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352 Cards in this Set
- Front
- Back
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What is the importance of carbon dioxide transport in the lungs?
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the lung excretes more than 10,000 mEq carbonic acid per day as a byproduct of oxidative metabolism
kidney excretes less than 100mEq fixed acid per day |
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What are the chemical buffers in the body?
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phosphates, proteins, hemoglobin, HCO3
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How long does it take the respiratory buffering system to kick in?
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minutes to hours
increases respiratory rate, increases alveolar ventillation, decreases [H+] |
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If there is insufficient ventillation to correct acid-base status, what system kicks in?
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renal excretion of H+ but it can take hours to days
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What is CO2's role in the acid base balance?
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it is part of an "open" buffer system that allows continual excretion of acid via the respiratory tract:
CO2 + H2O <--> H2CO3 <--> H+ + HCO3 |
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What pH levels are compatible with life?
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6.8-7.8
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What is the importance of hydrogen ions in the body?
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they influence protein configuration resulting in disruption of enzymatic activity:
Glycolysis myocardial function DNA, RNA syntehsis CNS disturbances metabolic intermediates end up stuck in the cell |
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How is carbon dioxide transported in the body?
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dissolved in plasma according to Henry's law
bicarbonate carbamino compounds (attached to hemoglobin) |
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What is Henry's law?
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the concentration of a gas in a liquid is proportional to its partial pressure
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What is the relationship between partial pressure and concentration for CO2?
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for each mmHg of CO2 dissolved in plasma, there is 0.03mL CO2 per 100mL plasma
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What happens to carbon dioxide within the red blood cells?
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carbonic anhydrase within the red cell catalyzes the reaction for it to become H2CO3 and there is a rapid dissociation to H and HCO3
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What is the Haldane effect?
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deoxygenation of the Hb facilitates uptake of H+
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How does unloading of O2 influence CO2 binding?
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it increases the frequency of CO2 binding to hemoglobin
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What are the measured values in blood gas determination?
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pH
PCO2 PO2 |
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What are the calculated values in blood gas determination?
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HCO3-
Base excess Total CO2 (TCO2) |
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What pH is considered acidemia?
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< 7.35
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What pH is considered alkalemia?
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>7.45
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What is the definition of acidosis?
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it is an abnormal physiologic process in which acid is added to or base is removed from the ECF
|
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What is metabolic acidosis?
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it is when the gain of H+ or the loss of base, typicallly via the kidney, GI tract, or exogenous causes an acidosis
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What is respiratory acidosis?
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an abnormal process in which there is a reduction in alveolar ventilation relative to CO2 production
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What is the definition of alkalosis?
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it is an abnormal physiologic process in which acid is lost from or base is added to the ECF
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What is metabolic alkalosis?
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a process characterized by the loss of H+ or gain of base typically via the kidney, GI tract, or exogenous
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What is respiratory alkalosis?
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it is a process in which tere is an increase in alveolar ventillation relative to CO2 production
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What is a primary disturbance?
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it is a metabolic or respiratory disturbance that initially alters the pH, can be an acidosis or alkalosis which results in an acidemia or alkalemia and is classified as respiratory or non-respiratory
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What is compensation?
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it is a secondary physiologic process that occurs to return the pH back toward normal
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What parameters indicate that the patient is fully compensated?
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the PCO2 and HCO3 values are outside normal limits but the pH is close to normal
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What does compensation tell you about duration?
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it implies chronicity
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What is base excess?
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it indicates an increase or decrease in total body buffers including the CO2-bicarbonate buffer system plus all other buffers
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What is the normal value for base excess?
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normally equal to zero
Dogs: 0 to -5 Herbivores: 0 to +5 |
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What is the numerical relationship between PCO2 and pH in acute respiratory acidosis?
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for every 10mmHg increase in PCO2, there is a 0.08 increase in pH, a 1-2 mEq/L increase of HCO3- and no change in base excess
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What is the relationship between PCO2 and pH in acute respiratory alkalosis?
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for each 10mmHg decrease in PCO2, pH increases 0.1 unit and HCO3 decreases by 1-2 mEq/L
base excess does not change |
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What is the relationship between PCO2 and pH in chronic respiratory acidosis?
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for each 10mmHg increase in PaCO2, bicarbonate increases by 3-4 mEq/L which results in pH returning toward normal
BE increases indicating addition of buffer base |
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What is the relationship between PCO2 and pH in chronic respiratory alkalosis?
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for each 10mmHg decrease in PaCO2, bicarbonate decreases by 4-5 mEq/L, BE decreases indicating a loss of buffer base
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What does a negative base excess indicate?
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metabolic acidosis
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What does a positive base excess indicate?
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metabolic alkalosis
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What is the maximum reduction in PaCO2 to sustain life?
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no lower than 15-20mmHg
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What can cause a respiratory acidosis?
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anesthesia or other respiratory depressent drugs
Head trauma obesity respiratory disease or obstruction thoracic trauma Opioids |
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What can cause a respiratory alkalosis?
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hypoxia
fever pneumoia, pulmonary embolus anxiety, fear left to right shunts iatrogenic endotoxemia |
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What laboratory error will cause PCO2 to be decreased?
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contamination of the sample with air
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What is the definition of pulmonary clearance?
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it is the sum total of all host mechanisms that protect the respiratory system from injury by external agents
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What is the dynamic equilibrium of pulmonary clearance?
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inhaled particles continuously brought in and deposited. clearance mechanisms continuously remove deposited particles so the net accumulation is 0
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What is the mucociliary escalator?
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it traps particles on a mucus sheet and moves it toward the pharyx so it can be coughed up or swallowed
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What are the components of the mucociliary escalator?
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mucus sheet- generated by goblet cells, sticky layer traps particles like fly paper
ciliated epithelium- rows the mucus toward the pharynx |
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What are PAM's?
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Pumonary-Alveolar macrophages that traffic through the lung and phagocytize particles that reach the alveoli
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What is the relationship between surface area and volume in large tubes vs small tubes?
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low in large tubes (trachea) but high in small tubes (bronchioles)
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What disease processes depend on surface area?
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inflammation,
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What disease processes depend on surface area?
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inflammation,
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What disease processes impinge on volume?
