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214 Cards in this Set
- Front
- Back
Typically, pneumonia develops in animals with ______ _____ ______. |
-- impaired respiratory defeses |
|
Most bacterial inf of the lungs are caused by? |
Commensal organisms of the lungs |
|
Normal defense mechanisms of the lungs? |
-- filtration of lg. particles in nasal turbinates -- clearance via mucociliary apparatus -- alveolar macrophages (E.g. sm, aerosolized bacteria) -- surfactant antibacterial properties -- lymphoid cells throughout airways |
|
Which regions are most susceptible to bacterial colonization? |
-- bronchoalveolar regions (bronchioles) >> major site of deposition of small particles >> epithelium is not protected by a mucus layer >> no protection from alveolar macrophages >> narrow bronchioles |
|
Most common isolates from dogs with pneumonia? |
-- gram negative infections |
|
Most common isolates from cats with pneumonia? |
-- Strep spp. -- Mycoplasma spp |
|
Anaerobic + aerobic bacteria are more capable of damage together than either alone. T/F? |
-- true >> act synergistically |
|
Factors that may predispos an animal to pneumonia? |
-- viral, parasitic, or fungal resp infection -- poor nutritional status -- immunosuppression -- altered consciousness -- NM disease (e.g. megaesophagus) -- bronchial disease -- laryngeal disease -- anesthesia |
|
Things that can cause immunosuppression in animals? |
-- glucocorticoids -- diabetes mellitus -- hyperadrenocorticism -- stress |
|
Clinical findings of animals with pneumonia? |
-- cough, nasal discharge, fever, tachypnea, dyspnea, crackles, wheezes, anorexia, lethargy, dehydration, weight loss |
|
Fever is an inconsistent finding with bacterial pneumonia. T/F? |
-- True |
|
Cats often have a concurrent URI with pneumonia. T/F? |
-- true |
|
CBC/chem with pneumonia? |
-- inflammatory leukogram +/- left shift -- sometimes, low albumin (inflammation, inc. vascular permeability, etc) |
|
Diagnosis of pneumonia? |
-- radiographs >> bronchial, alveolar, interstitial, mixed pattern -- cytology/culture via TTW/BAL |
|
Lung aspirates are rarely used. Why? Exception? |
-- low yield -- consolidated lung lobe |
|
Dorsal caudal distribution of pneumonia suggests? |
-- hematogenous spread -- bacterial pneumonia in cats |
|
Cytology sample suggestive of pneumonia? |
-- large numbers of degenerative neutrophils w/ intracellular organisms |
|
Absence of bacteria on cytology rules out infection. T/F? |
-- false, absence of bacteria DOES NOT rule out infection |
|
Special cultures for pneumonia? |
-- aerobic bacteria -- mycoplasma -- anaerobic if abscesses or consolidation noted |
|
Treatment of pneumonia? |
-- treat infection w/ abx 2-4 wks past clinical signs -- supportive care with O2 supplementation -- nebulization to inc. ciliary activity -- IV fluids to inc. ciliary activity -- bronchodilators -- ventilation -- coupage? |
|
Abx for pneumonia: how long should you treat? |
-- 2-4 wks past resolution of radiographic lesions |
|
Prognosis for uncomplicated pneumonia? Persistence of pneumonia may indicate? |
-- good -- persistence: FB, abscess, neoplasia |
|
Poor prognostic factors for pneumonia? |
-- hypoalbuminemia -- thrombocytopenia -- sepsis -- megaesophagus -- sudden acquired retinal degeneration (SARDS) |
|
Necrotizing hemorrhagic pneumonia in dogs, esp. in kennels, shelters, and research colonies? |
-- Strep equi zooepidemicus |
|
Mycobacterial pneumonia pathogen that is reportable? |
-- M tuberculosis >> granulomatous lesions >> organisms don't stain with routine stains |
|
Differential for cats with pneumonia in CO & NM? Important to remember? |
-- Yersinia pestis >> zoonotic disease >> dx: cytology + FA/culture/serology |
|
