呼吸系統(tǒng)大小3.33g-咳嗽鑒別診斷

COUGHINGDIFFERENTIAL

DIAGNOSISAND

CLINICAL

APPROACH咳嗽的鑒別

和病程Michael E.

HerrtageUniversity

of

Cambridge11/26/2020C94-259

Yorkshire

terrier14

year

old female

neutered約克夏，14歲絕育母犬Michael

E.

HerrtageUniversity

of

CambridgeHistory

病史Chronic

cough

for

3

months慢性咳嗽達(dá)3個月之久Dry,

hacking

cough

in

paroxysms陣發(fā)性干咳，頻咳Progressive

exercise

tolerance

and

panting進(jìn)行性耐受不良，喘氣No

response

to

antibiotics抗生素治療無效No

oculonasal

discharge無眼鼻

物C94-259

Yorkshire

terrier14

year

old

female

neutered患畜輕度過胖氣管觸診誘發(fā)咳嗽脈搏：100

次/分鐘Dog

slightly

over-weightCough

elicited

on

trachealpalpationPulse

rate

100

beats

per

minGrade

3/6

systolic

murmur

over

left

apexRegularly

irregularrhythm左心尖部有3/6級收縮期心雜音規(guī)律性出現(xiàn)節(jié)律不齊Reduced

lung

sounds

right

dorsal

lung

area右背部肺區(qū)呼吸音減弱Dullness

on

percussion

of

right

dorsallung

area右背肺區(qū)叩診濁音C94-259

Yorkshire

terrier14

year

old

female

neuteredClinical

Examination

臨床檢查LATERAL

THORACIC

RADIOGRAPH側(cè)位胸片DORSOVENTRALTHORACICRADIOGRAPH背-腹位胸片THORACIC

ULTRASOUND胸部超聲THORACIC

ULTRASOUND胸部超聲RESPIRATORY

VERSUS

CARDIAC

CAUSESOF

COUGHING心源性咳嗽vs肺源性咳嗽Small

breeddog

小型犬Chronic

valvular

disease

and

chronic

bronchitis

common

in

these

breeds常見慢性瓣膜病變和慢性氣管炎Obesity

肥胖Usually

associated

with

pulmonary

disease通常與肺部疾病相關(guān)Weight

loss

體重下降Congestive

cardiac

failure

usually

causes

dramatic

weight

loss.

May

be

seenwith

pulmonary

neoplasia.充血性心衰竭，通常導(dǎo)致明顯的體重下降，可在肺腫瘤中見到Pronounced

sinus

arrhythmia

明顯竇性心律不齊Associated

with

chronic

pulmonary

obstructive

disease.

Lost

in

heart

failure.與慢性肺部阻塞性疾病相關(guān)RESPIRATORY

VERSUS

CARDIAC

CAUSESOF

COUGHING心源性咳嗽vs肺源性咳嗽Soft

moistcough

濕咳Pulmonary

oedema

can

cause

this

type

of

cough肺水腫可Dryharsh

cough

干咳Can

occur

witheither

respiratory

or

cardiac

causes呼吸系統(tǒng)疾病或心臟病均可Exercise

intolerance/dyspnoea

運(yùn)動耐受力差/呼吸Usually,

but

not

always,

associated

with

heart

disease常見（但不全是）與心臟疾病相關(guān)Loud

murmur

響亮的心雜音There

is

no

correlation

between

the

intensity

of

the

murmur

and

the

severityof

the

disease雜音的強(qiáng)度與疾病的嚴(yán)重程度無關(guān)INVESTIGATION

OF

COUGHING咳嗽的History

病史Physical

examination

全身檢查Radiography

X光片Bronchoscopy

氣管鏡Bronchoalveolar

lavage

支氣管肺泡Laboratory

examinations

檢查COUGHING

咳嗽Description

of

cough:

harsh

and

dry,

soft

and

productive,honking

and

wheezing,

paroxysmal咳嗽的描述：粗大聲干咳，輕柔的濕咳（有 物），鵝鳴似咳嗽及喘鳴，陣發(fā)性咳嗽nocturnal,Precipitating

factors:

excitement,

exercise,tracheal

palpation易發(fā)因素：興奮、運(yùn)動、夜間、氣管觸診Otherfactors:

