呼吸系统大小3.33g-咳嗽鉴别诊断

COUGHINGDIFFERENTIAL

DIAGNOSISAND

CLINICAL

APPROACH咳嗽的鉴别

和病程Michael E.

HerrtageUniversity

of

Cambridge11/26/2020C94-259

Yorkshire

terrier14

year

old female

neutered约克夏，14岁絕育母犬Michael

E.

HerrtageUniversity

of

CambridgeHistory

病史Chronic

cough

for

3

months慢性咳嗽达3个月之久Dry,

hacking

cough

in

paroxysms阵发性干咳，频咳Progressive

exercise

tolerance

and

panting进行性耐受不良，喘气No

response

to

antibiotics抗生素治疗无效No

oculonasal

discharge无眼鼻

物C94-259

Yorkshire

terrier14

year

old

female

neutered患畜轻度過胖气管觸诊诱发咳嗽脉搏：100

次/分钟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级收缩期心杂音規律性出現节律不齐Reduced

lung

sounds

right

dorsal

lung

area右背部肺区呼吸音减弱Dullness

on

percussion

of

right

dorsallung

area右背肺区叩诊浊音C94-259

Yorkshire

terrier14

year

old

female

neuteredClinical

Examination

临床检查LATERAL

THORACIC

RADIOGRAPH侧位胸片DORSOVENTRALTHORACICRADIOGRAPH背-腹位胸片THORACIC

ULTRASOUND胸部超声THORACIC

ULTRASOUND胸部超声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常见慢性瓣膜病变和慢性气管炎Obesity

肥胖Usually

associated

with

pulmonary

disease通常与肺部疾病相关Weight

loss

体重下降Congestive

cardiac

failure

usually

causes

dramatic

weight

loss.

May

be

seenwith

pulmonary

neoplasia.充血性心衰竭，通常导致明显的体重下降，可在肺肿瘤中见到Pronounced

sinus

arrhythmia

明显窦性心律不齐Associated

with

chronic

pulmonary

obstructive

disease.

Lost

in

heart

failure.与慢性肺部阻塞性疾病相关RESPIRATORY

VERSUS

CARDIAC

CAUSESOF

COUGHING心源性咳嗽vs肺源性咳嗽Soft

moistcough

湿咳Pulmonary

oedema

can

cause

this

type

of

cough肺水肿可Dryharsh

cough

干咳Can

occur

witheither

respiratory

or

cardiac

causes呼吸系统疾病或心脏病均可Exercise

intolerance/dyspnoea

运动耐受力差/呼吸Usually,

but

not

always,

associated

with

heart

disease常见（但不全是）与心脏疾病相关Loud

murmur

响亮的心杂音There

is

no

correlation

between

the

intensity

of

the

murmur

and

the

severityof

the

disease杂音的强度与疾病的严重程度无关INVESTIGATION

OF

COUGHING咳嗽的History

病史Physical

examination

全身检查Radiography

X光片Bronchoscopy

气管镜Bronchoalveolar

lavage

支气管肺泡Laboratory

examinations

检查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，輕柔的湿咳（有 物），鵝鳴似咳嗽及喘鸣，陣發性咳嗽nocturnal,Precipitating

factors:

excitement,

exercise,tracheal

palpation易发因素：兴奋、运动、夜间、气管觸诊Otherfactors:

gagging,

retching,

vomiting其他因素：作呕、干呕、RESPIRATORY

SOUNDS

呼吸音Referred

lung

sounds

参照肺音Normal

respiratory

sounds

正常呼吸音Bronchial

(blowing)

