Respiratory Disease Flashcards
What are 7 signs that can localize disease to the upper airways?
- nasal discharge
- sneezing/reverse sneezing
- prolonged, deep inspirations
- increased efforts on expiration and inspiration
- audible sounds - sterdor, stridor, snoring
- inability to breath easily if mouth is closed
- pawing at face
What are 4 signs that can localize disease to the lower airways?
- cough
- respiratory distress
- prolonged expiration
- abdominal push
more severe
Signalment: Keegan, 10 y/o MC Border Collie
Hx
- nasal congestion and sneezing with right-sided mucopurulent discharge over the past 5 days
- recently epistaxis has been noted
- UTD on vaccines
- receives HW and flea/tick prevention monthly
Create a problem list.
- congestion
- sneezing for 5 months
- unilateral right-sided discharge
- recent epistaxis
Where does sneezing localize disease to? What are the 2 types and what are they indicative of?
nasal cavity
- PAROXYSMAL (short fits) - acute viral disease, foreign bodies, trauma
- INTERMITTENT - intranasal tumor or chronic foreign body
What is a reverse sneeze?
forceful INSPIRATORY nasal effort secondary to nasopharyngeal irritation where the head is pulled back with the mouth closed
What is nasal discharge a sign of? What are the 2 main exceptions?
local disease within the sinonasal cavity
- bacterial pneumonia
- coagulopathies
What are the 4 ways of describing nasal discharge? What are the indicative of?
- SEROUS - viral, allergic, parasitic (many start this way)
- MUCOID - inflammation associated with FB, neoplasia, fungal rhinitis, and bronchopneumonia
- MUCOPURULENT - secondary bacterial invasion
- BROWN/RED-TINGED - blood from trauma, coagulopathy, fungal rhinitis, neoplasia, or Ehrlichiosis
When is acute nasal discharge accompanied by sneezing typically indicative of?
- viral upper respiratory disease
- FB
What is the difference between tachypnea and hyperpnea? Bradypnea and hypopnea?
TACHYPNEA = increased respiratory rate/frequency
HYPERPNEA = abnormally rapid or deep breathing
BRADYPNEA = decreased respiratory rate/frequency
HYPOPNEA = decreased depth or frequency of breathing
What is orthopnea?
sensation of breathlessness in recumbency that is relieved when sitting or standing
What is a restrictive breathing pattern?
short, rapid, and shallow breaths caused by “stiff” lungs from pnemonia, pulmonary edema, or neoplasia, where they are prevented from mechanical expansion
What is stertor? What are some causes?
upper low-pitched sound that suggests flaccid tissue is vibrating throughout the respiratory cycle, and sounds like snoring, congestion, fluttering, or gurgling (INSPIRATION)
when tissue or secretions transiently obstruct flow
- narrowed nasal cavity
- elongated soft palate
- edematous or everted laryngeal saccules
What is stridor? What is the most common cause? What does this indicate?
lower high-pitched sound from rigid tissue vibrations commonly associated with laryngeal or tracheal disease (EXPIRATION)
laryngeal paralysis and tracheal collapse - airway narrowing/stricture where air flows past rigid obstructions
What is the purpose of panting? In what animals is this concerning?
dispel heat (normal in dogs, not necessarily sign of distress)
cats —> associated with stress, respiratory disease, or cardiac arrhythmias
What are normal causes of panting in dogs? Abnormal?
overheating, stress, excitement, exertion, pain
- decreased lung compliance from pneumonia, edema, contusions, or obesity
- laryngeal paralysis
- pulmonary thromboembolism
- heart failure
- metabolic: hyperthyroidism, Cushing’s
- hyperthermia
- acidosis: DKA, renal failure, antifreeze
- hypertension
- exogenous steroids
What is the hallmark sign of lower airway disease? What can this also indicate?
coughing —> irritation of tracheobronchial mucosa or lung parenchyma by inflammatory products of neutrophils or eosinophils, excessive secretions, and airway collapse
cardiac disease
How are coughs described?
- dry, non-productive
- moist, productive (secretions)
In what 2 ways does cardiac disease cause coughing? How can this be confirmed?
- pulmonary edema
- chamber enlargement of LA compresses airway
heart murmur - not enough to prove cardiac cause, but NOT hearing one make it much less likely of being cardiac —> animal will likely also be tachycardic
Can coughing in cats also indicate cardiac disease?
NO - cats rarely cough due to congestion heart failrue
What is an obstructive respiratory pattern? How does it differ with upper vs lower airway disease?
slower and deeper than normal
- UPPER = pronounced inspiratory effort
- LOWER = increased effort during expiration due to recruitment and contraction of abdominal muscles
In what other instance is it common to see increased inspiratory effort (other than obstructive respiratory disease)?
pleural space disease
What is a restrictive respiratory pattern? What causes this?
faster and more shallow than normal breaths with an increased respiratory rate/effort and low tidal volume
decreased lung compliance from parenchymal, pleural , or chest wall disease that makes expansion of the chest difficult
What is paradoxical respiration? What are the 2 most common times this happens?
discordant motions of chest/abdominals walls
1, flail chest resulting from thoracic trauma
2. respiratory muscle fatigue from over worked muscles (respiratory failure imminent)
What is flail chest? What causes it?
freely movable segment of the thoracic wall secondary to fractures of consecutive ribs (thoracic trauma)
negative pressure gradient that normally pulls air into the lungs also exerts this force on the freely moveable flail segment, causing inward displacement
Where are the normal bronchial, vesicular, and bronchovesicular lung sounds heard? What do they sound like?
