resp Flashcards
physical exam
- Airflow at nostrils: Symmetry?
- Sinus percussion (fluid will have dull sound)
- Submandibular lymph nodes
- Spontaneous or inducible cough?
- Tracheal and lung auscultation
- Rectal temperature
physical exam nasal 1ts part
- Distance examination
- Posture
- Breathing rate & pattern
- Nostril flare (horse)
- Nasal discharge
- Unilateral vs. bilateral
- Characteristics of nasal discharge
- Colour
- Consistency
- Blood
respiratory definitions
- Tachypnea:
- Increase in respiratory rate
- Hyperpnea
- Increase in respiratory rate and depth of respiration
- Dyspnea
- Shortness of breath (subjective)
- Respiratory distress
- Inappropriate degree and effort to breathing (dyspnea)
clinical manifestations of dyspnea
- Tachypnea
- Extended head & neck position
- Mouth breathing (not horses)
- Nostril flaring (not cattle)
- Increased effort
- Abdominal effort
- Abducted elbows
- Stridor
- Anxious expression
- Cyanosis with severe
distress - Anorexia
causes of tachypnea / dyspnea
- Dyspnea physiologic after strenuous exercise;
pathologic at rest or following minimal exercise - Tachypnea can be physiologic (exercise, heat);
pathologic at rest - Need for additional O2
- Compensation for metabolic acidosis
- Heat stroke
- CNS disease
- Weakness of respiratory muscles/ motor nerves
need for additional Oxygen
- Decreased O2 in environment:
- High altitude
-Fire or toxic fumes - Disorders interrupting O2 transfer:
- Respiratory tract disease (ventilation/perfusion
mismatch) - Cardiovascular disease (bypassing lungs)
- Decreased O2 carrying capacity of the blood:
- Anemia (less hemoglobin)
- Abnormal hemoglobin
trachea and lung sounds normal vs abnormal
-listen to lungs both sides, four quadrants and trachea
- Normal:
- Air movement through conducting airways
- Broncho-vesicular sounds
- Abnormal:
- Increased intensity/harshness (compare to trachea)
- Crackles (fluid, pleuropneomia)
- Wheezes (heaves)
- Absence of sounds
dyspnea Intrathoracic airway obstruction
- Lower airway
- Dynamic airway collapse during expiration
- Expiratory distress
dyspnea Extrathoracic airway obstruction
- Upper airway
- Dynamic airway collapse during inspiration (e.g. laryngeal hemiplegia)
- Inspiratory distress
dyspnea fixed airway obstruction
- Intraluminal mass
- Bronchoconstriction
- Inspiratory and expiratory distress – severity
depending on anatomic site
dyspnea restrictive disease
- Pleural effusion
- Inhibition of lung expansion
- Inspiratory distress
Purpose of rebreathing examination
- Rebreathe expired air
- Deeper breaths
- Clinical findings to observe:
- Respiratory rate
- Respiratory pattern
- Respiratory effort
- Coughing
- Lung sounds
- Recovery
diagnostic imaging
- Radiographs:
- Head/sinuses (teeth)
- Guttural pouches (horse)
- Lungs
- CT:
- Head only in horses
- Ultrasound:
- Lungs (abscesses can show rhodococcus equi in foals)
airway endoscopy
- Upper airway:
- Middle meatus: ethmoids (horse)
- Ventral meatus
- Guttural pouches (horse)
- Larynx
- Pharynx
-mucus, tracheal muscle score - Lower airway:
- Trachea
- Lungs
Airway sampling
- Nasopharyngeal & guttural pouch swabs/washes
- Tracheal wash:
- Trans tracheal
- Endoscope guided
- Bronchoalveolar lavage (BAL)
airway sample analysis
- Nasopharyngeal & guttural pouch swabs/washes
- PCR (influenza, EHV 1&4, strangles)
- Tracheal Wash (TW):
- Cytology
- Bacterial culture & sensitivity testing
- Bronchoalveolar Lavage (BAL):
- Cytology
- Bacterial culture & sensitivity testing (small animal)
BAL cytology interpretation
- Interpret findings together with clinical signs!**
- Normal cytology horse
- ≤ 1% eosinophils
- ≤ 2% mast cells
- ≤ 5 % neutrophils (up to 10% may be normal)
- Mild to moderate equine asthma (IAD):
- Different “phenotypes”
- Eosinophilic inflammation (< 5 years old)
- Mast cell inflammation (usually younger)
- Neutrophilic inflammation (> 7 years old
sinus disorders
-sinusitis:
primary: bacterial or viral
secondary: dental disease, cyst, neoplasia, foreign body, trauma
upper airway disease diagnosis
-history:
-upper resp tract infections
-trouble eating, weight loss,
(could also be dental disease)
- nasal discharge
-sinus percussion