gagging,

retching,

vomiting其他因素：作嘔、干嘔、RESPIRATORY

SOUNDS

呼吸音Referred

lung

sounds

參照肺音Normal

respiratory

sounds

正常呼吸音Bronchial

(blowing)

soundsVesicular

soundsAdventitious

soundsCrackles

(rales)Wheezes

(rhonchi)Pleural

friction

rubs支氣管呼吸音肺泡呼吸音外來呼吸音音（鑼音）喘 （干鑼音）胸膜摩擦感THORACIC

RADIOGRAPHY胸部X光片Sedation

or

general

anaesthesia藥或全麻creen

combination,

particularly

rare

earth給Fast

fiscreens高感光度底片/增感屏結(jié)合使用，特別是用稀有元素的增感屏Use

cassette

ofsufficient

size

to

include

the

whole

thorax用足夠大小的片匣以包含整個胸部THORACIC

RADIOGRAPHY胸部X線Use

a

grid

if

thorax

is

>

15-

20

cm

thick若胸部>15-20cm厚,要使用柵板Close

collimation

of

the

beam使用集光筒Use

high

kV

low

mAs

technique用高KV低mAs技術(shù)Accurate

positioning正確擺設(shè)胸腔位置Expose

film

atfullinspiration深吸氣時(shí)照光THORACIC

RADIOGRAPHY胸部X光片THORACIC

RADIOGRAPHY胸部X光片LATERAL

THORACIC

RADIOGRAPH側(cè)位胸部X光片Right

lateral

右側(cè)位Left

lateral

左側(cè)位NORMAL

LUNG

PATTERN正常肺模式FACTORS

AFFECTINGNORMAL

LUNG

PATTERN影響正常肺模式的因素Incorrect

exposurePhase

of

respirationAge

of

animalConformation/obesity

ofpatientProlonged

lateral

recumbency不正確的

呼吸的時(shí)相動物的患畜生理構(gòu)造/肥胖長時(shí)間的側(cè)躺BRONCHOSCOPY

支氣管鏡檢查BRONCHOSCOPY支氣管鏡檢查BRONCHOSCOPY

氣管鏡檢查DIFFERENTIAL

DIAGNOSIS

OFACUTE

COUGHING急性咳嗽的鑒別Infectious

tracheobronchitis傳染性氣管-支氣管炎Airway

irritationoniaBronchopInfectiousAspirationAllergic

lung

disease氣道刺激支氣管傳染性吸入性過敏性肺部疾病Pulmonary

oedema/haemorrhage肺水腫/肺Airway

trauma

氣道ONIABRONCHOP支氣管Bacterial

bronchoponiaONIABRONCHOP支氣管oniaEosinophilic

bronchop嗜酸性支氣管ONIATREATMENT

OF

BRONCHOP支氣管

的治療Ensure

patent

airway保證氣道通暢Oxygen

therapy

氧(氣)療法Minimal

stress避免刺激Fluid

therapy

輸液AntibiosisPhysiotherapy抗生素理療TREATMENT

OFONIA的治療BRONCHOP支氣管Bronchodilators?支氣管擴(kuò)張劑Expectorants

祛痰藥Surgery

if

only

one

lobe

involved只一葉發(fā)炎時(shí)可手術(shù)切除DIFFERENTIAL

DIAGNOSIS

OFCHRONIC

COUGHING慢性咳嗽的鑒別Chronic

bronchitisBronchop

oniaAllergic

lung

diseaseBronchial

asthmaAllergic

bronchitis慢性支氣管炎支氣管過敏性肺病支氣管哮喘過敏性支氣管炎Pulmonary

infiltration

with

eosinophils嗜酸性細(xì)胞肺浸潤Bronchie

is

支氣管擴(kuò)張CHRONIC

BRONCHITIS慢性支氣管炎Damaged

mucociliary

carpet支氣管纖毛受損Adu ogs,

usually

smallbreeds常發(fā)生于：小型成犬Persistent

cough

>

2

months

duration持續(xù)性咳嗽>2周Affected

animals

often

obese多數(shù)患畜體形肥胖

Pronounced

sinus

arrhythmia明顯的竇性心律不齊BRONCHIAL

PATTERN支氣管模式CHRONIC

BRONCHITIS慢性支氣管炎BRONCHOSCOPY支氣管鏡檢查CHRONIC

BRONCHITIS慢性支氣管炎Chronic

bronchitis

withbronchial

