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Medicine I > Respiratory - Tracheal Disease > Flashcards

Respiratory - Tracheal Disease Flashcards

1
Q

What is the cough reflex?

A
  • Elicited by irritation of mucous membranes int he pharynx, larynx, trachea, or bronchi
    • mechanical, chemical, mucus
  • CNS cough center in medulla
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2
Q

What is Kennel Cough

A
  • Infectious Tracheobronchitis
  • Caused by:
    • Canine Parainfluenxa virus
    • Canine Adenovirus-2
    • Bordetella bronchiseptica
    • Mycoplasma spp
    • Others
    • Any combination of the above
  • Very contagious!
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3
Q

Which kennel cough virus has a vaccine that is considered “core”

A
  • Adenovirus-2 = “core”
  • Parainfluenza = “non-core”
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4
Q

What is Bordetella bronchiseptica?

A
  • Aerobic Gram-negative bacteria
  • one of the causative agents of Kennel Cough
  • Common in dogs, less common in cats
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5
Q

What is the pathogenesis of Bordetella bronchiseptica infection?

A
  • Colonize respiratory mucosa
  • Adhere to and destroy cilia, causes ciliostasis
  • Mucociliary clearance fails
  • Release toxins and inflammatory mediators
  • Other bacteria can then adhere and cause disease
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6
Q

What are the clinical signs of Kennel Cough?

A
  • 3-10 day incubation period after exposure
  • Dogs get classic loud honking cough
  • “healthy” other than the cough
  • Anorexia, fever, lethargy, nasal-ocular discharge possible
    • Not typically seen
    • Consider if it has progressed to pneumonia
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7
Q

How does a typical Kennel Cough dog present?

A
  • BAR
  • Energetic and happy
  • Loud honking cough
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8
Q

How is Kennel Cough Diagnosed?

A
  • Uncomplicated case:
    • “healthy” kennel cough
    • Exposure, cough, exam
    • no further tests needd
  • Complicated cases:
    • “sick” kennel cough
      • Anorexia, fever, lethargy
    • Thoracic radiographs
      • If show pneumonia, then consider tracheal was
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9
Q

What is the treatment for Kennel Cough

A
  • Viral component is self-limiting
  • Healthy Kennel Cough:
    • Hydrocodone or butorphanol for cough suppression
      • Mechanism: opioids inhibit cough center in medulla
      • side effects: sedation, decreased clearance of bacteria
  • Sick Kennel Cough:
    • Antibiotic based on culture and susceptibility when available
      • Doxycycline, amoxicillin, or Clavamox (empirically)
    • Cough suppressants are contraindicated in pneumonia cases
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10
Q

What is the Vaccine for Bordetella bronchiseptica?

A
  • Not core
  • Minimizes risk of infection
    • develop fewer clinical signs if infected
  • 2 Types:
    • IN: (MLV) quick onset, can develop cough
    • SQ: (killed) initial dose requires booster in 2-4 weeks
    • Booster annually or 1+ week prior to exposure
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11
Q

When should kennel cough dogs be isolated?

A
  • During clinical signs and therapy
    *
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12
Q

Who are the hosts of Distemper Virus?

A
  • Dogs (especially puppies 3-6mo)
  • Large cats (tigers), seals, minks, ferrets, raccoons
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13
Q

How is Distemper virus spread?

A
  • Mostly respiratory secretions
  • Can be spread in all bodily fluids
    • feces, urine, transplacental
  • Can spread for up to 90 days after infection
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14
Q

What is the pathophysiology of Distemper Virus?

A
  • Aerosol drops of fluids reach tonsils
  • Infect macrophages, travel by lymphatics and bloodstream to many organs
    • lymph nodes, lungs, spleen, liver, GI tract, eyes, marrow, skin and CNS
  • If vaccinated/maternal antibodies - puppies can clear the infection with no/mild signs
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15
Q

What are the signs of Distemper Virus?

A
  • Subclinical
  • Acute Disease:
    • Respiratory
      • Nasalocular discharge
      • Kennel cough/pneumonia
    • Gastrointestinal Disease
      • Decreased appetite
      • Vomiting/diarrhea
    • CNS
      • Myoclonus, blindness
      • seizures, ataxia, hypermetria, paralysis
  • Enamel hypoplasia
  • Hard-Pads or pustular skin lesions
  • KSC/uveitis/optic neuritis/blindness
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16
Q

How is Distemper Virus diagnosed

A
  • CBC:
    • may have lymphopenia, thrombocytopenia, regenerative anemia
    • May see inclusions in blood cells from CBC or bone marrow
  • Thoracic Radiographs: unstructured interstitial pattern that is diffuse or dorsocaudal in distribution
    • Can have alveolar pattern if 2o bacterial penumonia
  • PCR, IFA, Necropsy
    • On respiratory secretions, conjunctiva, blood, CSF, feces, tissues
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17
Q

What is the treatment for Distemper Virus?

A
  • For coughing/pneumonia
    • +/- antibiotics, nebulization
  • For GI:
    • Antiemetics, nutrition, fluids
  • For seizures:
    • Anti-epileptics
    • Poor Prognosis if neurologic
  • Isolate suspect/confirmed dogs
18
Q

How can Distemper be prevented?

A
  • Vaccination
19
Q

What are the Influnza viruses in Dogs?

A
  • Canine Influenza (H3N8 and H3N2)
20
Q

How is Canine Influenza (H3N8/H3N2) transmitted?

A
  • Through respiratory secretions
  • Via fomites
21
Q

What are the signs of Canine Influenza (H3N8/H3N2)?

