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299 Cards in this Set
- Front
- Back
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How does age-breed-sex information aid in the diagnosis of respiratory disease?
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age: young usually infectious and congenital
old: neoplastic and degenerative disease Breed: Sex: female mammary carc (most common) |
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What respiratory mycotic infections are endemic to the Ohio River Valley
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Histoplasmosis
Blastomyces crypto (yeast) |
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What thoracic injury may have a prolonged delay following trauma before noticable clinical signs occur?
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Diaphragmatic hernia
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Why is vaccination status an important part of respiratory history?
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can indicate a higher (or lower) risk for certain infectious diseases
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What is epistaxis and what are some common causes?
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epistaxis = nosebleeds
clotting disorder nasal tumor foreign body trauma |
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What are common signs of nasal cavity disease and their clinical significance?
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nasal discharge
epistaxis sneeze blockage of nasal passages facial bone deformity (malignant tumors) depigmentation of external nasal planum (aspergillus) |
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What is the difference between productive and non-productive cough? How do you identify a productive cough? How can treatment differ for these two types?
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productive (moist, rattling, gurgling)
nonproductive (dry, harsh) |
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What is the definition of hemoptysis and what can cause it?
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bloody cough
-indicates trauma, infarction (heartworms), pulmonary hypertension, neoplasia |
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What causes a musical goose-honk cough?
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tracheal collapse
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What type of lung disease can result in severe lameness and bone lesions?
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hypertrophic pulmonary osteopathy- new bone formation on the limbs causes diffuse swellings that are firm and warm on palpation
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What is the clinical significance of mucous membrane cyanosis?
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it indicates an abnormal amount of unoxygenated Hb in the arterial blood and can signify severe, life-threatening hypoxemia
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Why does detection of a tumor anywhere on the body have important implications for the respiratory system?
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metastatic lung disease is more common than primary lung tumors, and pulmonary neoplasia is almost always malignant
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What diagnostic procedures are used to evaluate the nasal cavity?
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oro-naso-pharyngeal exam under anesthesia
nasal imaging: radiography, CT rhinoscopy or nasal flush biopsy |
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What is panting and why do dogs do it?
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it is fast breathing
they do it for thermoregulation anxiety hypercortisolism liver disease |
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Dyspnea
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difficult or labored breathing; respiratory distress; the sensation of shortness of breath
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Hyperpnea
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abnormal increase in the depth of respiration
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Tachypnea
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increase in the rate of respiration
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Orthopnea
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preference for breathing in an upright (sitting) position which allows maximal expansion of the thorax
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Bradypnea
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abnormally slow breathing; occurs with depression of brainstem respiratory centers, especially with acute head trauma or effects of depressant drugs; may progress to apnea
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apnea
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cessation of breathing
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wheeze
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high-pitched, whistling sound heard most prominently on expiration; associated with lower respiratory obstruction
asthma, bronchospasm |
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stridor
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harsh, high-pitched inspiratory sound often heard in acute laryngeal edema or obstruction
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What is the localizing significance of an inspiratory stridor sound during breathing?
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inspiratory stridor indicates upper airway obstruction such as in Brachycephalic syndrome
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What diagnosis is suggested by the loss of throacic compressability in the cat?
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if it cannot be compressed cranially- large mediastinal masses (ex lymphoma)
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What is the clinical significance of chest percussion findings of increased and decreased thoracic resonance?
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increased = pneumothorax
decreased= pulmonary effusion, diaphragmatic hernia, large pulmonary masses |
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What is the significance of eosinophilia in a dog or cat with respiratory signs?
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could indicate flukes and worms causing diseases
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What are the indications for thoracocentesis?
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physical and radiographic evidence of intrapleural fluid or air
-use to obtain fluid for analysis cytology or culture -relieve life-threatening compression atelectasis of lung or pneumothorax |
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What are the indications for collection of respiratory cytology specimens?
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chronic or unexplained bronchopulmonary disease
focal lesions |
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List the methods for collection of respiratory cytology specimens and what are the advantages and disadvantages of each?
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transtracheal washing:
bronchial washing: FNA: Bronchoscopy: BAL: |
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What are the expected cytology findings in bacterial pneumonia?
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neutrophils and bacteria
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What is the most abundant type of cell found in normal bronchoalveolar lavage fluid (BALF)?
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alveolar macrophage instead of epithelial cells as in the transtrach wash
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What are the most common etiologies of feline infectious respiratory disease?
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Herpesvirus (FHV)
Calicivirus (FCV) Chlamydia Bordatella bronchiseptica Mycoplasma felis |
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FIP transmission occurs primarily by what route?
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contact with feces/ fomites
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What signs are seen with most viral respiratory infections, regardless of etiology?
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inappetance, lethargy and fever
sneeze and cough naso-ocular discharges |
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Which infectious agent has a predilection for epithelium of the nasal cavity and trachea, and induces necrosis in these areas?
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crypto in cats
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Which respiratory virus causes oral ulcers?
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Feline calicivirus
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Which respiratory virus causes corneal ulcers?
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feline herpesvirus
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Which respiratory virus has many strain variants, including some that cause joint disease (polyarthropathy) and some that cause fatal systemic infections characterized by multi-organ failure?
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Feline calicivirus
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Why are carrier states clinically important for the feline respiratory viruses?
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they can lead to huge outbreaks in catteries, shelters, and confined groups of cats
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How effective is vaccination in preventing feline respiratory viruses?
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it protects against disease expression but NOT infection and may create carrier states.
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Besides vaccination, what else can be recommended to prevent feline infectious respiratory disease in young kittens?
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early separation of kittens (<6 weeks of age) from adult cats
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What body systems are commonly affected by CDV and what are the main clinical signs that result?
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epitheliotrophic: ocular, nasal, airways, lung, GI, skin, teeth
affinity for the nervous system |
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Are secondary bacterial complications important in the pathogenesis of CDV?