BRONCHIAL - over the trachea and large airways in health; wind blowing where expiration is lounder and longer (if heard in periphery = consolidation)
VESICULAR - peripheral airways; rustling of leaves where inspiration is longer (indicates air-filled lung)
BRONCHOVESICULAR - intermediate lung regions in health; harsh expiratory sounds closer to central airways
Why can early lung disease or congestive heart failure be heard upon auscultation of the lungs?
fluid/tissue in the lungs transmits sounds better
What do crackles sound like? What are they caused by? Common examples?
distant popping of bubble wrap or Rice Krispies in milk
snapping open of airways that have closed due to fluid in or around them
- bronchitis
- pneumonia
- fibrosis
- severe pulmonary edema
When are wheezes most commonly heard upon auscultation? What are 5 possible causes?
expiration of air through a narrow opening (continuous, long sound with musical quality)
- stricture
- compression
- FB
- tumors
- hilar lymphadenopathy
When are end-expiratory snaps or clicks heard? What causes them? Example?
over the chest and can be felt with a hand on the chest wall as the animal coughs
snapping together of the walls of large intrathoracic airways during a cough
loud snap over hilus at the end of expiration = collapse of intrathoracic trachea, carina, or mainstem bronchi
Where are goose honks most audible? What do they sound like? What are they commonly associated with?
thoracic inlet (audible in room)
kazoo sound from large airways
lengthy flattening of the trachea (kennel cough)
Where are pleural friction rubs heard? What do they sound like? What causes them?
over regions of pleural inflammation during both inspiration and expiration
creaking or grating sounds
roughened mucosal surfaces move against one another (NOT heard with adhesions or large effusions)
What is respiratory distress most commonly associated with? What are 4 common causes?
lower airway disease
NOT ENOUGH O2
- insufficient oxygen in inspired air
- insufficient ventilation
- insufficient RBC
- abdnomal Hb
What is cyanosis? What does it indicate?
bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood
severe hypoxemia resulting from the cardiac or respiratory system
What are the 5 steps to examining the respiratory system?
- observation
- assess nasal air flow with a wisp of cotton, glass slides
- palpation, including tracheal pinch to elicit cough
- auscultation in a quiet room (maximize tidal volume by closing off nostrils)
- percussion
How can radiographs be used as diagnostic tests for respiratory disease? How should patients be prepared beforehand?
- observe nasal passages with general anesthesia and open-mouthed shot
- observe thorax with lateral and VD 3 views; standing radiographs can identify fluid/air in the chest of dyspneic animals
ensure stability - do not stress a dog or cat in respiratory distress for a radiograph
In what cases can thoracocenteses be done before radiographs?
- pleural effusion
- pneumothorax
How do CT scans and MRIs compare in diagnosing respiratory cases?
CT = standard for evaluating the nasal chambers and paranasal sinuses
MRI - better for soft tissues, like brain
What are 3 common findings on CBC in respiratory cases? What are their causes?
- neutrophilia with left shift - bacterial pnemonia
- eosinophilia - parasites, feline asthma, hypersensitivites, EBP
- neutrophilia and monocytosis - fungal disease (chronicity)
Why may a fecal exam be helpful for coughing dogs with unknown underlying cause?
LUNG WORMS - Eucoleus aerophilus, Oslerus osleri Crenostoma vulpis
(Baermann or float_
In what 3 situations is nasal flushing indicated?
- obtain samples for cytology and culture
- improve visualization of nasal structures prior to rhinoscopy
- retrieve FB and clear excessing mucous and debris
In what 3 situations are rhinoscopies indicated? What are the 2 most common insruments?
- nasal disease signs - acute paroxysmal sneezing, chronic discharge, swelling
- FB removal
- collecting samples for histology, cytology, and microbiology
- FLEXIBLE ENDOSCOPE: allows for nasopharyngoscoppy, rhinoscopy, and biopsy
- RIGID RHINISCOPE: allows continuous saline flushing during procedure
What is the general rule of thumb for collecting samples during rhinoscopy?
measure distance to eye and do not go further, or else the brain will be involved
What is the indication for laryngoscopy? What can aid in laryngeal function interpretation?
assess laryngeal function, look for FB or masses
doxapram hydrochloride - laryngeal opening should abduct and adduct symmetrically while breathing
How can samples be taken or fluid be expelled from the larynx when anesthesia is contraindicated?
trans-tracheal wash sampling - go between tracheal rings at cricothyroid notch, push in saline, and pull back
When are trans-oral tracheal washes indicated? What is required before this is possible?
scoping not available
- general anesthesia
- measurement of the catheter to estimate carina
In what 3 situations are tracheoscopies and bronchoscopies indicated?
