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Resp path - airways
dse mini test revision
66
Veterinary Medicine
Undergraduate 3
02/21/2012

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Term
What are the possible consqeuences of dz affecting the airways?
Definition
-coughing and sneezing - result of irritation and to move and expel mucus
-airway obstructions - by mucus, exudate, thickening of mucosal walls and bronchoconstriction
-wil reduce ventilation of the lungs
-impaired defences - damage to mucociliary escalator
Term
List development abnormalities associated with airways
Definition
-Brachiocephalic airway syndrome
-Cleft palate
-Cysts
-Guttoral pouch tympany
-Hypoplastic epiglottis
-Tracheal collapse
Term
Brachiocephalic airway syndrome
Definition
Range of anatomical abnormalities found in brachiocephalic breeds that result in obstruction of the upper air passages
Term
Describe the combination of anatomical problems and secondary changes associated with brachiocephalic airway syndrome
Definition
Anatomical problems
-stenotic nares
-elongated and often thickened soft palate
-thickened tounge
-turbinates may protrude into nasopharynx
-hypoplastic trachea in some cases
Secondary changes
-collapse and obsruction of nares
-everted laryngeal saccules
-everted tonsils
-inflam and oedema e.g. palate, larynx
-laryngeal collapse
Term
What clinical signs may result from upper airway obstruction?
Definition
-Resp. noises
-Gagging, retching, vomiting
-Dysponea, exercise intolerance, cyanosis, collapse
Term
Cleft palate
Definition
Failure of closure of the palatine shelves causes a defect in the palate
Term
What are the possible consequences of cleft palate?
Definition
-Food can directly access the nasal cavity from the oral cavity
-Aspiration pneumonia is a common sequel
Term
Name different types of cysts that may obstruct the airways and the species associated.
Definition
-Epidermal inclusion cysts (horses)
-Paranasal sinus cysts (horses)
-Cystic nasal conchae (cattle)
-Subepiglottal and pharyngeal cysts (horses)
Term
Guttural Pouch Tympany
Definition
Defect of the nasalpharyngeal opening that results in trapping of air and mucus in the guttoral pouch
Term
What are the potential consequences of guttoral pouch tympany?
Definition
-Pressure on the oesphagus and trachea can cause dysphagia and dysponea.
-Can lead to aspiration of food and resultant pneumonia
-Can predispose to guttoral pouch bacterial infection.
Term
Hypoplastic epiglottis
Definition
-Under-development of the epiglottis
-Small epiglottis may become entrapped under arytenoepiglottic fold causing airway obstruction and resp. noise
Term
Tracheal (tracheobronchial) collapse
Definition
-Dorsoventral flattening of the trachea
-Results from deformity in supporting cartilage and causes a widening of the dorsal tracheal membrane
Term
What are the potential consequences of tracheal collapse?
Definition
-The widened dorsal tracheal membrane may prolapse into the trachea during inspiration
-Membrane may become thickened if it becomes chronically inflamed
-Varying degress of resp. noise incl. "goose-honk" cough
Term
List potential circulatory disturbances associated with airways
Definition
-Congestion and hyperaemia
-haemorrhage
-oedema
-Progressive ethmoid haematoma in horses
Term
Define congestion and hyperaemia
Definition
Congestion - PASSIVE - reduced outflow of blood
(can be a non-specific finding at PM)
Hyperaemia - ACTIVE - increased blood flow into tissues and vasodilation
Term
Some causes of airway haemmorhage
Definition
-trauma
-inflam
-infection
-septicaemia / sepsis
- clotting defects
-neoplasia
-progressive ethmoid haematoma (horse)
Term
Progressive ethmoid haematoma (horse)
Definition
Haemorrhagic polypoid masses that arise in the ethmoid region
-with areas of haemorrhage and organisation and the formation of fibrous granulation tissue, macrophages and haemosiderin deposition
Term
What are the potential consequences of airway oedema?
Definition
Obstruction of airflow - can be a medical emergency
Term
What is oedema of the airways commonly associated with?