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yes because it causes immunosuppression
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What does CDV do to the lymphoid tissues and the peripheral lymphocyte count? What is the significance of these effects?
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it causes lymphoid depletion and immunosupression as well as lymphopenia
this makes them susceptible to secondary bacterial infections |
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How would you treat a dog with CDV?
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supportive fluids, antibiotics for pneumonia, isolation from other dogs
treat manifestations as they arise |
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What is an appropriate vaccination strategy for CDV?
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yearly is nearly 100% effective
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What infectious agents commonly cause canine ITB?
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bordatella bronchiseptica
parainfluenza virus adenovirus-2 |
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What are the typical clinical features of ITB in a mature dog that has recently been at a boarding kennel? How might this differ from a 6-week-old puppy from a pet shop?
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mature dog: acute onset of persistent, paroxysmal coughing for 7-14d
puppies: severe disease (pneumonia, fever) or mixed infections |
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What is unique about the way Bordetella bronchiseptica produces respiratory disease and how does its location in the host affect therapy?
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Bordatella attaches to the cilia of the airways and causes ciliostasis so the M-C escalator doesn't work and mucous and antigens cannot be cleared
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How would you treat a dog that develops ITB after boarding at a kennel?
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Antibiotics for bordatella
airway hydration (nebulize) cough control (hydrocodenone exercise restriction |
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What can be done to prevent ITB in an individual dog? What about prevention in a facility such as a kennel or veterinary hospital?
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routine vaccination for the distemper, adenovirus, parainfluenza and possibly bordetella
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How does the disease expression (clinical presentation) for canine influenza virus differ from the common kennel cough agents that cause ITB?
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influenza virus signs are flu-like (like ITB) but much more severe
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What are some clinical situations that predispose to bacterial pneumonia?
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aspiration pneumonia
impaired respiratory defencses immunosuppression nosocomial factors |
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What are the typical clinical signs and exam findings in bacterial pneumonia?
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malaise, fever, cough, tachypnea, dyspnea, auscultatory abnormalities
- mixed interstitial and alveolar infiltrates on rads |
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What are the typical CBC and cytology findings in bacterial pneumonia?
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neutrophilic leukocytosis with a left shift
septic purulent inflammation (neutrophils, bacteria) |
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What are the radiographic signs of bacterial pneumonia? Aspiration pneumonia?
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bacterial: mixed interstitial and alveolar infiltrates w/ air bronchograms and ventral/middle distribution
aspiration pneumonia: |
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How would transtracheal or bronchial washings help you in bacterial pneumonia?
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it will allow you to look for evidence of bacteria on cytology and do a culture and sensitivity to find out what the best antibiotic treatment would be
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Are gram-negative or gram-positive organisms more often isolated in bacterial pneumonias of dogs or cats?
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gram-negative more often
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How would you treat a dog or cat with bacterial pneumonia?
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antibiotics (broad-spectrum)
hydration physical therapy bronchodilators oxygen support if indicated +/- lung lobectomy |
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What are the common geographic areas for each of the following systemic mycoses: histoplasmosis, blastomycosis, coccidiomycosis
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histoplasmosis: river valleys midwest/central US
blastomycosis: river valleys midwest/ central US coccidiomycosis: desert southwest |
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What is the principal source of infection for these fungi?
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they are found in the soil and usually are spread by inhaled spores- the yeast phase occurs in the tissues and produces the disease
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How contagious are the systemic mycoses to other animals (and to humans)?
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it is not contagious to other animals and humans
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The cough in mycotic pneumonia may be due to mainstem bronchi compression by what?
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enlargement of the peri-hilar tracheobronchial lymph nodes impinge on the mainstem bronchi and cause cough
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What is the radiographic appearance of healed histo granuloma lesions?
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they become encapsulated or calcified within the lung interstitium
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What type of inflammatory response occurs in mycotic infection of the lung?
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it is a macrophage response (granulomatous or pyo-granulomatous)
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Which mycoses are the most common within the nasal cavity?
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cryptococcus
aspergillus |
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What are some sites outside of the respiratory tract that commonly become involved in disseminated mycotic infection?
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lymph nodes
eyes CNS skin GI Bone Bone marrow liver spleen genital tract etc |
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How would you diagnose an animal with disseminated blastomycosis?
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antigen tests
radiography cytology and biopsy |
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What oral antifungal drugs are used to treat the systemic mycoses? What is the major toxicity associated with amphoteracin B?
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azole drugs- slow onset but preferred for low toxicity
amphoteracin B- nephrotoxic, IV only |
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What hematologic finding is often a clue to parasitism?
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eosinophilia
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What parasite causes protozoan pneumonia in a cat?
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Toxoplasma gondii- public health implications
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pulmonary cysts in a dog
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flukes
Paragonimus sp. |
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tracheal mucosal nodules in a dog
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tracheal worms
Filaroides milksi, F. hirthi Capillaria aerophilia |
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lungworm disease in a dog with bi-operculated ova in the feces
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capillaria
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lungworm disease in a cat
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Aelurostrongylus abstrusus
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Which lungworms are identified by larvae in feces rather than ova?
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Filaroides milksi, F. hirthi
Aelurostrongylus abstrusus |
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Name 2 drugs that can be used to treat lungworms?
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fenbendazole or ivermectin
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Name 2 drugs that can be used to treat lung flukes?
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praziquantel or fenbendazole
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What clinical signs indicate disease of the nasal cavity and sinuses?
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nasal discharge
epistaxis sneeze blockage of nasal passages facial bone deformity depigmentation of external nasal planum |
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What is the most common cause of acute rhinitis in cats?
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allergic rhinitis
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List the most important causes of chronic nasal discharge:
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infectious
allergic nasal foreign body |
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What is the most common mycotic infection in the nasal cavity of dogs? Of cats?
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dogs: Aspergillus
cats: Cryptococcus |
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How are the nasal mycotic infections in dogs and cats diagnosed and treated?
