to the thoracic duct
Haemothorax -> occurs if there is bleeding

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12
Q

What is the most common cause of a pleural effusion with a Transudate

A

decreased oncotic pressure due to hypoalbuminaemia

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13
Q

Describe immediate treatment of pleural effusion

A

oxygen supplementation
Emergency thoracic ultrasound
If severely dyspnoeic do not radiograph- unstable and stressed
Thoracocentesis: provides immediate relief and stabilisation, can be diagnostic (cell counts, protein, bacterial cultrue)

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14
Q

Describe how you would perform a thoracocentesis for pleural effusion

A

clip and quick surgical prep
Butterfly needle/actheter at IC 6-8 (ICS 7 usually safe). Insert at level of the costochondral junction
Idealise localise a large pocket of fluid with ultrasound first
Use aseptic technique (colleages holds syringe while you remain sterile)

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15
Q

List 6 indications for a thoracostomy (chest drain)

A

Animals that will require multiple thoracocentesis over a short period of time
If large volumes of effusion
pneumothorax
chest wall injuries
most pyothorax cases
following chest surgery

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16
Q

Describe how you manage a plueral effusion case

A

Depends on cause –> ideally treat primary cause where possible
- Heart failure –> treat where possible
- pericardial effusion–> treat and drain
- pyothorax –> chest drain and lavage, need broad spectrum and anaerobe antibiotic coverage
- chylothorax –> diet and/or surgery

17
Q

Describe a pneumothorax

A

Accumulation of air within the pleural space
Most commonly caused by trauma

18
Q

T/F rupture of the oesophagus can produce pneumothorax

A

True

19
Q

List 3 clinical findings of a pnemonthorax

A

restrictive breathing
auscultation reveals dull lung sounds dorsally, increased sounds ventrally
percussion–> increased resonance (like a drum)

20
Q

How do you diagnose a pneumothorax

A

physical exam
assessment of resp status
thoracic radiographs- if stable enough
blood gases and pulse oximetry

21
Q

Describe how you treat a pneumothorax

A

oxygen
drain pneumothorax as necessary, avoid over drainage
strict cage rest for 2 weeks

22
Q

Describe signalment, diagnosis and treatment of thyoma

A

RARE commonest in older dogs
thoracic radiographs to confirm mass
present in resp distress +/- cranial caval syndrome
surgical resection as treatment of choice- good prognosis

23
Q

Describe cranial caval syndrome

A

facial swelling like stung by lots of bees, mass pressing on cranial vena cava so causes problem with return of blood

24
Q

Why is the pleural space having a negative pressure important

A

Means fluid wants to flow there

25
Q

What is the mediastinum? What does it contain?

A

Space between the left and right pleural sac
Contains blood vessels, nerves, oesophagus heart, trachea etc

26
Q

What is the most common form of pleural space disease

A

pleural effusion

27
Q

In pleural effusion, what will you pick up on auscultation

A

Muffling of heart and lung sounds - especially ventrally when standing (due to gravity)

28
Q

Name different types of fluid which can be present in a pleural effusion

A

Transudate - low protein
Modified transudate = higher prtein
Exudate - puss and gross stuff - can be non-septic, septic, blood or chyle

29
Q

What is the most common cause of modified transudate fluid in plural effusion

A

Increased hydrostatic pressure secondary to high sided heart failure

30
Q

What causes non-septic (exudate) fusions

A

FIP, neoplasia, fungal infection
(no bacteria, lots of neutrophils)

31
Q

What causes septic (exudate) effusions - aka pyothorax

A

Penetrating chest wound
FB inhalation
Ruptured oesophagus
Tumour

32
Q

What causes chylothorax

A

Disruptions of the thoracic duct
e.g. cranial VC obstruction, neoplasia, trauma to thoracic duct

33
Q

What causes a haemothorax

A

Trauma, coagulopathy, neoplasia, lung lobe torsion

34
Q

List the diagnostic methods for pleural effusions

A

Based on clinical findings
Imaging e.g. radiography/Ultrasound
Thoracocentesis and look at the fluid

35
Q

What is the most common cause of spontaneous pneumothorax

A

Ruptured pulmonary bulla or sub-pleural bleb

36
Q

Describe the management of spontaneous pneumothorax

A

Medical management to stabilise
Lobectomy if needed

37
Q

List 4 causes of mediastinal disease

A

Benign or malignant tumours
Cystic lesions
Enlarged mediastinal lymph nodes
Haematomas

38
Q

What is a common sign of mediastinal disease on a radiograph

A

Displaced trachea

39
Q

Clinical signs of mediastinal lymphoma

A

Tachypnoea, inspiratory hyperpnoea, dull heart sounds, pleural effusion
Non compressible anterior mediastinum

1- SA- Respiratory Disease (15 decks)

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