Tobias full > Thoracic Cavity > Flashcards

Thoracic Cavity Flashcards

(41 cards)

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1
Q

What is normal plural fluid volume in dogs and cats?

A
  • Dog - 0.1ml/kg
  • Cats: 0.3ml/kg
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2
Q

What cells make up normal plueral fluid?

A
  • mesothelial cells 9-30%
  • Monocytes/macrophages 61-77%
  • Lymphocytes 7-11%
  • Neutrophils under 2%

1500-2500 cells/mcL
Protein less than 2.5g/dL

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3
Q

What % of dogs have a dorsal thoracic lymph centre?

A

25%

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4
Q

Which parts of the body are NOT drained by the thoracic duct?

A
  • Right thoracic limb
  • Right shoulder
  • Cervical regions

Drained by the right lymphatic duct

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5
Q

What is the cisterna chyli and where is it located?

A
  • Bipartite, dilated, retroperitoneal lymph channel, ventral to L1-L4 along cranial abdominal aorta
  • Most cmmonly sits ventral to L3, caudal to coeliac and cranial mesenteric arteries
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6
Q

What is the major difference in the thoracic duct anatomy in dogs and cats?

A
  • Dogs - travel on right sife through caudal thorax, dorsolateral to aorta. Crosses to left at T5/6
  • Cats: On the left!
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7
Q

Where does the thoracic duct drain?

A

Left external jugular vein or jugulosubclavian vein
(Significant anatomical variation - some branches may terminate in azygous)

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8
Q

What embryonic structure forms the thymus?
At what age does it stop growing and starts to involute?

A
  • Arises from the 3rd pharyngeal pouch
  • Grows until 4-5mo
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9
Q

What is the normal functional residual capacity (volume of air remaining in lung at end of expiration)

A

45ml/kg

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10
Q

What fluid dynamics favour pleural fluid production and absorption?

A
  • Increased hydrostatic pressure of systemic and pulmonary capillaries compared to pleural fluid favours pleural fluid production
  • Increased osmotic pressure of systemic and pulmonary vascular beds are greater than pleural fluid, favouring absorption

Tends to enter pleural space from parietal pleura and be absorbed by visceral pleura

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11
Q

What are the functions of the thymus?

A

Cell mediated immunity
- maturation and selection of T-cells
- Termination of defective or autoreactive thymocytes

Endocrine
- Secretion of thymosin, thymic humoral factor, thymopoietin, thymostimulin, thymulin
- Involved in T-cell enhancement and maturation

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12
Q

How do you classify pleural transudate, modified transudate and exudate?

A
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13
Q

List causes of a pleural transudate

A
  • Hypoproteinaemia
  • Increased hydrostatic pressure as with CHF (NT-proBNP significantly higher in cats with effusion from heart disease)
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14
Q

List DDx for a serosanguinous (modified transudate) effusion

A
  • Lung lobe torsion
  • D-hernia with liver entrapment
  • Pericardial effusion
  • Right sided heart failure
  • Neoplasia (diffuse mesothelioma or carcinomatosis)
  • Idiopathic pleuritis
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15
Q

List DDx for a sanguinous effusion

A
  • Trauma
  • Coagulopathy
  • Acute lung lobe torsion
  • Iatrogenic
  • Tumours (chemodectoma, right atrial HSA)
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16
Q

List DDx for chylous effusion

A
  • Any condition that increases hydrostatic pressure in the cranial vena cava
  • Trauma
  • Idiopathic
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17
Q

How do you confirm chylothorax?

Study These Flashcards
A
  • Triglycerides higher and cholesterol lower than serum
  • Chylomicrons in the fluid can be stained with Sudan black
  • Positive ether clearance test
  • Modified transudate (protein 2.5-4g/dL, cell count less than 7000/mcL, specific grav leass than 1.032
18
Q

List DDx for inflammatory effusion

Study These Flashcards
A
  • D-hernia
  • Neoplasia
  • Chronic chylothorax
  • Lung lobe torsion
  • Infectious disease
  • Pancreatitis
  • Penetrating FB
  • Oesophageal trauma
  • Repeat thoracocentesis
  • Surgery

Oropharyngeal flora are most commonly isolated from cats

19
Q

What is the reported rate of pneumothorax and haemorrhage after a CT-guided lung FNA?

Study These Flashcards
A
  • Pneumothorax 0-27%
  • Haemorrhage up to 30%

Usually minimal and require no treatment

20
Q

What is the most realiable way to differentiate transudates and exudates in cats?

