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Cardiopulmonary test 1 > Pleural space disease > Flashcards

Pleural space disease Flashcards

1
Q

parietal pleura cover what? where does blood flow come from?

A

covers mediastinum, diaphragm and chest wall

blood flow from systemic circulation

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2
Q

Visceral pleura covers what? Where does the blood come from?

A

covers lungs

blood flow from pulmonary circulation

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3
Q

pressure gradients of pleural space

A

net pressure at the level of parietal pleura drives fluid into pleural space.

a net pressure move fuid from pleural space into visceral pleura

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4
Q

Causes of pleural fluid accumulation

A

increased capillary hydrostatic pressure

increased capillary permeability/vasculitis

decreased capillary oncotic pressure-hypoalbuminemia

increased oncotic pressure of pleural cavity

lymphatic obstruction and/or interference with lymphatic drainage

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5
Q

What can alter net filtration and lead to pleural effusion?

A

vasculitis

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6
Q

types of pleural fluid

A

hemothorax-blood

pyothorax-pus

transudate-serum

chylothorax-chyle

malignant effusion

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7
Q

diseases associated with pleural effusion

A

CHF

neoplasia

chylothorax

FIP

pyothorax

diaphragmatic hernia

lung lobe torsion

trauma

hemorrhage

pancreatitis

others: hypoalb, PTE, parasitic

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8
Q

Pleural effusion: clinical presentation

A

dyspnea, inability of lungs to expiration-restrictive

exercise intolerance

cough

anorexia, lethargy, weight loss

fever

dehydration, shock

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9
Q

Pleural effusion: PE findings

A

muffled heart sounds

decreased lung sounds ventrally

dyspnea

jugular venous distension (CHF)

other cardiac abn (murmur, gallop)

ascites

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10
Q

Pleural effusion: Dx work up

A

Chest rads

thoracocentesis

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11
Q

Pleural effusion: dx work up-Chest rads

A

only a stable patient

thoracocentesis often done prior to rads

obscured cardiac silhouette

interlobar fissure lines

rounding of lung margins

fluid density surrounding lung lobes

scalloping of lung margins dorsal to the sternum

widening of mediastinum

dorsla elevation of trachea

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12
Q

Pleural effusion: location

A

usually bilateral

unilateral if adhesions or compartalization-pyothorax, chylothorax, lung lobe torsion, neoplasia, hemorrhage, hernia

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13
Q

Pleural effusion: diagnostic work up-thoracocentesis Procedure

A

for therapeutic and dx purpose

clip and prep site

sternal recumbency or standing

proper restraint req

mild sedation

butterfly needle, extension set, three way stopcock, syringe

between 7th & 9th rib space

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14
Q

Pleural effusion: dx work up-Thoracocentesis-fluid analysis

A

color, clarity, odor, clots/fibrin

PCV/TP (TP<1.5 mg/dl)

specific gravity

nucleated cell type (<500 cell/ul)

cytology

triglycerides & chol

others

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15
Q

Fluid characterization: transudate

A

sp <1.017

TP<2.5

nuc cell <1000

predominant cell type: mononuclear, mesothelial

bacteria absent

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16
Q

fluid characterization: modified transudate

A

sp grav: 1.017 to 1.025

TP: 2.5-5

nuc cells: 500-10,000

predominant cell type: lymphocytes, monocytes, mesothelial, RBCs

bacteria absent

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17
Q

fluid characterization: exudate

A

sp grav: >1.025

TP >3.0

Nuc cell >5000

predominant cell type: neutrophils, mononuclear, RBCs

bacteria: present or absent

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18
Q

Disease associations:; transudate

A

Hypoalbuminemia

Protein losing enteropathy

protein losing nephropathy

liver failure

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19
Q

Disease associations: modified transudate

A

heart failure

malignant effusions

diaphragmatic hernia

PTE

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20
Q

Disease associations: exudate

A

pyothorax

FIP

neoplasia

diaphragmatic hernia

lung lobe torsion

PTE

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21
Q

Disease Associations: Chyle

A

lymphangiectasia

CHF

neoplasia

heartworm disease

hernia

trauma

tornsion

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22
Q

disease associations: hemorrhage

A

trauma

coagulopathy

neoplasia

lung lobe torsion

PTE

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23
Q

Fluid from thoracocentesis

Color-cloudy

TP: 4.5 mg/dl

cell count: 15,000

predominant cell type: neutrophils

classification?

