Localization of the pulmonary problem (Proceedings)
Nov 01, 2009
CVC IN SAN DIEGO PROCEEDINGS
Evaluation of the pet with respiratory disease may be challenging. The best approach to problem solving usually reflects first an assessment for immediate intervention, and then careful evaluation to localize the problem, and then finally determination of the specific problem and the available options for controlling or curing it. Immediate intervention is warranted in any pet that is having difficulty breathing. Respiratory distress may be appreciated by observing loud or noisy breathing, labored breathing, discolored (pale pink, grey or bluish) mucous membranes or by difficulty laying down or on one's side (orthopnea). Respiratory distress may be a life-threatening emergency and should be treated promptly. The appropriate immediate therapy will reflect the underlying cause, and may include supplemental oxygen, thoracocentesis, or sedation and intubation.
Localizing the problem
All causes of true pulmonary problems may be traced to abnormalities in the upper airway, the lower airway, the pulmonary parenchyma or the pleural space. Occasionally, pets with either marked metabolic acidosis or pain may have tachypnea which may be misinterpreted as respiratory distress.Most effective localization relays on pattern recognition, which is an appreciation of a conglomerate of historical and physical findings which are linked with a specific condition. Most successful clinicians incorporate pattern recognition as a method of problem solving in most day to day clinical challenges.
Upper airway obstruction
Causes of upper airway obstructions include brachycephalic airway syndrome (specifically elongated soft palate, laryngeal collapse and everted laryngeal saccules), laryngeal paralysis, pharyngeal foreign bodies, and neoplasia. Recently nasopharyngeal turbinate have also been described as a component of upper airway obstruction in brachycephalic airway syndrome. All upper airway obstructions are magnified in heat, humidity and with exertion. Clinically, upper airway obstruction may be suspected with loud or noisy breathing and longer inspiratory times.
Management of upper airway obstruction may include surgical or medical therapy. Surgical therapy includes soft palate resection, stenotic nares resection, arytenoids lateralization and in rare cases permanent tracheostomies. Medical therapy includes sedation, anti-inflammatory agents (steroids), harnesses and weight loss. Dogs that have laryngeal paralysis may have concurrent neuromuscular disease or esophageal motility disorders, including megaesophagus.
Lower airway disease