Respiratory Flashcards
differentials of coughing dog
- Inflammatory diseases of the bronchi and the lungs (infectious or non-infectious)
- Tracheal/bronchial collapse
- Pulmonary edema (cardiogenic/noncardiogenic)
- Lung tumours
- Foreign body
- Haemorrhage
- Bronchial compression
chronic bronchtiis
Defined clinically as cough that occurs on most days of 2 or more consecutive months in the past year in the absence of other active disease
predisposition of chronic bronchitis
middle aged- older small breed dogs, cocker spaniels, terriers, poodles
cause of chronic bronchitis
unknown non specific/aspecific chronic bronchitis. Long standing inflammatory process initiated by infection, allergy or inhaled irritants or toxins
pathogenesis of chronic bronchitis
irritating factors chronic airway inflammation increased mucus secretion airway thickening bronchiectasis
signs of chronic bronchitis
loud, harsh cough, mucus hypersecretion, exercise intolerance
diagnosis of chronic bronchitis
need to exclude: tracheal collapse, idiopathic pulmonary fibrosis, eosinophilic broncho pneumopathy, parasitic pneumonias, bronchial/pulmonary tumours, heart disease
- BALF cytology: lot of mucous, normal or hyperplastic bronchial epithelial cells, predomination of nondegenerated neutrophils, presence of bronchial cylinders, increased number of macrophages, goblet cells and lymphocytes
- bronchoscopy, radiohtaphy, cytology
treatment of chronic bronchtiis
maintained symptomatically
Glucocortioids
- decrease the mucosa inflammation and secretion of mucous
- act rapidly
- systemic and local usage
Methyxanthines
- theophylline and aminophylline can be used in combination with glucocorticoids
for cough suppression (antitussive drugs)
- butorphanol, hydrocone, codeine, phocodin
prognosis of chronic bronchitis
good if compliant owner
complications of chronic bronchitis
bacterial or mycoplasma infection, tracheobronchomalacia, pulmonary hypertension and bronchiectasis
differentials of chronic bronchitis
bronchiectasis, CHF, airway foreign body, bacterial pneumonia, pulmonary edema, tracheal collapse
predisposition of feline asthma
Siamese + Burmese cats, more common in female and in young-middle aged cats
cause of feline asthma
allergens, exercise, physical/chemical factors, infection, drugs, stress
signs of feline asthma
cough, respiratory distress, long (forced) expiration, barrel shaped thorax, asymptomatic periods, lethargy, mucus swallowed after cough, increased airway sounds
diagnosis of feline asthma
- CBC – eosinophilia in 20% of cats, elevated stress leucogram
- biochemistry – Hyperglobinemia
- bronchoscopy: excessive mucus, roughened mucosa
- bronchial pattern, hyperinflation, straightening of the diaphragm, middle right lobe atelectasis
- microbiology of BALF
treatment of feline asthma
Emergency
- minimise stress, oxygen, rapid acting glucocorticoids (dexamethasone, methylprednisolone) bronchodilators (terbutaline/aminophylline), last resort: adrenaline
Glucocorticoids
- to control the inflammation in the airways and to stop/slow down the progression of the disease, inflammation is present in asymptomatic patients also
Bronchodilators
- methylxanthines: aminophylline/theophylline, they also have anti-inflammatory effects and increase mucocilliary clearance
- beta-2 agonists: salbutamol (fast acting), salmeterol (slow)
prognosis of feline asthma
dependent on response to treatment, if no response – euthanasia
differential of feline asthma
pulmonary edema, pneumothorax, lymphoma, anaemia, HCM, thromboembolism
predisposition of bacterial pneumonia
young animals < 1 years of age (spontaneous)
cause of bacterial pnuemonia
Bordetella bronchiseptica, strep, staph, E.coli, Pasteurella, klebsiella
signs of bacterial pnuemonia