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obstruction of air flow
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What disease processes impinge on volume?
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obstruction of air flow
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What radiographic technique should be used to radiograph the lungs?
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High kVp 85-100, low mAs (short exposure time), peak inspiration
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What projections are generally used for small animal lung radiographs?
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one lateral, VD/DV
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What projections are generally used for large animal lung radiographs?
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four lateral projections
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What projections should be used for lung radiographs in a foal?
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2 lateral projections: VD if animal is small enough
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What radiographic projections should be used for metastatic examination in the lungs?
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right and left lateral projections, VD/DV
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Which lobes are better evaluated in a lateral radiograph?
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the non-recumbent lung lobes because they will be fully inflated
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Which lobes are better evaluated on standing projections of large animals?
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the lobes closer to the film are sharper
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What are the pulmonary patterns of disease in lungs?
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vascular
bronchial interstitial alveolar |
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What changes will you see in a vascular pulmonary pattern on radiographs?
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increased or decreased prominence of the pulmonary vascular structures
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What causes a bronchial pulmonary pattern on radiographs?
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fluid and/or cellular material within the bronchial wall, bronchial lumen, and/or peribroncial space, commonly associated with chronic inflammation and hypersensitivity, mineralization
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What is the radiographic appearance of a bronchial pulmonary pattern?
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doughnuts and tram-lines
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How would you diagnose the cause of a bronchial pulmonary pattern?
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trans-tracheal wash
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What causes an interstitial pattern on lungs?
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accumulation of fluid and/or cells in the pulmonary interstitial space- connective tissue between the airway and alveoli
can be structured/nodular or unstructured |
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What is the radiographic appearance of unstructured interstitial patterns?
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soft tissue haze that obscures the pulmonary vasculature due to fluid and/or cells in the interstitium
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What is the radiographic appearance of structured/nodular interstitial patterns?
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round, soft tissue opacities that have shape and form
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What causes an alveolar pulmonary pattern on radiographs?
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displacement of air fromt he distal spaces of the lung
flooding of the pulmonary acini fluid spreads and causes collapse of the airway |
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What is the characteristic radiographic appearance of an alveolar pulmonary pattern?
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Air bronchograms
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How do you diagnose the cause of an interstitial pulmonary pattern?
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FNA if structured, transtracheal wash if unstructured
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How do you diagnose the cause of an alveolar pulmonary pattern?
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with transtracheal wash or bronchoalveolar lavage
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What type of radiographic pattern is it if an entire lung lobe is collapsed?
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Alveolar
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What can cause artifacts on lung radiographs?
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underexposure- lungs too white
films during expiration- lungs too white, cranial displaced diaphragm overexposure- lungs too black |
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What does pulmonary metastasis look like radiographically?
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non-cavitated structured interstitial pattern that contains multiple, round, soft tissue nodules of various sizes usually in the middle to peripheral aspect of the lungs
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What does fungal pneumonia look like radiographically?
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nodular pattern distributed throughout the lungs, all nodules the same size
tracheobronchial lymphadenopathy frequently seen structured/nodular interstitial patterns |
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What are the differentials for a thoracic wall lesion on radiographs?
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primary lung tumor
pulmonary metastasis lymphosarcoma granuloma traumatic bulla hematoma abscess cyst mucus-filled bronchus |
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What does a primary lung tumor look like radiographically?
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usually solitary, usually in the periphery, can be cavitated if it communicates with a bronchus
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What does a pulmonary abscess look like radiographically and how do you diagnose it?
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thick, irregularly margined wall
confirm with cytology |
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What does paragonimiasis look like radiographically?
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well defined pulmonary masses with central lucency
generally the interstitial space adjacent to the bronchus |
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What does a pulmonary bulla look like radiographically?
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spherical radiolucent areas, smooth, thin walls
Pulmonary bleb if in a subpleural location |
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What are the differential diagnoses for an unstructured interstitial pattern?
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geriatric thorax
pulmonary edema non-cardiogenic pulmonary edema atelectasis pulmonary hemorrhage/ contusion bacterial pneumonia aspiration pneumonia pulmonary embolism lung lobe torsion |
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What is a geriatric thorax and what does it look like radiographically?
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unstructured interstitial/ alveolar pattern
interstitial fibrosis which the severity depends on amt of pollutants inhaled, occurs in older animals |
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What is the radiographic distribution of cardiogenic pulmonary edema?
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interstitial lung pattern or alveolar if severe and is distributed in the hilar and perihilar regions
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What does cardiogenic pulmonary edema look like in cats radiographically?
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it can look like anything
very irregular distribution look for cardiac changes to confirm |
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What can cause non-cardiogenic pulmonary edema?
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Neurologic: head trauma, seizure, electric shock
Severe allergic reaction advanced uremia pancreatitis irritating inhalants drowning radiation damage |
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What does non-cardiogenic pulmonary edema look like radiographically?
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generalized distribution compared to cardiogenic edema, heart and pulmonary vein size usually normal, peripheral distribution more common
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What can cause atelectasis on radiographs?
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incomplete aeration (prolonged recumbency, incomplete aeration)
airway obstruction increased intrapleural pressure (pneumothorax, pleural effusion) |
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What lung pattern is caused by pulmonary hemorrhage/contusion?
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interstitial or alveolar
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What can cause pulmonary hemorrhage or contusion?
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trauma (look for other signs), coagulopathy
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What radiographic lung pattern is caused by bacterial pneumonia?
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interstitial or alveolar
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What does bacterial pneumonia look like radiographically?
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interstitial/alveolar
focal or multifocal distribution Brochial- usually lobar Hematogenous- patchy multifocal distribution |
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What does aspiration pneumonia look like radiographically?
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interstital or alveolar pattern
distribution depends on patient position at the time of aspiration passive- right cranial, right middle forceful- right caudal Right middle lung lobe most commonly affected with megaesophagus |
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Which lung lobe is commonly affected with megaesophagus?
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right middle lung lobe
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How can you identify pulmonary embolism radiographically?
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may see blunting distal to the obstruction although radiographs are insensitive for this problem
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Which lung lobe is most commonly effected by lung lobe torsion?
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right middle lung lobe
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What does lung lobe torsion look like radiographically?
