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75 Cards in this Set
- Front
- Back
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Does chronic bronchitis have an insidious onset that is detected late in the course?
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yes
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What type of infiltrate is involved in the pathogenesis of chronic bronchitis?
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neutrophilic or eosinophilic infiltrate
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What type of injury do you see do to the infiltrates?
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cell products and oxidant injury
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Do the infiltrates and the cell products and oxidant injury result in increased epithelial permeability, cellular injury, and mucus hypersecretion in the pathogenesis of chronic bronchitis?
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yes
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What are 4 things you see in chronic bronchitis?
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1) mucus gland and goblet cell hypertrophy
2) smooth muscle hypertrophy 3) lamina propria fibrosis 4) epithelial erosion with squamous metaplasia |
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What is the end result of all the preceding factors in the pathogenesis of chronic bronchitis?
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airflow obstruction
chronic cough exercise intolerance |
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What dogs are predisposed to having chronic bronchitis?
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middle aged or older --> large breed dogs
-terriers (Westies) -poodles -cocker spaniels |
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What is the hallmark of the history of chronic bronchitis?
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chronic persistent cough of greater than 2 months duration
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Do you see exercise intolerance and possibly syncope/collapse in dogs with chronic bronchitis?
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yes
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On chronic bronchitis examination are the animals usually in good health, often overweight, and have excessive panting?
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yes
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Might you see a prolonged inspiratory and expiratory push in chronic bronchitis?
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yes
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May tracheal sensitivity be present with chronic bronchitis?
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yes
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What do you hear on auscultation in the case of chronic bronchitis?
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coarse inspiratory crackles
expiratory wheezes may be normal |
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What might the vagal tone be like in chronic bronchitis?
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High
-heart rate normal to low -exagerrated sinus arrythmia |
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Might you have neurohormones like (NT-pro) BNP ELISA with chronic bronchitis?
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yes
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What do you have to do to diagnose chronic bronchitis?
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exclude other chronic respiratory diseases
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What would clinicopathology look like in chronic bronchitis?
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unremarkable
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What pattern do you see with chronic bronchitis?
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bronchial pattern
30% are normal |
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Do you often see right-sided cardiomegally with pulmonary hypertension or cor pulmonale?
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yes
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What do type of cell do you see on tracheal wash with chronic bronchitis?
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non-degenerate neutrophils
mucus may have Curschmann's spirals |
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What might you see on bronchoscopy?
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rough, hyperemic airways
-mucoid or purulent lining -fibrous nodules protude into airways |
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Can you cure chronic bronchitis?
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no you manage it
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Are the structural alterations in chronic bronchitis reversible?
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no
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Might the management of chronic bronchitis be complicated by bronchiectasis, tracheobronchial collapse, emphysema, and bronchopneumonia?
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yes
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What are the five components of therapy of the treatment of chronic bronchitis?
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1) avoid exacerbating factors and control body weight
2) relieve airway obstruction and inflammation 3) control cough 4) control infection 5) oxygen therapy |
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What are two exacerbating factors you can avoid in chronic bronchitis?
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-inhaled irritants
-avoid collar (use harness) |
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Does controlling the bodyweight significantly reduce clinical signs of bronchitis?
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yes
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What are some drugs you can use to reduce airway inflammation in chronic bronchitis?
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anti inflammatory pred
-inhalational fluticasone salmeterol |
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There is little benefit that bronchoconstriction is present in dogs with chronic bronchitis. When should you give them the benefit of a trial with bronchodilators?
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wheezing o if steroids alone are ineffective
bronchodilators are synergistic with steroids at reducing airway inflammation |
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What are some things you can do to relieve airway obstruction in chronic bronchitis?
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-saline nebulisation followed with light exercise
-chest percussion/coupage -expectorants (questionable efficacy) -mucolytic - acetylcysteine |
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When do you use anti-tussives to control the cough with chronic bronchitis?
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once the clinical signs improve
-increased exercise tolerance -improved thoracic radiographs -chronic non-productive cough |
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What is the benefit of anti-tussives? i.e. what do they prevent?
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They avoid repeated airway injury and syncope
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What two instances do you not want to use anti-tussives?
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if a productive cough is present
if bronchopneumonia is present |
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The fourth step for treatment of chronic bronchitis is to control infection. Is bacterial infection typically involved?
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No
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When is a lavage for culture and sensitivity indicated?
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-bronchiectasis
-fever -acute worsening of symptoms -mucoid discharge -lobar consolidation on rads |
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What type of antibiotics are necessary and why?
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Lipophilic antibiotics due to the blood-bronchus-barrier
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In bacterial bronchopneumonia why are the bronchiolar alveolar junctions vulnerable?
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-deposition of inhaled particles
-damage from vapors -lack of protective mucous layer or alveolar macrophages -ease of obstruction with mucus plug |
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What are some common reasons for bacterial bronchopneumonia to develop?