cough (less common in cats), bilateral mucopurulent nasal discharge, exercise intolerance and respiratory distress, lethargy, anorexia, fever and weight loss
diagnosis of bacterial pneumoni
CBC, thoracic radiographic findings, tracheal wash fluid cytologic analysis and bacterial culture
- CBC = neutrophilic leucocytosis with a left shift, neutropenia with degenerative left shift
treatment of bacterial pneumonia
ATB and supportive care, airway hydration, physiotherapy, bronchodilators, expectorant (questionable), acetylcysteine
prognosis of bacterial pneumonia
more guarded in animals with underlying problems
complication of bacterial pneumonia
pulmonary abscess formation is an uncommon complication
cause of viral pneumonia
Distemper, canine influenzas, feline calicivirus, feline herpes virus
signs of viral pneumonia
lethargy, anorexia, tachypnoea, coughing, resp distress, collapse, exercise intolerance, increased lung sounds, crackles on lung auscultation, nasal and ocular discharge, fever
diagnosis of viral pneumonia
x-ray
- direct airway sampling transtracheal wash, bronchoscopy with BAL or fine needle aspiration of lungs
treatment of viral pneumonia
fluid therapy, supplemental oxygen, nutritional support, airway therapy (saline nebulisation for 5-10minx 3-4x daily followed by coupage)
Antimicrobial therapy
- puppy (outpatient) = doxycycline, puppy (inpatient) = ampicillin and gentamicin
- adult (OP) = co-amoxiclav/ fluoroquinolone and beta lactam combination, adult (IP) = ampicillin and gentamicin
- adult dog hospital acquired = carbapenems or 3rd gen cephalosporins
follow up of pnuemonia
repeat x-ray, stay in hosp until no longer oxygen dependent, treatment at home continue for 2-6 weeks and at least 1 week after complete resolution of clinical signs
prognosis of viral pneumonia
survival in puppy is 90%, older depends on underlying disease
cause of pleural effusion
can be blood (trauma, poison), chyle (thoracic duct rupture), exudate (bacteria into pleural space, bite etc), transudate (imbalance of absorption + filtration of fluid across pleura = hypoproteinemia) or modified transudate (long standing transudate, CHF)
pathogenesis of pleural effusion
luid accumulates, lung lobes retract and lung lobe borders become rounding
signs of pleural effusion
- problem in lower airways: pronounced + prolonged expirium, loud auscultation, whistles
- problem in upper airways: stridor +/or stertor, gasping, increased RR + labour, voice change, panting
- problem in lung parenchymal cyanosis, increased RR + labour, crackles, productive cough
- problem in pleural space: shallow breathing, Paradoxal breathing, muffled respiratory sounds
diagnosis of pleural effusion
radiography: fluid silhouettes the heart and diaphragm, obscuring their borders, displaced trachea dorsally
- thoracocentesis = detect fluid type (lower 1/3 = fluid, upper third = air)
- CBC – neutrophil with left shift in pyothorax
- cytopathology = for fluid type
o degenerate neutrophils and bacteria = pyothorax
o lymphocytes = chylothorax
o neoplastic cells = tumour
treatment of pleural effusion
thoracocentesis and treatment of underlying cause, placement of chest drain
prognosis of pleural effusion
guarded overall, uncommonly cured but may be successfully managed
differential of pleural efusion
mediastinal disease, diaphragmatic hernia, lobe collapse, pulmonary neoplasia, pulmonary edema
transudation
o due to increased hydrostatic pressure
o decreased colloid – osmotic pressure
o clear, TP <25g/L, <1500cell/uL, CHF or hypoproteinemia, SG < 1.0.17
exudate
o due to trauma/ rupture
o increased endothelial permeability
o variable colour- septic/aseptic
o TP > 30g/L, neutrophils, RBC, bacteria, SG > 1.025
- If exudate:
o tomato soup = neoplasia
o pyothorax = trauma/ infection
o chylothorax = mediastinal lymphoma
pneumothorax predisposition
: large deep chested (spontaneous)