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serology for aspergillus
serum capsular antigen test for crypto clotrimazole to treat aspergillus fluconazole for crypto |
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What is the role of radiography and CT in the diagnosis of nasal/sinus disease?
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CT is the best visual tool
radiography allows you to look for masses, opacity, or turbinate destruction in the nasal cavity |
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What other diagnostic aids are useful int he differential diagnosis and treatment of nasal cavity disease?
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anesthesia
rhinoscope biopsy serology oro-nasao-pharyngeal exam under anesthesia |
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What are the common tumors of the canine nasal cavity?
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adenocarcinoma in older animals
squamous cell carcinoma |
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How are most nasal tumors treated?
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radiation therapy
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What is the association of chronic rhinosinusitis and dental disease?
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root infections can lead to an oro-nasal fistula that leads to infection in the nasal cavity
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What are the indications for exploratory nasal surgery?
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debridement, drainage, biopsy of the nasal cavity
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What are the clinical signs of laryngeal disease?
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snoring (stertor), gagging, cough, inspiratory stridor
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How is laryngeal paralysis diagnosed? How is it treated?
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diagnosed: by clinical signs
treated: -emergency: steroids, intubation, tracheostomy -long term: various surgical procedures to restore a patency |
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When does a small animal veterinarian most often see laryngospasm?
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in cats during anesthesia induction and intubation
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What is the mechanism of difficult breathing in many brachycephalic dogs?
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the soft palate is enlongated , so it increases airway resistance and leads to excessively negative airway pressure during inspiration
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What are the primary and secondary anatomic characteristics of brachycephalic syndrome?
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primary:
- elongated soft palate - stenotic nares secondary: - laryngeal edema and everted saccules - laryngeal collapse |
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How do you treat brachycephalic syndrome?
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surgical correction (palate, nares, saccules)
emergency stabilization: cool ambient temperature, oxygen, sedation, corticosteroids |
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What is the age and breed predilection for tracheal collapse?
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miniature/toy breeds
older, obesity |
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List 2 ways of confirming a diagnosis of intrathoracic tracheal collapse?
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it collapses on expiration
radiographs |
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How would you initially treat a dog with tracheal collapse?
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weight control
steroids cough suppression bronchodilators |
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What are the options for treating a dog with tracheal collapse that is refractory to medical therapy?
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surgical- extralumenal tracheal ring prosthesis
intraluminal mesh stent |
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What are the radiographic findings in chronic bronchitis?
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bronchial patter, interestitial density
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What, other than radiographs, would you do to evaluate a dog with chronic bronchitis?
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airway cytology (mucous and inflammatory cells)
absence of other identifiable causes of chronic cough (elimination) |
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What are potential etiologies for chronic bronchitis?
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irreversible bronchial thickening and narrowing from age
idiopathic- chronic exposure to airborne irritants bronchiectasis- dilation and sacculation |
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What is the clinical signficance of left atrial enlargement in a 10 year old poodle with persistant cough?
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it will compress the left mainstem bronchus so the cough is due to heart disease
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What are the respiratory signs of feline bronchial asthma?
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cough
dyspnea (episodic) wheezing (expiratory) |
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What is the pathophysiology of feline asthma and how does it differ from canine bronchitis?
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it is from bronchial inflammation, bronchial hyperreactivity, bronchoconstriction (reversible airway obstruction) whereas canine bronchitis is irreversible
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What hemogram abnormality may be found in feline asthma?
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eosinophilia in some cats
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What are the radiographic features of feline bronchial asthma?
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bronchial pattern, overinflation
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What are the treatment options for feline bronchial asthma?
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control allergens
corticosteroids bronchodilators antigen-specific immunotherapy serotonin blocker/ leukotriene blockers |
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Which are more common: benign or malignant lung tumors? Primary or metastatic lung tumors?
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malignant lung tumors are more common
metastatic tumors are more common than primary |
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Describe the Progressive Discipline Process (PDP).
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The PDP is the process of gaining and maintaining discipline within your organization. It provides a way for the supervisor to establish lines of acceptability and communicate those lines to your subordinate. As the supervisor monitors behavior and identifies substandard performance, he or she can apply the PDP utilize the least amount of force necessary to modify the behavior.
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What are some complications of lung tumors?
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pleural effusion
compression of mediastinal structures (esophagus- dysphagia, regurgitation) |
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Describe some radiographic findings and patterns seen with lung tumors?
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lobar lung mass with secondary nodules, infiltrations
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How can you confirm pulmonary neoplasia?
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confirm with cytology: cancer cells in washings, ultrasound-guided lung aspirates or pleural fluid
surgical lung biopsy |
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What is the role of radiography in the preoperative evaluation of a dog with a mammary tumor?
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radiography will identify metastasis within the lungs. If there are multiple masses, then surgery is not recommended
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Why would a dog with a lung tumor present mainly for signs of lameness?
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because while there may not be signs of the primary lung tumor, it can metastasize--> hypertrophic pulmonary osteopathy which would manifest as lameness
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Are pleural effusions in small animals more often unilateral or bilateral?
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bilateral
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What are the clinical signs and physical findings of pleural effusion?
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labored breathing
nonspecific signs depending on cause` |
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How is the "horizontal fluid line" detected and what does it mean?
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it is detected by percussion- the line between dull fluid sound and air
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What is the adverse effect of overzealous restraint in an animal with severe pleural effusion?
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they could become apneic
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Considering the impact of pleural effusion on respiratory physiology, what emergency procedure is most beneficial for relieving life-threatening respiratory distress in an animal with severe pleural effusion and why?
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thoracocentesis because it will restore the negative pressure in the pleural space and allow the lungs to expand (coupled with oxygen supplementation
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What are the typical radiographic signs of pleural effusion?
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fluid density surrounding lung lobes
fluid-filled interlobar fissures fluid-filled costophrenic angles (VD) Obscuring of the cardiac and diaphragmatic shadows |
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How would thoracic ultrasound examination help in pleural effusion?
