Test 44 pleura space disease

Question 1

pathophysiology of pleural effusion

Answer 1

Air or fluid in the pleural space cause the
parietal and visceral pleura to separate
Lungs collapse
Chest wall expands

leads to hypoventilation and VQ mismatch

Question 2

rapid shallow breathing from pleural disease is due to

Answer 2

decreased tidal volume
decreased functional reserve capacity
decreased compliance

Question 3

clinical signs of pleural effusion

Answer 3

Sternal, sitting
Head and neck extended
Elbows abducted

• Cough, pain with inflammatory effusions
• Muffled heart sounds
• Breath sounds absent ventrally with effusions?

Question 4

diagnosis of pleural effusion

Answer 4

xray
ultrasound
chest tap- fluid analysis

Question 5

where to tap?

Answer 5

not the heart- use ultrasound to confirm if needed

Question 6

when to place chest tube

Answer 6

when you will need repeated or continuous aspiration

Question 7

blood vessels on ribs are on what side

Answer 7

caudal border

Question 8

how to place chest tube

Answer 8

make incision into pleura
place tube
make skin incision farther away use forceps to pull tube through

• makes tunnel to prevent air coming in ot out and keep tube in place

Question 9

what can cause pneumothorax

Answer 9

penetrating wounds- dog bite
pulmonary trauma
esophageal rupture (rare)
rupture of pulmonary bleb or bullae

Question 10

how can pt survive even with massive pneumothorax

Answer 10

pulmonary capillaries can sense O2 in aveoli- if too low will constrict and direct blood elsewhere

hypoxic pulmonary vasoconstriction

Question 11

diagnosis of pleural effusion

Answer 11

chest tap- analysis of fluid
evaluation of cardiac function
investigation of lungs, mediastinum, diaphragm
Investigation of other diseases

• Pancreatitis
• Protein losing nephropathy, enteropathy

Question 12

when to not chest tap

Answer 12

hypercoaguable- rat posion

Question 13

transudates

Answer 13

low total protein
cells < 1500

Usually the result of changes in hydrostatic pressure
Heart disease
Decreased production of albumin (liver) or increased loss (kidney, GI)

Question 14

modified transudates

Answer 14

1500-5000 cells/microL
total protein= 3 g/dL

caused by nearly any disease causing long standing effusion

Ddx: Myocardial failure, pericardial effusions, neoplasia, diaphragmatic hernia, lung lobe torsion, pancreatitis

Question 15

exudates

Answer 15

high cell count > 5000
protein > 3
high nucleated cell counts

Non-septic: FIP, chylothorax, neoplasia, fungal, foreign body
Septic: Wound, esophageal perforation, necrotic tumor, pulmonary abscess

Question 16

what causes chylothorax

Answer 16

Accumulation of chyle in the pleural space

dont know what causes it
Dilation ( “Lymphangectasia”) and leakage from thoracic duct system

• physical obstruction- cancer, thrombosis, heartworm
• ↑ cranial vena caval pressure: CHF, pericardial disease
• idiopathic

Question 17

how to diagnosis chylothorax

Answer 17

Pleural fluid : Serum triglyceride ratio > 1
Pleural fluid triglyceride levels >100mg/dl

Interpret with caution in animals that have not eaten for several days

Question 18

how to treat chylothorax

Answer 18

pleural drainage

surgical: thoracic duct ligation, thoracic duct embolization

Question 19

pyothorax can be caused by

Answer 19

Penetrating wounds
Esophageal perforations
Migrating foreign bodies
Extension from pneumonia
Pulmonary abscessation
Neoplasia
Hematogenous spread

Question 20

what kind of bacteria cause pyothorax

Answer 20

anaerobic and aerobes

Question 21

treatment of pyothorax

Answer 21

drain- chest tube
supplemental fluids
antibiotics

Question 22

when to do surgery for pyothrorax

Answer 22

when they dont respond to medical therapy

if there is obvious lesion (abscess or foreign body)