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-aspiration pneumonia (gram- enteric bacteria)
-opportunistic infection from resident microflora |
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What is a rare reason for bacterial bronchopneumonia to develop?
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hematogenous spread from sepsis, phlebitis
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Do decreased host defenses such as increased age, organ failure, poor nutrition, other respiratory infections, metabolic disease, reduced levels of consciousness, anesthesia, seizures, neuromuscular disease, and functional anatomical abnormalities (ciliary dyskinesia, tracheal hypoplasia, and pharyngela abnormalities and dysphagia) increase the host risk for bacterial pneumonia?
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yes
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What type of bacterial pnumonia infections are favored by multi-animal housing, unsanitary conditions with young unvaccinated animals, or infected animals?
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opportunistic infections
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What does the endotoxin due in opportunistic bacterial pneumonia?
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It decreases the surfactant efficacy
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What do the exotoxins due in opportunistic bacterial pneumonia?
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it directly harms the epithelium
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What do adhesins do in opportunistic bacterial pneumonia?
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facilitate epithelial attachment
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What do the polysaccharide capsules do in opportunistic bacterial pneumonia?
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inhibit phagocytosis
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What are some examples of gram negative opportunistic bacterial pneumonia?
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E.coli
bordatella klebsiella pasturella |
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What are some examples of gram positive opportunistic bacterial pneumonia?
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strep
staph enterococcus |
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What are some examples of anaerobes?
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bacteroides, clostridium
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What is the other type of opportunistic bacteria?
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mycoplasma
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What are some risk factors for aspiration pneumonia that are due to impairment of the protective airway reflexes?
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-sedation
-general anesthesia -muscle relaxants -seizures -laryngeal/pharyngeal dysfunction |
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What are some of the risk factors for aspiration pneumonia that are due to large volumes of intragastric flood/fluid?
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-recent meal
-delayed gastric emptying (ileus, anxiety, pain, opioids) -overfeeding by enteral tube |
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What are some risk factors for aspiration pneumonia that are due to impaired function of the gastroesophageal sphincter?
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-megaesophagus, myasthenia gravis
-reflux esophagitis |
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Do you expect systemic disease with pneumonia?
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yes
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What type of radiograph do you expect to see with pneumonia?
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alveolar pattern with air bronchograms
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How do you diagnose pneumonia?
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lavage followed by cytology, gram stain, culture and sensitivity
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Should you wait to treat with antibacterial therapy?
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No; you should treat empirically with broad spectrum and wait for culture and sensitivity
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What types of antibiotics do you use to treat mild pneumonia?
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TMS or cephalexin
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What types of antibiotics due you use to treat severe pneumonia?
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ampicillin and enrofloxacin/amikacin/2nd or 3rd generation cephalosporin
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How long do you treat pneumonia?
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1 to 3 months
TWO WEEKS BEYOND RESOLUTION OF RADIOGRAPHIC SIGNS |
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What are the comprehensive supportive Rx for bacterial pneumonia?
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-respiratory monitoring and treatment
-IV fluids -nebulization and coupage -physiotherapy (turn recumbent patients every two ours to decrease atelectasis...short walks) |
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What type of refractory patients do you see with bacterial pneumonia?
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immunocompromised
antibiotic failure concurrent viral or fungal pathogens consolidated lung lobes lung abcesses functional/anatomical defects development of sepsis incorrect diagnosis -can see ARDS |
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What type of dog do you commonly see fungal pneumonia in?
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young, male, sporting dogs
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Is it common to see fungal pneumonia caused by dissemination to the lungs from a different portal than by inhalation of airborne spores?
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no; it is rare
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What are the common kinds of fungal pneumonia in dogs?
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Blastomycosis
Histoplasmosis Coccidiomyocosis Crypto |
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How do you test for Blastomyces, histoplasma?
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-urine antigen test
-AGID test for serum antibodies |
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How do you test for coccidioidomyces?
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AGID
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What do you see on thoracic radiographs with fungal pneumonia?
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diffuse, nodular interstitial pattern with or without hilar lymphadenomegally
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How do you get your cytologies for the diagnosis of fungal pneumonia?
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lavage
lung aspirate |
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What is the treatment for fungal pneumonia?
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azoles (itraconazole, fluconazole)
polyene antibiotics (amphotericin B) corticosteroids (3-7 days) |
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What breeds are predisposed to development of pneumocystis carinii?
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miniature dachsunds and cavalier king charles spaniels
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What is the treatment for pneumocystic carinii?
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TMS
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Protozoal pneumonia (toxoplasmosis) treatment?
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clindamycin
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What type of parasitic pneumonia of the dog can not be diagnosed by fecal float or TTW/BAL cytology?
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crenosoma vulpis - must be diagnosed by Baermann
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What is the treatment for parasitic pneumonia in the dog?
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fenbendazole or ivermecting
-praziquantel or fenbendazole (paragonimus kellicotti) |
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Should you include a CBC chem on your baseline diagnostics for canine cough?
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no
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