Cardiorespiratory Diseases. Alveoli-Capillary Gas Exchange Alveoli surrounded by capillaries – Incoming RBCs low in O 2 – Exiting RBCs rich in O 2 –

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

Lower Respiratory Tract includes trachea, bronchi, lungs, _pleural cavity

Upper respiratory

Upper respiratory

Upper Respiratory Diseases

• Rhinitis• Sinusitis• Tonsilitis• Laryngitis

Upper Respiratory DiseasesUpper Respiratory Tract is any resp structure above the trachea

• Rhinitis—inflammation/infection of nasal passagesUsually 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• 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• LaryngitisMost 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 DiseasesLower 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• 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• 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—asthmaAirways more prominent because of

inflammation and mucus buildupDoughnuts (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

• Highly contagious• High mobidity• Low mortality• Most severe in kittens

Feline Viral Rhinotracheitis• Signs

– 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– 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

– 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

Fluid in thorax• Types of fluid Causes

– Transudate R-sided CHF, FIPplasma-like fluid; straw colored

– Blood trauma, neoplasia– Chyle neoplasia, pancreatitis, traumalymphatic fluid from intestine; high fat content infection, parasites --Empyema Infection, foreign body, traumapus in thorax

All types of fluid cause same signs– dyspnea– may show cough, fever, pleural pain

Dx—x-ray

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 DiseasesUsually result from inhalation of fungal spores or wound contaminationFungi release enzymes/toxins that damage host’s cellsEndemic along east coast, Great Lakes, river valleys of the Miss, Ohio, St

Lawrence

• Commonly seen fungal diseases of animals– 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

– 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

• 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

radius-ulna

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 susceptiblethan normal animal• Signs

– Feline• Lesions in nasal and sinus cavities; chronic nasal discharge• enlarged LN, wt loss, anorexia, lwo-grade fever

– Canine• Usually CNS lesions (vestibular dysfunction)

• Dx– 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• Client info

– Localized dis—poor Px; Generalized dis—grave Px; not zoonotic

Pulmonary NeoplasmsTumors 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

• 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

Same dog as x-ray