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Clinical signs of nasal cavity (inflammation infections, tumors) disease. (5)
sneezing, nasal d/c, pawing/rubbing face or neck, open mouth breathing at rest, throat clearing
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Clinical signs of nasopharyngeal disease. (3)
open mouth breathing at rest, throat clearing, reverse sneezing
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Clinical signs of laryngeal disease. (1)
change in voice
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Clinical signs of necrosis, secondary infection in oral cavity of respiratory tree. (4)
halitosis, breathing noise, exercise intolerance, increased inspiratory effort (+/- expiratory if fixed obstruction)
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Respiratory sounds in airway obstruction. (8)
stertor, stridor, change in inspiratory pitch, cough, throat clearing, increased tracheal sounds, "goose honk", tracheal snaps/clicks
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Stertor is USUALLY localized to the __(2)__.
soft palate or nasopharynx
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Fixed obstructions cause...
inspiratory and expiratory dyspnea/ sounds.
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Paradoxical breathing indicates a(n)...
chronic adaptation of respiratory distress.
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Describe the initial management of upper airway obstruction. (6)
oxygen, sedation, control body temp, corticosteroids (reduces mucosal edema), +/- intubation if necessary, +/- tracheostomy
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Brachycephalic upper airway syndrome is a product of ___________; it is characterized by... (4)
centuries of in-breeding; stenotic nares, redundant soft palate, everted laryngeal saccules, and laryngeal collapse (arytenoids)
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Describe redundant soft palate.
soft palate hangs down into glottis
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What are secondary problems associated with brachycephalic upper airway syndrome? (3)
- everted laryngeal saccules (laryngeal ventricles)- sucked up into the airway due to high inspiratory pressure
- laryngeal collapse (arytenoids)- due to high inspiratory pressure
- laryngeal edema
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What are primary lesions with brachycephalic upper airway syndrome? (2)
- stenotic nares
- redundant soft palate
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What additional abnormalities often occur in brachycephalic dogs in addition to upper airway syndrome? (3)
Ethmoidal turbinate protrusion (pugs), tracheal hypoplasia (english bulldogs), macroglossa (bulldogs)
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What GI abnormalities might result from increased inspiratory pressures? (3)
gastro-esophageal reflux, hiatal hernias, esophageal anomalies
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How is brachycephalic upper airway disease managed? (8)
- relieve airway obstruction
- rhinoplasty (treatment of stenotic nares)
- +/- soft palate surgical trim
- +/- laryngeal surgery
- environmental awareness of owners- heat, humidity, fans
- weight control
- PPI for GI reflux
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What are some common nasopharyngeal diseases? (8)
follicular reaction, nasal mites, nasopharyngeal polyps (cats), extension of rhinitis, neoplasms extending from ventral nasal meatus, nasopharyngeal stenosis, nasopharyngeal spasm (reverse sneeze)
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What are possible etiologies of nasopharyngeal stenosis? (4)
congenital, post-infection, acid reflux/ vomiting, prior FB
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What is a minimally invasive intervention for a discrete nasopharyngeal stenosis?
balloon dilation
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What is the best way to evaluate the larynx?
laryngoscope and a light plane of anesthesia
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What is laryngeal paralysis?
laryngeal motor dysfunction due to nerve trauma, neuropathy, surgery, or neoplastic invasion (cats)
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What is the usual signalment of lar-par?
older, large breed dogs(labs, st. bernard, golden retriever)
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What are clinical signs of chronic presentation of lar-par? (4)
change/loss of bark, airway noise (increased during exercise), gagging, cough
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What are clinical signs of the acute presentation of lar-par? (2)
life-threatening obstruction, often associated with increased heat/ hyperthermia
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How is lar-par usually diagnosed? (4)
clinical signs, auscultation, laryngoscopy under light anesthesia (usually with Doxapram concurrently), +/- US
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What are some differentials that should be on your list with laryngeal paralysis? (4)
laryngitis, mass, granuloma, cysts (cats)
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What is a common mistake when diagnosing lar-par by laryngoscopy?
don't confuse expiration pushing the vocal folds out for abduction of vocal folds; be careful when ruling out laryngeal paralysis
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What will usually be seen on laryngoscopy with lar-par? (3)
insufficient abduction of arytenoids, medial collapse of the arytenoid tubercles, mucosal edema
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What are common co-morbidities with laryngeal paralysis? (5)
hypothyroidism, polyneuropathy, pharyngeal-esophageal dysfunction, aspiration pneumonia, non-cardiogenic pulmonary edema from acute airway obstruction
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Describe the management of lar-par.
