Veterinary Medicine Quiz: Pleural Space Disorders

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to Lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following best describes the function of pleural fluid?

  • To facilitate gas exchange between the lungs and blood.
  • To prevent friction between the pleura during respiration. (correct)
  • To provide structural support to the thoracic cavity.
  • To aid in the removal of cellular debris from the lungs.

A dog presents with rapid and shallow breathing and decreased lung sounds. Which of the following is the most likely cause based on the material presented?

  • Increased lung capacity due to hypertrophy.
  • An increase in pleural fluid lubricating the lungs.
  • Normal breathing compensation for increased oxygen demand.
  • Reduced tidal volume due to decreased lung expansion. (correct)

Which type of pneumothorax is most likely caused by a penetrating wound?

  • Spontaneous secondary pneumothorax
  • Spontaneous primary pneumothorax
  • Traumatic pneumothorax (correct)
  • Iatrogenic pneumothorax

Which of the following is NOT a typical cause of secondary spontaneous pneumothorax in dogs?

<p>Pulmonary blebs or bullae (B)</p> Signup and view all the answers

What does the 'glide sign' indicate when assessing the pleural space?

<p>A normal finding when the visceral and parietal pleura make contact. (D)</p> Signup and view all the answers

Which of the following is NOT a primary cause of hemothorax?

<p>Pulmonary infection (C)</p> Signup and view all the answers

What diagnostic finding is indicative of bilothorax?

<p>A peripheral blood bilirubin to fluid bilirubin ratio less than 1:1 (D)</p> Signup and view all the answers

In dogs, which bacterial family is most commonly associated with pyothorax?

<p>Enterobacteriaceae (D)</p> Signup and view all the answers

Which of the following clinical signs is LEAST likely to be associated with pleural space disease?

<p>Bradycardia (B)</p> Signup and view all the answers

Why is intermittent thoracocentesis not recommended for managing pleural space disease?

<p>It is associated with a higher mortality rate. (D)</p> Signup and view all the answers

What is the most common cause of pleural effusion?

<p>Right sided heart disease (A)</p> Signup and view all the answers

When performing thoracocentesis for a pneumothorax, in which location should the needle be inserted?

<p>7th to 9th intercostal space at the highest part of the chest (A)</p> Signup and view all the answers

Which of the following is a potential indication for therapeutic thoracocentesis?

<p>Previously identified clinically significant pleural fluid (D)</p> Signup and view all the answers

For a therapeutic thoracocentesis in a dog, which size catheter is most appropriate?

<p>14-18 gauge (A)</p> Signup and view all the answers

Which of these is a recommended position for a patient undergoing a therapeutic thoracocentesis?

<p>Sternal recumbency (C)</p> Signup and view all the answers

The lack of a glide sign during thoracic ultrasound is most suggestive of what condition?

<p>Pneumothorax (D)</p> Signup and view all the answers

What does the reflection coefficient (σ) in the fluid flux equation represent?

<p>Effectiveness of the capillary wall in preventing protein passage (C)</p> Signup and view all the answers

An increase in which parameter is most likely to cause a transudate or modified transudate effusion?

<p>Capillary hydrostatic pressure (D)</p> Signup and view all the answers

Which diagnostic method is LEAST likely to be useful in the initial diagnosis of a pleural effusion?

<p>Culture (B)</p> Signup and view all the answers

Which of the following is most likely to cause a pure transudate?

<p>Decreased oncotic pressure (D)</p> Signup and view all the answers

What characteristic of feline infectious peritonitis (FIP) is considered atypical?

<p>Effusion in only very acute cases (D)</p> Signup and view all the answers

Which of the following is least helpful in diagnosing FIP?

<p>Cytology (A)</p> Signup and view all the answers

For both a pleural effusion and pneumothorax, which intercostal space is generally used for needle placement?