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alveolar pattern- early
lung lobe sometimes has multiple gas bubbles in it, consolidated lobe and abrupt termination of the bronchus |
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What species generally get allergic bronchitis?
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cats
peribronchial infiltrate of eosinophils and mononuclear cells |
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How does viral bronchitis differ between cats and dogs?
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dogs get tracheobronchitis, cats get upper respiratory disease
usually not seen unless complicated by secondary bacterial infection |
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What are the differentials for a bronchial pattern on radiographs?
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allergic bronchitis (cat)
viral bronchitis (dog or cat) Bronchiectasis |
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What is the pattern of disease in bronchiectasis?
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loss of normal bronchial tapering leads to changes in the epithelium, mucus characteristics and ciliary function and exudate accumulates causing an interstitial or alveolar pattern
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What causes hyperlucent lungs?
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overexposure
hypovolemia |
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What can cause focal pulmonary mineralization on radiographs?
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bronchial mineralization
pulmonary osteomas granulomas histoplasmosis primary lung tumor aspirated barium sulfate |
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What causes diffuse pulmonary mineralization on radiographs?
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hyperadrenocorticism
hyperparathyroidism chromic uremia idiopathic |
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What does bacterial pneumonia in large animals look like radiographically?
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usually bilateral, ventral distribution,
Interstitial/alveolar abscess or granuloma formation possible |
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What does rhodococcus equi pneumonia look like radiographically?
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it is more common in foals
multiple "fluffy" soft tissue masses that may be cavitated |
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What do pulmonary abscesses in large animals look like radiographically?
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soft tissue masses with cavitated center, thick, irregular walls
hidden within interstitial/alveolar disease |
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What is COPD in large animals and what does it look like radiographically?
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air trapping- inspiration and expiration films are similar
reticulated interstitial pattern possible bronchiectasis |
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What is the process of respiratory body buffering?
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increased respiratory rate, increased alveolar ventilation that decreases hydrogen ion concentration
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Why is carbon dioxide considered part of an "open" buffer system?
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it allows continual excretion of acid through the respiratory tract, and the Law of Mass Action
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How does the pH relate to electrolyte concentration?
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equal to one millionth the millimolar concentration of Na+, K+, and Cl-
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What pH is compatible with life?
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between 6.8 and 7.8
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What is Henry's Law?
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the concentration of a gas in a liquid is proportional to its partial pressure- relates to how much carbon dioxide is dissolved in plasma
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What are the two carbon compounds that are dissolved in plasma?
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Bicarbonate
Carbamino compounds |
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How much CO2 is dissolved in plasma per 100ml per each mmHg CO2
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0.03mL CO2 per 100mL plasma for each mmHgCO2
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How does the concentration of dissolved oxygen relate to its partial pressure?
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for each mmHg of O2, 0.003mL of oxygen per 100mL plasma
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How is CO2 transported in the blood as bicarbonate?
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CO2 diffuses into the RBC, carbonic anhydrase within the red cell catalyzes conversion to H2CO3 with water, rapid dissociation of carbonic acid to H+ and HCO3-
Bicarbonate diffuses out of the cell and H+ combines with hemoglobin |
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What is the Haldane effect?
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deoxygenation of Hb facilitates uptake of H+
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How is CO2 transported as carbamino compounds?
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CO2 combines with the terminal amine groups of blood proteins creating "Carbamino-hemoglobin"
deoxygenated Hb facilitates binding |
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How does the CO2 dissociation curve relate to the O2 dissociation curve?
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it is more linear
unloading of oxygen into the tissues increases the affinity of the Hb for CO2 |
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Why should blood gas samples be anaerobic and measured immediately?
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RBC metabolism will decrease O2 and increase CO2
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What values on blood gas are measured?
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pH
PCO2 PO2 |
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What values on blood gas are calculated?
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HCO3-
Base Excess Total CO2 |
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What is a normal base excess?
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-5 to +5
species dependent |
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What pH is considered acidemia?
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pH < 7.35
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What pH is considered alkalemia?
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pH >7.45
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What is the definition of acidosis?
|
an abnormal physiological process in which acid is added or base is removed from the ECF
|
|
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What is the definition of metabolic acidosis?
|
an abnormal process characterized by the gain of H+ or the loss of base, typically via the kidney, GI tract, or exogenous
|
|
|
What is the definition of alkalosis?
|
an abnormal physiologic process in which acid is lost or base is added to the ECF
|
|
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What is the definition of metabolic alkalosis?
|
an abnormal process characterized by the loss of H or gain of base, typically via the kidney, GI tract, or exogenous
|
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What is the definition of respiratory alkalosis?
|
an abnormal process in which there is an increase in alveolar ventilation relative to CO2 production
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At what values is the patient considered fully compensated?
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if PCO2 and HCO3 values are outside normal limits, but the pH is close to normal
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What does base excess indicate about body buffers?
|
it indicates an increase or decrease in total body buffers which includes the CO2 bicarbonate buffer system plus all other buffers:
plasma proteins phosphate buffers |
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How does normal base excess differ between small and large animals?
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dogs and cats: 0 to -5
herbivores 0 to +5 |
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How does an increase in PCO2 change pH in respiratory acidosis?
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for each 10mmHg increase in PCO2, pH decreases by 0.08 units
|
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How does PCO2 change pH in respiratory alkalosis?
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for each 10mmHg decrease in PCO2, pH increases 0.1 unit
|
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How does base excess change in chronic respiratory acidosis?
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it increases, indicating addition of buffer base
|
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How does base excess change in chronic respiratory alkalosis?
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base excess decreases indicating loss of buffer base
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What does base excess tell you about the process of acidosis/alkalosis?
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BE=0 then no metabolic component present
BE negative= metabolic acidosis BE positive= metabolic alkalosis |
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How does chronic elevation of PaCO2 change the concentration of HCO3-?
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for each 10mmHg increase in PaCO2, HCO3- will increase by 4mEq/L
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How does PaCO2 relate to HCO3- during chronic metabolic acidosis?
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PaCO2 is reduced 1.5mmHg for each 1mEq/L decrease in HCO3-
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What is the rule of thumb for PaCO2 and HCO3- during chronic metabolic alkalosis?
