Unit 2: 9 - Lower Respiratory Flashcards
What is pneumothorax?
Loss of negative pressure in the thoracic space
How should the site for a thoracocentesis be prepped?
Clip, aseptic scrub, sterile gloves
What samples can be taken with a thoracostomy tube placement?
Air/fluid, cytology, PCV/TP, culture
What are 4 surgical approaches to the thoracic cavity?
Lateral thoracotomy, median sternotomy, thoracoscopy, thoracoscopic-assisted
What are 4 considerations for thoracotomy?
- All animals with resp distress require O2 supplementation
- All animals with open chest cavities require IPPV, including diaphragmatic hernias
- High ventilatory pressures should be avoided in patients with chronic collapsed lung lobes, pneumonia - reperfusion injury
- Thoracotomy procesures cause substantial pain, will require adequate post-op analgesia
What are advantages to an intercostal (lateral) thoracotomy?
Good access to dorsal structures and specific structures directly under the intercostal space
What are disadvantages to an intercostal (lateral) thoracotomy?
- Poor access to contralateral hemithorax
- Limited access to ipsilateral structures not directly under the intercostal space
Where are the nerves and vessels of the ribs located?
caudal to each rib
What is the general landmark for an intercostal thoracotomy?
4th to 5th ICS
What are advantages to a median sternotomy?
- Access to entire thoracic cavity
- Can combine with abdominal approach
What are disadvantages to a median sternotomy?
Difficult to access dorsal structures
What are advantages to a thoracoscopy?
- Magnification, illumination
- Visualization of difficult to reach places
- Less pain faster recovery in short term
What are disadvantages to a median sternotomy?
- Technically challenging, needs training
- Specialized equipment needed
What are the 2 approaches to a partial lobectomy and which is preferred?
- Suture method
- Surgical stapler = PREFERRED
When is a pneumonectomy indicated?
For lesions that have extended to all lobes of one side, but spare the contralateral
Animals can survive ___% loss of total lung volume, but die after ___% loss.
50, 75
What pleural effusions can occur?
Chylothorax, hemothorax, pyothorax, neoplastic, transudative
What are the 3 main space-occupying lesions of the thorax that restrict lung expansion?
Fluid, air, cells
What are the 2 more common surgical indications with a pleural effusion?
Chylothorax, pyothorax
What is usually the cause of chylothorax?
idiopathic
What is chyle?
Milky fluid consisting of lymph, emulsified fats, and free fatty acids
What color is chyle?
white/pink
What is the TP of chyle?
>2.5 g/dL
What is the WBC count of chyle?
>5000/uL
NPs and LCs
In chyle, triglycerides in effusion will be _____ than peripheral blood.
higher
In chyle, cholesterol in effusion will be _____ than peripheral blood.
less
What other diagnostics should be done to rule out a chylothorax/the cause for it?
Chest rads, CT, U/S, cardiac workup (echo, ECG)
What are 3 procedures used to surgically correct a chylothorax?
- Thoracic duct ligation (TDL)
- Pericardectomy (subtotal/partial)
- Cisterna chyli ablation (CCA)
What is the TP of pyothorax effusion?
>3.0 g/dL
What is the cell count for pyothorax?
>3000/uL
What is commonly found in cytology for pyothorax?
Gram+, acid fast, filamentous rods:
Nocardia, Actinomyces
Medical management of pyothorax needs _____ treatment.
aggressive
What is the gold standard for pyothorax treatment?
Surgery
What is the short-term vs. long-term survival of dogs with pyothorax?
Short = 92%
Long = 70%
What should always be performed following high impact trauma?
Thoracic rads
What type of pneumothorax is life threatening?
Tension pneumothorax = air enters pleural space during inspiration and is unable to escape during expiration
What is the etiology for spontaneous pneumothorax?
Pumonary blebs/bullae rupture
What breed gets spontaneous pneumothorax?
Siberian Huskies
What can spontaneous pneumothorax lead to?
Bullous emphysema
Which are more common, pulmonary blebs or bullae?
blebs
What treatment is recommended for spontaneous pneumothorax?
Surgery
What are 3 pleural and mediastinal masses that can occur?
- Mesothelioma
- Thymoma
- Thymic branchial cysts and mediastinal cysts
Lung lobe torsion is rotation of the lung along the _____ axis.
long
What does lung lobe torsion lead to?
Twisting of bronchus and pulm vessels at hilus –> congestion, edema, pleural effusion
What is the treatment for lung lobe torsion?
Lung lobectomy - NOT de-rotation
What type of neoplasia is common in the lungs?
Metastatic
What is the main primary tumor seen in the lung?
Carcinoma (97%)
What is the treatment for primary lung neoplasia?
Lung lobectomy - complete or partial
What is a patent ductus arteriosus?
Failure of ductus arteriosus to close following birth (PA –> aorta)
What is the direction blood is shunted in a PDA?
Left to right
What are 3 treatments for PDA?
- Left 4th thoracotomy
- Percutaneous coil embolization
- Amplatz ductal occluder
What does pericardial effusion lead to?
cardiac tamponade
What are 3 causes of pericardial effusion?
Transudative, exudative, sanguinous
What is the most common vascular ring anomaly?
Persistent right aortic arch with left ligamentum arteriosum
What is the CS for a PRAA?
Frequent regurgitation, poor BCS after weaning
Dilation of the esophagus occurs ____ to ring in a PRAA.
cranial