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Year 4 - Small Animal > Week 1 - Coughing > Flashcards

Week 1 - Coughing Flashcards

1
Q

What are the principle presenting signs of respiratory tract disease?

A

Changes in rate or character of respiration – dyspnoea, tachypnoea, hyperpnoea, orthopnoea

Coughing

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2
Q

What are the other clinical signs

A

Sneezing/nasal discharge Respiratory noise
Cyanosis

Others
- Weight loss
- Collapse/syncope
- Changes in “voice” - laryngeal lesion
- Exercise intolerance
- Facial deformity

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3
Q

What is it important to do when owners say their dog is coughing?

A

Make sure it is a cough (and not a sneeze, retch) -> ask for a video

Cough
- Closed larynx = build up air/pressure
- Open larynx = expel air

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4
Q

In dogs, what differentials are on the list for an acute cough?

A

Hight: Tracheobronchitis - “kennel cough”

Irritation by smoke/dust/chemicals/medicines! Airway FB
Pulmonary haemorrhage
Acute pneumonia, e.g. inhalation Acute oedema (cardiogenic/non/cardiogenic) Airway trauma - choke chains/bites etc.

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5
Q

For an acute cough in the dog, which differential present often with dyspnea as well as cough?

A

Pulmonary haemorrhage
Acute pneumonia, e.g. inhalation Acute oedema

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6
Q

What causes infectious tracheobronchitis - “kennel cough”?

A

Canine parainfluenzavirus
Canine adenovirus (2)
Bordetella bronchiseptica

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7
Q

Which causes of tracheobronchitis are covered in the intranasal and injectable vaccines?

A

Intranasal:
Bordetella bronchiseptica

Injection:
Canine adenovirus (2)
Bordetella bronchiseptica

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8
Q

What is the treatment for tracheobronchitis?

A

Spontaneous recovery in 7-10 days.

Animals often clinically well with just a cough.

Systemic antibacterial agents often dispensed when animal is:
* pyrexic
* systemically ill
* Muco-purulent nasal discharge

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9
Q

What does Bordetella bronchiseptica cause along with a cough, and how can it be treated?

A

Causes: URT/nasal infection – bronchopneumonia

Can be fatal

Common in puppies (and groups)

Treatment: Clavulanate-ptd amoxicillin

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10
Q

When should antitussives be used?

A

Don’t use cough suppressants unless absolutely necessary

COUGH IS PROTECTIVE (REMOVE FB, MUCOUS, FLUID)

Antitussives in a non-productive pathological cough (e.g. neoplasia)

Butorphanol/codeine can be used to calm patient down -> and that can help calm the cough

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11
Q

In dogs, what differentials are on the list for an chronic cough?

A

HIGH:
Chronic bronchitis/bronchiectasis
Airway F.B.
Bronchopneumonia *

L. heart failure – heart failure * Parasite (Oslerus /Aelurostrongylus infestation)
Tracheal collapse – “URT”
Pulmonary neoplasia (primary or secondary – neoplasia)
Extra-luminal mass lesions (thyroid, abscess, lymphoma)
Eosinophilic disease

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12
Q

How is canine chronic bronchitis characterised?

A

MAIN POINT = thickening of bronchial tissue, overproduction of
airway mucus and narrowing of the airways (particularly terminal bronchi)

  • Daily coughing for over 2 months
  • Neutrophilic/eosinophilic infiltration
  • Thickening of smooth muscle -> fibrosis -> scarring
  • increased goblet and glandular cell size and number =increased thick mucous production
  • Loss of ciliated cells = decrease clearance of mucus and debris
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13
Q

What are some complication so canine chronic bronchitis?

A

dilation of airways, airway collapse due to wall weakness (bronchomalacia)

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14
Q

What can cause canine chronic bronchitis?

A

Usually cause unknown.

Not often a primary cause.