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PaCO2 increases 0.6mmHg for each 1 mEq/L increase in HCO3-
|
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What can cause respiratory acidosis?
|
anesthesia, respiratory depressent drugs
Head Trauma Obesity Respiratory disease or obstruction Thoracic trauma |
|
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What can cause respiratory alkalosis?
|
hypoxia
fever pneumonia, pulmonary embolus anxiety, fear left to right shunts iatrogenic endotoxemia |
|
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What is the equation for total CO2?
|
TCO2= 0.03(PaCO2) + [HCO3-]
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What is the effect of contamination with air of the arterial blood gas sample?
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PCO2 will be decreased and PO2 will be increased
|
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What is the dynamic equilibrium of the lung?
|
inhaled particles continuously brought in and deposited; clearance mechanisms continuously removed deposited particles
|
|
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What is the mucociliary escalator?
|
it traps particles on a mucous sheet and moves it toward the pharynx- generated by goblet cells and "rowed" up by the ciliated epithelium
|
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How does the surface area to volume ratio change as you move from the trachea to the lungs?
|
it is low in the large tubes but high in the small tubules (bronchioles)
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What types of disease processes are dependent on surface area?
|
inflammation where SA is large with respect to volume
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What types of disease processes impinge on volume?
|
obstruction of air flow most important where volume is small
|
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What are the functions of the nasopharynx?
|
conduction of air
filtration of air clearance of particles air modification: temp and humidity |
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What are developmental disease of the nasopharynx that obstruct air flow?
|
brachycephaly- short nasal, maxillary bones -> narrow lumen
K9 stenotic nares K9/horses with alar fold abnormalities |
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What inflammation diseases of the nasopharynx obstruct air flow?
|
viral
bacterial parasitic fungal immune mediated 2ndary extension |
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What viral diseases of the nasopharynx cause obstruction of air flow?
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IBR, FVR, CDV, Eq herpes, flu
|
|
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What bacterial diseases of the nasopharynx obstruct air flow?
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pasteurella, bordetella, streptococcus
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What types of space occupying masses obstruct air flow in the nasopharynx?
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neoplasms- SCCA, AdenoCA, melanoma
Inflammatory polyps Granulomas and abscesses |
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What is palatoschisis and how does it affect the nasopharynx and respiration?
|
cleft palate- the nasal cavity becomes contaminated by oral contents and can lead to aspiration
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What is atrophic rhinitis of swine and what is its effect on respiration?
|
pasteurella and bordetella that inhibit osteoblasts
decrased turbinates, increased particulates, decreased temp, decreased humidity all lead to lower respiratory tract disease |
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What is the surface ratio and volume of the nasopharynx?
|
moderate surface area, low functional volume- high SA/Vol so it is easily obstructed and inflammatory disease is important
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Why is obstruction of the nasopharynx not life threatening?
|
auxillary air flow through the mouth
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How does destruction or modification of the filter function of the nasopharynx affect the respiratory system?
|
it predisposes the patient to lower respiratory tract disease
|
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What are the functions of the larynx?
|
air conduction
air filtration/ clearance protects lower respiratory tract during deglutition |
|
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Describe the surface area and volume of the larynx?
|
narrow lumen= small volume
small surface area SA/Vol ration= high, easily obstructed |
|
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What causes developmental obstruction of the larynx?
|
usually partial
elongated soft palate- K9 hypoplasia of the epiglottis and epiglottal entrapment- Eq |
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What is Rorers in horses and how does it affect the larynx?
|
laryngeal hemiplagia in horses
damage to left recurrent laryngeal nerve leads to circoarytenoideus dorsalis muscle atropy, incomplete abduction of the vocal fold- partial obstruction- fold "flutters" |
|
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What types of inflammation can obstruct air flow through the larynx?
|
edema, exudate
viral- IBR, MCF bacterial- Fusobacterium, Hemophilus, calf diptheria trauma- edema and swelling |
|
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What types of neoplasms can obstruct air flow in the larynx?
|
papillomas, carcinomas
|
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What diseases can cause failure of the larynx to close during deglutition?
|
paralysis- rabies, white muscle disease
|
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Is obstruction of the larynx life threatening and why?
|
yes it is life threatening because there is no auxillary flow
|
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What are the functions of the trachea and bronchi?
|
air conduction and filtration
clearance- mucociliary escalator |
|
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Describe the volume and surface area of the trachea and bronchi?
|
volume- moderate
surface area- small SA/Vol- low |
|
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How do obstructions of the trachea and bronchi differ in importance between large and small animals?
|
they are relatively unimportant in large animals, and important in small animals
|
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What developmental defects can cause obstruction of air flow in the trachea?
|
collapsed trachea
|
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What viral diseases can cause obstruction of air flow in the trachea and bronchi?
|
IBR, FVR, laryngotracheitis, adenovirus, paramyxoviruses
|
|
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What parasites can obstruct air flow in the trachea and bronchi?
|
Dictyocaulis, Syngamus, Metastrongylus
|
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What immune-mediated diseases can cause obstruction of air flow in the trachea and bronchi?
|
asthma
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How does exudation obstruct the trachea and bronchi?
|
fibrinogen polymerizes the fibrin that sticks to surface --> fibrinogenic membrane
|
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What disease causes decreased filtration in the trachea and bronchi?
|
Bronchiectasis- dilation of the bronchi beyond physiologic limits
Scar tissue contracture around the airway Weakening of bronchial wall |
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How does ciliary dyskinesis result in decreased clearance in the trachea and bronchi?
|
the cilia don't function properly and cannot move the mucus sheet
Cartaginar syndrome in humans |
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How does physical impairment lead to decreased clearance of the trachea and bronchi?
|
it decreases temperature and can also lead to dehydration of the air
|
|
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What can cause chemical impairment of the clearance mechanisms of the trachea and bronchi?
|
SO2, NH3, Ozone, air pollutants
|
|
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How does inflammation result in decreased clearance of the trachea and bronchi?
|
it changes the composition of the mucus
edema creates thin mucus so it cannot be move dup and out |
|
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What are the effects of Ciliary-associated respiratory bacillus?