What can you do to help inform antibiotics choice if you can't wait for C&S? |
-- gram stain |
|
Rods are usually gram _____, while cocci are usually gram _____. |
-- rods: gram negative -- cocci: gram positive |
|
Gram negative bacteria assoc. with pneumonia? Anaerobes? |
Gram Negatives: -- E. coli, Klebsiella, Proteus -- Pasteurella, Bordetella, Pseudomonas Anaerobes -- Bacteroides spp. -- Clostridium spp. -- anaerobes are larger/abnormally shaped |
|
Gram positive bacteria? |
Strep or staph spp., enterococcus spp. |
|
Bacteri_____ drugs are preferred, but bacteri_____ drugs may be used w/ a competent immune system. |
bactericidal drugs are preferred, bacteriostatic drugs may be used w/ competent immune system |
|
Abx levels within the parenchyma are similar to serum, but airway levels may not be. Why? |
blood-bronchoalveolar barrier limiting penetration >> may be more easily penetrated w/ inflammation, more difficult once inflammation subsites |
|
Good antibiotic choices for airway infections? |
-- tetracyclines (bacteriostatic) -- macrolides (static >> cidal) -- chloramphenicol (static >> cidal) -- fluoroquinolones (cidal) >> more lipid soluble |
|
Drugs that are less lipid soluble? |
-- penicillins (cidal -- aminoglycosides (cidal) -- sulfas (cidal) |
|
Intracellular bacteria? |
-- Chlamydia -- Mycoplasma -- Bordetella |
|
Antibiotics for intracellular bacteria? |
-- chloramphenicol -- macrolides --lincosamides (static) -- tetraccyclines -- fluoroquinolones |
|
Three phases of aspiration pneumonia? |
1. immediate airway response to the aspirate 2. inflammatory response 3. bacterial colonization |
|
First phase of aspiration pneumonia? |
-- lasts about 4h -- chemical burn from acidic aspirate -- edema in tissues of airways -- airway obstruction >> food particles, bronchoconstriction, inc. mucus, exudate --hypoxia & V/Q mismatch (collapse/atelectasis) |
|
Second phase of aspiration pneumonia? |
-- 4-6h after aspiration, lasts 1-2 days -- large # neutrophils enter alveolar space -- inc. capillary permability >> fluid loss into interstitium >> fluid loss may cause hypotension -- hypoxia results in pulm. vasoconstriction >> may result in pulmonary hypertension -- fever + consolidation of lung lobes |
|
Final phase of aspiration pneumonia? Associated with which pathogens? |
--secondary bacterial infection >> E. coli, Klebsiella, Strep, Pasteurella |
|
Animals that are predisposed to aspiration? |
-- sedated/anesthesia -- NM disorders -- pharyngeal/esophageal motility disorders -- chronic vomiting -- seizures -- altered mentation -- delayed gastric emptying |
|
Factors that influence morbidity of aspiration pneumonia? |
-- acidity (pH <2.4) -- gastric fluid volume ( >0.4 ml/kg) -- size of particulate (obstructs small airways) |
|
Clinical signs of aspiration? |
-- lethargy -- cyanosis -- tachypnea -- dyspnea -- fever -- acute respiratory distress syndrome (ARDS) -- death -- +/- signs of regurg., vomiting, seizures, etc. |
|
Thoracic rads of aspiration pneumonia? |
bronchial or alveolar pattern most often in right middle or cranial lung lobes >> radiographic signs can lag |
|
Viral causes of pneumonia in dogs? |
-- canine parainfluenza virus (CPI) -- canine adenovirus 2 (CAV-2) -- distemper (CDV) -- canine influenza |
|
Viral causes of pneumonia in cats? |
-- Feline Herpes Virus -- feline calici virus |
|
Viral pneumonia occurs due to? |
-- inflammation of the alveolar epithelium, interstitium, and pulmonary capillary epithelium >> often progresses to bronchiolitis |
|
Airway defenses against viruses? |
-- mucociliary apparatus -- opsonization and neutralization via Ig -- complement fixation/cell lysis -- cytokine formation -- lymphocytes (cytotoxic T-cells) -- alveolar macrophages (phagocytosis, etc) |
|
Sequelae to viral infection in lung? |