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you can look for neoplasms, abscesses associated with pyothorax, lung lobe torsion, cardiac abnormalities and diaphragmatic hernia
-also localize for FNA |
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What are some causes of dual cavity effusion (both pleural and abdominal)?
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neoplasia
diaphragmatic hernia FIP? |
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Why are post-thoracocentesis radiographs sometimes helpful?
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to visualize a mass, the heart lungs, diaphragmatic hernia or lung lobe torsion
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How is a transudate distinguished from an exudate, and what is the clinical significance?
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transudate has a low TP and low WBC
exudate has a high TP and higher WBC |
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What is a "modified transudate"?
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it is in between transudate and exudate
can be caused by CHF, neoplasia, or diaphragmatic hernia |
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Describe the characteristics of chylous fluid
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"strawberry milk"
from CHF, lymphoma, thoracic lymphangiectasia, heartworms, jugular vein thrombosis, diaphragmatic hernia, lung lobe torsion - high lipid content |
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Describe the characteristics of the fluid found in pyothorax
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septic pleuritis (bacteria and neutrophils)
really high WBC mod TP |
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In cats, pyogranulomatous effusion is indicative of what disease?
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FIP
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What is the most common category of organism isolated from pyothorax?
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bacteria
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How is pyothorax treated?
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antibiotics, chest tube drainage and lavage
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How is primary idiopathic chylothorax treated?
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thoracic duct ligation via thoracotomy; indwelling bump for pleural evacuation as needed
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What is the difference in hydrostatic pressure between the arterial and venous end of the capillary?
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30-40mmHg on the arterial end --> 10-15mmHg on the venous end
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What determines capillary hydrostatic pressure?
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venous pressure ENTIRELY
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Capillary hydrostatic pressure causes movement of fluid in what direction?
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out of the vessel
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How do you determine net capillary hydrostatic pressure?
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see equation in notes
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What is the primary determinant of interstitial hydrostatic pressure? (Pi)
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depends on the "looseness" of the tissue
can be negative in loose tissues (skin) causes movement of fluid INTO the vessel |
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What is the capillary oncotic pressure?
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the force of proteins to attract/keep fluid in the vessel
"Size doesn't matter...quantity does!" |
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What are the primary proteins responsible for capillary oncotic pressure?
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albumin with minimal contribution from globulins
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Capillary oncotic pressure causes fluid movement in what direction?
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into the vessels
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What is interstitial oncotic pressure?
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the force of protein in tissue to draw water out of vasculature
low movement OUT of vessel |
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What determines the filtration coefficient (Kic) of capillary hydrostatic pressure?
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-capillary surface area
- hydraulic conductivity (leakiness) kidneys and liver leaky brain and muscle tight |
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What is the reflection coefficient in determining capillary hydrostatic pressure?
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it is the relative permeability of the capillary bed to protein
low in liver high in kidney lungs low Kic, high this |
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What are the overall causes of edema?
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-increased capillary (venous) hydrostatic pressure
-decreased capillary oncotic pressure -increased vascular permeability -obstruction to lymphatic drainage |
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What does cardiogenic edema indicate?
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left ventricular failure or fluid overload
increased pressure in l atrium translates into pulmonary veins, increases capillary hydrostatic pressure which increases the net fluid movement out of the capillary bed |
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What causes "high pressure" edema?
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resisted initially by interstitial pressure, but then the interstitial fluid moves into the alveoli which prevents gas exchange and leads to a V/Q mismatch
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What is the protein content of cardiogenic effusion?
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low protein
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What are potential causes of cardiogenic effusion?
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- congestive left heart failure
- left ventricular dysfunction + IV fluids - fluid overload |
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What are physical exam findings in a patient with cardiogenic edema?
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dyspnea
tachypnea orthopneic stance cyanosis crackles on pulmonary auscultation |
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How do you diagnose cardiogenic edema?
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-thoracic radiographs: perihilar disp, PV distension, LV bulge
-echo: LA dilitation, LV dysfunction/mitral valve disease |
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How do you treat cardiogenic edema?
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reduce catecholamine release
oxygen supplementation sedation- use cardiovascular sparing drugs diuretics: pulmonary venodilation- VIAGRA! |
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What drugs should you NOT give to a patient with cardiogenic edema?
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-bronchodilators
-IV fluid therapy |
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What causes non-cardiogenic pulmonary edema?
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- endothelial injury: inflammation, barotrauma, rapid increase in pulmonary vascular pressure
- increases endothelial permeability: translocation protein rich fluid |
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What is ALI/ARDS?
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Acute lung injury, acute respiratory distress syndrome often caused by inflammatory injury (SIRS)
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How do you diagnose ALI/ARDS?
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disease process that causes SIRS
physical: tachypnea respiratory distress, crackles radiographs: diffuse, patchy interstitial to alveolar pattern, any lobe inflammatory exudate on airway wash- **high protein** |
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How do you treat ALI/ARDS?
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treat the underlying problem
reduce catecholamine release: oxygen therapy, sedation positive pressure ventillation fluid therapy: crystalloids vs colloids |
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What treatments are NOT to be used in ALI/ARDS?
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diuretics- not helpful
bronchodilators |
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What causes neurogenic pulmonary edema?
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- endothelial injury from rapid increase in pulmonary vascular pressure due to massive catecholamine release
-seizures, head trauma, electrocution, strangulation, airway obstruction, near drowning |
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What are clinical signs of neurogenic pulmonary edema?
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-history suggests cause
-burn or bruising on tongue -suggestive of primary injury -varying degrees of tachypnea, pulmonary crackles and respiratory distress |
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What are radiographic signs of neurogenic pulmonary edema?
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-caudo-dorsal distribution in dogs **
interstitial to alveolar pattern diffuse pattern in severe cases |
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How should you treat neurogenic pulmonary edema?
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-oxygen
-sedation -conservative crystalloid therapy -positive pressure ventillation |
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What should be considered when giving fluids to a patient with neurogenic pulmonary edema?