A

exudate

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24
Q

pyothorax

A

infection in the pleural space

hematogenous spread/sepsis, direct innoculation, spread from adjacent tissue

aspiration of plant material

25
Q

pyothorax: etiology

A

actinomyces

nocardia

bacteriodes fragillis-cats

pasteurella, clostridium-cats

26
Q

pyothorax: clinical presentation

A

hunting dogs

outdoor cat, multi cat household

poss penetrsting wound

anoxeria

exercise intolerance

fever

dyspnea

weight loss

cyanosis

tachypnea

orthopnea

muffed heart and lung sounds

27
Q

pyothorax: dx

A

CBC-leukocytosis & left shift

chem: poss hypoalb

chest rads: pleural effusion, uni or bilateral

thoracocentesis: culture

28
Q

pyothorax-tx: drainage of chest

A

chest tube placement is preferred

cotinuous or intermittent suction

lavage of pleural space with sterile saline

29
Q

pyothorax tx

A

chest tube

abx based on C&S

parenteral abx initially

tx at least 2 months after resolution of clin sxs

supportive care

30
Q

pyothorax-patient monitoring

A

volume of fluid recovered daily

microscopic exam of effusion dail

rads-EOD initially then 1 week after chest tube removal, repeat 1-2 weeks after stopping abx

chest tube remove: once fluid resolved on rads and cytology shows no infectious agents, low quantity of fluid retrieve

31
Q

pyothorax: px

A

good with aggressive therapy

adhesions may form

32
Q

pyothorax: surgical indications

A

if fluid is localized and not improving after 2-3 days

consider CT scan

for removal of foreign body

for removal of nidus of inf

to break down adhesions

33
Q

9 yo MC DSH dyspnic cat

started last night, indoor/outdoor cat, no coughing, otherwise healthy

PE: weak, sternal recumbency, mildly cyanotic, intermittently open mouth breathing, shallow, rapid respirations, unable to hear lung or heart sound billaterally

what could be causing these signs?

A

pleural effusion

34
Q

9 yo MC DSH dyspnic cat

started last night, indoor/outdoor cat, no coughing, otherwise healthy

PE: weak, sternal recumbency, mildly cyanotic, intermittently open mouth breathing, shallow, rapid respirations, unable to hear lung or heart sound billaterally

next best step?

A

thoracocentesis

35
Q

9 yo MC DSH dyspnic cat

started last night, indoor/outdoor cat, no coughing, otherwise healthy

PE: weak, sternal recumbency, mildly cyanotic, intermittently open mouth breathing, shallow, rapid respirations, unable to hear lung or heart sound billaterally

thoracocentesis done, fluid is clear, cat is breathing more comfortably

repeated chest ausculations: lung sounds audible bilaterally, heart murmur, poss gallop

diagnostics?

A

chest rads, fluid analysis, bloodwork

36
Q

9 yo MC DSH dyspnic cat

started last night, indoor/outdoor cat, no coughing, otherwise healthy

PE: weak, sternal recumbency, mildly cyanotic, intermittently open mouth breathing, shallow, rapid respirations, unable to hear lung or heart sound billaterally

thoracocentesis done, fluid is clear, cat is breathing more comfortably

repeated chest ausculations: lung sounds audible bilaterally, heart murmur, poss gallop

Fluid analysis: clear, colorless, odorless, TP: 3.0, SpGr: 1.018, cellularity: 1500 mononuclear, no organisms

Classify fluid?

A

modified transudate

37
Q

Chylothorax

A

collection of chyle in pleural space

fluid leakage from dilated thoracic lymphatic vessels

form in response to increased lymphatic flow

38
Q

Chylothorax etiology

A

idiopathic-most otr

mediastinal mass

CHF-cats

HW disease-cats

lymphangiectasia

venous thrombi

trauma

diaphragmatic hernia

congenital

lung lobe torsion

39
Q

Chylothorax clinical presentations

A

cough

dyspnea

40
Q

chylothorax dx

A

chest rads

thoracocentesis

41
Q

Chylothorax: dx-chest rads

A

pleural fluid

compartmentalization of fluid

fibrinous pleuritis

42
Q

Chylothorax: cytology

A

milky white fluid

opaque

protein usually >2.5

500 to 200,000 cells/ul lymphocytes

chylomicrons

triglyceride and cholesterol

43
Q

chylothorax tx

A

if idiopathic, can’t do anything

dietary fat restriction

Medium chain triglyceride oild

pred

periodic thoracocentesis

rutin

sx: subtotal pericardectomy with thoracic duct ligation

44
Q

chylothorax: px

A

poor

spontaneous/prolonged remission poss

45
Q

hemothorax

A

trauma

coagulopathy-rodenticide toxicity, DIC

neoplasia-primary or metastatic

46
Q

hemothorax: dx

A

fluid characteristics to support: PCV fo chest fluid is => than peripheral blood, chest fluid does not clot after removal, no plt, erythrophagocytosis