-- epithelial cells are damaged >> protein-rich fluid enters the alveoli along with neutrophils, cellular debris, and macrophages -- type I pneumocytes are injured |
|
FIP can cause what pulmonary pathology? |
-- pulmonary granulomas
|
|
Infection of pathogens causing viral pneumonia occurs how? |
-- inhalation of aerosolized virus -- contact with secretions/fomites |
|
Canine Distemper Virus is what kind of virus? What kind of tropism does this virus have? |
-- RNA morbilivirus -- epithelial tropism |
|
Signs of distemper virus? |
-- biphasic fever (5 & 11 days postexposure) -- ocular and nasal discharge (mucopurulent) -- dyspnea and cough -- anrexia, vomiting, diarrhea -- blindness, seizures, myoclonus |
|
Radiographs of dog with distemper? |
-- diffuse interstitial pattern progressing to bronchial or alveolar pattern |
|
Definitive diagnosis of distemper? |
-- virus isolation (blood) -- IHC -- PCR (tissues, blood, urine) -- ELISA for antigen |
|
Detection of distemper via FA or PCR in epithelial tissues is not diagnostic if dog has been previously vaccinated. T/F? |
-- FALSE -- detection of distemper in epithelial tissues IS diagnostic if dog has been previously vaccinated >> does not spread beyond non-lymphoid organs |
|
Distemper (CDV) is a core vaccine. T/F? |
-- true |
|
CDV vx regimen? |
-- stars as early as 3 wks of age -- every 3-4 wks until 16 wks of age -- booster in 1 y |
|
Canine Adenovirus II is associated with what? |
-- infectious tracheobronchitis |
|
Thoracic radiographs of Canine Adenovirus II? |
-- bronchointerstitial lung pattern -- crnaioventral alveolar infiltrates |
|
Canine parainfluenza virus I has similar lesions/radiographic findings as CAV-II. T/F? |
true |
|
H3N8 Canine Influenza is derived from equine influenza virus. T/F? |
true |
|
Canine influenza H3N8 virus incubation period? Who sheds the virus? |
-- 2-5 days incubation -- 7-10 days viral shedding (after incubation) -- all infected dogs shed virus |
|
Canine influenza H3N8 signs? Signs are similar to? |
--cough for 3 wks -- unresponsive to antibiotics and cough suppressants -- purulent nasal discharge (2nd bacterial inf) -- fever -- tachypnea/dyspnea, lung consolidation (rare) -- similar to kennel cough |
|
Diagnosis of canine influenza? |
serologic tests (paired titers), PCR (nasal swab) |
|
Nasal swab & PCR for canine influenza must be done within ___ days while virus is still being shed. |
within 7 days |
|
PCR for canine influenza is ____ specific. |
strain specific |
|
There is a vaccine for the which canine influenza viruses? |
-- H3N8 and H3N2 -- non-core vx |
|
Cats are susceptible to avian influenza virus ____. |
H5N1 |
|
Cats are not susceptible to H3N8. T/F? |
true |
|
H3N2 influenza virus can be shed for up to __ wks, so longer isolation periods are recommended than for H3N8. |
shed for up to 3 wks |
|
Cats are susceptible to both H3N2 and H3N8. T/F? |
False. |
|
Fungal pathogens that may cause pneumonia? Which are endemic to Oregon? |
-- Histoplasma -- Blastomyces -- Coccidioides -- Cryptococcus spp. (endemic to OR) |
|
Which of these fungal organisms also causes GI tract symptoms? |
Histoplasma |
|
Which of these fungal organisms also cause CNS signs? Uveitis/retinitis? |
all of them |
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Which of these fungal organisms also cause bone infections? |
-- histoplasmosis -- blastomycosis -- coccidiomycosis |
|
Which of these fungal organisms also cause restrictive pericarditis? |
-- coccidiomycosis |
|
What do ketoconazole, itraconazole, and fluconazole do? Side effect? |
inhibit synthesis of ergosterol (fungal wall) >> interfere with cytochrom P450 |
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Why is it important to give azole drugs with food? |