|
it interrupts the beating of the cilia so the trachea and bronchi cannot clear invading organisms
|
|
|
What is the most important disease mechanism in the trachea and bronchi?
|
decreased clearance because it predisposes the patient to lower tract disease
|
|
|
What are the functions of the bronchioles?
|
air conduction- volume dependent
clearance- surface area dependent |
|
|
Describe the surface area and volume of the bronchioles:
|
the volume of the individual brochioles is very small, the volume of the total bronchioles is very large
SA/Vol is very high- easily obstructed |
|
|
Why do aerogenous particles deposit in the bronchioles?
|
because the total volume is high there is a rapid decrease in air velocity
the accumulation of particles predisposes to inflammation |
|
|
What is the difference in severity between the focal and diffuse lesions in the bronchioles?
|
focal lesions are generally not serious because there are many individuals
diffuse lesions are significant because of complete obstruction |
|
|
How does inflammation obstruct airflow in the bronchioles?
|
it narrows the airway lumen- inhibits air flow
destroys surface cells- inhibits clearance rapidly spreads to alveoli- pneumonia chronic inflammation- proliferation, mucus secretion, obstruction |
|
|
What viruses cause inflammation of the bronchioles?
|
CDV, measles, adenovirus, BRSV, herpesvirus, PI3, Influenza
|
|
|
What bacteria cause inflammation in the bronchioles?
|
pasturella, bordetella, hemophilus, strep, corynebacterium
|
|
|
What immune mediated diseases cause inflammation of the bronchioles?
|
asthma (cats), COPD (horses)
|
|
|
Where is the primary site of particle accumulation in the respiratory system?
|
the bronchioles
|
|
|
What is the function of the alveoli?
|
gas exchange
|
|
|
Describe the anatomic geometry of the alveoli:
|
SA/Vol on individual alveoli is very high and restriction is important
Total alveolar SA and Vol is very large and focal disease is not as important as diffuse |
|
|
What is the function of the large surface area of the alveoli?
|
it absorbs things including toxic substances, by-products of pathogens, inflammatory cells
|
|
|
Describe the air-blood barrier in the alveoli:
|
very thin, SQ cells, type I pneumocytes, endothelium, narrow interstitial space
|
|
|
What diseases decrease gas exchange in the lung alveoli?
|
Pneumonia:
Bronchopneumonia Interstital pneumonia Atelectasis Emphysema Pulmonary edema |
|
|
What is bronchopneumonia?
|
it is inflammation centered on the bronchioles with secondary spread to alveoli
usually anterior-ventral distribution |
|
|
What is interstitial pneumonia?
|
it is inflammation centered on the air-blood barrier
hilar to diffuse distribution can be exudative or non-exudative |
|
|
What can cause interstitial pneumonia?
|
septicemia, viremia
3MI, O2, paraquat toxin Type I, II hypersensitivity |
|
|
What is the sequellae of pneumonia?
|
systemic hypoxia
if exudate accumulates it decreases gas exchage if pneumonia is cleared without necrosis--> recovery if lung parenchyma destroyed then it leads to fibrosis and decreased gas exchange |
|
|
What is atelectasis and what is its affect on gas exchange?
|
it is collapse or failure of the alveoli to inflate
it leads to decreased ventillation and therefore decreased gas exchage can be caused by fluid, space-occupying mass, loss of negative pressure or obstruction of airways |
|
|
What is metastrongylus and what is the affect on the respiratory system?
|
Porcine lungworms that leads to atelectasis
|
|
|
What is the definition of emphysema and what is its affect on gas exchange?
|
abnormal permanent enlargement of the air spaces distal to the terminal bronchiole accompanied by destruction of walls
increased compliance and decreased elasticity- can't expel air decreased gas exchange, decreased surface area |
|
|
What is the most common type of emphysema?
|
interstital emphysema- air in the interlobular septae
|
|
|
What can cause edema in the alveoli?
|
increased pulmonary hydrostatic pressure from heart failure, shock, hypertension, iatrogenic
capillary damage from vascular or alveolar side of air-blood barrier lymphatic obstruction- space-occupying masses in the mediastinum |
|
|
What, other than pneumonia causes decreased gas exchange in the alveoli?
|
hemorrhage
embolism infarction space-occupying masses |
|
|
How does renal amyloidosis lead to respiratory disfuction?
|
you lose antithrombin III which can lead to embolisms
|
|
|
What is the function of the pleural cavity?
|
it supports mechanical ventillation
expansion volume negative pressure |
|
|
Describe the anatomic geometry of the pleural cavity:
|
volume is moderately large but occupied by the thoracic viscera
surface area is moderate SA/Vol is high so restriction is an important process |
|
|
What diseases cause decreased volume of the pleural cavity?
|
fluid accumulation
-Hydrothorax -Chylothorax -Hemothorax Inflammation Space-occupying masses |
|
|
What diseases can cause loss of negative pressure in the pleural cavity?
|
air accumulation in the pleural cavity
Trauma Ruptured lung |
|
|
What diseases cause impairment of ventilation?
|
Acute pleuritis- painful
Chronic pleuritis- fibrous adhesion |
|
|
What are the descriptive characteristics of pulmonary lesions?
|
Distribution
Size and shape Weight Consistency Color Contour |
|
|
What is usually the most obvious change in pulmonary pathology?
|
color
|
|
|
What components make up the color of the lung?
|
lung tissue (white)
other tissue and cells (white) Blood (red) Air (clear) |
|
|
What does it mean in general when the lung is darker than normal in color?
|
relatively more blood, tissue, less air
usually= congestion, atelectasis |
|
|
What does it mean when the lung is lighter than normal in color?
|
relatively more air, clear fluid, less blood, more cells
Processes causing light color can be masked by processes causing dark color |
|
|
What does an anterior-ventral pattern of lung pathology indicate?
|
Airborne pathogenesis
Bronchopneumonia Firm consistency (consolidation) Dark early, light late WELL DEMARCATED Fluid, exudate, or cut surface Variable extent |
|
|
Why does an anterior-ventral patter start dark and become light?
|
early on there is congestion and exudation but later the blood is absorbed and pressure impedes further blood flow
|
|
|
What does bovine pasteurellosis look like on pathology?
