Small Ani. Med- Clinical Manifestation of Respiratory Disease 2

drraythe's version from 2016-04-29 14:47

Lower resp dzs-- general

Question Answer
where do you start to consider it "lower" airway dz, anatomically?starting with trachea down
**most common clinical sign of lower resp dz? (what are some others?)**COUGH, also can see Respiratory distress, exercise intolerance, Weakness, Cyanosis, syncope, fever, anorexia, weight loss, depression
what IS a cough? what does it do? how can you categorize the cough? what would you call it if blood was present?Explosive release which is generally protective, acting to Expel material, inflammation, and compression. Can be productive or unproductive. if there is blood= hemoptysis
you should check if a cough is inducible. how do you do this/ poster child for this?pinch it a little, just enough to add some pressure, they should start coughing. poms are prone to this.
what does a "goose honk" cough mean?collapsing trachea
Harsh and paroxysmal (sudden) cough means?bronchitis (this is the smokers cough)
SOFT aka WET cough means what?Pneumonia, Pulmonary edema
PRODUCTIVE cough--> if clear/foamyish material comes up, what do you think the problem might be?usually indicates some sort of edema!!! could be CHF, or Non-cardiogenic pulmonary edema
PRODUCTIVE cough--> if mucus/exudate comes up, what do you think the problem might be?Canine Infectious tracheobronchitis, Canine chronic bronchitis, Idiopathic feline bronchitis, Allergic bronchitis, Bacterial bronchitis or pneumonia, Parasitic infection, Aspiration pneumonia, Fungal pneumonia
PRODUCTIVE cough--> if HEMOPTYSIS, what do you think the problem might be?***Heartworm*, ****Pulmonary neoplasia*, fungal, FB, severe CHF, TBE, Torsions, bleeding disorders, DIC
whats this grossness? This is actually little Oslerus osleri parasites sitting in there
(just to read over) dzs of trachea and bronchi?Canine Infectious tracehobronchitis/kennel cough, Canine Chronic Bronchitis, Collapsing trachea, Feline bronchitis/Asthma, Bacterial and Mycoplasmal infections, Oslerus osleri, neoplasia, Trauma/tracheal tears, Bronchial compression
what are three things that cause Bronchial compression?Left atrial enlargement, Hilar Lymphadenopathy, Neoplasia
(read over) Diseases of Pulmonary Parenchyma?Infectious, Aspiration pneumonia, Eosinophilic Lung Disease, Idiopathic interstitial pneumonias (Idiopathic pulmonary fibrosis) Neoplasia, Contusions, Pulmonary hypertension, PTE, pulmonary edema
chart of infectious parynchymal dzs?
(from chart) viral infectious parenchymal dzs?Canine influenza, canine distemper, calicivirus, FIP
(from chart) fungal infectious parenchymal dzs?blastomycoses, histoplasmosis, Coccidioidomycosis
(from chart) parasitic infectious parenchymal dzs?Heartworm, Paragonimus, Aelurostrongylus, Capillaria, Crenosoma
what is the protozoal dz which causes infectious parenchymal dz?toxoplasmosis
dx of lower resp dz--> what should you try to observe?Resting rate, effort, pattern (Inspiratory effort, Expiratory effort, abdominal component)
So you SWEAR this patient has some nasty pneumonia, but when you run your CBC chem, you don't see any signs of inflammation at ALL. what do you think?50% of pneumonias wont have inflammation markers like an inflammatory leukogram! weird.
2 definitive tests for testing function of lungs?Pulse Oximetry, Arterial Blood Gas
WHERE do you ascult on the chest?ALL FOUR QUADRANTS AND THE TRACHEA!
explain the Oxygen Hemoglobin Dissociation CurveWhen you have inc affinity for O2 to Hgb, it is when there is low temp and low H+ ions-- ie the LUNGS. bc want hgb to pick up oxygen and take it to the body. But once in body, dont want them to stay associated, so, when temp inc and H+ inc, in the body, dec affinity--> release O2 to tissues.
what is "left shift" on Oxygen Hemoglobin Dissociation Curve? Right shift?LEFT SHIFT= INC AFFiniTY. RIGHT SHIFT=DEC AFFINITTY (as go right, partial pressure of oxygen inc, so less inclined to move in then)