Definition
-Local inflammation/trauma (most commonly)
-Systemic dz (occasionaly)
Term
List degernerative diseases associated with the airways
Definition
Laryngeal paralysis
Includes - Equine laryngeal hemiplegia (roaring)
Term
Laryngeal paralysis
Definition
paralysis and atrophy of the dorsal and lateral cricoarytenoid muscle - results in failure of one or both the arytenoid cartilages to abduct during insipiration
Term
What is the cause of laryngeal paralysis?
Definition
Impairment of the recurrent laryngeal nerve
Term
What are the consequences of laryngeal paralysis?
Definition
Obstruction of the airways and so hypoxia
Term
AFTER 23
What type of dog is predisposed to laryngeal paralysis? uni or bilateral?
Definition
Large breeds predisposed and in dogs it tends to be bilateral
(c.f. horse - usually unilateral and usually L)
Term
Equine recurrent laryngeal neuropathy / laryngeal hemiplegia / roaring
Definition
Degeneration of left recurrent laryngeal nerve
-results in paralysis and atrophy of dorsal and lateral cricoarytenoid and so incomlete dilation of the larynx
-flaccid arytenoid cart. is sucked into airway during insp. causing airflow obstuction and turbulence
-turbulence and vibration of loose vocal cords results in roaring sound
Term
After 24
What is the cause of recurrent laryngeal nerve impairment in laryngeal paralysis?
Definition
NB: long nerve so easily damaged
-congenital abnormality
-primary idiopathic neuronal degeneration
-secondary trauma, compression or irritation of the nerve
e.g. cervical trauma, inj. of irritating substances to neck and so inflam resp., guttoral pouch dz., enlarged LNs, neoplasia
-generalised neuromusc. dz.
-neurotoxins e.g. lead poisoning, hepatic encephalopathy
-secondary to hypothyroidism in dogs
-occasionally arises following anaesthesia
Term
BEFORE 25
What type of neoplasms are most common in the upper airways of dogs and cats and horses?
Definition
Malignant tumours more common and epithelial origin.
Dog and cat - nasal origin more common
Horse - paranasal origin more common
Term
Name possible upper airway neoplasias
Definition
-Epithelial tumours are most common i.e. Carcinoma, adenocarcinoma (malignant non-gland epithelial/glandular origin)
-Lymphoma in cats
-Chondrosarcoma is most common mesenchymal tumour in dogs (malignant)
Term
Examples of upper-airway neoplasias
Definition
-Nasal adenocarcinoma
-Squamous cell carcinoma
-Transitional carcinoma
-Lymphoma
-Chondrosarcoma
Term
AFTER 26
Briefly describe tumours of the larynx trachea and bronchi / bronchioles
Definition
Larynx / trachea tumours are fairly rare, may occur from spread from local tissues.
Tumours of bronchi/bronchioles are rel. uncommon, mostly of epithelial origin, and mostly malignant.
Term
List possible causes of inflam of the airways
Definition
-Microbial infections agents e.g. viruses, bact., fungi
-Parasites
-Physical injury (trauma, thermal or chemical), forign body, inhaled irritants
-Toxins (inhaled or haemattogenous
-Allergens
-Extension from local tissue e.g. dental
Term
Types of airway inflam
Definition
-Serous
-Catarrhal and mucopurulent
-Purulent (suppurative)
-Fibrinous
Term
Describe what happens following injury to the airway epithelium
Definition
-detachment and shedding of ciliated cells
-basement membrane denuded
-increased secretions from seromucous glands
-vasodynamic changes - heat, swelling, redness, hyperaemia
-within ~24hrs, get proliferation of non-ciliated reserve cells which will try to cover denuded BM
-increased mucous secretion from mucosal glands results in a change from the serous discharge associted with early inflam to a catarrhal discharge
-in severe inflam the exudate may become fibronous and haemorrhagic
Term
Describe serous inflam, in reference to the airways
Definition
-Mildest form of inflam - may be seen in early viral inf., mild allergic reactions
-mucosal hyperaemia and oedema
-increased production of fluid from naso mucoserous glands
-clear, watery discharge
Term
Describe catarrhal inflam, in reference to the airways
