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Year 4 - Small Animal > Week 1 - Lung and Airway Diagnostics > Flashcards

Week 1 - Lung and Airway Diagnostics Flashcards

1
Q

What diagnostic tests are available in a coughing dog?

Rank them as that diagnoses the most things to the least things.

A
  1. Imaging (CT/Radiography)
  2. Endoscopy
  3. Bronchoalveolar lavage (BAL)
  4. Trans-tracheal wash (TTW)
  5. Haematology/Biochemistry
  6. Faecal (parasites only)
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2
Q

What are the indications for a tracheal wash?

A

Main indication - suspect a large airway disease (tracheobronchial tree up to the level of segmental bronchi).

Can also provide information about small airways (bronchioles and acartilagenous airways).

Cough reflex retained.

Patients that cannot be anaesthetised (too compromised to be induced for a BAL) as can be carried out on a conscious patient.

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3
Q

What is the difference between a trans-tracheal wash (TTW) and a endotracheal wash (ETW)?

A

TTW = smaller patients than a tube can be passed through a sterile endotracheal tube.

ETW = Needle needs to be passed directly into the trachea.

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4
Q

Which test is more sensitive, tracheal wash or bronchoalveolar lavage?

A

Bronchoalveolar lavage

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5
Q

As a tracheal wash can be done on a conscious patient, how is the area prepared?

A
  • Clip and surgically prep the area
  • Inject local over the site between tracheal rings
  • Nick skin with scalpel to facilitate passage of catheter
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6
Q

What are the indications for a bronchoscopy?

A

Investigate unexplained clinical signs.

To obtain diagnostic samples.

Evaluate radiographic lung lesions.

Assessment of airways.

Treatment of airway disease.

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7
Q

What are the benefits of bronchoscopy?

A

Relatively safe procedure
Diagnostic for a number of conditions.
Allows collection of samples.
Allow removal of foreign material

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8
Q

What are the contraindications for a bronchoscopy?

A

Take care with hyper-responsive airways:
- Cats with allergic bronchial disease
- Dogs with wheezing suggesting airway spasm

Unstable cardiac failure/arrhythmias

Tracheal obstructions

Haemorrhage…increased risk with:
- Pulmonary hypertension
- Uraemia
- Coagulopathies
- Neoplasia/gross lesions

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9
Q

How is bronchoscopy performed?

A
  1. Sterile
  2. Under GA to prevent scope damage (scope type: video better than fibreoptic). Note airway vs scope diameter is important
  3. Sternal recumbancy
  4. Elevate head so note is parallel to the table
  5. Lubricate scope as necessary (sterile lube required).
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10
Q

What equipment is needed for bronchoscopy?

A
  • Sterile large ET tube
  • Y connector/T connector
  • Adapter self sealing port
  • Sterile lube
  • Urinary catheter
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11
Q

Can an ET tube be always used for bronchoscopy?

A

No - small cats and dogs cannot use an ET tube as they are too small to pass the endoscope down.

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12
Q

How are the patients monitored?

A

With pulse oximetry/end tidal capnography

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13
Q

How is the endoscope passed down in bronchoscopy?

A

Directly through the larynx - TAKE EXTREME CARE!

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14
Q

What equipment is used for pre-oxygenation and for how long in bronchoscopy?

A

Urinary catheter is used to delivery oxygen.

Pre-oxygenation 30-45 seconds

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15
Q

What is the order of the structures assessed in bronchoscopy?

A

Larynx, pharynx, trachea

Right principle bronchus
- Right cranial lung lobe
- Right middle lung lobe
- Right accessory lung lobe
- Right caudal lung lobe

Left principle bronchus
- Left cranial lung lobe (2 branches, cranial and caudal)
- Left caudal lung lobe

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16
Q

When passing the scope down the trachea, what structures are noted?

A
  • Tracheal ring should be easily seen.
  • Narrow, taut, dorsal tracheal membrane
  • Carina (cartilage where the trachea divides into the two bronchi)
  • Brochi entrances
17
Q

What should the bronchi entrances look like on bronchoscopy?

A

Brochi entrances should be round, crisp, defined edges and should remain open with respiration.

18
Q

What are you looking for when conduction bronchoscopy?

A

Abnormalities in size, shape, colour of airways

Dynamic diameter changes

Presence/absence of abnormal secretions

19
Q

How are the samples collected in bronchoscopy?

A

Saline lavage - Bronchoalveolar lavage (BAL)

Surface brushing (cytology brush)

Biopsies

20
Q

What are the samples submitted for in bronchoscopy?

A

Cultural - bacterial/mycoplasma/fungal

Viral isolation

PCR for infectious organisms (mycoplasma)

Cytology

21
Q

What are the indications for a bronchoalveolar lavage (BAL)?

A

For lobar or diffuse lower airway disease.

Interstitial lung disease

22
Q

What equipment is needed for bronchoalveolar lavage (BAL)?

A
  • 0.9% sterile solution
  • Bacterial swabs
  • Sterile plain tubes
  • EDTA tubes
  • BAL catheter
  • Urinary catheter (deliver oxygen)
  • Continuous suction device
  • Syringes
  • Formulin
  • An assistent!
23
Q

What equipment is used for pre-oxygenation and for how long in bronchoalveolar lavage (BAL)?

A

Pre-oxygenate with a urinary catheter.

2 minutes in compromised patients.

24
Q

What is the technique for bronchoalveolar lavage (BAL)?

A
  1. Lodge endoscope in small airway (bronchioles and acartilagenous airways).
  2. Install sterile water via a catheter
    - Medium to large dogs = 25ml per lobe (2 lobes washed)
    - small dogs and cat = 10ml bolus up to 4 sites.
  3. Immediate suction after fluid installed.
    - Too much suction can collapse airway
    - 100 to 170 mmHg pressure
  4. Lavage several lobes (foam should sit on top of sample -> due to surfactant in fluid)
25
Q

What is non-bronchoscopic bronchoalveolar lavage (BAL)?

A

Lavage conducted without the guidance of an endoscope - “Blind BAL”

7/9 patients, the lavage takes place in the right caudal lung lobe as this is the most direct passage (there is more of an angle needed for left and this cannot be visualised).

26
Q

How do you place the tube in non-bronchoscopic bronchoalveolar lavage (BAL)?

A
  • Pre-oxyegenate
  • Animal in dorsal recumbency
  • Use urinary catheter or feeding tube
  • Pass tube as far down until resistance is felt.
27
Q

How much saline is administered non-bronchoscopic bronchoalveolar lavage (BAL) and what are does it sample?

A

Dogs = 20-25ml saline and 5ml air

4kg Cats = 20ml per boys in 2 to 3 sites.

Instil saline and immediately aspirate

Likely collect material form large airways (maybe small airways and alveoli).

Can place the dog with the lung of interest on the recumbent side to help with tube placement.

28
Q

How are patients managed post-BAL?

A

100% oxygen for 5-10 minutes.

Gental positive pressure ventilation.

Normal to osculate crackles for up to 24 hrs post BAL.

29
Q

What should be considered if a stable patient does not return to ebbing stable post-BAL?

A

Obstruction of ET tube

Bronchospasm (bronchodilator?)

Pneumothorax

30
Q
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31
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32
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Year 4 - Small Animal (20 decks)

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