increased bioavailability when given with meals (acid pH) |
|
Ketoconazole has the ____ side effects and is ____ expensive. |
-- most side effects -- least expensive |
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Fluconazole is the _____ expensive and has the _____ side effects. |
-- most expensive -- fewest side effects |
|
Side effects of ketoconazole? |
-- anorexia, vomiting, diarrhea -- hepatotoxicity -- light hair coat -- thrombocytopenia -- adrenal insufficiency |
|
Side effects of itraconazole? |
-- intestinal signs -- skin eruptions -- hepatotoxicity |
|
Side effects of fluconazole? |
-- GI -- less likely to be hepatotoxic |
|
Only ____azole can be given IV. |
fluconazole >> all are available as oral formulations |
|
Amphotericin B mechanism of action? |
binds irreversibly to sterols (e.g. ergosterol) >> membrane permeability change, cell lysis |
|
Amphotericin B is effective against? Not effective against? |
-- Histoplasma -- Blastomyces -- Coccidioides -- Crytpococcus -- Candida -- Zygomyces -- NOT effective against Aspergillus spp. |
|
Side effects of Amphotericin B? |
nephrotoxic (esp. IV doxycholate prep) vomiting, anorexia, hypokalemia, hypomagnesemia, phlebitis |
|
Histoplasma is found where? |
Missisippi, Missouri, Ohio River valleys |
|
Histoplasma is usually found where? Incubation period? Clinical signs? |
-- liver, spleen, LNs -- incubation period: 12-16 days -- clinical signs: cough, tachypnea, dyspnea |
|
Serology for diagnosis of Histoplasma? |
not useful |
|
Diagnosis of Histoplasma? |
FNA, lung aspirates, lavage/wash, pleural effusion |
|
Blastomyces is found where? |
Great Lakes region |
|
Clinical signs of Blasto infection? |
cough, dyspnea, fever, lethargy, exercise intolerance |
|
Radiographs of Blasto infection? |
miliary nodular interstitial pattern |
|
Diagnosis of Blasto infection? Serology? |
-- ELISA test for antigen in urine --serology is poor |
|
ELISA test for Blasto: high ____, poor ____. Why? |
high sensitivity, poor specificity >> cross-reacts with other fungal organisms |
|
Blasto prognosis for dogs? Cats? |
-- dogs: good in absence of severe respiratory disease, guarded in dog with severe respiratory signs -- cats: do not respond as well to therapy |
|
Where is Coccidioides found? |
-- Southwest US |
|
Clinical signs of Coccidioides? |
-- cough, fever, lethargy, weight loss, anorexia -- bony involvement common -- restrictive pericarditis can occur |
|
Diagnosis of Coccidioides? |
-- organism ID on cytology and histopathology -- serology: titer > 1:32 |
|
Which animals get Coccidioides? |
-- rare in cats -- most common in young male dogs >> esp. Doberman Pinschers, Boxers |
|
Which animals get Blasto? |
-- more common in young male dogs -- uncommon in cats |
|
Which animals get Histoplasma? |
-- cats of any age -- younger dogs >>much more common in dogs |
|
Where is cryptococcus located? |
Pacific Northwest |
|
Which dogs are most commonly affected by Crypto? |
-- Great Danes -- Doberman pinschers -- German shepherds |
|
Clinical signs of crypto? |
-- rhinitis -- eyes, CNS, pulm. parenchyma, LNs, and skin may also be involved |
|
Radiographs of crypto? |
nodular pulmonary pattern |
|
Diagnosis of crypto? |
-- organism ID -- serology |
|
Aspergillus causes what? |
-- most commonly causes fungal rhinitis in the dog, occasionally has been isolated in lungs of dogs and cats |
|
Who gets Aspergillus? |
-- german shepherds -- young, ill, immunosuppressed cats |
|
Radiographs of aspergillus? |
-- may be normal -- pleural effusion, lung consolidation, interstitial or alveolar pattern |
|
The only antifungal that might work against Aspergillus? |
Itraconazole |
|
Who gets Pneumocystis carinii? |
-- young, immunosuppressed animals -- Mini dachshunds -- Cavalier King Charles spaniels -- cats on immunosuppressive therapy |
