Small Ani. Med- Clinical Manifestation of Respiratory Disease 4

wilsbach's version from 2015-12-01 22:12

Bacterial pneumonias, Protozoal and Fungal Pneumonias

Question Answer
bacterial pneumonia can be basically anything...what is a list of some possible agents?Bordetella, Streptococcus, Staphylococcus, Escherichia, Pasturella, Klebsiella, Proteus, Pseudomonas, +/- anerobes, Mycoplasmas
do bacterial pneumonias like to be in airways? alveoli? interstitium?All three!
(said in class) if you hear crackles, what are the two things she wants us to think of?CHF and pneumonia
usually some sort of predisposing cause of bact pneumonia-- what are some predisposing causes?Aspiration, Cleft palate, Megaesophagus, Decreased clearance (Ciliary dyskinesia, chronic bronchitis, bronchiectasis), Immunosuppression, Other infections (FeLV, FIV, CDV, influenza, fungus), FB, neoplasia
clinical signs of bact pneumonia?Respiratory and systemic signs!! can be any of these: Cough, nasal discharge, exercise intolerance, crackles, Fever, depression, lethargy, weight loss
how do you dx bact pneumonia?CBC(look for white cell changes), Thoracic radiographs, Airway wash cytology and culture, looking at predisposing factors
giant megalist of things that can possibly cause aspiration pneumonia?
why dont you want to force feed cats?(1) aspiration pneumonia risk (2) cats are assholes and will develop a food aversion
what things can you do/give to tx pneumonia?(1) oxygen!! (2) airway hydration (3) abx (best if do Susceptibility testing and broad spectrums so no mutation) (4) Physiotherapy (5) bronchodilators
tx of bact pneumonia--> airway hydration--> what are some ways to provide these fluids?Systemic fluid therapy, Saline nebulization (+/-abx in nebulizer, including aminoglycosides like gentamycin and wont get kidney failure bc local!)
what is some Physiotherapy you can perform to help pts with bact pneumonia?Coupage (cup your hands and pat on their sides to bang out the gunk), and Turning recumbent animals (shit falls down to lower side-- if good side, dont want that crap in there)
what do you NOT want to use as tx for bact paneumonia?DONT DO: Diuretics (want them moist), cough suppressants (want them to get that shit outta there), corticosteroids (they have an infection)
Protozoal and Fungal Pneumonias--> (5 causative agents?)Toxoplasmosis, Blastomycosis, histoplasmosis, coccidioides, Pneumocystis
what is Pneumocystis, who is prone to it? why? tx?Pneumocystis pneumonia (PCP) is a form of pneumonia, caused by the yeast-like fungus Pneumocystis jirovecii. Miniature dachshunds and CKCS (cavalier king charles) are prone. Prolly bc theyre immunodeficient. USually tx this with Potentiated sulfonamides (icky SEs to be mindful of if black and tan doxy)

eosinophilic lung dz(weird thing!) + idiopathic pulmonary fibrosis + Primary Ciliary Dyskinesia