- initial management of airway obstruction with oxygen, sedation, steroids
- if surgery is deemed necessary: "tie-back" or lateralize one side
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What is a long-term risk with surgical correction and "tie-back" for treatment of laryngeal paralysis?
aspiration pneumonia
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What are potential etiologies of bronchial collapse or compression? (3)
- primary bronchial collapse- degenerative or dynamic
- compressed LMSB (left mainstem bronchus)(MR)
- hilar or pulmonary mass lesion
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Tracheal collapse can be caused by...
bronchial collapse or compression by Intraluminal obstruction (FB, parasites, tumors, granulomas) or extraluminal (thyroid carcinoma ,esophageal mass lesion, mediastinal or hilar lymph nodes, or a medisatinal or pulmonary mass or hemorrhage)
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Describe tracheal collapse of toy breed dogs. (3)
degeneration of tracheal cartilages, hypertrophy of dorsal membrane, dorsal flattening of trachea
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Intrathoracic tracheal collapse commonly causes __________ collapse; extrathoracic tracheal collapse causes __________.
expiratory; inspiratory
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What are the most common clinical signs of tracheal collapse in small and toy breed dogs? (5)
long history of cough, honk, stridor, causing distress
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What are some common radiographic findings with tracheal collapse in toy breed dogs? (3)
narrowing of trachea on lateral, marked narrowing in intrathoracic region during expiration, herniation of cranial lung lobe
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Many intrathoracic tracheal collapses are also associated with __________.
chronic bronchitis
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Describe diagnosis of tracheal collapse. (4)
- breed, history, PE, and radiography
- +/- fluoroscopy if needed
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Describe the management of tracheal collapse. (7)
weight loss, harness (not collars), avoid stress/smoke/heat, cough suppressants (hydrocodone), anti-inflammatory corticosteroids, trial course of antibiotics (doxy, clavamox), LAST RESORT stenting
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When do you resort to stenting for a dog with tracheal collapse?
- life-threatening airway obstruction that fails medical treatment
- NEVER stent for coughing only (these dogs will cough for the rest of their lives)
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Noncardiogenic pulmonary edema is aka... (3)
adult respiratory distress syndrome, shock lung, permeability lung edema
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What radiographic findings are very suggestive of noncardiogenic pulmonary edema?
bilateral caudodorsal pulmonary infiltrates- unstructured interstitial and alveolar, air bronchograms over diaphragm
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Noncardiogenic pulmonary edema is classically associated with __(2)__.
shock or sepsis
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Classically, noncardiogenic pulmonary edema, such as that caused by shock or sepsis, has a pathogenesis as follows...
increased capillary permeability--> protein and fluid leakage into alveoli--> low pressure, high-protein alveolar edema
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What is the proposed pathogenesis of noncardiogenic pulmonary edema caused by upper airway obstruction and seizures?
redistribution of blood from systemic circulation, which has a very large storage capacity, to pulmonary circulation, which has small storage capacity
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Noncardiogenic edema can be associated with... (5)
sepsis, lung injury, re-expansion, upper airway obstruction, smoke inhalation
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What is the management of noncardiogenic pulmonary edema?
oxygen, sedation, time, ventilation [NO FLUIDS, even tho the animal is in shock...will increase edema]
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Idiopathic pulmonary fibrosis is most common in ___________; it is characterized by ___________.
middle-aged to older westies; fibrosing alveolitis.
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Idiopathic pulmonary fibrosis is commonly mistaken for ___________.