Definition
-Increased production of serous secretions and mucus from mucous glands and goblet cells, compared to serous inflam
-thick, viscous, translucent to slightly turbid discharge with a few inflam cells and cell debris
Term
Describe mucopurlent inflam, in reference to the airways
Definition
Catarrhal inflam with the presence of neutrophils - makes the exudates appear cloudy
Term
Describe purulent /suppurative inflam, in reference to the airways
Definition
-Massive emigration of neutrophils
-Often necrosis and sloughing of epithelial cells
-Thick, opaque discharge, may be white, yellowish, green or brown depending on cells/bact. present
Term
Describe fibrinous inflam, in reference to the airways
Definition
-Caused by severe injury
-Dramatic increase in vascular permeability and exudation of plasma fibrinogen - coagulates to form fibrin
-May be associated with haemorrhage and tissue necrosis
-Thick, often haemorrhagic discharge with yelllowish, fibrinous strands
Term
AFTER 34
Fibrinonecrotic / diptheritic inflam, in reference to the airways
Definition
-when the mucosa is covered by an adherent layer
-composed of necrotic, superficial layers of the mucosa, combined w. the inlfam exudate
Term
AFTER 34
Pseudomembranous inflam in reference to the airways
Definition
Formation of a superficial fibrinous membreane that can be easily peeled off the mucosal surface
Composed of fibrin, necrotic cells, WBCs
Term
Describe how inflam of the upper airways may change over time
Definition
Serous --> Catarrhal --> Purulent
OR
Serous --> Catarrhal --> Fibrinous --> Purulent

At any point may progress to -->healing and resolution
OR -->chronic inflam
Term
Descibe the typical pathological changes associated with chronic inflam of the airways
Definition
-Mucosal hypertrophy and hyperplasia (esp. goblet cells)
-Metaplasia of epithelium (squamous metaplasia) and goblet cells in bronchioles (goblet cell metaplasia)
-Infiltration of chronic inflam cells (macro., lympho., plasma cells, +/- neutro., eosino.)
-Fibroplasia/ granulation tissue
Term
Describe a granulomatous inflam of the airways
Definition
Where mucosal inflam is characterized by the presence of an inflam cell infiltrate, with many macro. mixed with lympho. and plasma cells in the mucosa
Term
Nasal / nasopharyngeal polyps
Definition
-Diffuse or focal polypoid or pedunculated mucosal nodular thickenings, composed of granulation tissue/fibrous tissue and chronic inflam cells
-covered by normal, hyperplastic or metaplastic epithelium
Term
What can lead to the formation of nasal and nasopharyngeal polyps?
Definition
Chronic rhinitis or sinusitis (ie. chronic upper airway inflam) can lead to proliferative changes and thickening of tissues including the formation of polyps
Term
AFTER 39
Where do nasal / nasopharngeal polps tend to arise in the cat and horse?
Definition
Horse: nasal polyps tend to arise in ethmoid region (progressive ethmoid haematoma)
Cats: Nasopharyngeal polps tend to arise in auditory tube or tympanic bulla/middle ear and may extend into pharynx or ext. ear canal (=aural polyp)
Term
Bronchiolitis obliterans
Definition
Formation of fibrovascular polypoid nodules that protrude into the bronchiolar lumen and interfere with airflow
-can result from severe inflam and organisation of the exudates during healing in the bronchioles
Term
What are the main signs associated with chronic bronchitis and bronchiolitis?
Definition
-increased mucus
-thickeninng of the airway walls/mucosa
Term
What are the main sources of increased mucus associated with chronic bronchitis and bronchiolitis?
Definition
-mucus gland hyperplasia (bronchi)
-goblet cell hyperplasia (bronchi)
-goblet cell metaplasia (bronchioles)
Term
What are the main causes of thickened airway walls associated with chronic bronchitis and bronchiolitis?
Definition
-mucus gland hyperplasia
-epithelial hyperplasia and metaplasia
-inflam cell infiltrates
-fibrosis
-smooth muscle hypertrophy and hyperplasia
Term
What is the most common cause of chronic bronchitis and bronchiolitis?