Question Answer
eosinophilic lung dz...aka? what is going on? WHERE are the eosinophils?aka Pulmonary Infiltrates with Eosinophils PIE, aka Eosinophilic Pulmonary Granulomatosis. It's eosinophils all up in yo lungs n shit. Can be in airways AND interstitium, and can totally be bc of or concurrent with Allergic bronchitis and idiopathic bronchitis.
WHO gets eosinophilic lung dz, and what are clinical signs like?Cats and dogs get it, and they get Progressive respiratory signs, +/- crackles and wheezes +/- peripheral eosinophilia, +/- hilar lymphadenopathy
how do you dx osinophilic airway dz?Airway wash, lung aspirate or biopsy
what does eosinophilic lung dz look like on rads?Bronchial, interstitial to nodular pattern, +/- alveolar (so basically anything)
how do you tx eosinophilic lung dz? what is the prog? Antigen removal, Corticosteroids—lowest effective dose. Prognosis depends on severity and response to treatment
idiopathic pulmonary fibrosis--> what is going on? how do you dx?cats, there is fibrosis in lungs and we don't know why. This is usually a dx of exclusion where there are consistent biopsy results- histopath will show Fibrosis, fibroblast proliferation, alveolar epithelial metaplasia, inflammation…can appear similar to carcinoma. So might need to bx to dx.
idiopathic pulmonary fibrosis--> who is prone to getting this?******Westies!!!!****, Pit Bulls, Jack Russell, Cairn Terriers, Schipperkes, and Middle aged to older dogs and cats
clinical signs of idiopathic pulmonary fibrosis?Slowly progressive Respiratory compromise WITH CRACKLES. EVEN THO RADS ARE Diffuse interstitial to bronchiolar radiographic pattern!! also +/- pulmonary hypertension (bc fibrosis is inc resistance)
How do you treat idiopathic pulmonary fibrosis?"steroids with some steroids...lowest dose possible" so... Glucocorticoids (lowest dose), +/- Azathioprine (ONLY DOGS), +/- Cyclophosphamide (but can make it worse so prolly not). Can also give Bronchodilators like Theophylline. Treatment for pulmonary hypertension if needed (Viagra or Cialis-- lol)
what is the prog for idiopathic pulmonary fibrosis?Poor.... 20-30% dogs alive at 5 years with treatment. Dog MST 18 months, Cats 14/23 euthanized within weeks, 7/23 alive at 1 year (so....poor)
what is happening in Primary Ciliary Dyskinesia? How do animals get this? signalment of who gets this?This is an IMMOTILE CILIA SYNDROME which is a congenital condition where there is a Inherited microtubule defect--> without microtubules working, the animal is Predisposed to chronic infection. (Acquired form can be a sequella of chronic infections!) Usually seen in young dogs with a History of chronic resp infections (pic- not the right number or arrangement of microtubules in the cilia)
(mentioned in class) how do you dx primary ciliary diskinesia?electron microscope to look at microtubules in cilia-- hey, there are cilia in sperm!
what is Kartagener’s syndrome?Primary Ciliary Dyskinesia + Situs inverus and dextrocardia (first she said she wouldnt ask it but then said it is fair game. so idk man)
So along with the repiratory tract malfunctioning in primary ciliary diskinesia, what other body systems are affected? Respiratory tract, oviducts, sperm, and eustacean tubes
clinical signs of primary ciliary dyskinesia?along with chronic resp infections, Sterility, deafness, hydrocephalus, renal disease, skeletal deformaties
which breeds like to get primary ciliary diskinesia?Newfies, Bichon, OESD, springers, goldens, pointers, Gordon and English Setters, rotties
how do you tx/prevent primary ciliary diskinesia?No specific treatments.... just Monitor for infections and quality of life, and DONT BREED THEM (CAN USE SPERM SAMPLE TO DX to look at under electron microscope so you dont breed them)

Pulmonary neoplasia + Pulmonary Thromboembolism (PTE) + pulmonary hypertension + effusions