Study These Flashcards
A
  • Pleural fluid lactate dehydrogenase
  • Ratio of pleural fluid to serum TP.

Senstivity, specificity and accuracy 100% with a cut off for lactate at 226IU/L
Accuracy of TP ratio 95% with a cutoff greater than 0.56

21
Q

What is a relaible measurement to differentiate transudaet and exudate in dogs?

Study These Flashcards
A
  • CRP greater than 4mcg/ml 100% sensitive and 94% specific
  • 11mcg/ml 88% sensitive and 100% specifice for differentiating modified transudate and exudate
22
Q

What ICS is used for thoracocentesis?

23
Q

What effect does mechanical ventilation have on the lungs and heart?

Study These Flashcards
A
  • In closed chest, increases intrapulmonry pressures to 3-5cmH2O
  • This decreases coronary circulation, pulmonary circulation and venous return to the heart
  • Inspiratory:expiratory phases should be kept between 1:2 to 1:3
24
Q

In which ICS is a thoracostomy tube placed?

25
What is the recommended amount of crossing of a finger-trap
Spaced apart approx equal to width of tube with atleast 6 crosses on each side
26
What has been shown to be more effective at preventing leakage around the chest tube?
- Trocar tipper tube for tunneling rather than Carmalt forceps - Polyvinyl tubes more effecting than red rubber
27
What is the recommended ICS for surgical approach to the following structures - Heart and pericardium - PDA, PRAA - Pulmonic valve - Cranial lung lobe - Middle lung lobe - Caudal lung lobe - Cranial oesophagus - Caudal oesophagus - Cranial vena cava - Caudal vena cava - Thoracic duct in dog and cat
28
What pressure is continuous suction usually maintained at for a thoracostomy tube?
5-10cmH2O
29
What is the motality rate of thoracotomies? What factors are associated with nonsurvival?
Mortality rate 13-22% (5.9% in another study) Factors assoc with nonsurvival: - Preanaesthetic O2 requirement - Use of neuromuscular blocking agents during anaesthesia - Surgical duration over 180min - Blood products
30
What is the mortality rate of thoracic trauma?
- 11-15.5% with extensive bite wound trauma - 63% survival in cats
31
List DDx for spontaneous pneumonthorax
- Bullae/blebs - Emphysema - Neoplasia - Pleuritis - Migrating plant material - Pulm abscess - Feline asthsma or inflammatory airway disease (most common cause in cats) - Chronic pneumonia - Heartworm, lungworm Siberian Huskies overrepresented
32
What is the outcome of autologous blood patching for spontaneous pneumothorax?
- Resolved pneumothorax in 7/8 dogs after 1-3 treatments (5-10ml/kg blood)
33
What is the recurrence rate and mortality rate of spontaneous pneumo in dogs treated conservatively vs surgically
- Conservatively 50% recurrence, 53% mortality - Surgically 3% recurrence, 12% mortality
34
What do desquamated mesothelial cells make with chronic chylothorax?
- Type III collagen promoting fibrosis and leading to fibrosing pleuritis
35
What are the surgical options for chylothorax?
- Thoracic duct occlusion/embolisation - Pericardiectomy - Cisterna chyli ablation - Omentalisation
36
WHat is the prognosis for idiopathic chylothorax?
- Thoracic duct attenuation alone: 50-59% dogs, 14-53% cats successful - Thoracic duct and subphrenic pericardiectomy: 55-100% dogs, 80% cats - Thoracoscopic duct ligation and pericardial window 83-86% - Thoracic duct and cisterna chyli 63-88% - Thoracic duct, percardiectomy and omentalisation 57-77%
37
What are the options for managing recurrent chylous effusion?
- Percutaneous drainage systems (Pleuraport) - Pleuroperitoneal shunts
38
What breed is predisposed to pyothorax?
Labs and English Pointers
39
What is the prognosis of pyothorax? What factors are associated with increased survival in cats?
Successful Tx in 47.8 - 86% 85% disease free at 6m and 78% at 1yr post-op Factors assoc with increased survival in cats: - Lower resp rate - Higer heart rate - Higher WBC counts
40
What breeds are overrepresented with thymoma? What paraneoplastic syndromes are common? How many have concurrent nonthymic neoplasia?
- Labs and Goldens - Myaesthenis gravis (up to 47%), hypercalcaemia - 27% concurrent nonthymic neoplasia
41
How can you differentiate thymoma and lymphoma on cytology?
- Both contain large numbers of lymphocytes - Thymoma will more consistently have epithelial cells which may also exfoliate mast cells, eosinophils and erythrocytes
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