** blood gas AND an A-A gradient TQ~know how to calc (more on this later I think)
what should you know about thoracic rads and dzs?any of these dzs can have normal looking rads. Rad changes lag behind CS!!
if there are crackles auscultated, what radiographic pattern would you expect?alveolar
what kinda dzs cause bronchial pattern on rads?Canine chronic bronchitis, Feline bronchitis/asthma, Allergic bronchitis, Canine infectious tracheobronchitis, Bacterial and mycoplama infection, Parasites (basically everything that says bronchi in it, plus infection and parasites)
WHAT DOES A bronchial pattern on rads look like? why?SEE DOUGHNUTS AND TRAMLINES-- there is inflammation around the bronchi, so bronchi get thicker, and you start to be able to see the walls. is see longitudinally, look like tram lines. If transversely, look like doughnuts.
what kinda dzs cause interstitial patterns on rads?Infections (viral, bact, toxo, mycotic, parasitic) (often interstitial before become alveolar), Neoplasia, Eosinophilic Lung Disease, Idiopathic pulmonary fibrosis, Hemorrhage
what does a interstitial pattern look like? why?everything looks grey. Interstitial tissue is affected so everything in background gets greyed out, bc fluid gathering in the interstitial spaces.
what dzs will cause an alveolar pattern on rads?Pulmonary Edema, Severe Inflammatory Disease (Bacterial pneumonia, aspiration pneumonia), Hemorrhage (Contusions, PTE, neoplasia, Fungal pneumonia, coagulopathy/DIC)
what does an alveolar pattern look like on rads? Why does it look like this?"Trees in a snowstorm" AKA the "air bronchograms" in order to get an alveolar pattern need to go through an interstitial pattern bc the alveoli fill up last. So water filling up interstitium, then alveolar membrane is actually impervious to water, so need to fill it up to the terminal bronchioles bc those ARE permeable, so then it goes through terminal bronchiole into the alveoli. So by the time you get to a alveolar patter, the only thing without fluid in them are the airways--->The bronchi are the dark lines still filled with air, everything else around it is grey.
what are some lung things CT is particularly useful for helping you see?Really nice for bullae and blebs, and < 3mm masses (rads cant pick up this small of a mass)
what is Fluoroscopy good for seeing?shows motility/motion, so good for dx Dynamic tracheal collapse, helps with Placement of stents, angiography(PTE)
you wanna get an airway sample on a dog- best way to do it?BAL (bronchoalveolar lavage)
how do you do BAL, who do you do these for?DOGS-- take camera, put it into the lungs, find area of lungs you wanna wash, wedge camera into that airway, and then through the channel in the scope you put in your saline, shake dog around, suck fluid back out through the channel. all of this is going through the ENDOSCOPE!
you wanna get an airway sample on a cow- best way to do it?Transtracheal wash
you wanna get an airway sample on a tiny cat- best way to do it?NOT BAL, that is through the special scope....for cats using endotracheal wash bc just through an ET tube, cant see what youre doing (often cats are just too small for the whole scope to be in there)
which "wash" sample collection is most specific to where you wanna be?BAL (see other cards for more)
(other cards is actually what she talked about on this slide, this is the stuff she didnt mention, so prolly not as important but to read over:)(1) Transtracheal/endotracheal wash (2) Transthoracic aspiration/biopsy (3) Bronchoscopy (Visual inspection, Bronchoalveolar lavage for cytology and culture, Bronchial brushing, Transbronchial biopsy), Thoracotomy/scopy(bx), Contamination??
other dxs--> what are some things you might wanna do serology for?Heartworm, Histoplasmosis, Blastomycosis (urine Ag), Coccidioidomycosis, Toxoplasmosis, Feline coronavirus (+/-PCR), Canine Influenza
asthma in cats looks just like ___ (and how do you treat these two dzs?)looks same as heartworm! and you treat the same too!
what are three types of fecal exams you can do, and why do you want to do these?Floatation, Baermann(special- looking for lungworm larvae specifically), Sedimentation