|
Diagnosis of pneumocystis? |
-- airway samples, special stains must be used -- BAL |
|
Which parasites cause verminous pneumonia during their migration? |
-- Toxocara spp. -- Ancylostoma spp. |
|
Why might fecals be negative with verminous pneumonia? |
-- lung migration occurs before eggs are shed in the feces |
|
Where does Oslerus osleri like to live? |
-- mucosa of the distal trachea, tracheal bifurcation, mainstem bronchi |
|
Oslerus osleri is a _____ nematode that causes what clinical signs? |
-- metastrongyloid nematode -- cough |
|
Pathology of Oslerus osleri infection? Diagnosis? |
-- nodules that cause airway obstruction and dyspnea -- zinc centrifugation for diagnosis, bronchoscopy |
|
Filaroides milksi and hirthi cause what kind of disease? |
-- interstitial pneumonia >> eosinophilic, granulomatous, or mononuclear |
|
Filaroides milksi and hirthi live where? Diagnosis? |
deep in the alveoli and terminal bronchioles >> infect dogs diagnosis: zinc sulfate centrifugation |
|
Aleurostrongylus abstrusus infects which spp? Where do adult worms live? |
infects cats, adult worms live in bronchioles and alveolar ducts |
|
Clinical signs of Aleurostrongylus abstrusus can mimic what? |
inflammatory airway disease |
|
Aleurostrongylus abstrusus diagnosis? |
Baermann |
|
Crenosoma vulpis infects? Where do adults live? |
-- infects wild dogs in NE US and Europe -- occasionally infect domestic dogs -- adult nematodes live in bronchi and bronchioles |
|
Crenosoma vulpis causes what clinical sign? |
-- bronchitis >> cough, nasal discharge >> diffuse bronchial or bronchointerstitial pattern is most common |
|
Diagnosis of Crenosoma vulpis? |
Baermann |
|
Capillaria aerophila infects who? Causes what kind of disease? |
-- infects dogs and cats -- causes bronchitis >> live in mucosa of trachea and bronchi |
|
Signs of Capillaria infection? |
-- asymptomatic -- cough, dyspnea, wt. loss, bronchopneumonia |
|
Paragonimus kellicotti infects who? |
-- dogs and cats in Great Lakes, Midwest, Gulf of Mexico |
|
Pathogenesis of Paragonimus? |
-- adult flukes live in subpleural cysts that communicate with bronchi |
|
Clinical signs of Paragonimus infection? |
-- chronic cough, exercise intolerance, weight loss, occasional hemoptysis -- spontaneous pneumothorax from cyst rupture |
|
Lesions from Paragonimus are most common? |
-- right caudal lung lobe |
|
Diagnosis of Paragonimus? |
-- zinc centrifugation or fecal sedimentation -- cavitary lesions on radiographs |
|
Treatment of Pargonimus? |
fenbendazole or praziquantel >> fluke |
|
Treatment of lungworms in general? |
-- fenbendazole -- ivermectin -- levamisole -- praziquantel |
|
Heartworm effects on lung? Clinical signs? |
-- pulmonary hypertension -- vascular compromise of pulmonary tissue -- interstitial disease due to inflammatory mediators from worm antigen -- eosinophilic pneumonitis due to immune-mediated destruction of microfilaria -- clinical signs: cyanosis, crackles, muffled lung sounds |
|
Causes of Eosinophilic Pneumonia? |
-- hypereosinophilic syndrome (paraneoplastic) >> eosinophilopoiesis in bone marrow -- parasitic infections, e.g. heartworm, lung worm -- chronic bacteria and fungal infections -- asthma, bronchitis -- Idiopathic pulmonary fibrosis (IPF) -- lymphoma, mast cell tumors |
|
Causes of protozoal pneumonia? |
-- Toxoplasma gondii >> multisys. inf., immunocompromised animals -- Neospora caninum >> myositis, encephalitis |
|
Respiratory infections of Toxoplasma are most common when? |
-- most common with transplacental and transmammary transmission >> kittens are most commonly affected |
|
Definitive diagnosis of Toxoplasma? |
-- identification of Toxoplasma in tissues >> antibody titers present in normal dogs/cats |