Question Answer
Are primary lung tumors usually benign or malig? examples?MALIG. Bronchoalveolar carcinomas, adenocarcinomas, SCC. (*dont forget!! HYPERTROPHIC OSTEOPATHY FOR LEG LAMENESS can be a paraneoplastic syndrome from 1* lung tumors!!)
what kinda multicentric neoplasias like to be in the lungs?Lymphoma, disseminated histiocytic sarcoma, mastocytoma (multicentric= tend to start in diff places at the same time. dont necessarily met to the lungs- its everywhere to begin with. Think of all the lymph shit in the lungs)
how do you dx lung neoplasia?Histopathology, cytology, Lung biopsy or aspirate
clinical signs for tumors in lungs? What do lung rads look like? prog?Any to none! Hemorrhage, edema, inflammation, infection, airway occlusion, ANY rad pattern. Prog depends on what kinda tumor and CSs
what are associated conditions with PTE?(in class just said "tons of conditions associated with it" and moved on so here is just the list to read over) Trauma, Hyperadrenocorticism, IMHA, Hyperlipidemia, Glomerulopathies, Heartworm disease and treatment, Cardiomyopathy, Endocarditis, Pancreatitis, DIC, Hyperviscosity syndrome, Neoplasia
how do you dx PTE?high index of suspicion-- aka you say "I think he threw a clot" Basically this is one of the only things there you go "urk" and fall over dead-- so if that happens prolly PTE. you can try CS, radiographs, ABG, Histopathology? (sample might not contain the problem), CT, angiography, nuclear perfusion canning
CS of PTE? if you think its PTE what do you do to tx?CS range in severity-- May need to treat for shock. PUSH FLUIDS, oxygen, glucocorticoids, anticoagulant therapy (heparin or low molecular weight heparin- smaller bits of heparin which provide anticoag therapy but without making them too bleedy)
how do you dx pulmonary hypertension? (what are the numbers!!)Echocardiography, with doppler blood flow, across tricuspid and pulmonary valves---> so, a tricuspid regurg > 2.7 m/sec, or a pulmonic insufficiency of > 2 m/sec is DIAGNOSTIC for pulmonary hypertension (she prefers tricuspid, said its easier to get a pic of on US)
what are some of the major general reasons that pulmonary hypertension happens?(1) Increased pulmonary blood flow (Congenital L to R shunts, ↑ CO) (2) Increased blood viscosity (3) Increased pulmonary vascular resistance (PVR) (↓ drainage (left heart), Loss vessels, PTE, HWD, HAC, IMHA, sepsis, neoplasia, nephrotic syndrome,Cor pulmonale, chronic upper airway disease) (4) Luminal narrowing--- (a) Anatomic (Eisenmengers, HWD, 1° pulmonary hypertension) (b) Pulmonary vasocontriction (High Altitude, Cor pulmonale, Hypoventilation, NMD, obesity, chest wall deformaties)
diagram pic which shows how pulmonary hypertension affects the heart etc
Effusions--> clincial signs? what kinda breathing pattern?see dyspnea/Tachypnea, Orthopnea, Muffled/abnormal lung sounds. RESTRICTIVE breathing pattern bc lungs cant expand!! also will see things like inappetance and lethargy
are effusions usually uni or bilateral?usually bilateral- only separation is mediasteinum and its not like its super strong.
anything can be in a chest effusion- how do you know what it is?TAPPITY TAP! Transudate/mod.transudate/exudate--> look for protein and cells. Might also be Blood, Pus, Chylous/pseudochylous, or Neoplastic. Fluid analysis, culture, Cytology can all be looked at. can also look for Triglycerides, pH, glucose. (pH and glucose helpful for pyothorax)
pyothorax akaseptic exudate
(breezed by in class, read over) chart which are your rule outs for types of effusions you might find in the thoracic cavity
(FYI) exudate vs transudate?
who tends to get pyothorax? what kinda effusion is in pyothorax? what are some reasons this can happen?Younger dogs and cats (4-6 years), there is SEPTIC exudate. FB, wounds with direct or hematogenous spread, esophageal tears, idiopathic, aspiration and parapneumonic spread (paraspread=out of alveoli, into interstitium, out of lungs, and into chest) (Cats ~50% have pneumonia concurrently- bc things travel well)
what are some clinical signs of pyothorax?Poor BCS, +/- cough 30%, +/- fever- 28-50%, Hypothermia and bradycardia ~ sepsis?
What TENDS to be the causative agent of pyothorax in cats? Dogs?in CATS, tends to be Obligate and facultative anaerobes (ie mouth bugs), dogs it tends to be FBs either inhaled or traumatically introduced (if wounds, think nocardia and actinomyces-- which if its these you might need to sx debride them)
why do URTI cats tend to get pyothoax?URTI= impaired mucociliary clearance
*how fast do you need to fix pyothorax? how do you handle these guys? what can you do to stabalize?First 48 hours critical!!!! (if you can get them past 2 days you might have just saved them). You need to do CAREFUL, minimally stressful handling. O2, thoracocentesis, pulse ox for monitoring, and then provide supportive care ( address the Hypothermia, hypotension, Hypoglycemia, fluids and electrolytes)
If you wanna take rads of pyothorax, what should you keep in mind?If/after stabilized!, if not stabalized, at the very least tap them first-- Cats with large volumes can become hypoxic in lateral recumbency
what is T-Fast? how is it useful with pyothorax?Thoracic-Focused Assessment with Sonograph for Trauma, triage and tracking (cts= chest tube site, pcs=pericardial site, DH- diaphragmatichepatico site)-- allows you to look for fluid, see where you can get samples, etc
how do you treat pyothorax?(!) Supportive care (2) Drainage (BILATERAL CHEST TUBES-- often on both sides!!, THORACOTOMY if really bad) and lavage, try to provide constant or intermittent sucking. (3) Antibiotics--Best if you culture and susceptibility! If not able to C/S, use big guns. For cats with their Anaerobic bacteria, you can give POTENTIATED PENICILLIN (+/- metronidazole-cats, +/- Clindamycin or enrofloxacin-dogs, +/-Trimethoprim sulfa<--esp if you think you have nocardia)
What is happening in chylothorax? what are some common reasons this happens?When chyle Leakage from thoracic duct!! Usually trauma, tumors can do it too, many reasons (Idiopathic, congenital, trauma, neoplasia, cardiac disease, pericardial disease, heartworm, lung lobe torsion, diaphragmatic hernia). \
what thing do you want to look at, comparing your effusion and your serum, to see if its chylothorax?Triglycerides in fluid and serum!
what are some things you can do to try to tx chylothorax?Identification and treatment of primary disease if possible is best answer, also can do Thoracocentesis and provide supportive care, along with a low-fat diet (fat is the molecule encouraging the fluid to stay in there). Can give supplements Rutin/octreotide (but she said really sx management is the way to go) Surgical management= Thoracic duct ligation and pericardiectomy
(big chart) what are some tests you can do with chylothorax, and what might you find?
what is neoplastic effusion like?Can be any effusion type- Hard to dx on fluid alone (And Inflammatory cytology difficult to interpret)

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