|
causes bronchopneumonia with an anterior-ventral pattern
dark bluish-reddish firm hepatization well demarcated |
|
|
What does a hilar pattern indicate in lung pathology?
|
vascular pathogenesis
Roughly semicircular around the hilus may be firmer than norma dark/denser than normal wet or dry on cut surface variable extent POORLY DEMARCATED can be interstitial pneumonia, pulmonary edema |
|
|
What type of pathologic pattern is caused by interstitial pneumonia?
|
a hilar pattern
|
|
|
What does a diffuse pattern on lung pathology indicate?
|
extension of a hilar pattern
minimal or no normal for contrast so difficult to tell other patterns may be superimposed congestion (dark), edema (wet), dense |
|
|
If you have a dark, heavy, wet, dense lung what type of pattern is it likely?
|
diffuse pattern
|
|
|
What does an agonal pattern look like on the lungs?
|
one lung will have a diffuse pattern
most animals die on their side |
|
|
What does a miliary pattern on the lungs indicate pathologically?
|
an embolic shower
Dark-red: hemorrhage, endothelial damage, platelet defect, DIC light: necrosis, inflammation |
|
|
What does a light colored milliary pattern indicate in lung pathology?
|
necrosis, inflammation
septicemia metastatic tumors |
|
|
What does a dark/red milliary pattern indicate in lung pathology?
|
hemorrhage, endothelial damage, platelet defect, DIC
|
|
|
What type of lung pattern is caused by metatstatic hemangiosarcoma?
|
a dark red milliary pattern
|
|
|
What does a dark focal pattern on lung pathology indicate?
|
hemorrhage, infarct, atelectasis, pigment, neoplasm
|
|
|
What does a light focal pattern on lung pathology indicate?
|
abscess, granuloma, neoplasm
|
|
|
What is a common neoplasm that metastasizes to the lung?
|
oral melanoma in dogs
|
|
|
What does a uniform multifocal pattern on lung pathology indicate?
|
same age, rate of growth
hemorrage, necrosis, emboli "recent if small" |
|
|
What does a nonuniform multifocal pattern indicate on lung pathology?
|
different ages, growth rates
abscesses, neoplasm "older, recurring processes" |
|
|
What type of lung pattern is caused by metastatic chondrosarcoma on pathology?
|
a nonuniform multifocal pattern
|
|
|
What does size indicate about lung pathology?
|
tiny usually indicates a recent event
large lesions are usually older than small nonuniform lesions are separated by time |
|
|
What types of disease can cause a mutifocal coalescing pattern on lung pathology?
|
feline pulmonary histoplasmosis
bronchogenic carcinoma |
|
|
What is the pathognemonic lesion for feline pulmonary histoplasmosis?
|
miliary to coalescing pattern
|
|
|
What does a lung that is smaller than normal indicate?
|
atelectasis
dense color, wrinkled pleura |
|
|
What does a lung that is larger than normal indicate?
|
emphysema
interstitial pneumonia light color, light weight, don't collapse, rib impressions |
|
|
What do distinct geometric shapes and arrangements of lung pathology suggest?
|
they suggest a process that highlights anatomic structures: airways, lobules, vascular subunits
|
|
|
What type of lung pattern is caused with murine respiratory mycoplasmosis?
|
symmetrical linear arrays of ectatic pus-filled airways
|
|
|
What does a heavier than normal lung indicate about the pathology?
|
something is added
fluid- congestion/ hemorrhage, edema cells/tissue- inflammatory exudate, hyperplasia/ neoplasia |
|
|
What does a lighter than normal (in weight) lung indicate?
|
relatively more air- emphysema, distended septae
|
|
|
What type of lung pattern is caused by metastatic chondrosarcoma on pathology?
|
a nonuniform multifocal pattern
|
|
|
What does size indicate about lung pathology?
|
tiny usually indicates a recent event
large lesions are usually older than small nonuniform lesions are separated by time |
|
|
What types of disease can cause a mutifocal coalescing pattern on lung pathology?
|
feline pulmonary histoplasmosis
bronchogenic carcinoma |
|
|
What is the pathognemonic lesion for feline pulmonary histoplasmosis?
|
miliary to coalescing pattern
|
|
|
What does a lung that is smaller than normal indicate?
|
atelectasis
dense color, wrinkled pleura |
|
|
What does a lung that is larger than normal indicate?
|
emphysema
interstitial pneumonia light color, light weight, don't collapse, rib impressions |
|
|
What do distinct geometric shapes and arrangements of lung pathology suggest?
|
they suggest a process that highlights anatomic structures: airways, lobules, vascular subunits
|
|
|
What type of lung pattern is caused with murine respiratory mycoplasmosis?
|
symmetrical linear arrays of ectatic pus-filled airways
|
|
|
What does a heavier than normal lung indicate about the pathology?
|
something is added
fluid- congestion/ hemorrhage, edema cells/tissue- inflammatory exudate, hyperplasia/ neoplasia |
|
|
What does a lighter than normal (in weight) lung indicate?
|
relatively more air- emphysema, distended septae
|
|
|
What is crepitance and what does it indicate about lung pathology?
|
it means it is air-filled which is normal
|
|
|
What does firm consistency of the lungs indicate about pathology?
|
consolidation, pneumonia
|
|
|
What does structural integrity on the cut surface of the lung indicate about pathology?
|
viable, organized tissue, likely neoplasia/ hyperplasia
|
|
|
What does a spreadable consistency on the cut surface of the lung indicate about pathology?
|
necrosis, exudate
|
|
|
What does canine lymphomatoid granulomatosis cause pathologically on the lung?
|
the cut surface is smooth and not spreadable
|
|
|
What does the cut surface of the lung look like with murine respiratory mycoplasmosis?
|
exudate in the airways makes it spreadable
|
|
|
What does a raised contour on the lungs indicate about pathology?
|
something has been added
cells, tissue, fluid, air |
|
|
What does depressed contour on the lungs indicate about pathology?
|
something removed
necrosis air (atelectasis) |
|
|
What might cause a raised lesion on the lungs?
|
neoplasia
abscess granuloma |
|
|
What type of lung lesion is caused by metastatic thyroid carcinoma ?