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you need to weigh the administration of fluids against shock reversal
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What drugs should not be given to a patient with neurogenic pulmonary edema?
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diuretics
antibiotics bronchodilators |
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How can you distinguish cardiogenic from noncardiogenic pulmonary edema?
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cardiogenic will be a low-protein effusion, noncarddiogenic is a protein-rich effusion
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What is the difference in radiographic distribution between cardiogenic and noncardiogenic pulmonary edema?
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- cardiogenic: perihilar
- noncardiogenic: caudodorsal |
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What does inspiratory distress indicate?
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upper airway/ upper resp tract disease
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what does expiratory distress indicate?
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small airway disease (lower respiratory tract)
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What does a restrictive breathing pattern indicate?
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pleural space/thoracic cage disease
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What does stridor indicate?
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inspiratory sounds
associated with dynamic obstruction |
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What does stertor indicate?
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both inspiratory and expiratory
associated with fixed obstruction |
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What are indicators of inspiratory distress?
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stertor/stridor
orthopneic stance prolonged, slow, forced inspiration OBSTRUCTIVE PATTERN |
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What are indicators of expiratory distress?
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-collapse of the small airways
-rapid increase in transpulmonary pressure collapses airways before the alveolus is empty -prolonged, forced expiration with abdominal componenet -Auscultation--> respiratory wheeze |
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What does inspiratory and expiratory distress indicate?
|
"both" or "labored" breathing
- alveolar/ lower airway disease rapid, deep respirations Crackles = alveolar fluid Wheezes= small airway collapse harsh lung sounds= increased airway turbulence |
|
|
What does a restrictive pattern indicate?
|
-pleural space disease
-short, rapid respiration -usually quiet -more rapid and shallow with progression -auscultation--> quiet/decreased lung sounds |
|
|
What are the most common thoracic traumas?
|
-pulmonary contusions
-pneumothorax -rib fractures |
|
|
What are traumatic causes of upper airway disease?
|
head trauma, tracheal rupture
|
|
|
What are traumatic causes of pulmonary parenchymal disease?
|
- contusions, NCPE
|
|
|
What are traumatic causes of pleural space disease?
|
pneumothorax, diphragmatic hernia
|
|
|
What are traumatic causes of thoracic cage disease?
|
Rib fractures, flail chest
|
|
|
What is the pathophysiology of respiratory distress from upper airway disease?
|
- narrowing of the airway (swelling or crushing) leads to reduced or turbulent flow
alveolar hypoventilation leads to increased CO2 and impaired O2 exchange -hypoxemia and hypercarbia -increased effort of breathing -intrathoracic/airway pressure -exacerbation of collapse -severe HYPERTHERMIA |
|
|
What are clinical findings in upper airway trauma?
|
increased respiratory joise
predominantly inspiratory dyspnea possible expiratory dyspnea with intrathoracic upper airway disease |
|
|
How do you treat upper airway trauma?
|
supplemental oxygen
sedation control airway (intubation) |
|
|
What are radiographic signs of upper airway trauma?
|
large amounts of free air SQ or tracheal occlusion
|
|
|
What is pneumomediastinum and what causes it?
|
accumulation of air in the mediastinal space
-from blunt and penetrating classifications of thoracic trauma --usually a sign of other injuries |
|
|
How do you diagnose pneumonediastinum?
|
-from thoracic radiographs
could lead to pneumoretroperitoneum due to tracking on tissue planes |
|
|
What is the pathophysiology of pulmonary parenchymal disease?
|
fluid in alveolus creates a barrier to diffusion so O2 is not taken up and CO2 is not released
hypoxic vasoconstruction further impairs oxygenation--> decreased flow to the alveolus decreased lung compliance increases the work of breathing |
|
|
What is the pathophysiology of pulmonary contusions?
|
-blood in alveoli
-physical barrier from the extravasation of RBCs and plasma -dilutes and reduces the effect of surfactant |
|
|
Why should pulmonary contusions be monitored?
|
they will worsen over the first 24 hours because of the inflammatory response
|
|
|
What are physical exam findings of pulmonary contusions?
|
-respiratory distress
-harsh lung sounds/ crackles -blood-tinged fluid from mouth or nose -coughing up blood -respiratory fatigue and arrest |
|
|
What are radiographic signs of pulmonary contusions?
|
-interstitial to alveolar pattern
any lung fiend atelectasis and shifting of cardiac silhouette |
|
|
What abnormalities on arterial blood gas indicate pulmonary contusions?
|
-A-a gradient or PaO2/ FiO2 ratio
-determines the extent of V/Q mismatching |
|
|
How do you treat pulmonary contusions?
|
-supplemental oxygen and sedation
-cautious crystalloid fluid therapy- -ventilation if needed -tincture of time |
|
|
What is the importance of pneumothorax?
|
-air in pleural space
-releases the "suction" that keeps the visceral and parietal pleura together -allows collapse of the lungs |
|
|
What are causes of an open pneumothorax?
|
-pleura communicates to outside world
-penetrating chest wound |
|
|
What are causes of a closed pneumothorax?
|
-air leak from pulmonary parenchyma
|
|
|
What causes spontaneous pneumothorax?
|
bulla rupture
neoplasia severe parenchymal disease idiopathic |
|
|
Describe tension pneumothorax:
|
-rapidly progressive, severe form of closed pneumothorax
-one way valve allows leakage only during inspiration -leads to rapid accumulation of air in pleural space -FATAL UNLESS IMMED TREATED! |
|
|
What are the primary physical exam findings of pneumothorax?
|
-restrictive breathing pattern
dull or absent lung sounds cyanosis secondary to low oxygen saturation |
|
|
What is the first diagnostic that should be done for a pneumothorax?
|
thoracocentesis ALWAYS
|
|
|
What are radiographic signs of pneumothorax?
|
-collapsed lung unable to support heart in lat recumbency
-lateral deviation of the heart heart is "lifted" from sternum |
|
|
What is the most common cause of traumatic diaphragmatic hernia?