cause of pneumothorax
traumatic injury, faulty pleural drainage system, during abdominal surgery
pathogenesis of pneumothorax
as greater volume of air accumulates in pleural space, the lung parenchyma becomes more dene
signs of pneumothorax
respiratory distress, cyanosis, orthopnea
tension pneumothorx
one-way valve is created by tissue at site of leakage, such that air can enter into pleural space during inspiration but cannot return to the airways or atmosphere during expiration
- severe lung compression, over distension of thorax
traumatic pneumothorax
from trauma
- cage rest, removal of accumulating air by periodic thoracocentesis or by chest tube and radiograph
spontaneous pneumothorax
pre-existing pulmonary lesions rupture
- more often in dogs than cats
- thoracocentesis is for initial stabilisation
- radiographs and faecal exams,
diagnosis of pneumothorax
radiograph: heart generally elevated above sternum, with air opacity between two structures
treatment of pneumothorax
removal of free air from pleural space, cage rest, thoracocentesis, exploratory thoracotomy
prognosis of pneumothorax
always guarded initially as volatile situation with sudden deterioration possible
differentials of penumothorax
diaphragmatic hernia, pleural effusion, metastatic neoplasia, pulmonary contusion
predisposition of reverse sneezgin
small breed dogs
cause of reverse sneezing
unknown, mostly idiopathic, exacerbated by allergies, excitement, scents from environment, foreign body, nasopharyngeal inflammation
pathogenesis of reverse sneezing
air is suddenly drawn into the nose
signs of reverse sneeznig
dog looks like he’s trying to breathe whilst sneezing, spreads the neck and head forward, immediately returns to normal as soon as event is over
Noisy, laboured inspiration, initiated by nasopharyngeal irritation
diagnosis of reverse sneexing
recommended when it becomes a frequent problem
- dynamic upper airway obstruction
o stertor: noise absence with mouth open. Nasal/nasopharyngeal obstruction, consider: nasopharyngeal mass, nasal mass or FB
o stridor: noise present with mouth open or closed: laryngeal or laryngopharyngeal obstruction, consider: laryngeal paralysis/collapse or tumour
- lab tests: CBC, serum biochemistry, urinalysis, serology, pulse oximetry and arterial blood gas
- X-ray, CT, MRI, fluoroscopy, US, endoscopy
- collecting sample: culture, cytology, histology
- nasal airways: nasal swabbing/brushing, saline hydrop pulsion, nasal biopsy
- lower airways: BAL, tracheal wash, endobronchial brush, transthoracic needle, surgical and thoracoscopic lung biopsy
treatment of reverse sneezing
usually self-limited episodes, depending on ddx, drugs used periodically
differentials of reverse sneezing
upper respiratory tract infection, collapse of trachea, tumours or polyps in the nose, FB and parasites
predisposition of tumours of nasal cavity
older animals (10yr) more common in dolichocehalic and mesecpahlic animals
cause of tumours of nasal cavity
carcinomas, sarcomas, rarely polyps
tumours of nasal cavity (cats + Dogs_
Cats: round cell tumour (lymphoma), cancer (adenocarcinoma, undifferentiated carcinoma)
Dogs: carcinoma (adenocarcinoma, undifferentiated carcinoma), sarcoma (younger animals), round cell
pathogenesis of tumours of nasal cavity
1/3 of all cause of chronic signs of nose disease, mostly malignant, rarely mts
signs of tumours of nasal cavity
respiratory, ocular and neurological, nasal discharge, epistaxis, sneezing, facial deformity
diagnosis of tumours of nasal cavity
- CBC: anaemia, thrombocytopenia
- biochemistry: hypercalcaemia
- X-ray of nasal cavity
- CT, MRI, endoscopy, histopathology
treatment of tumours of nasal cavity
radiation + surgery, chemotherapy, piroxicam (NSAID), prednisolone
prognosis of tumours of nasal cavity
