Clin Med- Intro to Respiratory 2

untimely's version from 2015-05-15 02:53

Lower Respiratory Diseases

Question Answer
Lower Respiratory Diseases include which structures?from the trachea down (trachea, bronchi, bronchioles, alveoli, interstitium, vasculature, pleural space)
**what is the MOST COMMON CLINICAL SIGN OF LOWER RESP DZ? (what are some other signs?)COUGH!!!!! (other signs seen might be: Respiratory distress, Exercise intolerance, Weakness, Cyanosis, Syncope, Fever, Anorexia, Weight loss, and depression)
in what way is the cough generally protective?Expel material (it is an explosive release), Inflammation, and can be triggered by Compression
what are the two categories you can describe a cough as?productive vs unproductive
what's hemoptysis?coughing of blood. MIGHT happen in lower resp dz
what's one way you can check for tracheal dz/ see if there has been a problem with coughing even if they aren't coughing in the vet office?you can see if there is a problem if there is an INDUCIBLE cough- that is to say, with light compression of trachea-- run fingers up and down it-- you will get a cough response.
what does it mean if the dog has a Goose honk cough? what should you tell the owner to do?means there is Tracheal collapse-- use a harness instead of a neck collar
what does it mean if the animal has a Harsh and paroxysmal cough (violent cough attack)?probably Bronchitis
what does it mean if the animal has a soft cough?might be Pneumonia or pulmonary edema
what are 2 reasons you can have a PRODUCTIVE cough with edema fluid?CHF, Non-cardiogenic pulmonary edema
8 reasons you can have a PRODUCTIVE cough with mucus or exudate?Canine Infectious tracheobronchitis, Canine chronic bronchitis, Idiopathic feline bronchitis, Allergic bronchitis, Bacterial bronchitis or pneumonia, Parasitic infection, Aspiration pneumonia, fungal pneumonia
what are the two major reasons an animal would have Hemoptysis (a productive couhg of blood)? (some other reasons?)MAJOR reasons: Heartworm*, Pulmonary neoplasia*. (could also be: Fungal, Foreign bodies, Severe CHF, TBE, Torsions, Bleeding disorders, DIC)
Kennel cough affects which structures?aka Canine Infectious trachea and bronchi
Bacterial and Mycoplasmal infections can affect what structures?trachea and bronchi
Oslerus osleri-->what is this? what does it do?it's a parasite, you will see eggs in the trachea/bronchi (usually right at the carina)
Bronchial compression can happen in what three situations?Left atrial enlargement, Hilar Lymphadenopathy, neoplasia
Aspiration pneumonia affects the pulmonary parenchyma--> WHERE specifically do you see it the most?R MIDDLE LUNG LOBE is the poster child for aspiration penumonia. its the -2-nd branch of R main stem bronchus, but first one on bottom of the tube so thats the one shit goes down (gravity works)
what does a bronchiolar pattern on rads look like? if bronchioles get enlarged, thats tramlines and doughnuts
how can a bronchiole pattern turn into an alveolar pattern, when alveoli are impremeabile to water? alveoli is impermeabile to water (cnt diffuse into it) but bronchus is--so once gets to level of bronchiole, then it comes in bronchiole and spills into alveoli
Infectious Parenchymal Diseases--> 4 VIRAL causes?Canine influenza, Canine distemper, Calicivirus, FIP
Infectious Parenchymal Diseases--> 3 FUNGAL causes?Blastomycosis, Histoplasmosis, Coccidioidomycosis
Infectious Parenchymal Diseases--> 5 PARASITIC causes?Heartworm, Paragonimus (flatworm), Aelurostrongylus (nematode), Capillaria (nematode), Crenosoma (nematode lungworm)
Infectious Parenchymal Diseases--> bacterial causes?basically ANY bacteria, can be mycoplasma too
which protozoa can lead to infectious paranchymal dz?toxoplasmosis
for diagnostics of lower resp dz, what should you be looking at in the first "observation" stage?look at resting rate, effort, pattern (inspiratory, expiratory, if there is an abdominal component)
how can a pneumonia affect the CBC? how often?50% of the time there will be a neutrophilia and left shift. This, of course, means 50% of the time there wont be!!
what two things can you use to test how well the lower resp tract is functioning?Pulse Oximetry/SpO2, or ABG (arterial blood gas)
7 things you can pick up on SEROLOGY which might explain the lower resp dz?Heartworm, Histoplasmosis, Blastomycosis (can also pick this up on urine Ag), Coccidioidomycosis, Toxoplasmosis, Feline coronavirus (+/- PCR), Canine Influenza
you can do a FECAL FOR LOWER RESP PROBS!!!! what three types of fecal exams can you do?Floatation, Baermann (for lungworm larvae), Sedimentation
why might you use Echocardiography for lower resp dz?Pulmonary hypertension
what does the SPO2and Oxygen Hemoglobin Dissociation Curve tell you?plots PO2 (partial pressure of O2) against SO2 (saturation of O2 in Hg) and shifting to the left means there Hb has a higher affinity for O2, and a shift to the right means there is lower affinity
Arterial Blood Gas lets you measure what? what can you calc? which tells you about what?measure PaO2, PaCO2, HCO3, and pH. From this you can calculate the A-a gradient, and this tells you about the possible V/Q mismatch (ventilation/perfusion)
what's a caution you should know about imaging for dyspnea or cough?any cause of these may show up normal on rads, esp in early stages.
what are 4 things which can cause dyspnea, which you can pick up on a radiograph?PTE (pulmonary thromboembolism), Acute aspiration, hemorrhage, and foreign bodies