|
Neospora is an _____ cause of respiratory disease. |
-- uncommon |
|
What is the most common interstitial lung disease of small animals? |
Idiopathic pulmonary fibrosis |
|
Who gets Idiopathic Pulmonary Fibrosis (IPF)? |
Westies other small terrier-ish dogs |
|
IPF is thought to be what? |
-- end-result of chronic inflammation in the pulmonary parenchyma -- abnormal healing response to an insult that results in fibrosis -- increased amount of fibrous tissue |
|
IPF occurs in dogs with what? |
-- paraquat poisoning -- hyperadrenocorticism |
|
Clinical signs of IPF? |
-- exercise intolerance -- dyspnea -- tachypnea -- cyanosis -- syncope -- cough is less common -- crackles may be auscultated |
|
Radiographs of IPF? |
-- may be normal -- interstitial pattern -- bronchitis -- right heart enlargement, RHF |
|
Diagnostics for IPF? |
-- TTW/BAL to rule out other causes -- lung biopsy for definitive diagnosis (rare) -- CT: peripheral reticulation, honeycombing, traction bronchiectasis (don't narrow) |
|
Treatment of IPF? |
-- bronchodilators -- glucocorticoids -- pulmonary vasodilators (sildenafil) -- oxygen if needed -- manage collapsing trachea, bronchitis >> inc. quality of life |
|
MST of IPF? |
15.5 mo (~1y) |
|
______ is more common than _____ neoplasia. |
-- metastatic is more common than primary |
|
Increased risk of primary lung tumors in? |
-- dogs in urban environments -- brachycephalics exposed to cigarette smoke |
|
Clinical signs of pulmonary and bronchial neoplasia? |
-- often asymptomatic -- cough, dyspnea, tachypnea, wheezes, heptysis, lameness have been reported |
|
Radiographs for pulmonary neoplasia? |
three view thorax |
|
Malignant lung tumors? |
-- adenocarcinoma (dogs, cats) -- SCC (dogs, cats) -- bronchial carcinoma (cats > dogs) -- alveolar carcinoma (dogs > cats) -- hemangiosarcoma (dogs > cats) -- sarcoma (dogs, cats) -- malignant fibrous histiocytoma (dogs) |
|
When does pulmonary edema occur? |
-- increased hydrostatic pressure -- decreased oncotic forces -- lymphatic obstruction -- increased vascular permeability |
|
Increased pulmonary vascular pressures occur due to? |
-- fluid within the alveoli, decreased pulmonary compliance, airway compression |
|
Hypoxemia with pulmonary edema occurs due to? |
-- V/Q mismatch |
|
Causes of non-cardiogenic pulmonary edema? |
--electrocution -- seizure/head trauma -- acute airway obstruction (strangulation) -- systemic disease >> ARDS -- pulmonary injury -- hypoalbuminemia (low oncotic pressure) -- vasculitis -- near drowning --pheochromocytoma |
|
Causes of pulmonary injury? |
pneumonia, smoke inhalation, contusion, hypoxia, lung lobe torsion |
|
Clinical signs of non-cardiogenic pulmonary edema? |
-- moist cough -- resp. distress -- cyanosis -- orthopnea -- crackles |
|
Pathogenesis of non-cardiogenic pulmonary edema? |
-- vascular damage/permeability >> protein rick fluid leaks out >> water follows |
|
Treatment of non-cardiogenic pulmonary edema? |
-- oxygen -- ventilation -- furosemide (neurogenic or volume component) -- alpha agonists/dopamine (neurogenic: dec. cerebral blood flow) --synth. colloids/albumin (low oncotic pressure) -- careful with fluid admin >> risk exacerbating edema |
|
Cause of exogenous lipid pneumonia? |
inhalation of oils (animal, vegetable, mineral) |
|
Pathophysiology of aspirated oils? |
-- interfere with mucociliary apparatus -- overwhelm/damage alveolar macrophages -- cause inflammation & fibrosis |
|
Pathology of endogenous lipid pneumonias? |
-- accumulation of cholesterol or other lipids in the alveoli -- can occur due to damage of epithelial cells |
|
Causes of endogenous lipid pneumonias? |