median survival time without treatment approx. 95 days, depending on treatment: radiation + surgery 2-3 years
differentials of tumours of nasal caivty
nasal aspergillosis, rhinitis, other causes of epistaxis
aspergillosis predisposition
normal inhabitant of nasal cavity in many animals (some dogs, rarely cats), more common in young male dogs, primarily in GSD (disseminated)
signs of aspergillosis
chronic nasal discharge (bilateral, depigmentation, pain), loss of appetite, periostitis and bone resorption, mild muscular atrophy, messy hair coat, submandibular LN moderately enlarged, sneezing
- highly suggestive of aspergillosis are sensitivity to palpation of the face or depigmentation and ulceration of the external nares
diagnosis of aspergillosis
chronic nasal discharge (bilateral, depigmentation, pain), loss of appetite, periostitis and bone resorption, mild muscular atrophy, messy hair coat, submandibular LN moderately enlarged, sneezing
- highly suggestive of aspergillosis are sensitivity to palpation of the face or depigmentation and ulceration of the external nares
treatment of aspergillosis
rhinoscopy: fungal debridement, topical therapy (enilconazole, clotrimazole), re-evaluate 2-3 weeks
prognosis of aspergillosis
grave with disseminated
predisposition of tracheal collapse
certain breeds of dogs (yorkies), cervical collapse most often in small breeds, middle and older dogs, any breed: collapse of intrathoracic part, bronchus and bronchioles
- > 7 years = acquired collapse, 4-6 months for congenital
cause of tracheal collapse
inflammation of respiratory system, difficulty in breathing and cough, glycoprotein and glycosaminogen deficiency
pathogenesis of tracheal collapse
reduction in the lumen of the trachea resulting from the weaking of cartilage rings of the trachea, relaxation of the dorsal membrane or a combination of these processes
consequence of tracheal collapse
of trauma, intraluminal mass, extraluminal compression, tracheal hypoplasia
signs of tracheal collapse
honking cough, trachea (sensitive on palpation), lateral borders of cervical trachea are often palpated, abnormal respiratory sound, inactivity, cyanosis, syncope
diagnosis of trahceal collapse
X-ray, fluoroscopic examination, Tracheobronchoscopy (4 levels) blood count, biochemistry, ECG, echo
treatment of tracheal collapse
weight loss, avoid hot environment, short period of steroid administration, broncho dilators (if chronic bronchitis present), ATB if needed, oxygen as needed, reduce excitement (butophanol, acepromazine)
- Stents - hydrocodone, prednisolone, ATB
prognosis of tracheal collapse
fair to poor
differentials of trachealcollapse
chronic tracheobronchitis, chronic bronchitis, left atrial enlargement, CHF
predisposition of brachycephalic syndrome
brachycephalic and in Himalayan cats, many 2- 4 years
cause of brachycephalic syndrome
congenital shortening of the bones of the skull when the soft tissues within the upper airway don’t reduce in size proportionally
- obesity, hot weather, exercise, excitement, stress
pathogenesis of brachycephalic syndroe
stenotic nares, elongated soft palate, hypoplastic trachea (bulldogs)
signs of brachycephalic syndrome
loud breathing sounds, stertor, increased inspiratory efforts, cyanosis, syncope, concurrent gastrointestinal signs, excessive panting, collapse
diagnosis of brachycephalic syndroe
specific breed, clinical signs, X-ray, laryngoscope, CT, rhinoscopy
treatment of brachycephalic syndrome
surgery (correction of anatomic defects), emergency therapy: short acting glucocorticoids (prednisolone), laser turbinectomy
prognosis of brachycephalic syndrome
depends on severity of the abnormalities at the time of diagnosis. Prognosis after early surgical correction of the abnormalities is good for many animals. Laryngeal collapse is generally considered a poor prognostic indicator