<p>7th-8th intercostal space (C)</p> Signup and view all the answers

Neoplastic effusions can be any of the following EXCEPT:

<p>Chylothorax (D)</p> Signup and view all the answers

Before inserting the catheter for a thoracocentesis, what is the correct method of skin disinfection?

<p>Aseptically scrub with chlorhexidine for 3 minutes followed by alcohol for dogs, betadine or povidone iodine for 3 minutes for cats followed by alcohol (A)</p> Signup and view all the answers

Which of these is NOT a step in placing a thoracocentesis catheter using the technique described?

<p>Angle the catheter caudally once inside the subcutaneous space (D)</p> Signup and view all the answers

What is the most common cause of a diaphragmatic hernia?

<p>Trauma (C)</p> Signup and view all the answers

What is the recommended volume of sterile warm saline for pleural lavage in a patient?

<p>10-20 mL/kg every 6 hours (B)</p> Signup and view all the answers

What is the typical daily fluid production threshold that would prompt removal of a chest tube?

<p>&lt; 2.2 ml/kg/day (D)</p> Signup and view all the answers

What was a potential complication noted in the lab owned dogs with chest tubes?

<p>Chewing out of the chest tube (B)</p> Signup and view all the answers

What was concluded regarding the use of large vs small bore thoracostomy tubes in the cadaver study?

<p>There was no significant difference in evacuation between the two sizes of tubes. (B)</p> Signup and view all the answers

What is the typical prognosis for cats with chylothorax using medical management?

<p>95% survival rate (C)</p> Signup and view all the answers

Which of the following is a characteristic of chylous effusion?

<p>Triglycerides are higher in the fluid than in serum (C)</p> Signup and view all the answers

What cell type predominates in the cytology of a chylous effusion?

<p>Small lymphocytes (D)</p> Signup and view all the answers

Which of these can contribute to the pathogenesis of chylothorax?

<p>Abnormal lymphatic vessels (C)</p> Signup and view all the answers

Flashcards

Pleura

A pair of serous membranes lining the thorax and lungs.

Pleural Space

A potential space between the pleura that contains fluid preventing friction.

Pneumothorax

Presence of air in the pleural space, causing lung collapse.

Clinical Signs of Pleural Disease

Signs include orthopnea, dyspnea, and cyanosis.

Signup and view all the flashcards

Glide Sign

Normal finding when visceral and parietal pleura touch during respiration.

Signup and view all the flashcards

Hemothorax

Accumulation of blood in the pleural cavity, usually due to trauma, coagulopathy, or neoplasia.

Signup and view all the flashcards

Bilothorax

Presence of bile in the pleural space, often due to trauma; diagnosed by bilirubin ratio in blood and fluid.

Signup and view all the flashcards

Pyothorax

Pus accumulation in the pleural space, commonly caused by inhaled foreign bodies or infections.

Signup and view all the flashcards

Medical management of Pyothorax

Includes thoracocentesis, chest tube placement, and broad spectrum antibiotics.

Signup and view all the flashcards

Antibiotic resistance in infections

Some bacteria resist treatments like enrofloxacin, requiring alternative antibiotics.

Signup and view all the flashcards

Idiopathic

Conditions with no identifiable cause; most frequent diagnosis.

Signup and view all the flashcards

Thoracocentesis

A procedure to remove fluid or air from the chest cavity.

Signup and view all the flashcards

Indications for Thoracocentesis

Signs of respiratory distress and reduced breath sounds.

Signup and view all the flashcards

Materials for Thoracocentesis

Includes syringe and needle (22 gauge 1 inch).

Signup and view all the flashcards

Butterfly Catheter Technique

Technique using a specific catheter to perform the procedure.

Signup and view all the flashcards

Sterile Procedure

A medical process requiring strict cleanliness to prevent infection.

Signup and view all the flashcards

Chylothorax

Accumulation of chyle in the pleural cavity due to impaired lymphatic drainage.

Signup and view all the flashcards

Chylous Effusion

Characterized by a large volume of milky fluid with high triglycerides.