Maybe seen secondary to underlying conditions
- Tracheal collapse, chronic barking - - FB
- Previous infections or inhalant toxins
- Environmental factors
- Chronic smoke inhalation/noxious gas

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15
Q

What are typical presentation of canine chronic bronchitis on clinical exam?

A

Often very little to find on exam

  • Typically seen in small / toy breeds (but can be any breed)
  • Worse on excitement
  • Harsh cough with attempts at production (clear/frothy, yellow suggests infection)
  • Externally well
  • Obese
  • Occasionally pant excessively
  • Tracheal pinch positive
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16
Q

How is canine chronic bronchitis diagnosed?

A

Typical history, physical findings

Often exaggerated sinus arrhythmia

Thoracic Radiographs
* Increased bronchial lung pattern *

Bronchoscopy and BAL

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17
Q

This is a dog with Canine chronic bronchitis - what lung patterns are visible?

A

Bronchiole = tramlines

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18
Q

This is a dog with Canine chronic bronchitis - what lung patterns are visible?

A

Bronchiole = donuts

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19
Q

This is a dog with Canine chronic bronchitis - what lung patterns are visible?

A

Bronchiole = donuts

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20
Q

This is a dog with Canine chronic bronchitis - what is visible on its bronchoscope?

A

Increased mucous production

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21
Q

When doing a BAL on a dog with canine chronic bronchitis, what is found?

A

Increased mucus

Non-degenerate neutrophils (non-toxic), eosinophils and macrophages

Cushmann’s spirals (airway mucus casts)

Uncommon: Presence of bacteria / particulate matter -> this would suggest another underlying cause.

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22
Q

What has happened to this dog with canine chronic bronchitis?

A

Chronic (permanent) change in the airway walls

Increased numbers of goblet cells (mucous metaplasia),

Ciliary loss affecting the epithelium of the airways which is now overlain by stratified squamous epithelium (squamous metaplasia).

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23
Q

What is the general management for a dog with canine chronic bronchitis?

A

General management:
* Weight control
* Harness rather than collar / lead
* Avoid irritants / smoking environment
* Coupage (tap chest to break down mucous)

Mucous is easier to shift if hydrated
* Avoid very dry environments
* Steam in the bathroo

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24
Q

What is the medical management for a dog with canine chronic bronchitis?

A

Glucocorticoids (oral or inhaled)
- Inhaled = reduces systemic side effects

Bronchodilators (efficacy ???)

Antimicrobials based on evidence

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25
Q

What is the problem when doing a bacterial culture on the respiratory tract?

A

URT and large airways are not sterile
* have commensal bacteria
* Numbers are increased in dogs with reduced clearance

LOOK FOR: Evidence of infection
* Intra-cellular bacteria
* Growth from BAL fluid
* Neutrophilic inflammation on cytology

BAL only often performed if antibiotic therapy has not resolved clinical signs.

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26
Q

List some treatment for lower airway disease (dogs and cats)?

A

Inhaled medications
- Corticosteroids
- Bronchodilators
- Nebulisers

Oral therapy
- Anti-inflammatories (Corticosteroids, NSAIDs, anti-leukotrienes)
- Bronchodilators (terbutaline, Theophylline)
- Antibiotics
- Anthelminthics
- Mucolytics (N-acetyl cysteine (NAC)

27
Q

How can inhaled medications be delivered?

A

Mask
Spacing device/chamber
Metered dose inhaler (MDI)

28
Q

What is the value of inhaled medications?

A

Management of chronic airway disease

Minimal absorption into systemic
circulation = less side effects

Lower doses required

Effective in acute situation.

Faster onset of action

29
Q

What drugs can be delivered by inhalation?

A

Beta 2 agonist
* Salbutamol (albuterol in USA)
*Salmeterol – longer acting medication

Corticosteroids
*Fluticasone
*Beclomethasone

30
Q

What are disadvantages of inhaled medications?