- evaluation of tracheal and lower airway disorders
- acquisition of cytology and bacteriology samples of smaller airways by bronchoalveolar lavage
- FB removal
How are bronchoalveolar lavages performed? What does success rely on?
insert sterile tube through bronchoscope and pass into airways containing abnormal secretions or pathology (can also use syringe with a catheter though an ET tube)
ability to wedge the scope gently into small airway and isolate segment of alveolar area
What cells should predominate on cytology of tracheal washes and bronchoalveolar lavages? What do changes indicate?
large mononuclear cells
- neutrophils = inflammation or infection
- eosinophils = allergic or parasitic
- organisms within phagocytes = pathogens
What microorganisms predominate in airway isolate cultures? What other organisms should be considered?
aerobes
- anaerobes: aspiration pneumonia, pulmonary abscesses
- Mycoplasma
- fungi
In what situations will lung tissue be FNA?
obtain cytology samples of large focal lung lesions or mediastinum, or interstitial lung disease in close contact with the thoracic wall
When is thoracocentesis contraindicated? What is its general purpose?
presence of known coagulopathy
remove as much air or fluid as possible
What are 4 common reasons for a negative thoracocentesis tap?
- no fluid or air present
- fluid more ventral or deeper than needle
- fluid is walled-off or on the contralateral side
- fluid very thick
Why should cholesterol and triglyceride levels be considered following a thoracocentesis tap?
alters effusion —> high fats = chylous and cloudy
What is the recommended site for thoracocentesis?
- 7th-8th intercostal
- ventral 1/3 for fluid
- go wherever you need to!
What are the 2 most common indications for a chest tube placement?
- treat pyothorax - huge amount of fluid too much for tap
- management of pneumothorax when air is continually accumulating
What are the 5 most common bacteria found in the flora of the respiratory tract?
- Staph
- Strep
- Pasteurella
- Bordetella
- Mycoplasma
can become pathogenic
What are the 2 common antibiotics used for respiratory disease? Which ones also have anti-inflammatory effects?
- Amoxicillin-clavulanic acid (clavamox)
- fluoroquinolones
(penicillin derivatives ineffective against Mycoplasma)
Doxycycline and azithromycin
What is required for maximum control of feline and canine respiratory infections?
FELINE - long course about 4-6 weeks due to common chronic cases
CANINE - 7-10 days
How are antibiotics chosen for lower airway infections? Why? Which ones are most commonly used?
culture and sensitivities - infections more life-threatening
- Fluoroquinolone
- Amoxicillin-clavulanic acid
- Doxycycline
(2-6 weeks)
What antifungals are most commonly used to treat respiratory disease? Which are fungistatic and fungicidal?
FUNGISTATIC = azoles (itraconazole, fluconazole, voriconazole), terbinafine
FUNGICIDAL = amphotericin B (highly nephrotoxic)
How can the deleterious effects of Amphotericin B be avoided?
lipid complex reduced the likelihood of renal insufficiency (more $$ and formulated in a single-use vial)
When are corticosteroids indicated for respiratory disease? What 2 effects do they have?
long-term control of felin bronchial disease, chronic bronchitis, and canine eosinophilic lung disease
- reduce inflammation by inhibiting phospholipase A2
- decrease migration of inflammatory cells into airways and granulocyte products
What steroids are prefered for treating respiratory disease?
prednisolone* and prednisone
What bronchodilators are not used in emergency situations? Which are?
METHYLXANTHINES: theophylline and aminophylline are relatively weak and more beneficial for adjunctive therapy with steroids
BETA-AGONISTS: terbutaline and albuteral cause direct relaxation of airway smooth muscle
What additional effect does theophylline have that can aid with respiratory disease?
- increases diaphragmatic muscle strength
- improves pulmonary perfusion
- reduces respiratory effort
- stimulates mucociliary clearance
What effect is common when methylxanthines and beta-agonists are first used?
excitability or tremors
(become accustomed to drug)
Why are antitussive agents carefully used with respiratory disease?
coughing clears secretions from airways and suppression can lead to serious pneumonia?
In what animals are antitussive agents used?
dogs with airway collapse or irritants tracheitis - helps improve inflammation because chronic cough can cause repeated airway injury
What 4 antitussive agents are commonly used?
- hydrocodone bitartrate
- butorphanol tartrate
- cerenia
- diphenoxylate atropine (lomotil)
What is the purpose of nebulization? How does usage compare with upper and lower airways?
hydrates airway secretion (saline) and can administer drug directly to epithelial surface (aminoglycosides, albuterol, budesonide)
- UPPER = standard humidifier
- LOWER = ultrasonic or compressed nebulizer decreases size of particles
What is commonly done after nebulization?
gentle exercise or coupage - encourages evacuation of airway mucus
What adjunctive therapy should be provided to animal animal presenting with respiratory difficulty?
(tachypnea, hypernea, cyanosis, collapse)
OXYGEN from face mask, cage, nasal tube, or tent/chamber
When is ventilator support commonly required?
- hypoxemia
- refractory to supplemental oxygen
- respiratory muscle fatigue.
(cannot breath by themselves)