Signup and view all the flashcards

Pleural Lavage

Flushing out the pleural space with saline to manage fluid buildup.

Signup and view all the flashcards

Chest Tube Maintenance

Requires daily inspection and scrubbing to maintain sterility.

Signup and view all the flashcards

Fluid Production Measurement

Drain removal depends on fluid output, <2.2 ml/kg/day per tube.

Signup and view all the flashcards

Cytology Findings

Small lymphocytes predominate; chronic cases may show neutrophils.

Signup and view all the flashcards

Prognosis with Medical Management

Cats show 95% survival; dogs 71-77% with surgical treatment.

Signup and view all the flashcards

Pneumothorax Sign

Lack of a glide sign suggests pneumothorax, where air enters pleural space.

Signup and view all the flashcards

Pleural Effusion

Accumulation of fluid in the pleural cavity, identified clinically as fluid.

Signup and view all the flashcards

Net Fluid Flux Equation

Equation describing fluid movement: Net Fluid Flux = K[(Pc – Pi) – σ(πc - πi)].

Signup and view all the flashcards

Exudate vs Transudate

Exudates indicate increased permeability, transudates indicate pressure issues.

Signup and view all the flashcards

Feline Infectious Peritonitis

Aseptic exudative effusion caused by coronavirus with symptoms in cats.

Signup and view all the flashcards

Diagnosis of Effusions

Diagnosis involves evaluating pleural or peritoneal effusion's appearance and tests.

Signup and view all the flashcards

Modified Transudate Causes

Causes include heart failure, vasculitis, and chronic irritation leading to increased cell count.

Signup and view all the flashcards

Neoplastic Effusions

Fluid accumulation due to cancer processes, can be transudates or exudates.

Signup and view all the flashcards

Pneumothorax Location

Occurs in the 7th-8th intercostal space at the lateral chest wall.

Signup and view all the flashcards

Pleural Effusion Location

Fluid accumulation occurs in the 7th-8th intercostal space, just above the costochondral junction.

Signup and view all the flashcards

Local Anesthesia Technique

Block the area with lidocaine, aspirate, then inject as the needle is withdrawn.

Signup and view all the flashcards

Diaphragmatic Hernia Causes

Usually caused by trauma (85% of cases), requiring supportive therapy and possible surgery.

Signup and view all the flashcards

Study Notes

Pleural Space Disease

  • Pleura is a pair of serous membranes lining the thorax and lungs.
  • Parietal pleura includes costal (incomplete), mediastinal (incomplete), and diaphragmatic.
  • Visceral pleura is also called pulmonary pleura.
  • Pleural space is a potential space between parietal and visceral pleura filled with fluid (0.1-0.3 ml/kg).

Pleural Space Fluid

  • Fluid prevents friction during respiration.
  • Pleural Effusion is fluid in the pleural space.
  • Types of pleural fluid:
    • Transudate
    • Modified Transudate
    • Exudate
  • Causes of pleural effusion:
    • Increased capillary hydrostatic pressure
    • Reduced capillary colloid osmotic pressure
    • Increased capillary wall permeability
    • Lymphatic drainage obstruction

Pleural Space Air (Pneumothorax)

  • Pneumothorax is air in the pleural space.
  • Types of pneumothorax:
    • Traumatic (penetrating, blunt)
    • Spontaneous (primary, secondary, iatrogenic)
      • Iatrogenic: needle or scalpel, barotrauma, traumatic intubation, feeding tube misplacement
  • Imaging: chest radiographs.
  • Clinical signs of pneumothorax: rapid, shallow breathing; decreased lung expansion; reduced tidal volume; mild to severe orthopnea, dyspnea, cyanosis

Pleural Space Soft Tissue

  • Includes diaphragmatic hernia, mass (neoplasia, granuloma, abscess).

