Pleural Space Disease And Pulmonary Parenchymal Disease Flashcards
What is pleural effusion?
Abnormal accumulation of fluid in plural space
Pleural effusion causes increased intrathoracic pressure which leads to a __________ breathing pattern
Restrictive (shallow and rapid)
—> decreases work of breathing but maintains minute volume
What are the types of effusion and which is most common?
Transudate
Modified transudate (most common)
Exudate
What disease causes a transudate pleural effusion in dogs and cats?
Hypoalbuminemia
What diseases causes modified transudate, pleural effusion in cats and dogs?
Neoplasia
CHF
-L or R in cat, only Left in dog
Pericardial disease (dog only)
What can cause an exudative pleual effusion in cats and dogs?
Septic - pyothorax
Non-septic
- neoplasia
- FIP (cats)
What are causes of a chylous pleural effusion in cats and dogs?
Trauma Neoplasia CHF Cranial vena cava bstruction (mass thrombus) HWD Idiopathic
What are causes of hemorrhagic pleural effusion in cats and dogs?
Trauma
Toxicity
Neoplasia
Lung lobe torsion
How would heart sounds change in moderate-severe pleural effusion?
Muffled or absent
Large pleural effusion is life-threatening. What procedure needs to be performed as soon as possible?
Thoracocentesis
T/F: thoracic radiographs should be done before thoracocentesis to confirm presence of fluid
False
—> fluid is life-threatening, patients can die suddenly while trying to do imaging.. thoracocentesis first!!
Perform radiographs once fluid has been removed
What is the initial treatment of pleural effusion ?
Thoracocentesis
Therapeutic –> moderate/severe effusion to releive dyspnea
Diagnostic —> in all patients for fluid analayis and cytology
NT-proBNP in pleural effusion of cats is highly sensitive for what disease in cats?
CHF
You have confirmed pleural effusion in your patient via thoracocentesis.. what additional diagnostics will you do now?
Minimum database
Thoracic radiographs
NT-proBNP in cats
Advanced
- Echo
- Abdominal US
- CT
- Lymphangiogram
What is the treatment for pleural effusion?
Treat underlying process
-if cannot resolve or idiopathic —> periodic thoracocentesis or pleural port
What is the treatment for pyothorax?
Drainage via thoracotomy tube
Antibiotics
Sometimes requires surgical intervention for drainage and resection of severely affected tissues
What is a mesothelioma and how would you treat?
Malignant neoplasm of serosal surfaces —> surgical biopsy for definitive diagnosis
Treat: intracavitary chemo, periodic thoracocentesis or pleural port
What is an idiopathic chylothorax? Diagnosis?Treatment ?
Accumulation of chyle due to abnormalities in thoracic duct system
Diagnosis: plural fluid triglyceride >serum triglyceride
Treatment: surgical, low fat diet, rutin, corticosteroid
What are potential complications of pleural effusion?
Fribosing pleuritis: pleura becomes fibrosis and non-compliant due to chronic inflammation
Lung lobe torsion
How is diagnosis of pneumothorax done?
Thoracocentesis
Radiographs
Ultrasound
What is a tension pneumothorax?
Volume of air is so significant that is depresses cardiac output
Fatal if not treated promptly
What are the 3 types of pneumothorax?
Traumatic
Spontaneous
Iatrogenic
What are causes of spontaneous pneumothorax ?
Primary- pulmonary blebs or bullae that rupture
Secondary- lung disease
—>treatment involves surgical resection of diseased lung
What are cause of iatrogenic pneumothorax?
Lung damage or laceration during thoracocentesis
Positive pressure ventilation
What are the most common causes of pneumomediastinum in cats?
General anesthesia with endotracheal intubation and PPV
—> improper tube management and pop-off valve
What is the treatment for pneumomedastium?
Analgesia
O2
Close monitoring
—> secondary pneumothorax is common —> require thoracocentesis
Clinical signs of pneumomediastinum?
Tachypnea
Dyspnea
Subcutaneous emphysema (crunchy skin)
Vomiting in cats
The primary function of the pulmonary parenchyma is?
Gas exchange
Rate of tans free is proportional to the tissue area and difference in partial pressure
What are the diseases of the pulmonary parenchyma ?
Pneumonia Idiopathic pulmonary fibrosis Non-cardiogenic pulmonary edema Eosinophilic pneumonia Neoplasia
What are the routes of infection of bacterial pneumonia?
Inhalation
Aspiration
Extension from nearby tissues
Hematogenous
What are the common opportunistic pathogens in dogs causing bacterial pneumonia?
Ecoli Pasturella Kelbsiella Staphylococcus Streptococcus Bordetella Mycoplasma
What are common opportunistic pathogens causing bacterial pneumonia in cats?
Mycoplasma Pasturella Bordetella Streptococcus Ecoli
T/F: strep equi subspecies zooepidemicus is a virulent primary pathogen causing bacterial pneumonia
True
What are the classifications of bacterial pneumonia?
Community-acquired pneumonia (CAP): in patient that has not been recently hospitalized
Hospital-acquired pneumonia (HAP): in patient >48 hours after hospital admission
T/F: treatment for CAP and HAP is different, but treatment for CAP and aspiration pneumonia is similar
True
What is the signalment for bacterial pneumonia?
Dogs>cats
Young or old (but any can be affected)
No breed predispositions
What are common clinical signs of bacterial pneumonia?