A

Expensive
Time consuming
Owner compliance
Patient compliance

31
Q

Do chronic bronchitis’s often have a bacterial cause?

A

No

Bacteria often present as a result of secondary infection.
- Antibiotics when indication but C&S or intracellular bacteria seen.

32
Q

What is the prognosis for dogs with canine chronic bronchitis?

A

Long term control possible

No cure = dog will always cough

Major goal is to prevent long term sequelae:
- Secondary pneumonia
- Bronchiectasis/bronchomalacia
- Emphysema

33
Q

What is feline bronchial disease

A

Feline asthma, feline allergic airway disease

Type I hypersensitivity condition to inhaled allergens

Suspected genetic predisposition e.g. siamese

Underlying factors
- Smoke, feathers, aerosol inhalation, dust, cat litters
- Seasonality

34
Q

Is feline airway disease progressive?

A

Yes

Acute asthma -> chronic bronchitis

35
Q

What is bacterial bronchopneumonia and what causes it?

A

RARE - Primary infections in healthy dogs (and cats)

If present should = search for underlying cause

Primary infections most common with primary pathogens
- Bordetella bronchiseptica, Streptococcus equi subspecies
zooepidemicus, Mycobacteria

Common pathogens
- E Coli, Klebsiella, Pasteurella,
staphs (coag +ve), streps, mycoplasma and B bronchiseptica.

Primary infections most common with primary pathogens
- Bordetella bronchiseptica, Streptococcus equi subspecies
zooepidemicus, Mycobacteria

36
Q

What are the clinical signs of Streptococcus equi subspecies
zooepidemicus?

A

CAUSES: bronchopneumonia

Highly contagious sudden onset

Pyrexia, dyspnoea, haemorrhagic nasal discharge and
haemoptysis

Causes a severe fibrino-suppurative necrotising haemorrhagic pneumoni

37
Q

What are some predisposing factors for bronchopneumonia?

A

Debilitation
Prolonged recumbency
Systemic immunosuppression
Immunodeficiency states (weimaraners, CKCS)
Defective respiratory defenses
Damaged respiratory epithelium
Aspiration
Airway obstruction
Systemic sepsis
Bronchiectasis

38
Q

What are clinical signs of bronchopneumonia?

A
  • minor clinical signs (occasionally)
  • signs alter with severity
  • cough
  • respiratory distress
  • ex intolerance
  • severe infections = hyperthermia
  • anorexia and lethargy
  • increased or decreased lung sounds (crackles)
  • severe = cyanosis
39
Q

What type of lung pattern is seen with bronchopneumonia?

A

Alveolar = bronchograms present

Alveoli filled with fluid/puss ect and give a soft tissue appearance

Air still visible in bronchioles

40
Q

How is bronchopneumonia diagnosed?

A

Radiograph
- Alveolar pattern with variable distension
- Early disease could just so interstitial pattern

Airway s
* TTW/BAL
* Culture and cytology on fluid
* Integration of inflammation and bacterial culture

41
Q

What are treatment options for bronchopneumonia?

A

Antibiotics – broad spectrum? Supplemental humidified oxygen
IVFT
Anti-inflammatories
Bronchodilators
Mucolytics
Physiotherapy (movement!)
Nebulisation
Surger

42
Q

What is the presentation for bronchial foreign bodies?

A

Sudden onset - coughing and gagging

Working dogs or those living
in rural environments.

Occurred after exercising in a field

Good initial response to antibiotics -> but worsen when course finished.

Halitosis

Weightloss

43
Q

What is the best diagnostic method for bronchial foreign bodies?

A

Bronchoscopy
- BAL and culture for specific antibiotic therapy
- Enables visualisation and retrieval of object

Radiograph mainly shows location (R lung lobe is more common to find FB as a more direct path.

44
Q

Would a dog cough with primary or secondary neoplasia?

A

Primary neoplasia = mass in the airway

Secondary neoplasia = dyspnea = mass in intersitium

45
Q

Is this primary or secondary neoplasia?