collapse慢性支氣管炎伴支氣管塌陷Inspiration吸氣Expiration呼氣CHRONIC

BRONCHITIS慢性支氣管炎Chronicbronchitiswith

bullae慢性支氣管炎伴肺大泡Chronic

bronchitiswithearly

bronchie

is慢性支氣管炎伴早期支氣管擴(kuò)張BRONCHOALVEOLAR

LAVAGE支氣管肺泡Alveolar

macrophages肺泡巨噬細(xì)胞Goblet

cells

杯狀細(xì)胞Macrophages

and

neutrophils巨噬細(xì)胞和中性粒細(xì)胞TREATMENT

OFCHRONIC

BRONCHITIS慢性支氣管炎的治療Avoid

irritant

factors

e.g.

smoke消除激發(fā)因素，如:煙Control

obesity

控制肥胖

Regular

vaccination

常規(guī)免疫Control

secondary

bacterial

infection控制繼發(fā)性細(xì)菌Reduce

airway

inflammation

減少氣道炎癥Bronchodilators

支氣管擴(kuò)張劑Antitussives

e.g.

butorphanol,

codeine鎮(zhèn)咳藥，如布托啡諾，可待因Mucolytics

粘液溶解藥FELINE

BRONCHIAL

DISEASE貓的支氣管疾病Bronchial

smooth

muscle

hypersensitivity

to

inhaled

substances支氣管平滑肌對吸入性物質(zhì)高度敏感Hypersensitivity

reaction

to

inhaled

allergens對吸入性過敏源有高度敏感性反應(yīng)Smoke,

aerosol

sprays,

house

dust

mite,

human

dander,

feathers,cat

litter

and

infections

have

been

implicated煙霧、噴霧劑、塵螨、人類皮屑、羽毛,

皮革、貓沙,

都會引起此病FELINE

BRONCHIAL

DISEASE貓的支氣管疾病Dry

cough

of

variable

severity,

often

paroxysmal干咳程度不一，通常是陣發(fā)性的Wheezing

and

dyspnoea,

whi

ay

be

inspiratory

orexpiratory吸氣或呼氣時(shí)可能出現(xiàn)喘鳴和呼吸End-expiratory

grunting,

wheezing

and

crackling

maybe

heard

on

auscultation肺部聽診：呼氣末呼嚕音,喘鳴和破裂音FELINE

BRONCHIALDISEASE貓的支氣管疾病FELINE

BRONCHIALDISEASE貓的支氣管疾病BRONCHO-INTERSTITIALPATTERN支氣管-間質(zhì)模式BRONCHO-INTERSTITIAL

PATTERNFELINE

BRONCHIAL

DISEASE貓支氣管疾病FELINE

BRONCHIAL

DISEASE貓支氣管疾病BAL

支氣管肺泡Eosinophils嗜酸粒細(xì)胞Degenerativeneutrophils中性粒細(xì)胞退變TREATMENT

OF

FELINEBRONCHIAL

DISEASE貓支氣管疾病的治療Control

obesity

控制體重Control

secondary

infection

控制繼發(fā)

染Glucocorticoid

therapy

(often

dramatic)糖皮質(zhì)激素治療(通常效果較顯著)BronchodilatorsTheophylline

4

mg/kg

TIDTerbutaline

1.25

mg/kg

TIDInhalation

therapy支氣管擴(kuò)張劑茶堿4

mg/kg

TID特布他林1.25

mg/kg

TID吸入性治療Supplemental

oxygen

in

a

severe

attack急性發(fā)作時(shí)補(bǔ)氧TREATMENT

OF

FELINEBRONCHIAL

DISEASE貓支氣管疾病的治療Inhaler

therapy吸入性治療PULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)嗜酸性粒細(xì)胞肺浸潤withBronchial,

interstitial

and/or

alveolar

infiltrationeosinophils支氣管、間質(zhì)和/或肺泡都伴有嗜酸性粒細(xì)胞浸潤Variable

severity

of

clinical

signs臨床征象嚴(yán)重程度不一Coughing

is

usually

the

primary

complaint咳嗽通常是主訴Tachypnoea,

dyspnoea,

weight

loss,

depression,

andanorexia

may

occur、體重下降、精神沉郁和表現(xiàn)為：呼吸急促、呼吸食欲減退PULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)嗜酸性粒細(xì)胞肺浸潤PULMONARY