|
raised contour
|
|
|
What type of lung lesion is seen with porcine lungworms?
|
depressed areas of atelectasis, well demarcated
|
|
|
What are well demarcated margins and what causes them?
|
abrupt interface between normal and abnormal
abscesses, granulomas, neoplasms |
|
|
What are poorly demarcated margins and what causes them?
|
blurred intervace
poorly contained inflammation, fluids |
|
|
What are the causes of obstructive disease in the large airways?
|
stenotic nares
redundant soft palate laryngeal hemiplagia tracheal compression/collapse compression of left mainstem bronchus |
|
|
What are the causes of obstructive disease in the small airways?
|
chronic bronchitis
asthma emphysema edema |
|
|
What restrictive diseases of the respiratory system are structural?
|
pulmonary fibrosis
surfectant deficiency space-occupying lesion |
|
|
What neuro-muscular diseases cause restriction of the respiratory system?
|
CNS
neuromuscular transmitter muscular |
|
|
What can cause thickening of the diffusion membrane in the respiratory system?
|
pulmonary edema
pneumonia RARE |
|
|
What can impair diffusion by affecting the surface area of the respiratory system?
|
emphysema
atelectasis |
|
|
What is the most common result of disability due to lung disease?
|
ventilation < perfusion
|
|
|
What does cyanosis indicate about blood oxygen?
|
>5G reduced hemoglobin per 100mL arterial blood
|
|
|
What does a hacking cough indicate vs a subtle cough?
|
hacking- due to large airways injury
subtle- due to parenchymal injury |
|
|
What causes tachypnea?
|
lung injury
|
|
|
What causes hyperpnea?
|
blood gas derangement
|
|
|
What causes a vesicular breath sound?
|
high velocity gas flow
normally in the trachea |
|
|
What is an adventitious breath sound and where is it made?
|
it is crackles that are created in the bronchi
|
|
|
What can cause a hyperresonant percussion of the lungs?
|
pneumothorax
air trapping gastric tympany |
|
|
What can cause a dull percussion of the lungs?
|
pneumonia
edema hemothorax |
|
|
What can be behavioral symptoms of respiratory disease?
|
reluctance to lay down
adducted thoracic limbs extended neck bloat bulging eyes flaring nares ripped strap muscles heave line exercise intolerance |
|
|
What is the main respiratory determinant of PaCO2?
|
alveolar ventilation
low- respiratory alkalosis high-respiratory acidosis |
|
|
What does low PaO2 indicate?
|
low FIO2
reduced alveolar ventilation V<Q shunt diffusion barrier- rare |
|
|
What respiratory signs can cause low pHa?
|
anything that elevates PaCO2
increased metabolic activity |
|
|
What does a blunted peak on the maximal expiratory flow-volume curve indicate?
|
elevated large airways resistance
decreased elastic recoil of lung decreased effort |
|
|
What does a concave (up) tail on the flow-volume curve indicate about lung pathology?
|
COPD
|
|
|
What does a decreased TV/VC on spirometry indicate?
|
restrictive lung disease
|
|
|
What does an increased FRC on spirometry indicate?
|
obstructive lung disease
|
|
|
What does a prolonged FEV1/ timed VC on spirometry indicate?
|
obstructive lung disease
|
|
|
What is the concept of frequency dependency of compliance in regards to the respiratory system?
|
if you breath slowly, there is less resistance to flow
the lung appears most compliant when you are breathing slowly |
|
|
Where are vesicular breath sounds made?
|
in the large airways (trachea)
|
|
|
What is the equal pressure point in the bronchopulmonary tree?
|
it is where the pressure inside equals the pressure outside
|
|
|
When the pressure outside the airway is greater than the pressure inside, where will the airway collapse?
|
the trachea will collapse on inspiration and the chest will collapse on expiration
|
|
|
How can you tell physically that an animal is experiencing hyperpnea?
|
the nares flare and the cupula sucks in
|
|
|
On an ECG, what would a normal sinus respiratory arrhythmia look like?
|
3-4 beats per breath, if it is any more, then likely there is difficulty breathing
|
|
|
What do cacauphonous breath sounds indicate about lung pathology?
|
shrunken, gnarled lungs
often the patient will bring their arms out to help aerate lungs |
|
|
What radiographic signs are typical of right ventricular enlargement?
|
air in esophagus because the pleural pressure is more negative, liver full of blood, small lungs, bloat?
|
|
|
What drugs are bronchodilators?
|
adrenergic agonists (B2, epinephrine)
methylxanthines antimuscurinics |
|
|
What drugs are decongestants?
|
adrenergic agnonists
- phenylephrine and oxymetazoline -pseudoephedrine |
|
|
What drugs are cough suppressants?
|
opioid agonists and opioid derivatives
-butorphanol -codeine/ hydrocodone -dextromethorphan Diphenhydramine |
|
|
What drugs are expectorants and mucolytics?
|
guafinasein
Potassium iodide ammonium chloride acetylcysteine |
|
|
What drugs are respiratory stimulants?
|
Doxapram HCl
|
|
|
What is the single most important theraputic intervention for hypoxemia?
|
oxygen
first line theraputic for animals with suspected hypoxemia |
|
|
What FIO2 is effective for treatment?
|
0.3 or greater
|
|
|
Increasing FIO2 is effective treatment for what conditions?
|
low FIO2
Hypoventilation Diffusion impairment V/Q mismatch (usually not so helpful) |
|
|
What are the signs of hypoxemia?
|
cyanosis
tachycardia decreased level of consciousness hyperpnea |
|
|
What is eupnea?
|
normal quiet breathing
|
|
|
What is tachypnea?
|
rapid respiratory rate
|
|
|
What is apnea?
|
absence of respiration
|
|
|
What is hyperpnea?
|
abnormally deep or rapid respiration
|
|
|
What is stertor?
|
loud "snoring" respiratory noise
|
|
|
What is stridor?
|
loud high pitched respiratory noise
|
|
|
What is the difference betweens stertor and stridor?
|
stertor is loud "snoring" while stridor is high pitched
|
|
|
What are the methods of oxygen administration?