A

Primary - mass
No interstitial nodules

46
Q

Is this primary or secondary neoplasia?

A

Primary - mass
No interstitial nodules

47
Q

Is this primary or secondary neoplasia?

A

Secondary - Interstitial nodules

48
Q

Is this primary or secondary neoplasia?

A

Secondary - Interstitial nodules

49
Q

What is more common, primary or secondary neoplasia?

A

Secondary neoplasia - metastatic disease common:
- Oral melanoma
- Thyroid carcinoma
- Osteosarcoma
- Haemangiosarcoma
- Mammary carcinoma

Primary lung tumours are very rare!

50
Q

When is ultrasound the best imaging modality?

A

In acute respiratory stress when differentiating between pleural space and lung disease

51
Q

When is bronchoscopy the best imaging modality?

A

Foreign body
Structural airway disease (e.g tracheal collapse)

52
Q

What are some characteristic of primary lung cancer?

A
  • Median age 11
  • Carcinoma (common)
  • Pulmonary lymphoma
  • Solitary neoplastic mass
  • Often in right caudal lobe

Clinical signs
- Non-productive cough
- Exercise intolerance

53
Q

What is the prognosis for primary lung cancer?

A

Depends on size, location (resectability) and spread

Chemotherapy NOT very effective

Best case scenario 50% alive at 1 year

54
Q

What is the diagnostic method for diagnosing neoplasia?

A

Transthoracic FNA
- When mass is against body wall
- Ultrasound guidance in patients with discrete lesions
- Can also use fluoroscopic or CT guidance
- Lesions >1cm

BAL rarely useful for neoplasia

55
Q

What are some contraindications for transthoracic FNA?

A
  • Pulmonary bullae or cysts
  • Coagulopathies
  • Pulmonary hypertension
  • Pre-existing pneumothorax
  • Suspected infectious process
56
Q

What are some complication that could occur from transthoracic FNA?

A

Pneumothorax
Empyema (a collection of pus in the pleural cavity)
Bleeding
Implantation
Seeding of neoplasia

57
Q

Name some primary cardiorespiratory parasites from the metastringylodea family for dogs and cats

A

DOG:
Oslerus osleri (Filaroides osleri)
Filaroides spp.
Crenosoma vulpis Angiostrongylus vasorum

CAT:
Aelustrongylus abstrusus

58
Q

Are parasites a common cause of respiratory disease?

A

Less common due to worming protocols

59
Q

What lung patterns do Angiostrongylus vasorum make?

A

Can present with all four:
Alveolar
Bronchiole
Vascular
Intersitium

60
Q

What are the clinical signs of Oslerus osleri?

A

RARE

Clinical signs:
- Chronic cough
- Dry, rasping cough after exercise
- Young dogs 6-12 months

Pre-patent period = 10-18 weeks * Nodules = appear around 2
months from infection

Immune response to adults in trachea and bronchus causes the
worm to encapsulates

61
Q

What is the best method to diagnose Oslerus osleri?

A

BRONCHOSCOPY - nodules (1-1.5cm) can be seen at the tracheal bifurcation;

L1 in faeces or BAL fluid (+ eosinophils)

Faecal L1 counts less reliable – variable shedding

62
Q

How is Oslerus osleri treated?

A

Fenbendazol

Can be hard to treat, nodules remain, may even calcify
and cough persists

Check in contact animals

63
Q

How do Filaroides spp. and Crenosoma vulpis present and how are they treated?

A

Filaroides spp.
- Few clinical signs
- Diagnosis on PM
- Interstitial pattern
- Treat as Oslerus osleri (fenbendazole)

Crenosoma vulpis
- lifecycle: indirect - slugs and snails
- cause bronchitis
- no nodules
- investigate and treat as Oslerus osleri (fenbendazole)

Year 4 - Small Animal (15 decks)

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