Cough Exercise intolerance Nasal discharge Increase respiratory rate/effort Lethargy Hyporexia Pyrexia
What are potential physical exam findings in a patient with bacterial pneumonia?
Abnormal lung sounds Tachypnea/dsypnea Nasal discharge Pyrexia Cyanosis Sinus arrhythmia (due to increased vagal tone)
What is the classic distribution and pattern of bacterial pneumonia on radiographs?
Alveolar and predominantly ventral
Interstitial/bronchial pattern may be present
A diffuse distribution of bacterial pneumonia is more common with what type of infection?
Hematogenous
What type of pneumonia usually only involves one lobe ?
Aspiration
Foreign body
Tumor
Diagnosis of bacterial pneumonia is usually based on thoracic radiographs but definitive diagnosis requires??
Identification of sepsis form lower airway samples (obtained via transtracheal or bronchoalveolar lavage)
What would you see on a minimum database for in a bacterial pneumonia case?
Neutrophillia
What is the treatment for bacterial pneumonia ?
Antibiotics for 10-14days
Or 1 week beyond clinical resolution
Is it ever appropriate to not obtain lower airway samples for bronchial pneumonia
Yes
If patient has a community acquired pneumonia, no history of pneumonia AND no recent history of antibiotic therapy
What drug therapies do you use in a hospital acquired pneumonia?
Multi-drug resistant pathogens are common in hospitals: therefore patients with HAP are at increased risk for MDR infection —-> especially important to do culture and sensitivity testing
Dog:
- 1st generation cephalosporin +2/3rd generation
- carbapenem or amikacin + amoxicillin or ticarcillin
Cat: same as above +/- enrofloxacin or doxycyline to treat mycoplasma spp
What other treatments can be done in addition to antibiotic therapy in bacterial pneumonia?
O2 in hypoxemia
Fluid therapy ->maintain tissue perfusion and mucocilliary defected
Nebulizaiton —> enhance mucus fluidity
Courage to encourage coughing
Bronchodilator and/or mucolytic
What re common pathogens in mycotic pneumonia?
Blastomyces
Histoplasma
Coccidioides
In addition to lower respiratory signs, what can you see in mycotic pneumonia ?
Lymphadenopathy and weight loss
What is the pattern and distribution of mycotic pneumonia on radiographs?
Nodular or miliary
Interstitial and perihilar lymphadenopathy may be present
How can you definitively diagnose mycotic pneumonias?
Cytologically
Urine fungal antigen test
The DDx is neoplasia
Must differentiate
What is the treatment for mycotic pneumonia?
Blastomyces and histo: itraconazole
Cocci: fluconzaole or itraconazole
Pneumocystis carinii is associated with severe morbidity and mortality in immunocompromised patients.
What breeds is it common in and what is the treatment?
Miniature dashunds and King Charles spaniel
Potentiates sulfonamides and supportive care
What is the EDX of viral pneumonias in dogs?
Parainfluenza Influenza Distemper Coronavirus Infectious hepatitis Herpesvirus
What is the EDX of viral pneumonias in cats?
Coronavirus
Calicivirus
Herpesvirus
What is the treatment for viral pneumonias?
Supportive
Antibiotic therapy is indicated if there is a secondary bacterial infection
What is the most common protozoal pneumonia? And how is it treated?
Toxoplasma gondii
Potentiated sulfonamides or clindamycine
What is idiopathic pulmonary fibrosis?
Interstitial lung disease that is characterized by fibrosis
What breeds are predisposed to idiopathic pulmonary fibrosis?
West highland terrier
Shafforshire bull terrier
Middle age to older
On PE of a dog with idiopathic pulmonary fibrosis, what do you hear on auscultation in all lung fields?
Crackles
Why may you see a polycythemia due to idiopathic pulmonary fibrosis?
Secondary to hypoxemia
Usually only in advanced disease
What pattern do you see with idiopathic pulmonary fibrosis on radiographs?
Dogs: DIFFUSE bronchointersitial pattern
Cat: DIFFUSE Bronchial, intersitial, and alveolar patterns are possible
How do you treat idiopathic pulmonary fibrosis?
No specific therapy
Cough suppressant
Sildenafil and exercise restriction in patients with pulmonary hypertension
Corticosteroids or bronchodilators may improve clinical signs
—> poor long term prognosis once symptomatic
What is non-cardiogenic pulmonary edema?
Edema is not the disease, it is a consequence of disease
- increased hydrostatic pressure
- decreased oncotic pressure
- increased vascular permeability
- impaired lymphatic drainage
What are causes of non-cardiogenic pulmonary edema?
Acute respiratory distress syndrome secondary to primary/secondary pulmonary disease
Airway obstruction
Seizure
Electrocution
Vasculitis
Hypoalbuminemia
Pulmonary arterial hypertension
What is the treatment for non-cardiogenic pulmonary edema?
Supplemental oxygen in hypoxemic
Reduce stress
Mechanical ventilation
Low dose furosemide
Therapy for underlying cause
What is acute respiratory distress syndrome ?
Pulmonary inflammatory disorder characterized by non-cardiogenic pulmonary edema, neutrophilic inflammation, and hypoxemia
—>potential component of systemic inflammatory response syndrome (SIRS) —> can have infectious or non-infectous origin