|
nasal prongs or cannula (up to 0.3)
tracheal intubation/ ventilator (invasive) face mask (max depends on seal) oxygen cages/ chambers (cumbersome) Hyperbaric Chambers |
|
|
What are the signs of oxygen toxicity?
|
substernal discomfort, cough, nasal congestion
Rats die w/in 3 days of FiO2=1 |
|
|
What are the pulmonary effects of oxygen toxicity?
|
type 1 pneumocytes degenerate
type 2 pneumocytes proliferate Endothelial breakdown thickened capillary/alveolar membrane |
|
|
What is absorption atelectasis?
|
collapse of the alveoli with FIO2 from oxygen moving from alveoli to blood
nitrogen is necessary to maintain alveolar volume can create V/Q mismatch |
|
|
What diseases are bronchodilators commonly used for?
|
COPD in horses and feline bronchial disease (asthma)
|
|
|
What are bronchodilators used for?
|
to dilate constricted bronchial smooth muscle and assist in prompt reversal of obstruction
|
|
|
What are the adrenergic agonists used as bronchodilators?
|
selective B2 agonists (w/o heart effects)
- terbutaline (brethine) - Clenbuteral (Ventipulmin) - Albuterol - Numerous others |
|
|
What is the mechanism of action of selective beta 1 agonists as bronchodilators?
|
bind to adrenergic beta 2 receptor --> increased adenyl cyclase with resultant increase in cAMP within the cell --> activates protein kinases within the airway smooth muscles --> decreased calcium and smooth muscle relaxation
|
|
|
Where is the greatest density of B2 receptors?
|
in the smaller airways
|
|
|
What are the possible results of giving a beta 2 agonist IV?
|
hypotension, tachycardia, sweating
|
|
|
How are selective beta 2 agonists generally administered?
|
orally
metered dose inhaler (horses and cats) |
|
|
What are the side effects of beta 2 agonists?
|
uterine smooth muscle relaxation
decrease serum potassium decrease histamine release from mast cells increase ciliary activity used illegally as a thermogenic |
|
|
What are examples of methylxanthines?
|
theophylline
caffeine theobromine |
|
|
What is the mechanism of action of methylxanthines?
|
non-specific adenosine receptor antagonism
phosphodiesterase enzyme inhibition-->increases cAMP and bronchial smooth muscle relaxation Inhibits Ca influx into smooth muscle cells |
|
|
What are the effects of methylxanthines on the body?
|
bronchodilation
CNS stimulation Cardiovascular -vasodilation -increased HR, Cardiac Arrhythmias Mild diursesis |
|
|
What are the routes of administration of methylxanthines?
|
parenteral: aminophylline
oral: theophylline |
|
|
What are the side effects of oral theophylline?
|
vomiting, tachycardia
|
|
|
What is the mechanism of action of anticholinergics for cough?
|
they inhibit the action of acetylcholine at the muscarine receptor- PNS induced bronchoconstriction and bronchospasm is in response to airway irritation and histamine
|
|
|
What are the effects of atropine?
|
bronchodilation
tachycardia decreased GI motility (horses) Decreased salivation Thickens respiratory secretions |
|
|
What is Ipratropium?
|
it is an inhalant with slow onset and long duration of action
May be of use with horses with COPD b/c of minimal GI stasis |
|
|
What airway diseases are corticosteroids used to treat?
|
COPD in horses
Feline asthma Canine chronic bronchitis |
|
|
What is the mechanism of action of corticosteriods in treatment of respiratory disease?
|
decrease leukocyte accumulation and cytokine production, inhibits leukotriene and prostaglandin release
increase responsiveness to B2 receptor agonists |
|
|
What are the pros and cons of giving corticosteriods via MIDI?
|
avoids systemic side effects
technical difficulties associated with its use in animals |
|
|
What corticosteroid is giving intramuscularly?
|
methyprednisolone acetate- only give every 2-8 weeks
systemic side effects DIABETES! |
|
|
What is the mechanism of action of phenylephrine and oxymetrazoline (afrin)?
|
alpha 1 receptor agonist
cause vasoconstriction to decrease dilation of nasal vasculature can cause rebound congestion |
|
|
What is the mechanism of action of pseudoephedrine?
|
nasal and systemic vasoconstriction (alpha 1 effects)
mixed adrenergic agonist |
|
|
What are the side effects of pseudoephedrine?
|
tachycardia, cardiac arrhythmias, CNS stimulation
|
|
|
What is the physiology of a cough?
|
stimulation of RAR and SAR stretch receptors in the bronchi, diaphragm, external auditory canal, larynx, nose, paranasal sinuses, pericardium, pharynx, pleura, stomach, trachea and tympanic membrane cause afferent impulses via the vagus nerve to cough center in medulla
the epiglottis closes, abdominal muscles contract, air is forcefully expelled as glottis suddenly opens |
|
|
What type of diseases are cough suppressants useful for?
|
chronic bronchitis
infectious tracheobronchitis |
|
|
What disease should cough suppressants not be used for?
|
lungworm
pneumonia pulmonary edema |
|
|
Why is homatropine added to hycodan?
|
to reduce abuse potential and "Dry secretions"
|
|
|
What is the dose dependent effects of butorphanol?
|
antitussive dose is low, analgesic dose is higher
|
|
|
What is dextromethorphan?
|
it is a D-isomer of codeine analog of levorphanol
centrally acting with no analgesic or addictive properties |
|
|
What is Doxapram HCL used for?
|
neonatal resuscitation
reversal of anesthetic induced respiratory depression short duration of action centrally acting CNS stiulant with respiratory selectivity |
|
|
What type of diseases are treated with Leukotriene receptor agonists?
|
airway edema, smooth muscle contraction, secretions
asthma symptoms and allergic rhinitis |
|
|
What is chromolyn Na and what is its use?
|
used to prevent bronchoconstriction and inflammation that results from exposure to irritants/allergens
prevents mast cell degranulation and histamine release inhibits inflammatory cells must be given BEFORE exposure delivered via aerosol |
|
|
What are the loop diuretics used to treat pulmonary edema?
|
furosemide (Lasix)
Bumetanide Reduce left atrial pressure and pulmonary blood volume |
|
|
What are the side effects of loop diuretics?
|
dehydration, hypokalemia, metabolic alkalosis
|