what are 6 things which can cause cough, which you can pick up on a radiograph?Canine infectious tracheobronchitis, Canine chronic bronchitis, Collapsing trachea, Feline bronchitis, acute FB, +/-GERD (gastroesopheal reflux dz)
Canine chronic bronchitis will cause what pattern on rads?bronchial pattern
Feline bronchitis/asthma will cause what pattern on rads?bronchial pattern
Allergic bronchitis will cause what pattern on rads?bronchial pattern
Canine infectious tracheobronchitis will cause what pattern on rads?bronchial pattern
Bacterial and mycoplama infection will cause what pattern on rads?bronchial pattern (Bact, Bronchial)
Parasites will cause what pattern on rads?bronchial pattern (P is a upside down b...sort of) or inerstitial
Infections can cause what patter on rads? (what kinda infections?)Interstitial Patterns! basically any infection-- Viral, Bacterial, Toxoplasmosis, Mycotic, Parasitic
neoplasia will cause what pattern on rads?interstitial
Eosinophilic Lung Disease will cause what pattern on rads?interstitial
Idiopathic pulmonary fibrosis will cause what pattern on rads?interstitial
Hemorrhage will cause what pattern on rads?interstitial or alveolar
what are two types of interstitial patters you can see on rads?Reticular (net like) or Nodular/Miliary
alveolar pattern looks like what?black trees in a snowstorm-- AKA AIR-BRONCHOGRAM (air is visible in and highlighing bronchus)
what three things can cause an alveolar pattern on rads?Pulmonary Edema, Severe Inflammatory Disease, Hemorrhage
Severe Inflammatory Disease can be caused by what two things? how will it look on rads?show up as Alveolar Pattern, can be caused by Bacterial pneumonia or Aspiraton pneumonia
Pulmonary Edema will cause what kinda pattern on rads?alveolar pattern
Hemorrhage--> what pattern does this cause on rads? what are some reasons you'd see hemorrhage in the lungs?ALVEOLAR pattern, see in Contusions, PTE (pulmonary thromboembolism), Neoplasia (note: neoplasia by itself causes interstitial patterns, but HEMORRHAGE caused by neoplasia causes alveolar pattern), Fungal pneumonia, Coagulopathy/DIC
Computed Tomography/MRI is super good for seeing what kinda things?bullae/blebs (big outpockets of air that go into intersititum of lungs-- they can rupture, and then you have hole in lung open to inside of chest.) and also <3mm masses
Fluoroscopy can diagnose what two things?Dynamic tracheal collapse and correct placement of stents
why might you use angiography?PTE (pulmonary thromboembolism)
**transtracheal/endotracheal wash-- which is for small animals and which is for large animals?TRANStracheal for LARGE ANIMALS (their tracheas are big enough to go across), ENDOtracheal for SMALL ANIMALS (tiny tracheas need an ET tube for you to even get down there)
** explain a Transtracheal washacross trachea, down, shoot in sterile saline, and suck it back up. sterile! for LARGE animals
**explain a endotracheal washwash fluid through ET tube and pull it back up. NOT sterile, for small animals
**which is sterile-- a transtracheal wash or an endotracheal wash?TRANSTRACHEAL bc going in from trachea which is sterile. (endotracheal has to go up and down through whole resp system including mouth-- not sterile)
*explain a Transthoracic aspiration/biopsyyou stick a needle through side of thorax into lungs- she seemed leery about this one
**Bronchoscopy- is this for small or large animals? explain how it works. is it sterile or not?SMALL ANIMAL PROCEDURE! done through bronchoscope! shoot sterile saline into guided area via camera. DIRECTED PULMONARY SAMPLING through BAL (bronchioalveolar lavage) through scope. BAL IS STERILE IF YOU CLEAN SCOPES BEFORE AND AFTER
**what are some things you can do with bronchoscopy?you can do a visual inspection (there is a camera-guided scope), you can do a Bronchoalveolar lavage (lets you do cytology and culture), you can do Bronchial brushing (cells are taken from the inside of the airway mucosa or bronchial lesions), as well as do a Transbronchial biopsy
why would you do a Thoracotomy/scopy?for a bx
If you suspect Pleural Space Disease/Effusions, what should you do?A TAP!!!
what are some things you can do with a pleural effusion tap?Cytology and culture, check for cholesterol (if it's chylous)
***Right sided heart failure will cause what kinda fluid type in the plural space?Pure and modified transudates
***Pericardial disease will cause what kinda fluid type in the plural space?Pure and modified transudates
***Hypoalbuminemia will cause what kinda fluid type in the plural space?Pure and modified transudates
***neoplasia will cause what kinda fluid type in the plural space?pure and modified transudate AND non-septic exudates AND hemorrhagic effusions
***Diaphragmatic hernia will cause what kinda fluid type in the plural space?pure and modified transudate AND non-septic exudates
***FIP will cause what kinda fluid type in the plural space?non-septic exudates
***Lung lobe torsion will cause what kinda fluid type in the plural space?non-septic exudates AND hemorrhagic effusion
***Pyothorax will cause what kinda fluid type in the plural space?septic exudates
*****Brachycephalic Airway Syndrome HAS WHAT THREE COMPONENTS? (what two other things may be present?)(1)Stenotic nares (2) Elongated soft palate (3) Everted laryngeal saccules. There might also be (+/-) hypoplastic trachea, +/-end stage laryngeal collapse
how can you dx BAS ((brachycephalic airway syndrome)?know Breed, Clinical Signs, PE and laryngeal exams, and imaging (Thoracic radiography)