Definition
Repeated infections, esp. bacterial inf., parasitic dz. and allergic dz e.g. RAO
Term
Consequences to chronic bronchitis and bronchiolitis?
Definition
-Narrowing and obstruction of the airways
-dysponea
-coughing
-incr. resp. noise
-hypoxia
-collapse or over-inflation of lung
-predispostion to chronic bact. inf.
-broncholamacia
-bronchiectasis
Term
Bronchomalacia
Definition
Weakening of the bronchial cartilage, can result from chronic bronchitis and bronchiolitis
Term
Bronchiectasis
Definition
Destruction of the bronchial wall tissues leading to permanent dilation of the bronchus
-a result of the release of proteolytic enzymes from purulent exudate
-associated with inf. and obstruction of the lumen with exudate
-airway obstruction and atelectasis occurs distally
Term
Infectious Bovine Rhinotracheitis (IBR)
Definition
Highly infectious dz caused by bovine herpes virus 1.
Term
Describe the basic dz progression of Infectious Bovine Rhinotracheitis (IBR)
Definition
-Aerosal infection of nasal and conjectival epithelial cells
-Viral replication
-Inflammatory response
-Damage to mucociliary escalator
-Impaired mucosal defences
-Secondary bact. infection
-Influx of neutrophils and so purulent discharge
Term
Canine Infectious Tracheobronchitis (Kennel cough)
(Bordetella bronchiseptica)
Definition
Lesions of respiratory track of variable severity
-a mucopurulent tracheobronchitis
Term
Strangles
Definition
-Caused by streptococcus equi
-colonies the nasopharyngeal mucosa
-purulent nasal discharge
-inf. spreads to LNs
-abscesses within LN can rupture and drain to the surface
-can cause guttoral pouch empyaema if ruptures into guttoral pouch
Term
Nasal and sinus aspersillosis
Definition
-most common fungal inf. in UK
-Caused by Aspergillus fumigatus
-mostly seen in dogs, esp. long nosed (may be immunocompromised / other nasal inf.)
-visible fungal plaques on nasal mucosa
-fibrinonecrotic to granulomatous inflam. associated w. mucopurulent or haemorr. nasal discharge
-often causes lysis of turbinate bone
Term
Guttoral Pouch mycosis
Definition
-most commonly caused by Aspergillus spp.
-severe inflam - fibrinonecrotic
-deep invasion of tissues can lead to complications
eg. damage to facial nn. (poss. facial, pharyngeal, laryngeal paralysis), erosion of b.v. and haemorr.
Term
Name 2 allergy associated dz. of the airways
Definition
Feline ashma (feline allergic bronchitis)
Recurrent airway obstruction (RAO)
Term
Feline asthma
Definition
Presumed to be an acute allergic response (i.e. HS rection)
-bronchial sm. musc. hyper-reactivity causes acute onset dyspnoea and wheezing due to broncho-spasm/constriction
-in chronic cases may see thickening of bronchial wall and evidence of inflam cells
Term
Recurrent Airway Obstruction (RAO)
Definition
-common condition in adult horses
-obstructive condition due to bronchospasm (hyper-responsiveness of the airway sm. musc.) and mucosal inflam and thickening (esp. of bronchioles)
Term
Cause of RAO
Definition
(Not fully understood)
Thought to be primarily a HS disorder to inhaled allergens commonly found in mouldy hay or bedding or in stable dust
Term
Clinical signs of RAO
Definition
-coughing
-mucopurulent nasal discharge (occludes airways)
-incr. resp rate
-pronounced effort during exp. w. obvious abdominal component - may result in "heave-line"
-wheezing and crackling lung signs on auscultation
Term
Progressive atrophic rhinitis in pigs
Definition
-Associated w. infection w. Pasteurella multocida (oft. facilitated by pre-inf. w. Bordetella bronchiseptica)
-B. bronchiseptica = inflam and mild reversible damage to turbinates
-P. multocida = production of osteolytic cytotoxin and progressive destruction of turbinates
-Causes moderate to severe atrophy of nasal turbinates, w. distortion and shortening of snout in advanced cases
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