-- obstructive lower airway disease -- inhalation of noxious substances -- primary lipid disorders -- fat emboli -- dietary deficiency of pantothenic acid -- idiopathic (cat) -- secondary to neoplasia, crypto, PTE (cat) |
|
Clinical findings with lipid pneumonia? |
-- tachypnea -- cough -- respiratory distress -- cyanosis -- crackles -- anorexia -- lethargy -- wt loss |
|
Thoracic radiographs with lipid pneumonia? |
-- may be normal -- diffuse, nodular, interstitial pattern -- patchy interstitial infiltrates -- pulmonary nodules and pleural effusion |
|
What kind of pleural effusion with lipid pneumonia? |
-- chylous or modified transudate |
|
Cytology of the airways with lipid pneumonia? |
-- mcrophages with large amounts of lipid |
|
Treatment for exogenous and endogenous lipid pneumonia? |
-- exogenous: supportive care -- endogenous: resolve underlying issue |
|
Pathophysiology of smoke inhalation? |
-- CO2 dilutes amount of oxygen -- CO competes with oxygen for binding Hb -- encourages anaerobic glycolysis and production of lactate (CO2, CO, cyanide) -- direct thermal injury to pulm. epithelium >> inflammation and edema formation -- chemical irritants and particulates >> bronchoconstriction, worsening hypoxia |
|
Clinical signs of smoke inhalation? |
-- may appear normal initially -- mild to severe respiratory distress -- alert/lethargic/ comatose, seizures/ataxic -- crackles and wheezes on auscultation -- coughing/gagging/ptyalism -- pawing at face (local irritation) -- MM wnl or hyperemic/edematous -- conjunctivitis/corneal irritation |
|
Lab work for animals with smoke inhalation? |
-- metabolic acidosis -- hypoxemia (blood gas or pulse ox) |
|
Treatment of smoke inhalation? |
-- IV fluids -- oxygen -- bronchodilators -- prophylactic antibiotics? -- glucocorticoids? |
|
Hypoxia is worst for smoke inhalation when? |
-- 24 - 48 h after exposure |
|
Normal pulmonary arterial pressures during systole and diastole? |
-- systole: < 25 mmHg -- diastole: <10 mmHg |
|
Pulmonary hypertension is defined as? |
-- mean pulmonary arterial pressures > 25 mmHg -- > 30 mmHg during systole |
|
Pulmonary hypertension can be arterial or venous in etiology. T/F? |
true |
|
Causes of pulmonary arterial hypertension? |
-- congenital L >> R shunts (e.g. PDA, VSD) -- pulmonary disease (e.g. COPD, IPF, neoplasia) -- thromboembolism (e.g. IMHG, PLE/PLN, DIC) -- parasites (HW, Angiostrongylus) -- vasculitis/arteritis -- high altitude disease -- idiopathic |
|
Causes of pulmonary venous hypertension? |
-- disease of left heart (LV failure, myocardial dz) |
|
What does endothelin 1 do? |
-- arterial and venous constriction |
|
What does prostacyclin do? |
-- vasodilator, inhib. platelets, antiproliferative |
|
What does thromboxane do? |
-- vasoconstrictor |
|
What does nitrous oxide do? |
-- vasodilator -- inhibits platelets -- inhibits smooth muscle proliferation |
|
What do natriuretic peptides do? |
-- vasodilators -- inhibit cell growth |
|
In pulmonary hypertension, the _____ pathway is upregulated, and the ______, _____, and _____ pathways are down regulated. |
-- endothelin -- prostacyclin -- thromboxane -- nitrous oxide |
|
Result of endothelin upregulation in pulmonary hypertension? |
-- prolif. of pulmonary aa. intima, adventitia -- vascular muscle hypertrophies -- adventitia |
|
Cardiac consequences of pulmonary hypertension? |
-- right ventricular hypertrophy (initially concentric, later eccentric) |
|
What causes mortality from pulmonary hypertension? |
-- right ventricular failure -- ascites -- low CO |
|
Clinical signs of pulmonary hypertension? |
-- cyanosis -- dyspnea -- cough -- exercise intolerance -- syncope -- crackles and wheezes -- inspiratory/expiratory effort -- heart murmur -- RHF (ascites, distended jugular, big liver) |
|