INFILTR

TIONWITH

EOEosinophilic

bronchoponiaPULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)EOSINOPHILIC

GRANULOMA嗜酸性粒細(xì)胞肉芽腫Not

all

nodules

aretumoursPULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)嗜酸性粒細(xì)胞肺浸潤Prednisolone

1

mg/kg

BID

initially

首劑：

龍1

mg/kgBID

Repeat

radiographs

toassess

responseX光片復(fù)查Reduce

to

lowest

effective

dose減量至最低有效劑量Mayrequire

alternate

day

dosing可根據(jù)需要隔日給藥Prognosis

for

control

is

good

except

for

the

moresevere

granulomatous

form

of

thedisease預(yù)后控制較好，除非是形成嚴(yán)重

芽腫BRONCHIEIS

支氣管擴(kuò)張BRONCHIEIS

支氣管擴(kuò)張DIFFERENTIAL

DIAGNOSIS

OFCHRONIC

COUGHING慢性咳嗽的鑒別Left-sided

heartfailurePulmonarycongestion/oedemaCompression

of

mainstem

bronchiParasitic

lung

diseaseOslerus

(filaroides)

osleriAngiostrongylus

vasorumAelurostrongylus

abstrusisInhaled

tracheal/bronchial

f.b.左側(cè)心衰肺充血/肺水腫壓迫主支氣管性肺?。惤z蟲屬）脈管圓線蟲

貓圓線蟲病吸入性氣管/支氣管異物L(fēng)EFT-SIDED

HEART

FAILURE左側(cè)心衰Pulmonary

congestion

andoedema肺充血/肺水腫Compression

of

mainstembronchi壓迫主支氣管OSLERUS

(FILAROIDES)OSLERI（類絲蟲屬）OSLERUS

(FILAROIDES)

OSLERI類絲蟲屬Endoscopic（內(nèi)窺鏡）

view

of

Oslerus(Filaroides)nodulesANGIOSTRONGLUS

VASORUM

INFECTION脈管圓線蟲Majority

of

cases

are

youngadults

often

reared

outdoors多數(shù)病例發(fā)生在青壯年犬，通常養(yǎng)在戶外Clinical

signs

are

variable

and

many

are

subclinical臨床表現(xiàn)不一，亞臨床表現(xiàn)亦多見Weakness,

haematoma

formation,

bleeding

anaemia,exercise

intolerance,

collapse,

weight

loss,

stunted

growth虛弱、形成血腫、 性貧血、運(yùn)動耐力差、虛脫、體重下降、發(fā)育遲緩ANGIOSTRONGYLUS

VASORUM脈管圓線蟲AELUROSTRONGYLUSABSTRUSUS

INFECTION貓圓線蟲Bronchiolar

parasite

of

cats貓細(xì)支氣管Intermediate

host

(slugs

and

snails)

may

be

eaten

by

birds

and

smallmammals中間宿主（鼻涕蟲、蝸牛）可被鳥和小型哺乳動物所食

Infection

usually

asymptomatic,but

may

cause

coughing,wheezingand

dyspnea通常是無癥狀的，但可導(dǎo)致咳嗽、喘鳴和呼吸Usually

self-limiting

with

spontaneous

resolution通常有自限性,能自行恢復(fù)Fenbendazole20

mg/kg

daily

for

5

days芬苯達(dá)唑：20

mg/kg/天，連續(xù)服用5天AELUROSTRONGYLUS

ABSTRUSUS貓圓線蟲BRONCHIAL

FOREIGN

BODY支氣管異物Spanner

板手in

tracheaTooth

牙齒in

tracheaBRONCHIAL

FOREIGN

BODY支氣管異物Ear

of

wheat

in

right

caudallobebronchus支氣管右後葉發(fā)現(xiàn)麥穗BRONCHIAL

FOREIGN

BODY支氣管異物Ear

of

wheat

in

right

caudallobebronchus支氣管右後葉發(fā)現(xiàn)麥穗DIFFERENTIAL

DIAGNOSIS

OFCHRONIC

COUGHING慢性咳嗽的鑒別性或繼發(fā)性腫瘤肺膿腫/肉芽腫氣道的壓迫左心房擴(kuò)大肺部腫瘤Primary

or

secondary

neoplasiaPulmonary