What are the causes of pericardial effusions?
- idiopathic
- neoplastic haemangiosarcoma, chemodectoma, lymphosarcoma
- LA rupture
- hypoproteinaemia
- haemorrhage
- CHF
Describe the pathophysiology of pericardial effusion
- effusion
- compresses R heart
- decreased filling
- decreased CO and forward failure
- R CHF
Describe cardiac tamponade
P from effusion compresses RA and RV walls making them thin. Walls collapse leading to R HF. L side doesn’t fill as well so cardiac output decreases.
Describe the signalment and presenting signs seen in dogs with pericardial effusion
Signalment:
- large breed dogs
Presenting signs:
- exercise intolerance
- lethargy
- abdominal distension
- weakness
What physical findings would be expected in cases with pericardial effusion?
- Poor CO - pallor, prolonged CRT, weak pulse, tachycardia, muffled heart sounds
- R CHF - jugular distension, ascites, hepatomegaly
What would be expected on diagnostic imaging in pericardial effusion?
- radiography - cardiomegaly, rounded cardiac silhouette
- ECG - small QRS complex
- echo - see effusion
How are pericardial effusions treated?
Pericardiocentesis
- effusion always haemorrhagic but shouldn’t clot
What is the prognosis with pericardial effusions?
- recur in ~ 50% patients
- pericardectomy recommened if effusion recurs (good prognosis)
- if effusion recurs quickly, neoplasia likely. Guarded prognosis
Small pericardial effusions are seen with which conditions?
- CHF
- hypoproteinaemia
- FIP
- infection
*don’t usually require drainage
List the different types of abdominal effusions
- transuadte
- modified transudate
- exudate
- chylous
- inflammatory (septic v non-septic)
- haemorrhagic
- bile
- urine
What are the causes of abdominal effusion in dogs?
- liver disease - chronic hepatopathies
- cardiac disease - pericardial effusion, DCM, mitral valve disease, pulmonic stenosis, dirofilaria
- neoplasia - haemangiosarcoma
- hypoalbuminaemia - PLE, PLN
What are the causes of abdominal effusion in cats?
- infectious disease - FIP
- neoplasia - abdominal carcinoma
- liver disease - chronic hepatopathies
- cardiac disease - cardiomyopathies
- hypoalbuminaemia - PLE, PLN
What are the physical signs of abdominal effusion?
- abdominal distension - fluid thrill
- tachypnoea, dyspnoea
- abdominal pain - particularly when lifted
What changes would be expected to be seen on radiography in cases with abdominal effusion?
- cardiomegaly
- enlargement of caudal vena cava
What are the properties of transudates and what can cause them?
Properties:
- clear
- non-viscous
- low protein <25g/L
- low cells <1000/uL
- slightly irritant
Causes:
- hypoalbuminaeia
- pre-sinusoidal obstruction - portal hypertension, hepatic fibrosis
- early bladder rupture - fluid high in urea and creatinine
What are the properties of modified transudates and what can cause them?
Properties:
- clear/straw coloured
- non-viscous
- high protein 25-75g/L
- low/moderate cells 1000-7000/uL
Causes:
- altered vascular permeability - chronic transudates, some tumours
- altered hydrostatic P - CHF, sinusoidal and post-sinusoidal obstruction, Budd Chiari-like syndrome (obstruction in cd vena cava)
What are the properties of exudates and what can cause them?
Properties:
- straw coloured - purulent +/- haemorrhage
- viscous
- high protein > 30g/L
- moderate-high cells >5000/uL
Causes:
- non-septic - FIP, ruptured gall bladder/bladder, severe accumulations of neutrophils (pseudochylous)
- septic - bacterial peritonitis, rupture of abdominal viscera, surgery, nocardiosis
What are the properties of neoplastic effusions?
- carcinoma - sero-haemorrhagic
- lymphoma - chylous
- necrotic - pseudochylous
- haemangiosarcoma - haemorrhagic
Which cardiac diseases can cause ascites?
- acquired - pericardial disease, biventricularr CHF secondary to DCM/endocardiosis (dogs) and CM (cats), Dirofilaria immitus
- congenital - pulmonic stenosis, tricuspid valve dysplasia, biventricular CHF secondary to end stage L-R shunts
List the types of pleural effusions
- transudate
- modified transudate
- exudate
- chylous
- haemorrhagic
What are the causes of pleural effusions?
- infectious - FIP, pyothorax
- neoplasia - lymphoma, carcinoma, mesothelioma
- cardiac disease
- chylothorax - CHF, trauma
- haemorrhage
- hypoalbuminaemia - PLE, PLN
What are the clinical signs associated with pleural effusions?
- dyspnoea
- tachypnoea
- muffled heart sounds
- dullness of ventral percussion
- +/- cough
How does heart worm present in dogs and cats?
- Dogs - cough, exercise intolerance, dyspnoea, syncope, hepatomegaly, ascites, death
- Cats - sudden death, vomiting, cough, dyspnoea, lethargy, anorexia, weight loss, chylothorax (secondary to CHF)
What findings on haematology would be expected with heart worm?
- eosinophilia
- neutrophilia
- basophilia
- anaemia
- lymphopenia