cytology: neoplastic cells

coag panel

toxicology screen

47
Q

hemothorax: tx

A

poss autotransfusion

blood transfusion

stop the bleeding-plasma, Vit K, Sx if neoplastic

48
Q

4 yo M beagle, dyspnic, acute onset, risk of trauma, coughing, on HW preventative, vomited yesterday

PE: shallow, rapid respirations, pale mucous membranes, unable to stand, no signs of trauma, decreased heart and lung sounds bilateraly

most likely cause?

A

pleural effusion

49
Q

4 yo M beagle, dyspnic, acute onset, risk of trauma, coughing, on HW preventative, vomited yesterday

PE: shallow, rapid respirations, pale mucous membranes, unable to stand, no signs of trauma, decreased heart and lung sounds bilaterally

poss pleural fluid, pneumothorax, shock and/or anemia, critical status

plan?

A

PCV/TP

IV catheter placement

thoracocentesis

50
Q

4 yo M beagle, dyspnic, acute onset, risk of trauma, coughing, on HW preventative, vomited yesterday

PE: shallow, rapid respirations, pale mucous membranes, unable to stand, no signs of trauma, decreased heart and lung sounds bilaterally

poss pleural fluid, pneumothorax, shock and/or anemia, critical status

Blood from chest does not clot, PCV of fluid: 16%, PCV of serum: 17%, no plt seen

other dx?

A

ACT

CBC

Coag panel

chest rads

rodenticide screen

51
Q

4 yo M beagle, dyspnic, acute onset, risk of trauma, coughing, on HW preventative, vomited yesterday

PE: shallow, rapid respirations, pale mucous membranes, unable to stand, no signs of trauma, decreased heart and lung sounds bilaterally

poss pleural fluid, pneumothorax, shock and/or anemia, critical status

Blood from chest does not clot, PCV of fluid: 16%, PCV of serum: 17%, no plt seen

very prolonged ACT, mild thrombocytopenia, prolonged PT/PTT, Chest rad-pleural fluid/infiltrate?

Case assessment?

A

suspect rodenticide toxicity

young dog with chance of exposure, no previous medical problems, acute clin sxs, V

52
Q

4 yo M beagle, dyspnic, acute onset, risk of trauma, coughing, on HW preventative, vomited yesterday

PE: shallow, rapid respirations, pale mucous membranes, unable to stand, no signs of trauma, decreased heart and lung sounds bilaterally

poss pleural fluid, pneumothorax, shock and/or anemia, critical status

Blood from chest does not clot, PCV of fluid: 16%, PCV of serum: 17%, no plt seen

very prolonged ACT, mild thrombocytopenia, prolonged PT/PTT, Chest rad-pleural fluid/infiltrate?

suspect rodenticide toxicity

Treatment plan?

A

Thoracocentesis

transfusion

Vit K therapy

ICU monitoring

53
Q

pneumothorax

A

accumulation of air within the pleural space

caused by trauma to chest wall, iatrogenic, spontaneous

54
Q

spontanoeus pneumothorax

A

primary: rupture of bullae or bleb in absence of underlying respiratory dz, rads normal except for pneumothorax

secondary-neoplasia, parasitism, inflammatory airway disease, pneumonia, abscess, foreign body

55
Q

pneumothorax-presentation

A

hx of trauma

tachypnea, dyspnea

abdominal component to breathing

poss cyanosis

decreased lung sounds

hyperresonance

56
Q

pneumothorax-chest rads

A

perform thoracocentesis first

air within pleural space

retraction of lung lobe from thoracic wall and diaphragm

displacement of heart away from sternum

57
Q

pneumothorax: dx

A

chest rads

endoscopy/bronchoscopy

HWT

fecal float

FNA, cytology of masses

CT scan

exploratory thoracotomy

58
Q

pneumothorax-tx

A

none if asymptomatic

evacuate the chest or air

chest tube placement

supportive care

sx

59
Q
A

Cardiopulmonary test 1 (9 decks)

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