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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
What is the problem when doing a bacterial culture on the respiratory tract?
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.
26
List some treatment for lower airway disease (dogs and cats)?
Inhaled medications - Corticosteroids - Bronchodilators - Nebulisers Oral therapy - Anti-inflammatories (Corticosteroids, NSAIDs, anti-leukotrienes) - Bronchodilators (terbutaline, Theophylline) - Antibiotics - Anthelminthics - Mucolytics (N-acetyl cysteine (NAC)
27
How can inhaled medications be delivered?
Mask Spacing device/chamber Metered dose inhaler (MDI)
28
What is the value of inhaled medications?
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
What drugs can be delivered by inhalation?
Beta 2 agonist * Salbutamol (albuterol in USA) *Salmeterol – longer acting medication Corticosteroids *Fluticasone *Beclomethasone
30
What are disadvantages of inhaled medications?
Expensive Time consuming Owner compliance Patient compliance
31
Do chronic bronchitis's often have a bacterial cause?
No Bacteria often present as a result of secondary infection. - Antibiotics when indication but C&S or intracellular bacteria seen.
32
What is the prognosis for dogs with canine chronic bronchitis?
Long term control possible No cure = dog will always cough Major goal is to prevent long term sequelae: - Secondary pneumonia - Bronchiectasis/bronchomalacia - Emphysema
33
What is feline bronchial disease
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
Is feline airway disease progressive?
Yes Acute asthma -> chronic bronchitis
35
What is bacterial bronchopneumonia and what causes it?
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
What are the clinical signs of Streptococcus equi subspecies zooepidemicus?
CAUSES: bronchopneumonia Highly contagious sudden onset Pyrexia, dyspnoea, haemorrhagic nasal discharge and haemoptysis Causes a severe fibrino-suppurative necrotising haemorrhagic pneumoni
37
What are some predisposing factors for bronchopneumonia?
Debilitation Prolonged recumbency Systemic immunosuppression Immunodeficiency states (weimaraners, CKCS) Defective respiratory defenses Damaged respiratory epithelium Aspiration Airway obstruction Systemic sepsis Bronchiectasis
38
What are clinical signs of bronchopneumonia?
- 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
What type of lung pattern is seen with bronchopneumonia?
Alveolar = bronchograms present Alveoli filled with fluid/puss ect and give a soft tissue appearance Air still visible in bronchioles
40
How is bronchopneumonia diagnosed?
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
What are treatment options for bronchopneumonia?
Antibiotics – broad spectrum? Supplemental humidified oxygen IVFT Anti-inflammatories Bronchodilators Mucolytics Physiotherapy (movement!) Nebulisation Surger
42
What is the presentation for bronchial foreign bodies?
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
What is the best diagnostic method for bronchial foreign bodies?
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
Would a dog cough with primary or secondary neoplasia?
Primary neoplasia = mass in the airway Secondary neoplasia = dyspnea = mass in intersitium
45
Is this primary or secondary neoplasia?
Primary - mass No interstitial nodules
46
Is this primary or secondary neoplasia?
Primary - mass No interstitial nodules
47
Is this primary or secondary neoplasia?
Secondary - Interstitial nodules
48
Is this primary or secondary neoplasia?
Secondary - Interstitial nodules
49
What is more common, primary or secondary neoplasia?
Secondary neoplasia - metastatic disease common: - Oral melanoma - Thyroid carcinoma - Osteosarcoma - Haemangiosarcoma - Mammary carcinoma Primary lung tumours are very rare!
50
When is ultrasound the best imaging modality?
In acute respiratory stress when differentiating between pleural space and lung disease
51
When is bronchoscopy the best imaging modality?
Foreign body Structural airway disease (e.g tracheal collapse)
52
What are some characteristic of primary lung cancer?
- Median age 11 - Carcinoma (common) - Pulmonary lymphoma - Solitary neoplastic mass - Often in right caudal lobe Clinical signs - Non-productive cough - Exercise intolerance
53
What is the prognosis for primary lung cancer?
Depends on size, location (resectability) and spread Chemotherapy NOT very effective Best case scenario 50% alive at 1 year
54
What is the diagnostic method for diagnosing neoplasia?
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
What are some contraindications for transthoracic FNA?
* Pulmonary bullae or cysts * Coagulopathies * Pulmonary hypertension * Pre-existing pneumothorax * Suspected infectious process
56
What are some complication that could occur from transthoracic FNA?
Pneumothorax Empyema (a collection of pus in the pleural cavity) Bleeding Implantation Seeding of neoplasia
57
Name some primary cardiorespiratory parasites from the metastringylodea family for dogs and cats
DOG: Oslerus osleri (Filaroides osleri) Filaroides spp. Crenosoma vulpis Angiostrongylus vasorum CAT: Aelustrongylus abstrusus
58
Are parasites a common cause of respiratory disease?
Less common due to worming protocols
59
What lung patterns do Angiostrongylus vasorum make?
Can present with all four: Alveolar Bronchiole Vascular Intersitium
60
What are the clinical signs of Oslerus osleri?
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
What is the best method to diagnose Oslerus osleri?
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
How is Oslerus osleri treated?
Fenbendazol Can be hard to treat, nodules remain, may even calcify and cough persists Check in contact animals
63
How do Filaroides spp. and Crenosoma vulpis present and how are they treated?
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 (16 decks)

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