|
tire over abdomen
|
|
|
where does rupture of the diaphragm usually occur?
|
in the muscular portion of the diaphragm
or avulsion from rib |
|
|
What are the sequellae of liver entrapment due to traumatic diaphragmatic hernia?
|
hydrothorax from venous occlusion and elevated venous hydrostatic pressures
|
|
|
What is the importance of gastric entrapment from traumatic diaphragmatic hermia pathophysiology?
|
it is a surgical emergency
cuts off gastric emptying gastric air accumulation-> further reduction in tidal volume |
|
|
What are physical exam findings in a patient with traumatic diaphragmatic hernia?
|
respiratory distress with restrictive pattern
dull/absent lung sounds cardiac sounds may be present or muffled depeding on organ location may hear borborygmi in thorax empty abdomen on abdominal palpation OR auscultation may be normal |
|
|
What should you look for in a contrast GI of a patient with diaphragmatic hernia?
|
- looks for presence of GI tract in thoracic cavity
|
|
|
What is a contrast peritoneogram?
|
injection of water-soluble iodinated contrast into the peritoneal sapce
- look for leakage of contrast into pleural space |
|
|
When is traumatic diaphragmatic hernia a surgical emergency?
|
gastric entrapment
severe non-responsive respiratory distress unresponsive shock/tissue perfusion abnormalities |
|
|
How do rib fractures lead to hypoventillation?
|
the pain associated with rib fracture reduces tidal volume which reduces oxygen exchage/ hypoventillation
|
|
|
What causes flail chest?
|
2 or more rib consecutive segments have 2 or more fractures
|
|
|
What breathing pattern will you see with rib fractures?
|
restrictive
|
|
|
How do you treat rib fractures?
|
supplemental oxygen
treat trauma pain management surgery |
|
|
What should be your first treatment for any respiratory emergency?
|
oxygen supplementation
|
|
|
What viruses are involved in BRDC?
|
-IBR
-PI3 -BVDV -BRSV -respiratory coronavirus -adenoviruses -rhinoviruses -herpesviruses |
|
|
What bacteria are involved in shipping fever?
|
Mannheimia hemolytica
Pasteurella multocida Hemophilus somnus Mycoplasma bovis and dispar |
|
|
What is the incubation period of shipping fever?
|
10-14 days post stress, weaning or shipment
|
|
|
What are clinical signs of shipping fever?
|
dyspnea/coughing
nasal discharge abn. lung sounds: - crackles - wheezes - adventitial sounds - pleural friction rubs - absence of sounds where lung consolidation occurs Fever dry cracked muzzle drooping ears anorexia diarrhea lone rangers |
|
|
What is the most frequent isolate from the lungs of animals with BRDC?
|
Mannheimia hemolytica- responsible for most of the deaths and lung damage in feedlot pneumonia
|
|
|
What is the most important strain of BRDC?
|
serotype A1- responsibile for most morbidity
|
|
|
What are the virulence factors of BRDC?
|
-fimbriae
-polysaccharide capsule -lipopolysaccharide -leukotoxin |
|
|
What are signs of Mannheimia?
|
nasal discharge, cough, inappetence, harsh lung sounds, crackles and wheezes, dyspnea
fever bilateral lung lesions in the anterioventral 2/3 of the lung fibrinous exudate on the pleura and the bronchi |
|
|
How is pulmonary clearance reduced in BRVC?
|
-IBR, PI3, BHV-4, BRSV, BVDV< Mycoplasma
-dehydration -dust, smoke, exhaust fumes -temp changes -endotoxin -pulmonary edema -corticosteroids -hypoxia |
|
|
How do you prevent BRVC?
|
1 reduce stress
2 vaccination |
|
|
What is IBR?
|
a ubiquitous herpesvirus that can cause conjunctivitis, central nervous system disease,neonatal calf disease, abortion, infectious pustular vulvovaginitis
|
|
|
What are the respiratory synonyms for IBR?
|
rednose, necrotic rhinotracheitis, dust pneumonia
|
|
|
How is IBR transmitted?
|
animal to animal via dusts, aerosols, and secretions of the respiratory and reproductive tracts
viable outside the body for days at 4C latent infections persist for years and recrudesce to create new outbreaks |
|
|
What are the clinical signs of IBR?
|
sudden onset w/ fever
serous nasal secretions turning to purulent conjunctivitis rales if complicated cough progressing to dyspnea hyperemic nasal mucosa with necrotic plaques |
|
|
How do you diagnose IBR?
|
- clinical signs and necropsy
- virus isolation - paired serology (4-fold rise) - fluorescent antibody testing of tracheal wash cytology or tissues - histopathology - PCR on tissues |
|
|
How do you treat IBR?
|
antibiotics to control bacterial complications, NSAIDS to reduce fever
|
|
|
What is parainfluenza (Pi3)
|
ubuquitous paramyxovirus affecting cattle and sheep
|
|
|
How do you prevent and control PI3?
|
vaccination: IM and IN attenuated and killed
|
|
|
What is the virus that causes BVD?
|
togavirus related to classical swine fever virus and border disease of sheep
|
|
|
What are serotypes?
|
differences demostrated by serum antibody response to specific antigenic epitopes, not usually in general nomenclature
|
|
|
What are biotypes?
|
- cytopathic vs non-cytopathic: related to nature of isolate in cell cultures in lab
|
|
|
What are clinical signs of acute BVD?
|
common
not clinical unless stressed could be fatal but not likely lymphoid cells and platelets affected |
|
|
What are clinical signs of prenatal infections of BVD?
|
infretility
abortion congenital defects of the eyes and brainstem persistent infections and immunotolerante calves small weak calves partial absence of hair normal calf- antibody to virus prior to birth |
|
|
What are the clinical signs of BVD in a persistently infected animal?