L-CHF
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Describe the presumed pathogenesis of idiopathic pulmonary fibrosis.
lung injury--> alveolar wall and interstitial inflammation--> irreversible lung injury--> fibrosis (end-stage)--> stiff lung + V/Q mismatch--> pulmonary hypertension +/- cor pulmonale
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What are the components of pleural fluid dynamics in health? (4)
- microcirculation, interstitium, and lymphatics
- negative pressure in intrapleural space
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Source of normal fluid in pleural space.
pariental and subpleural capillaries
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How does reabsorption of pleural fluid occur in health?
parietal pleura through lymphatic stoma and mesothelial microvilli that actively reabsorb fluid
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Describe the pathophysiologic consequences of pleural effusion.
compression atelectasis--> V/Q mismatch or shunting--> hypoxemia and restriction of inspiratory mechanics +/- pleural thickening (in some diseases)
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The visceral pleura in dogs and cats is supplied by ______________, but the drainage is through ___________, draining fluid in subvisceral pulmonary veins ends up in the _________ (lymph usually drains into __________________)—> this has implications in CHF
pulmonary and bronchial arteries; pulmonary veins; left atrium; systemic veins and into right heart
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How do animals compensate for pleural effusion?
thoracic volume increases and diarphragm moves caudally—> changes mechanics of ventilation (tachypnea, respiratory signs)—> ultimately, decreased effectiveness of inspiratory muscles
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What are the possible mechanisms of pleural fluid accumulation? (4)
- increased systemic circulation hydrostatic pressure (R-CHF--> impaired drainage of lymphatics)
- increase pulmonary circulation hydrostatic pressure (L-CHF)
- obstruction to lymphatic drainage (neoplasia, etc)
- increased capillary/ mesothelial permeability
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Describe the pathophysiology of pleural effusion in L-CHF.
fluid leaks across the visceral surface of the pleura due to increased pressure in the pulmonary capillaries (PHT)--> pleural effusion
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Describe the pathophysiology of pleural effusion in R-CHF.
fluid leaks across the parietal surface of pleura because of decreased lymphatic draining (due to high pressure in right heart)--> pleural effusion
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Clinical signs of pleural effusions. (6)
decreased activity, exercise intolerance, tachypnea, respiratory distress, +/- coughing (w/ pulmonary involvement or pleuritis), +/- whatever signs relating to underlying cause (CHF, pulmonary neoplasia, infection)
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Describe auscultation of patients with pleural effusion.
ventral dullness to percussion and auscultation- "pleural fluid line"
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What are diagnostic imaging findings with pleural effusion? (4 modalities)
- Rads: increased fluid density, border effacement, fissure line, lobe retraction
- US: fluid b/w lungs and chest wall
- Echo: only useful when HF is suspected as underlying cause
- CT: used to assess idiopathic effusions or when neoplasia is suspected
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What is a critical diagnostic to perform with pleural effusion?
thoracocentesis (therapeutic and diagnostic)--> cytological examination and classification of fluid, culture of fluid
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What is the classic appearance of pneumothorax?
looks like heart is floating above sternum
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What are the most common causes of pleural effusion? (6)
CHF, pericardial effusion, pulmonary neoplasia, pleural metastatic disease, chylo/pyothorax, FIP
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Describe the initial management of pleural effusion. (4)
thoracocentesis, oxygen, sedation, low-stress
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The majority of feline pyothorax cases are associated with ___________ and are thought to be of __________ origins.
anaerobic bacteria; endogenous
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What are the management principals of pyothorax? (6)
thoracocentesis, cytology, culture INCLUDING ANAEROBIC, antimicrobials, either chest tube with suction or surgery with chest tube, supportive care
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What is the characteristic of chylothorax?
lymph derived from the intestines and is therefore laden with triglycerides
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What are causes of chylothorax? (4)
usually idiopathic, CHF in cats, obstruction of cranial vena cava, trauma
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Describe the surgical management of chylothorax.
everything is scarred due to chronic irritation--> ligate thoracic duct, pericardectomy (to prevent constrictive disease)
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