Lower resp dzs- specific dzs (canine infectious tracheobronchitis + Canine chronic bronchitis)

Question Answer
Canine Infectious Tracheobronchitis-- aka? how contagious? what causes this?aka kennel cough. VERY contagious acute airway dz. There are a variety of agents which can cause this, usually a combo, most often: Canine adenovirus, Parainfluenza virus, Canine respiratory coronavirus, Bordetella bronchiseptica
how long does canine infectious tracheobronchitis, and what are the clinical signs you see during this time? how can you exacerbate the signs?Usually self limiting to a 2 week course. Usually a sudden onset of a NON-PRODUCTIVE COUGH (bc tracheal and bronchial irritation), and is often exacerbated with Exercise, excitement or tracheal pressure
if there is a canine infectious tracheobronchitis case but you see other signs than the normal ones (non productive cough), or it lasts LONGER THAN ___, what should you do?If longer than 2wk, you should prolly try to work them up for sthing else. If you see Systemic illness, its usually a 2⁰ infection taking advantage of the kennel cough causing inflammation, OR it could be a more serious pathogen like Canine influenza (do PCR)
what starts out looking like kennel cough but then the dog gets really sick?canine influenza
should you tx kennel cough (Canine Infectious Tracheobronchitis) with abx?prolly shouldnt. good chance it's viral
tx for kennel cough (Canine Infectious Tracheobronchitis)?(1) REST! (2) cough suppressants [prolly not abx, since dz is self limiting and possibly viral and all you'll do is make resistance]
when do you wanna use cough suppressants during kennel cough? what are some of them?DO NOT USE IF PRODUCTIVE COUGH (wanna get that shit out) and only give at night so they can sleep. Dextromethorphan, Butorphanol, Hydrocodone
how does Canine Chronic Bronchitis present? (how long, how to tell from other stuff) Why does this happen?This is when there is a frequent cough for 2 or more consecutive months in the ABSENCE of other dzs. May be due to long term inflammation(--> Fibrosis, epithelial hyperplasia, glandular hypertrophy, inflammatory infiltrates)
Canine Chronic Bronchitis--> who is prone to this?Middle aged to older small breed dogs (Terriers, poodles, Cockers)
what are common concurrent dzs to Canine Chronic Bronchitis?Mitral endocardiosis, collapsing trachea (bc same breeds that get CCB like to get these- ie small dogs like terriers and cockers and poodles), bronchial compression, CHF
what is the cough like for Canine Chronic Bronchitis? What is the auscultation like?Loud, harsh cough-- Usually systemically normal though. They often have Mucus hyper secretion, so you often see an "expiratory push" where there is an high frequency wheeze at end of inspiration and throughout expiration, along with inspiratory crackles and expiratory wheeze.
Canine Chronic Bronchitis can predispose sufferers to what other dzs?2⁰ infection, Pulmonary hypertension, Bronchiectasis ((walls of bronchi start breaking down and get wide dilated bronchi that get floppy and useless)—end stage
how do you dx Canine Chronic Bronchitis?Diagnosis of exclusion (pic is chart of things you might look for to see if you can dx CCB)
what complications can canine chronic bronchitis cause?Tracheobronchomalacia (weakening of trachea and bronchi from chronic neg pressure generation--> floppy trachea and bronchi), Pulmonary hypertension, Bacterial/mycoplasma infection, Bronchiectasis
Canine Chronic Bronchitis--> what pattern do you see on radiographs? what do you see on bronchoscopy?RADS: bronchial pattern, on bronchoscopy you will see Mucus, and Rough, hyperemic mucosa
what results would you get back from a BAL of a dog with Canine Chronic Bronchitis?Neutrophilic or mixed inflammation and inc mucus
how do you symptomatically tx Canine Chronic Bronchitis?Symptomatically: basically avoid anything that might trigger it- Avoid allergens/irritants (perfume/ tobacco), make sure teeth are clean (teeth has lots of nasty bugs that can drop down into airway), keep them hydrated (want to keep it moist and juicy to more easily hork stuff up) can keep hydrated via systemic water (avoid diuretics) and Nebulization. Also help them lose some weight
what are some specific/target treatments you can do for Canine Chronic Bronchitis once you have done all the symptomatic tx? (3)(1) Bronchodilators- (a) Methyxanthines- Theophylline, Aminophylline (b) Sympathomimetics—β2 agonists- Terbutaline, albuterol (2) Glucocorticoids- Anti-inflammatory use, lowest dose you can. (3) Cough Suppressants

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