Transcript Cardiorespiratory Diseases - Dr. Brahmbhatt's Class Handouts

Cardiorespiratory Diseases
Alveoli-Capillary Gas Exchange
• Alveoli surrounded by capillaries
– Incoming RBCs low in O2
– Exiting RBCs rich in O2
– Thin capillary membrane
Respiratory Diseases
Upper respiratory
Upper respiratory
Lower
Respiratory
Tract
includes
trachea,
bronchi,
lungs,
_pleural
cavity
Upper Respiratory Diseases
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Rhinitis
Sinusitis
Tonsilitis
Laryngitis
Upper Respiratory Diseases
Upper Respiratory Tract is any resp structure above the trachea
• Rhinitis—inflammation/infection of nasal passages
Usually occurs with other resp diseases
– Signs
• Nasal discharge; crusty nares
• Pawing at nose
• Staphylococcus spp
– Rx
• Clean nares
• Antibiotics if necessary
• Vasoconstrictive drugs: Phenylephrine
drops
Upper Respiratory Diseases
• Sinusitis
– Most common cause: tooth root abscess of 4th premolar
(Carnassial tooth)
• Largest tooth; roots extend into
frontal/maxillary sinus
– Signs
• Swelling under eye on infected side
• Unilateral nasal discharge
– Rx
• Remove infected tooth
• Antibiotics
• Flush fistula with iodine solution
Upper Respiratory Diseases
• Tonsillitis (Tonsils provide lymphoid protection to lower resp tract)
– Signs
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Anorexia
Increased salivation
Pain on opening mouth
It is more common in small dog breeds
– Dx
• Visualized inflamed, swollen tonsils
• Tonsils may be coated with mucus/pus
– Sx
• Antibiotics
• Surgical removal of chronic cases
Tonsillitis
Upper Respiratory Diseases
• Laryngitis
Most common cause is excessive barking
**Rabies can also change vocal quality
• Signs
– Loss of voice or alteration of voice
– Increased mucus production in back of throat
• Rx
– Restrict barking
– Anti-inflammatory medication (glucocorticoids: tapering dose)
• Client info
– Most Upper Respiratory Infections are self-limiting
Lower Respiratory Diseases
Lower Respiratory Tract includes trachea, bronchi, lungs, pleural cavity
• Infectious Canine Tracheobronchitis (Kennel Cough)
– Causes (a collection of several causative agents including viruses,
bacteria, mycoplasmas, fungi, parasites
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Canine parainfluenza virus
Canine adenovirus
Canine herpesvirus
Reovirus
Bordetella bronchiseptica
mycoplasma
– Signs
• Hx of exposure to animals at a kennel, hospital, groomer, show
• Dry hacking cough in an otherwise healthy animal
– Rx—antibiotics, glucocorticoids, antitussives
– Client info
• Self-limiting (2-3 wks); Rx is to make animal/owner more comfortable
• Vaccinate 2-3 wk before chance of exposure
COLLAPSING TRACHEA
Lower Respiratory Diseases
• Collapsing trachea
Failure of proper development of tracheal rings
– Signs
• Cough, esp during excitement or exercise
– Dx
• Goose-like honk on tracheal palpation
• r/o other causes of coughing
– Rx
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Acepromazine to calm excitement
Antitussives (Hycodan, Butorphanol)
Glucocorticoids
Bronchial dilators
Prosthetics have been surgically implanted, but complications have occurred
– Client info
• Wt reduction
• Use shoulder harness rather than neck collar
Lower Respiratory Diseases
• Feline Bordetella Infection
Bordetella bronchiseptica grow in ciliated respiratory mucosa; release toxins
– Signs (look like respiratory viral infections)
• Fever
• Sneezing, nasal discharge, coughing, rales
• Submandibular lymphadenopathy
– Rx (usually self-limiting)
• Antibiotics (oral tetracycline or doxycycline)
– Prevention
• Eliminate stress
• Good hygiene, good nutrition
• Vaccination
– Client info
• Looks like resp infections caused by feline herpes and calicivirus
• Usually self-limiting
• Vaccination effective
Lower Respiratory Diseases
• Feline asthma (bronchoconstriction, inflamed/hyperreactive airways)
– Signs
• Coughing, wheezing
• Labored breathing
– Dx
• Clinical signs
• X-rays show “doughnuts” typical of airway inflammation
– Rx
• Long-term corticosteroids (prednisone, DepoMedrol)
• Bronchodilators (terbutaline [Brethine], cyproheptadine)
– Client info
• Prognosis is variable
– If allergens can be determined and exposure limited, most cats do well
– A cure is not usually possible
Feline Asthma
• Same cat
– Top—normal
– Bottom—asthma
Airways more prominent because of
inflammation and mucus buildup
Doughnuts (end-on view) and
tramways (lateral view) of airways
Feline Viral Resp Infections
• 2 viruses responsible for most feline resp diseases
– Feline Viral Rhinotracheitis (FVR; Feline Herpesvirus)
– Feline Calicivirus (FCV) Caliciviridae family
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Highly contagious
High mobidity
Low mortality
Most severe in kittens
Feline Viral Rhinotracheitis
• Signs
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Acute onset of sneezing
Conjunctivitis, severe rhinitis
Fever, depression, anorexia
Ulcerated hard palate, excess salivation
Corneal ulcers
• Rx
– Supportive Rx
• IV fluids, broad spectrum antibiotics, decongestants
• Nursing care: clean nose, eyes; force feed food; decrease stress
• Antiviral therapy
• Prevention
– Vaccination
• Client info
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FVR highly contagious; can transmit via clothing, hands, etc; only cats
Warming food may improve palatability
Vaccinated cats may show mild symptoms
Disinfectants kill herpesvirus type I virus
Feline Calicivirus
• Signs
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Fever
Serous ocular/nasal discharge; mild conjunctivitis
Oral ulcers, salivation
Pneumonia
Diarrhea
• Rx
– Supportive care
– Antibiotics
– Force feed disinfect using bleach
• Prevention
– Vaccination
• Client info
– Highly contagious
– Signs last 5-7 d
– Force-feeding may be necessary (if cats can’t smell, they won’t eat)
What do you see? or What do you not see?
