Respiratory - Bronchial Disease Flashcards
4 bronchial diseases
chronic bronchitis
eosinophilic bronchopneumopathy
primary ciliary dyskinesia
neoplasia
Anatomy of bronchi
mucosa, lamina propria, smooth muscle and submucosa with interspersed cartilage
What is chronic bronchitis (definition)
chronic inflammation of bronchial mucosa with no identifiable underlying cause
2 potential risk factors of chronic bronchitis
obesity, periodontal disease
Pathophysiology of chronic bronchitis
bronchial inflammation and mucus cause coughing –> bronchial walls become thicker due to chronic inflammation –> airways narrowed –> walls weakened and may collapse –> more coughing, more inflammation –> vicious cycle
Signalment of chronic bronchitis
middle-age to older, often small breed an overweight
Presenting complaint of chronic bronchitis
chronic cough (>1month)
non-productive (occasionally see white mucus, white foam)
harsh, hacking, deep
terminal retch and paroxysms of coughing are common
Potential exam findings of an animal with chronic cough
pulmonary crackles, wheezes, snapping
expiratory dyspnea
tachypnea, excessive panting
cyanosis
murmur of tricuspid regurgitation if pulmonary hypertension present
obesity, periodontal disease
pulmonary auscultation and vitals may be completely normal
Differential diagnoses for chronic cough
tracheal collapse, pulmonary fibrosis, eosinophilic bronchopneumopathy, parasitic lung disease, neoplasia, laryngeal disease, degenerative mitral valve disease, dilated cardiomyopathy
Which of the following is FALSE regarding diagnosis of chronic bronchitis?
A) 2 views of thoracic radiographs should be taken
B) A presumptive diagnosis often made by ruling out other causes
C) though no specific lab abnormalities are usually found with CB, a minimum database should still be conducted
D) A heart worm test should be conducted
A - 3 views should be taken and should include cervical region
rads help r/o any ddx
Some advanced respiratory diagnostics that may be useful in diagnosing CB
fluoroscopy - evaluate for airway collapse
bronchoscopy - above plus looks for neoplasia, foreign body, parasites, bronchitis, bronchiectasis, bronchomalacia
Bronchoalveolar lavage - evaluate for infectious or neoplastic causes
laryngeal exam - for laryngeal paralysis
Bronchoscopic findings characteristic of CB
hyperemic and irregular mucosa, excessive mucus, bronchomalacia
Which is NOT a treatment of chronic bronchitis? A) Avoid potential allergens B) Corticosteroid therapy C) Eliminate secondary resp infection D) none of the above
D - none of the above
Corticosteroid therapy of chronic bronchitis
reduces inflammation, mucus hyper secretion and bronchial wall thickening
find minimum effective dose, try to give every other day to allow normalization of hypothalamic pituitary axis and reduce clinical signs (PU/PD/PP)and risk of Cushing’s
T/F: all dogs with chronic bronchitis require life long therapy
false, some only need corticosteroid therapy intermittently for “seasonal flare ups”
Complications of chronic bronchitis
Bronchiectasis - permanent dilation and distortion of bronchi from chronic inflamamtion
bronchomalacia - bronchial collapse due t weaker walls - in dogs with tracheal collapse
chronic obstructive pulmonary disease (COPD) - obstruction of small airways due to thickening of walls and mucus accumulation
pulmonary hyper
What is eosinophilic bronchopneumopathy (EBP)?
eosinophilic infiltration of bronchial mucosa an pulmonary parenchyma suspected to be result of immunologic hypersensitivity, etiology unknown
Signalment of EBP?
young adult dogs, husky, malamute
Clinical signs of EBP
coughing, gagging/retching, dyspnea, nasal discharge
An owner brings her Siberian husky in because it has been coughing and having nasal discharge. You do rads and see moderate to severe diffuse bronchointerstitial pattern. You notice thickened and irregular yellow-green mucosa. What do you suspect?
eosinophilic bronchopneumopathy
Differential diagnosis of eosinophilic bronchopneumopathy
bronchopulmonary parasites - rule out fecal centrifugation-flotation, Baermann’s sedimentation, antihelmintic therapy
Treatment of eosinophilic bronchopneumopathy
corticosteroid therapy
What is primary ciliary dyskinesia (PCD)
defective ciliary motility resulting in mucus accumulation, inflammation, recurrent bacterial infections
Which part of the respiratory tract is affected by primary ciliary dyskinesia? A) upper airways B) lower airways C) Upper and lower airways D) PCD doesn't affect respiratory tract
C - upper and lower airways affected
Clinical manifestations of PCD?
rhino sinusitis
bronchitis
bronchopneumonia
bronchiectasis
A breeder comes to you concerned that one of her puppies from her latest litters may be sick. The puppy is 6 months old, and since birth has had repeated boughts go bronchitis and bronchopneumonia. The puppy also has recurrent bilateral nasal discharge. What do you suspect?