-submandibular lymph nodes
-radiography (CT) will see fluid line
guttural pouch diseases
- Need to know anatomy to understand clinical
findings, reach diagnosis & make treatment plan - Empyema
- Mycosis
neural anatomy with upper resp disease and gutteral
Medial compartment in contact with:
* Internal carotid artery
* Cranial cervical ganglion
* Cranial nerves IX, X, XI, XII
* Sympathetic nerves
* Recurrent laryngeal nerve
anatomy and nerves with the stylohyoid bones large animals
- Stylohyoid bone ends in the temporohyoid joint
- Facial (VII) and vestibulocochlear (VIII) nerves
located close to that joint - Openings of the pouches located in dorsolateral
aspect of the pharynx
clinical signs of guttural pouch diseases
- Damage to cranial nerve IX or X:
- Nasopharyngeal dysfunction, dysphagia
- Damage to recurrent laryngeal nerve:
- Unilateral laryngeal hemiplegia
- Involvement of sympathetic nerve fibers:
- Horner’s syndrome (miosis, ptosis of the upper eye
lid, protrusion of the 3rd eye lid, sweating of cranial neck & base of ear)
Pathogenesis of pneumonia
- Secondary to viral respiratory infection:
- Stress/immunosuppression
- Transport (shipping fever)
- May be preceded by upper respiratory symptoms
- Aspiration pneumonia:
- Esophageal obstruction (choke)
- Dysphagia
history which could point so pneumonia
-recent clinical symptoms of resp disease
* Unvaccinated/not up-to-date
* Travel or other recent stressors
* Choke or dysphagia (aspiration pneumonia, guttral pouch disease, incorrect bottle feeding)
* Strenuous exercise
* Recent surgery (general anesthesia)
clinical findings of pneumonia
- Fever
- Coughing
- Nasal discharge (bilateral)
- Tachypnea
- Increased respiratory effort
- Abnormal lung auscultation
diagnosis of pnuemonia
- History & clinical signs
- Complete blood count
- (Trans) tracheal wash
- Cytology
- Bacterial culture *& sensitivity (large animal)
- BAL (small animal, cattle)
- Diagnostic imaging
- Lung radiographs
- Ultrasound
equine asthma pathogenesis
- Non-septic lower airway inflammation
- Multifactorial
- Airway hyperresponsiveness** to airborne antigens
-environmental (pollen, dust, hay) - Different phenotypes
- Genetic predisposition
- (Previous viral infection)
- Airway microbiota
-hear wheezes on ascultatoin due to narrowing of airways** - Excessive mucus secretion + bronchoconstriction
- Chronic: airway remodeling
Mild to moderate equine asthma
- Usually younger – but any age
- Poor performance: Differentials: upper airway obstructions, cardiovascular,
musculoskeletal - Chronic cough (> 3 weeks), occasional/intermittent
- NO increased respiratory effort at rest
- Prognosis: good
Severe equine asthma – “heaves”
- Horses usually older than 7 years
- Frequent coughing
- Exercise intolerance
- Increased respiratory effort at rest
- ”Heaves line”
- Life-long management
- Long-term:
- hypoxic vasoconstriction
- arterial remodeling and
thickening - pulmonary hypertension-> cor pulmonale
asthma diagnostics
-rebreathing exam
-trans tracheal wash- culture + cytology to tule out bacterial pneumonia
-BRONCOALVEOLAR LAVAGE BAL
-endoscopic tracheal mucus grading
-case based: bloodwork, ultrasound, rads, pulmonary function test
BAL cytology
- Normal
- ≤ 1% eosinophils
- ≤ 2% mast cells
- ≤ 5 % neutrophils (up to 10% may be normal)
- mildly increased in IAD
- severely increased in RAO
management of equine asthma
-inhalent therapy
- Antigen avoidance**
- Do not store hay above horses
- Remove horses from barn when sweeping
- Water-down dusty arenas
- Low-dust feed and bedding
-taylor to individual case
Exercise induced pulmonary hemorrhage
AKA “Bleeders”
- Racehorses
- Performance at maximum capacity
- Hemorrhage within airways in pulmonary vessels
- Diagnosis: endoscopy +/- BAL
- Grading system 0-4
Exercise induced pulmonary hemorrhage
AKA “Bleeders” pathogenesis
- Increased capillary pressure
- Caudo-dorsal lung most affected
- Micro- to macroscopic hemorrhage
diagnosis of bleeders
- Upper airway endoscopy:
- Scoring of tracheal blood
- Immediately following exercise
- Lung radiographs:
- Increased interstitial opacity in
dorsal caudal lung - BAL:
- RBC
- Hemosiderophages
- Timing of diagnostics vs exercise important*