Pleural
Effusion
Dx—x-ray
Fluid in thorax
• Types of fluid
Causes
– Transudate
R-sided CHF, FIP
plasma-like fluid; straw colored
– Blood
– Chyle
trauma, neoplasia
neoplasia, pancreatitis, trauma
lymphatic fluid from intestine; high fat content
infection, parasites
--Empyema
Infection, foreign body, trauma
pus in thorax
All types of fluid cause same signs
– dyspnea
– may show cough, fever, pleural pain
Pleural Effusion
• Thoracentesis
– Clip hair, scrub skin, block with local anesthetic
• Most dependent space (7th-8th intercostal space)
– Aspirate using 3 way valve
– Remove as much fluid as possible
• Do not create pheumothorax
– Analyze aspirate
• Rx—depends on pathology causing effusion
• Client info
– Owner may need to continue pleural drainage
– Unless 1° is treated, effusion will return
– Rx can be long and expensive
Fungi
Fungal Diseases
Usually result from inhalation of fungal spores or wound contamination
Fungi release enzymes/toxins that damage host’s cells
Endemic along east coast, Great Lakes, river valleys of the Miss, Ohio, St
Lawrence
• Commonly seen fungal diseases of animals
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Blastomycosis
Coccidioidomycosis
Histoplasmosis
Aspergillosis
Blastomycosis (Blastomyces dermatitides)
• Signs (non specific)
– Anorexia, depression, wt loss
– Fever, cough, dyspnea
– Enlarged LN
• Dx
– X-rays—diffuse, nodular interstitial lung pattern (x-ray)
– Serology testing is available
– Most cases are diagnosed in the fall.
• Rx
– Amphotericin B
• Client info
– Blastomycosis usually not zoonotic disease, however, use caution with
animals with draining wounds
– Owners share same environment and are likely to be exposed
– Relapses are common
– Rx is expensive
Coccidioidomycosis (Coccidioides immitis)
• Signs
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Mild, non-productive cough
Low-grade fever, anorexia, wt loss
Weakness, depression
Lameness, pain is bone involvement
LN enlargement
CNS involvement
• Dx
– Parenchymal changes on x-ray
– Serology
radius-ulna
• Rx
– Ketoconozole
– Itraconazole
• Client info
– Usually not zoonotic disease, however, use caution with animals with draining
wounds
– Response to Rx is good, but recurrence is common
– Rx is expensive
Histoplasmosis (Histoplasma capsulatum)
• Organism which grows in bird manure, bat dropings or organically
enriched soil.
• Signs
– Feline (pulmonary signs)
• Wt loss, anorexia
• Fever, pale mm, swollen LN
– Canine (GI signs)
• Wt loss, diarrhea, low-grade fever
• Dyspnea, cough, pale mm
• Dz
– CBC: anemia
– X-ray: diffuse pulmonary interstitial pattern
• Rx
– Ketoconazole
– Itraconazole
• Client info
– Px fair to good for pulmonary form; guarded to grave for systemic form
Cryptococcosis (Cryptococcus neoformans)
A yeast-like fungus found in soil contaminated with pigeon and other bird droppings.
Inhalation major route of infection. Immunocompromised animal more susceptible
than normal animal
• Signs
– Feline
• Lesions in nasal and sinus cavities; chronic nasal discharge
• enlarged LN, wt loss, anorexia, lwo-grade fever
– Canine
• Dx
• Usually CNS lesions (vestibular dysfunction)
– Cytology of aspirates, impression smears
– Antigen test available
• Rx
– Amphotericin B
– Ketoconozole
– Itraconazole
• Px
– Fair to good unless CNS involvement
– No known health hazard to humans
Aspergillosis (Aspergillus fumigatus)
Inhalation major route of infection; nasal cavity is main location of lesions
• Signs
– Feline (uncommon)
• May be immunocompromised (FeLV)
• Lethargy, fever, wt loss, anorexia
– Canine (localized)
• Young to middle age
• Chronic nasal discharge, sneezing, loud breathing (like snoring)
– Canine (generalized infection)
• Primarily seen in G Shep
• Wt loss, anorexia
• fever, lameness, paresis/paralysis
• Dx
– X-ray—loss of nasal turbinates
– endoscopy:--yellow-green to black fungal plaques on nasal mucosa
Rx—topical clotrimazole
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• Client info
– Localized dis—poor Px; Generalized dis—grave Px; not zoonotic
Pulmonary Neoplasms
Tumors in lungs are usually metastatic, although primary lung tumors do
occur
• Signs
– Primary neoplasia
• Cough, exercise intolerance
• Wt loss, poor condition
• Dysphagia, vomiting, anorexia
– Metastatic neoplasia
• Evidence of primary tumor at other location
• Same signs as above for Primary neoplasia
Pulmonary Neoplasms
• Dx
– Chest X-rays—mass occupying lesions; can be mistaken for
abscess, parasitic dis, fungal infect, bact infect
– Biopsy—provides
definitive diagnosis
Pulmonary Neoplasms
Same dog as x-ray
• Rx—surgical removal is TOC
– Lobectomy for solitary tumor
• Chemotherapy (may reduce tumor size, may not increasse survival
time
• Client Info
– Px is guarded to grave
– By the time these tumors are diagnosed, they are usually
in advanced stages
– Chemotherapy may reduce clinical symptoms