Primary ciliary dyskinesia
Treatment of PCD?
antibiotics, hydration, coupage, close monitoring for infections
Feline asthma
inflammation, mucus, wall thickening, bronchospasm
The difference between chronic bronchitis and asthma is
asthma also involves bronchospasm
Pathophysiology of feline inflammatory bronchial disease
chronic inflammation –> thickening of bronchial mucosa, hypertrophy of smooth muscle, mucus production
airway narrowed, obstructed airflow
What are the primary effector cells in allergic asthma? A) Macrophages B) Mast cells C) Neutrophils D) eosinophils
D - eosinophils
Common signs of feline inflammatory bronchial disease
coughing, wheezing
some have dyspnea/tachypnea
cats with bronchitis cough every day
Physical exam findings in a cat with feline infectious bronchial disease
RR can be normal or expiratory dyspnea with or without dyspnea
can see respiratory distress with open mouth breathing and cyanosis
pulmonary auscultation may be normal, or wheezes, increased BV sounds or crackles may be heard
Which is FALSE regarding diagnosis of feline infectious bronchial disease?
A) eosinophilia, stress leukogram, and hyperglobulinemia can be seen
B) CT can be performed if rads are normal because higher sensitivity
C) bronchial or bronchointerstitial pattern, usually diffuse
D) right caudal lung lobe atelectasis
D - it is the right middle lung lobe, due to mucus accumulation
T/F: HW and fecal testing is imperative because cats with HARD may be identical to cats with bronchitis or asthma
True
Acute treatment of feline bronchitis
minimize stress/hadling
supplemental O2
rapid acting corticosteroid +/- bronchodilator
An owner brings in her cat because it has been coughing and wheezing. Upon PE you notice the cat is a little over weight. You notice the cat is showing mild dyspnea and tachypnea. The owner mentions that she usually smokes inside and thinks that could have made her cat sick. She said these signs have been around a while but it is progressively getting worse. How would you treat the cat?
Chronic bronchitis
give po corticosteroid, bronchodilator therapy if no improvement with steroids
put cat on weight loss plan
ask owner to not smoke inside
Differentiate between Asthma/bronchitis and CHF in a cat
Asthma/bronchitis
- young adult, Siamese, history of cough common
- recent exposure to allergens, may auscultate wheezing, usually normothermic or hyperthermic
CHF
- older (unless pure-bred), murmur, gallop or arrhythmia
recent Hx - stressful event, fluid therapy, steroid injection
mildly hypothermic
Describe Mammomonogamus ieri
small nematode
Puerto Rico, St kitts, Caribbean
attaches to mucosal lining of nasal cavity and nasopharynx –> mild chronic inflammation
CS minimal
fecal float to ID large embryonate eggs (similar to hookworm but larger with shell)
eggs also in rhiqnoscopic cytologic specimens and nasal flush samples
Tx not well documented but fenbendazole suggested
Pneumonyssoides caninum
small mite, infects nasal cavity and sinuses of dogs
endemic in Scandinavia
transmission through direct contact
CS - non specific, rhinitis and nasal irritation, sneezing, seromucoid discharge, impaired scenting ability
dx by visualization of yellow white mites
Tx - selamectin (Rev), ivermectin also. CS resolve well with Tx
Most bronchopulmonary parasite infections are caused by
metastrongyloid nematodes (oilers osleri, filaroides hirthi, filaroides milski and crenosoma vulpis in dogs aelurostrongylus abstrusus in cats
Most susceptible to lung fluke infection
young animals
Oslerus osleri
metastrongylus nematode, lives in granulomatous nodules on mucosal surface of distal trachea
direct LS, coughed up and swallowed, passed in feces
CS: chronic cough, growing nodules that obstruct airflow - exercise intolerance, tachypnea, obstruction, death, spontaneous pneumothorax
Dx: bronchoscopy preferred, fecal
Tx: fenbendazole or ivermectin
Oslerus rostratus
bronchial infection in cats
IH = slugs
Filaroides hirthi (and filaroides milski)
small metastrongyles, live in coiled nests deep in lung parenchyma of dogs
diffuse, multifocal interstitial pneumonia
direct LS, coughed up and swallowed, passed in faces
CS: acute or chronic cough and resp distress
Dx: thoracic rads, detection of eggs in feces
Tx: fenbendazole or ivermectin
Aelurostrongylus abstrusus
feline lungworm
live in terminal bronchioles and alveolar ducts
bronchiolitis, interstitial and alveolar pneumonia, muscular thickening of pulmonary aa.
indirect, IH = snail/slug
CS: signs mimic asthma or bronchitis
Dx: rads, larva in feces
Tx: usually self limiting, can use drugs (many commercial products available)
Crenosoma vulpis
metastrongyloid, chronic bronchopulmonary disease and productive cough in dogs
indirect LS, IH = slug/snails
CS: chronic productive cough, systemic signs usually absent
Dx: thoracic rads, ID of larvae airway or in feces
Tx: respond rapidly to moxidectin and imidacloprid
Eucoleus aerophilus
capillary nematode, infects tracheobronchial mucosa of cats and dogs
eggs coughed up and swallowed, passed in feces
CS: inapparent infection, can cause persistent cough
Dx: rads, eosinophilia, fecal sample
Tx: fenbendazole, ivermectin
Paragonimus kellicotti
lung fluke of wild carnivores 2IH : aquatic snail and crustacean CS: chronic cough, exercise intolerance, weight loss Dx: rads, feces Tx: praziquantel or fenbendazole