|
noncytopathic strain
all offspring will be infected MAJOR SOURCE OF NEW VIRAL STRAINS |
|
|
What are the characteristics of mucosal BVD?
|
-only in persistantly infected
-sporadic -nearly 100% die in 3-10 days -mucosal ulcerations, bloody diarrhea, depression |
|
|
How do you diagnose BVD?
|
serology
virus isolation virus antigen detection immunohistochemistry |
|
|
How do you prevent/control BVD?
|
-eliminate PI animals
-vaccination -management of stress |
|
|
How do you treat BRDC?
|
sulfadimethoxine
antibiotics antipyretics and NSAIDS corticosteroids |
|
|
How do you accomplish mass treatment of BRDC?
|
- by injection of feed or water
- sulfas or tetracyclines |
|
|
What is the sequellae of BRDC?
|
-chronic pneumonia or ill thrift --realizers
-lung abscesses -empyema -right heart failure -chronic bloat/ enlarge lymph nodes impinge on vagus -liver abscesses -arthritis -myopathy |
|
|
How can you prevent BRDC?
|
vaccination: 3 weeks before shipment
metaphylaxis: high risk population |
|
|
What needs to be done for a cow at risk for BRDC?
|
-preconditioning:
-vaccines -weaning |
|
|
What antigens are included in the BRDC vaccine?
|
IBR
PI3 BRSV BVDV Clostridial 7-way M. hemolytica P. multocida |
|
|
Which cows are more likely to get endemic pneumonia?
|
young calves 1-6 mo and both dairy and beef
|
|
|
What are clinical signs of endemic pneumonia of calves?
|
cough
fever anorexia increased respiratory rate to dyspnea weight loss and ill thrift in chronic disease |
|
|
How do you treat endemic pneumonia of cows?
|
antibiotics and sulfas as in BRDC
|
|
|
How do you diagnose endemic pneumonia of calves?
|
culture of tissues or tracheal washes and histopathology
post mortem lesions |
|
|
What are the main characteristics of endemic pneumonia of calves?
|
associated with same viruses as BRDC
damages pulmonary clearance mechanisms disease of calves 1-6mo of age |
|
|
How do you prevent endemic pneumonia of calves?
|
group animals by size and away from older animals
insure adequate colostral intake be sure ventilation is adequate, use calf hutches if possible selective use of vaccines based on investigation of etiology |
|
|
What viruses play important roles in enzootic pneumonia of sheep?
|
a respiratory syncytial virus and PI3 virus
|
|
|
What bacteria play a role in enzootic pneumonia of sheep?
|
Mycoplasma ovipneumoniae
M. hemolytica type A2 Pasteurella multocida Bibersteinia |
|
|
What is a common complication of enzootic pneumonia in lambs that can be fatal?
|
Otitis media
|
|
|
What are the clinical signs of enzootic pneumonia in sheep?
|
cough, fever, depression, rales, dyspnea, inappetence, drooping ears, weight loss
necropsy lesions are antero-ventral but appearance is different because of the anatomical differences between sheep and cattle serum and fibrin are usually present |
|
|
How do you diagnose enzootic pneumonia in sheep?
|
signs, history, necropsy lesions
|
|
|
How do you treat enzootic pneumonia in sheep?
|
antibacterials, ELUD considerations
|
|
|
How do you prevent enzootic pneumonia in sheep?
|
manage stress factors and colostral management
vaccine choice limited to ELUD and PI3 |
|
|
What vaccines can be used for enzootic pneumonia in sheep?
|
ELUD vaccines, really only PI3
M. hemolytica vaccine may offer no protection live Mannheimia hemolytica my be fatal for bighorn sheep |
|
|
Ovine progressive pneumonia is related to what other disease in goats?
|
retroviruses of caprine/arthritis/encephalitis
|
|
|
What causes the symptoms of ovine progressive pneumonia?
|
a non-oncogenic, non-immunosuppressive, retrovirus whose target cell is the macrophage
cellular response to the viral infected cell creates the pathology in the animal |
|
|
What management variables are important in ovine progressive pneumonia?
|
exposure dose, management variables such as ventilation, population density, and breed may influence the extent of disease seen
|
|
|
How is ovine progressive pneumonia transmitted?
|
by colostrum, direct contact with nasal secretions and aerosols but is dependent on cellular transmission
|
|
|
What is the incubation period of ovine progressive pneumonia?
|
1 to 6 months
|
|
|
What are the clinical signs of ovine progressive pneumonia?
|
-no signs before 2 years old
-respiratory system : alveolar cells transform to cuboidal and functional tissue crowded out causing hypoxia -bacterial complications common - weight loss - arthritis, non-indurative mastitis and CNS lesions may accompany the respiratory signs |
|
|
How do you diagnose ovine progressive pneumonia?
|
heavy, non-collapsing lungs that look like liver
serum testing by agar gel immunodiffusion cross reaction to caprine arthritis encephalitis virus histopathology Leukoencephalomalacia in the brain AVID testing ELISA PCR- available at Colorado State University |
|
|
How do you treat ovine progressive pneumonia?
|
there is no treatment; can only treat secondary bacterial invaders
|
|
|
How do you prevent ovine progressive pneumonia?
|
-establish an uninfected flock by serosurvey and culling
-pre-purchase testing, quarantine and retesting after 6 months -orphan rear lambs -90 ft or solid wall between |
|
|
What type of disease is considered to cause the largest economic loss attributable to disease in the swine industry?
|
respiratory diseases
|
|
|
How do respiratory diseases cause loss in swine production?
|
disease is in growing and finishing swine and can lead to outright pneumonia and chronic disease (slow growth)
|
|
|
What is the causative agent of atrophic rhinitis in pigs?
|
Bordetella bronchiseptica and toxigenic strains of pasteurella multocida type D
|
|
|
How is atrophic rhinitis of sheep spread?
|
through contact and aerosol.
|
|
|
What are the clinical signs of atrophic rhinitis?