_____ testing is imperative is pulmonary hypertension is a major complication of ____ dz in the dog. |
-- heartworm testing, heartworm dz |
|
Other diagnostic tests for pulmonary hypertension? |
-- testing for hypercoagulability -- testing for signs of PTE |
|
Radiographs with pulmonary hypertension? |
-- may be normal -- may have right-sided cardiac enlargement, pulmonary infiltrates, enlarged tortuous pulmonary arteries -- may have signs of RHF |
|
Definitive diagnosis of pulmonary hypertension? |
echocardiogram or cardiac catheterization to measure RH and pulmonary arterial pressures |
|
Treatment of pulmonary hypertension? |
-- resolve underlying diseases -- oxygen and NO for acute resp. distress -- sildenafil (pulmonary vasodilator) -- epoprostenol (prostacyclin analog) -- endothelin antagonists (bosentan) -- pimobendan -- L-arginine |
|
What is the effect of pulmonary thromboembolism? |
-- obstruct pulmonary vv. -- hypoxia -- reflex vasoconstriction -- inc. pulmonary vascular resistance -- inc. right heart outflow resistance -- inflammatory mediators |
|
In dogs, ___% of pulmonary vasculature must be occluded before an inc. in pulmonary pressure occurs. Why? |
-- 60% of pulmonary vasculature occluded -- recruitment of unused pulmonary vv. and capillary dilation |
|
Diseases that can cause vascular injury (predisposing to PTE)? |
-- HW disease -- immune-mediated disease -- pancreatitis -- sepsis -- trauma -- surgery -- neoplasia -- chronic respiratory disease |
|
Causes of hypercoagulable state? |
-- DIC -- sepsis -- necrotizing pancreatitis -- PLN/PLE -- hyperadrenocorticism -- glucocorticoid tx -- immune-mediated disease -- neoplasia -- Diabetes Mellitus |
|
Causes of slowed blood flow? |
-- cardiac disease -- hypotension -- chronic respiratory disease -- atherosclerosis |
|
Three things that contribute to thrombus formation (where are thrombi likely to form)? |
-- areas of endothelial damage -- areas where blood flow is stagnant -- in hypercoagulable states |
|
Clinical signs of PTE? |
-- dyspnea/tachypnea -- coughing, hemotpysis, -- cyanosis -- lethargy, syncope -- collapse and sudden death (marked drop CO) -- muffled heart & lung sounds (pleural effusion) -- crackles & wheezes (underlying resp. dz) -- heart murmur (tricuspid insuff., split S2) |
|
Radiographic changes with PTE? |
-- may be minimal -- may see pleural effusion -- may see interstitial/alveolar pattern -- enlarged main pulmonary a. -- pulmonary aa. tortuous and blunted |
|
Labwork signs for PTE? |
-- hypoxemia, normocapnia, hypocapnia -- thrombocytopenia in some cases -- inc.fibrinogen, inc. D-dimers, dec. AT-III |
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Treatment of PTE? |
-- address underlying disease -- change IV catheters -- oxygen supplementation -- can try: aspirin, clopidogrel, low MW heparin, heparin, warfarin, rivaroxaban (factor Xa inhib.) |
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What is Acute Respiratory Distress Syndrome (ARDS)? |
-- response to disease -- exaggerated inflamm. response w/ resp. failure >> pulmonary edema -- acute resp. distress, bilateral pulmonary infiltrates, normal pulmonary arterial pressure -- PaO2:FIO2 is < 200 (normal is 400) |
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Most common causes of ARDS in dogs? |
-- sepsis -- pneumonia |
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Causes of pulmonary bullae? |
-- large, air-filled structures within parenchyma or on pleural surface due to breakdown of alveolar structures -- trauma, inf., parasites, inflammation, neoplasia |
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Most pulmonary bullae are? |
-- idiopathic >> esp. large breed, deep chested dogs |
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Pulmonary bullae and blebs may cause pneumothorax. T/F? |
-- true |