Pleural Space Disease - Clinical Signs

  • Mild to severe orthopnea
  • Dyspnea
  • Cyanosis
  • Rapid, shallow breathing
  • Decreased lung expansion
  • Reduced tidal volume
  • Dull or quiet heart and lung sounds

Pleural Space Disease - Treatment

  • Thoracocentesis
  • Thoracostomy Tube
  • Continuous Suction
  • Blood Pleurodesis
  • Lung Lobectomy

Pleural Space Disease - Fluid Analysis

  • Assessment of oxygenation
  • Thoracic Radiographs, TFAST, Echocardiogram
  • TP or TNCC
  • NT-proBNP
  • Cytology
  • Culture
  • Radiographs, Ultrasound/POCUS, CT
  • Table 28-1 describes various characteristics and criteria of fluid types and exudates.
  • Pure Transudate (Hydrothorax): decreased oncotic pressure, increased hydrostatic pressure
  • Modified Transudate: increased post-hepatic hydrostatic pressure, decreased vascular permeability
  • Exudates: Feline Infectious Peritonitis (FIP), Neoplastic Effusions (e.g., pyothorax, billthorax, hemothorax, and chylothorax)

Feline Infectious Peritonitis (FIP)

  • Coronavirus
  • Aseptic exudative effusion

Pathophysiology

  • Infected macrophages deposited adjacent to small venules
  • Forms pyogranulomas in affected tissues
  • Inflammatory response can cause vasculopathy
  • Effusion accumulates in body cavities.

Diagnosis

  • Pleural fluid characteristics: viscous, straw-colored, high protein, low nucleated cells count (NCC).
  • High serum antibody test (>1:1600)
  • RT-PCR on effusion
  • IHC on cells from effusion
  • Rivalta Test

Diagnostics - Thoracentesis

  • Performed before thoracic radiographs
  • Signs of respiratory distress (increased respiratory effort) + reduced breath sounds

Preparation for Thoracentesis

  • Aseptically scrub with chlorhexidine for dogs.
  • Betadine or povidone iodine for cats.
  • Continuous contact for 3 minutes before removing with alcohol.
  • Tent the skin away from body wall.
  • Make a stab incision into the site.
  • Stab completely through dermis.

Materials

  • 3 ml syringe
  • 22 gauge 1" needle
  • Clippers & skin prep
  • Lidocaine for local anesthesia
  • 20, 35 or 60 ml syringe with stopcock and IV extension
  • #11 scalpel blade
  • 3 ml empty syringe
  • Catheter gauge (16-20 for cats, 14-18 for dogs)

Positioning for Thoracentesis

  • Standing
  • Sternal recumbency
  • Lateral recumbency
  • Avoid sitting; will make landmark isolation difficult.

Techniques

  • Butterfly catheter
  • Short intravenous catheter
  • Fenestrated plastic intravenous catheter

Materials (continued)

  • 35-60 ml syringe
  • 3 way stopcock
  • 19 gauge or 22 gauge winged needle catheter

Pleural Lavage

  • Sterile procedure
  • Warm saline (10-20 mL/kg every 6 hours).
  • Close monitoring ins/outs and fluid balance.
  • Heparin or tPA (humans only) can decrease adhesions in the pleural space.

Chest Tube Maintenance

  • Must be maintained sterilely.
  • Daily site inspection and scrubbing.
  • Drain removal depends on fluid production (<2.2 ml/kg/day per tube).

Pneumothorax Procedures

  • 7th-9th intercostal space, highest part of chest
  • Pleural effusion: 7th-8th intercostal space, just above costochondral junction

Diaphragmatic Hernia

  • Usually traumatic (85%)
  • Supportive oxygen therapy
  • IVC and fluid therapy (if in shock)
  • Surgical intervention

First Step for Affected Animals

  • Stabilize!!
  • Oxygen Therapy
  • Anxiolysis

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Quiz Team

Related Documents

Pleural Space Disease - MEF 2025 - PDF

More Like This

Use Quizgecko on...
Browser
Open
Browser
Browser