|
sneezing, rubbing of the nose, ocular discharge, severe lesions may produce dyspnea, cyanosis, paroxysmal sneezing and expelling of mucous and nasal bleeding
chronic combined infections--> facial deformities pneumonia lesions graded 0-5 based on increasing severity and have been correlated with increasing loss in performance and consequent dollar loss |
|
|
How do you diagnose atrophic rhinitis in pigs?
|
history, lesions at necropsy or slaughter checks
disease monitoring and incidence determination by slaughter checks culture |
|
|
How do you treat atrophic rhinitis in pigs?
|
antibiotics and sulfas in water or feed in early stages, no value to chronic disease
medicated early weaning programs |
|
|
How do you prevent/control atrophic rhinitis in pigs?
|
depopulate and repopulate
reduction of infection mass medication medicated early weaning programs vaccination of sows before farrowing control environment and manage ventillation and stress |
|
|
name the 2 clinically significant viral respiratory pathogens of the horse:
|
Equine Influenza
Equine Herpes Virus |
|
|
Describe the significant differences in epidemiology and pathogenesis of the two viral pathogens
|
Equine Influenza: confined to respiratory system, 72 hour diagnosis window, survives better in cold w/ low humidity
Equine Herpes Virus: systemic disease often, leads to abortion, can be spread in utero |
|
|
What are the clinical signs of equine viral respiratory diseases?
|
-sudden onset
-pyrexia -characteristic cough with influenza -serous nasal discharge -conjunctivitis, pharyngitis, laryngitis, tracheitis, bronchitis, lymph nodes of head |
|
|
How do you diagnose equine viral respiratory diseases?
|
virus isolation
hemogram- leukopenia lymphopenia viral detection by PCR |
|
|
How do you treat the equine viral respiratory diseases?
|
supportive therapy
anti-inflammatories antibiotics immunostimulants antiviral drugs |
|
|
Name two primary bacterial respiratory pathogens of the horse:
|
Streptococcus equi
Rhodococcus equi |
|
|
Describe the differences in epidemiology and pathogenesis associated with infection by viral vs primary bacterial respiratory pathogens:
|
Bacterial: tonsilar, strep is in lymph nodes, rhodococcus in macrophages--> accumulation in lung parenchyma, associated with pus, longer incubation time
|
|
|
Describe the general clinical signs associated with infectious respiratory disease:
|
fever, depression, anorexia
mucopurulent nasal discharge swollen lymph nodes |
|
|
Relate the pathopysiologic changs which occur during infectious respiratory disease to clinical signs:
|
fever- host response to invading organism
nasal discharge- attempt to remove organism as it attaches and invades mucosa |
|
|
Describe the difference in signalment and clinical presentation between horses with pleuritis and infection with other primary respiratory pathogens:
|
both will have fever, anorexia, weight loss and depression
pleuritis can be distinguished by pain on pressure over the ribs, a pleural friction rub and absence of airway sounds on ventral chest on auscultation |
|
|
Describe the tests/procedures that are used to definitively differentiate respiratory disease involving only the lung from pleuropneumonia:
|
radiography post- thoracocentesis to identigy changes in the lungs
trachal aspirate to view cytology |
|
|
Describe the normal composition of pleural fluid and the factors that govern pleural fluid production and the changes that occur during pleuropneumonia:
|
composition: low protein, few cells
factors: -plasma oncotic pressure -hydrostatic pressure -capillary permeability -lymphatic drainage changes: increased capillary permeability or decreased lymphatic flow leads to buildup of fluid and fibrin |
|
|
List 3 areas where obstruction of the upper airways of the horse commonly occurs and describe the conditions caused by them:
|
nasal cavities: atheroma, alar fold tissue, nasal septum defects, paranasal sinus abnormalitities, ethmoid hematomas
pharynx/larynx: epiglottic entrapment, dorsal displacement of soft palate, chondromas of arytenoid cartilages, pharyngeal cysts, lymphoid hyperplasia, laryngeal hemiplasia gutteral pouch: tympany, empyema, mycosis |
|
|
What are the two most common clinical signs of upper airway obstruction?
|
inspiratory noise: stridor, blowing
poor performance: exercise intolerance |
|
|
Describe the dynamics of aiirflow in a horse with upper airway obstruction:
|
- collapse occurs at the narrowest portions of the respiratory tract so the horse tries harder
-as a result the velocity of air is increased, there is a decrease in transmural pressure and the collapse gets worse -dynamic collapse during inspiration -other conditions interfere with flow -flow limitations occur and caannot get the flow rate to increase -the horse can't exercise anymore -inspiratory noise and prolonged inspiratory times result |
|
|
Describe the relationship of the clinical signs of upper airway obstruction to the pathophysiologic changes that occur in 2 specific conditions:
|
ex:
stenotic nares: -too small, horse has to work harder to get air in, creates more negative pressure which collapses them, airflow becomes high velocity, high resistance creating a noise |
|
|
abnormal sound production often accompanies upper airway obstruction. Explain this phenomenon.
|
whistlling as airflow is high velocity and turbulent through a small space
|
|
|
Describe the determinants of small airway caliber in the horse:
|
during exercise the horse dilates external nares, vasoconstricts erectile tissue of nasal mucosa, straightens the respiratory tract, and dilates the larynx
|
|
|
Describe the effects of beta and alpha stimulation, xanthine derivatives, atropine and cholinergic stimulation on airway caliber:
|
beta: bronchdilation
alpha: bronchoconstriction xanthine derivatives: |
|
|
Describe the clinical signs that accompany lower airway obstruction of the horse:
|
afebrile
chronic coughing mild exercise intolerance chronic inflammation normal ascultation |
|
|
What si the most commonly accepted etiology of COPD in the horse?
|
allergy
also blamed on poor feeding and watering habits |
|
|
Describe the techniques that may be used to confirm a diagnosis of lower airway obstruction:
|
auscultation and percussion
BAL endoscopy transtracheal aspiration radiography blood gas analysis lung function tests |