A
  • Decreased appetite
  • Fever
  • cough
  • lethargy
  • nasal discharge
  • can be subclinical
22
Q

How is Canine Influenza (H3N8/H3N2) diagnosed?

A
  • signs
  • PCR
23
Q

What is the treatment for Canine Influenza (H3N8/H3N2)

A
  • supportive care
24
Q

Is there a vaccination for Canine Influenza (H3N8/H3N2)

A
  • Killed vaccine, requires booster in 3-4 weeks, then yearly
  • only for at risk patients
25
Q

What is the pathophysiology of tracheal collapse?

A
  • 1o cartilage abnormality
    • ⇣ glycoproteins and GAGs in tracheal rings, can’t retain water, lose rigidity
  • 2o Initiating Factors
    • Obesity
    • inhaled irritants (smoke)
    • Concurrent Resp Disease
      • Infection, trauma, even just intubation
    • Cardiomegaly
    • Cushing’s Disease
26
Q

What breeds commonly suffer from tracheal collapse?

A
  • Toy/Miniature breeds
    • Yorkies, Pomeranians, Chihuahuas, Mini Poodles
27
Q

What are the signs of Tracheal Collapse? PE findings?

A
  • Paroxysmal Cough
    • Easily elicited, dry, nonproductive, goose honk
    • Triggered by stress, excitement, exercise
    • May have hypoxic collapse episodes
  • Exam:
    • Can induce cough on palpation
      • Can hear turbulence when auscult trachea
    • Otherwise can have unremarkable exam
28
Q

How is Tracheal Collapse diagnosed?

A
  • Radiographs
    • during different phases of respiration
    • Often radiographs don’t show collapse but make other differentials less likely
  • Fluoroscopy
    • Dynamic, real time
  • Endoscopy
    • Gold standard for visualization, not done routinely due to safety
  • CBC and Tracheal wash
    • if evidence of pneumonia
    • high anesthetic risk!
  • Chemistry Panel
    • Hepatic dysfunction has bee reported
      • true etiology unknown
      • not typically clinically relevant
    • Hepatomegaly is common - consider concurrent disease
29
Q

What is the medical management for an acute crisis with Tracheal Collapse?

A
  • Oxygen
  • Sedation
    • Acepromazine - 0.01 - 0.02 mg/kg, IV, IM, SQ
    • Butorphanol - 0.2 - 0.4 mg/kg IV
  • +/- Anti-inflammatory dose of steroids
    • Dexamethasone 0.05-0.1mg/kg IV, IM, Sq
30
Q

What is the chronic management for Tracheal Collapse?

A
  • No stress, Avoid triggers
  • Weight loss
  • harness, no collar
  • Antitussives: hydrocodone, butorphanol, maropitant
  • Treat underlying disease
    • Brochodialators w/ concurrent lower airway disease
  • Glucocorticoids (not standard)
31
Q

Can a stent be placed for Tracheal Collapse?

A
  • Try medical management first
  • Possible complications
    • stent breaks or moves
    • granulation tissue forms
  • Not a perfect cure
    • many show great improvement
    • Major complications requiring additional stent ~47%
    • still cough (hopefully less0
    • Still need daily meds
32
Q

What is Tracheal Hypoplasia?

A
  • Congenital defect
    • may be hereditary
      • do not breed
  • Part of Brachycephalic Airway Syndrome
    • stenotic nares
    • everted saccules
    • elongated soft palate
33
Q

What are the signs of tracheal hypoplasia?

A
  • Cough
  • Dyspnea
  • Stridor
34
Q

What is the treatment for tracheal hypoplasia?

A
  • no specific medical/surgical therapy
  • Weight management
  • protect from infections
35
Q

What is the prognosis of tracheal hypoplasia cases

A
  • incidental in some
  • Poor in severe cases
  • some improve with maturity
36
Q

What is Ciliary Dyskinesia?

A
  • Congenital defect of cilia
    • Autosomal recessive (most likely)
    • English springers, pointers, setters
  • erratic beating, poor mucociliary clearance
  • Typically present age 6-12 months
37
Q

What are the clinical signs of Ciliary Diskinesia?

A
  • Chronic rhinitis
    • mucopurulent nasal discharge, sneezing
  • Moist productive cough, can be dyspneic
  • Hydrocephalus
  • Otitis media
  • Infertile
  • May have chronic recurrent pneumonia
38
Q

How is Ciliary Dyskinesia diagnosed?

A
  • Radiographs:
    • 50% can have situs inversus
    • Bronchitis, pneumonia
    • Bronchiectasis
    • Can have rhinoliths
  • Tracheal Wash:
    • culture and susceptibility
  • Mucociliary Clearance
    • 99mTc albumin
    • 1 drop at the tracheal bifurcation
    • Watch for clearance (40min)
      • Normal: 7-20mm/minute
      • Dyskinesia: severely impaired or absence
    • Not a perfect test, other resp. disease can slow clearance
      • best used to rule out diskinesia
  • Biopsy nasal or tracheal epithelium
  • In vitro functional analysis
  • Electron microscopy for structural defects
39
Q

Why can checking sperm help diagnose Ciliary Dyskinesia?

A
  • Sperm are poorly motile or nonmotile, dogs may be infertile
  • An easy in-house test
40
Q

What is the Treatment for Ciliary Dyskinesia?

A
  • Manage recurrent infections
  • Encourage coughing (pulmonary therapy)
    • use coupage, nebulization to loosen mucus
  • Provide oxygen when needed
41
Q

What is the prognosis for Ciliary Dyskinesia?

A

variable, but not great for most dogs

Medicine I (43 decks)

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