soundsVesicular

soundsAdventitious

soundsCrackles

(rales)Wheezes

(rhonchi)Pleural

friction

rubs支气管呼吸音肺泡呼吸音外来呼吸音音（锣音）喘 （干锣音）胸膜摩擦感THORACIC

RADIOGRAPHY胸部X光片Sedation

or

general

anaesthesia药或全麻creen

combination,

particularly

rare

earth给Fast

fiscreens高感光度底片/增感屏结合使用，特別是用稀有元素的增感屏Use

cassette

ofsufficient

size

to

include

the

whole

thorax用足够大小的片匣以包含整个胸部THORACIC

RADIOGRAPHY胸部X线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技术Accurate

positioning正确擺設胸腔位置Expose

film

atfullinspiration深吸气时照光THORACIC

RADIOGRAPHY胸部X光片THORACIC

RADIOGRAPHY胸部X光片LATERAL

THORACIC

RADIOGRAPH侧位胸部X光片Right

lateral

右侧位Left

lateral

左侧位NORMAL

LUNG

PATTERN正常肺模式FACTORS

AFFECTINGNORMAL

LUNG

PATTERN影响正常肺模式的因素Incorrect

exposurePhase

of

respirationAge

of

animalConformation/obesity

ofpatientProlonged

lateral

recumbency不正确的

呼吸的时相动物的患畜生理构造/肥胖长時間的侧躺BRONCHOSCOPY

支气管镜检查BRONCHOSCOPY支气管镜检查BRONCHOSCOPY

气管镜检查DIFFERENTIAL

DIAGNOSIS

OFACUTE

COUGHING急性咳嗽的鉴别Infectious

tracheobronchitis传染性气管-支气管炎Airway

irritationoniaBronchopInfectiousAspirationAllergic

lung

disease气道刺激支气管传染性吸入性过敏性肺部疾病Pulmonary

oedema/haemorrhage肺水肿/肺Airway

trauma

气道ONIABRONCHOP支气管Bacterial

bronchoponiaONIABRONCHOP支气管oniaEosinophilic

bronchop嗜酸性支氣管ONIATREATMENT

OF

BRONCHOP支气管

的治疗Ensure

patent

airway保证气道通畅Oxygen

therapy

氧(气)疗法Minimal

stress避免刺激Fluid

therapy

輸液AntibiosisPhysiotherapy抗生素理疗TREATMENT

OFONIA的治疗BRONCHOP支气管Bronchodilators?支气管扩张剂Expectorants

祛痰药Surgery

if

only

one

lobe

involved只一叶發炎时可手术切除DIFFERENTIAL

DIAGNOSIS

OFCHRONIC

COUGHING慢性咳嗽的鉴别Chronic

bronchitisBronchop

oniaAllergic

lung

diseaseBronchial

asthmaAllergic

bronchitis慢性支气管炎支气管过敏性肺病支气管哮喘过敏性支气管炎Pulmonary

infiltration

with

eosinophils嗜酸性细胞肺浸润Bronchie

is

支气管扩张CHRONIC

BRONCHITIS慢性支气管炎Damaged

mucociliary

carpet支氣管纤毛受损Adu ogs,

usually

smallbreeds常发生于：小型成犬Persistent

cough

>

2

months

duration持续性咳嗽>2周Affected

animals

often

obese多数患畜体形肥胖

Pronounced

sinus

arrhythmia明显的窦性心律不齐BRONCHIAL

PATTERN支气管模式CHRONIC

BRONCHITIS慢性支气管炎BRONCHOSCOPY支气管镜检查CHRONIC

BRONCHITIS慢性支气管炎Chronic

bronchitis

withbronchial

collapse慢性支气管炎伴支气管塌陷Inspiration吸气Expiration呼气CHRONIC

BRONCHITIS慢性支气管炎Chronicbronchitiswith

bullae慢性支气管炎伴肺大泡Chronic

bronchitiswithearly

bronchie

is慢性支气管炎伴早期支气管扩张BRONCHOALVEOLAR

LAVAGE支气管肺泡Alveolar

macrophages肺泡巨噬细胞Goblet

cells

杯状细胞Macrophages

and

neutrophils巨噬细胞和中性粒细胞TREATMENT

OFCHRONIC

BRONCHITIS慢性支气管炎的治疗Avoid

irritant

factors

e.g.

smoke消除激发因素，如:烟Control

obesity

控制肥胖

Regular

vaccination

常规免疫Control

secondary

bacterial

infection控制继发性细菌Reduce

airway

inflammation

减少气道炎症Bronchodilators

支气管扩张剂Antitussives

e.g.

butorphanol,

codeine镇咳药，如布托啡诺，可待因Mucolytics

粘液溶解药FELINE

BRONCHIAL

DISEASE猫的支气管疾病Bronchial

smooth

muscle

hypersensitivity

to

inhaled

substances支气管平滑肌对吸入性物质高度敏感Hypersensitivity

reaction

to

inhaled

allergens对吸入性过敏源有高度敏感性反应Smoke,

aerosol

sprays,

house

dust

mite,

human

dander,

feathers,cat

litter

and

infections

have

been

implicated烟霧、噴霧劑、尘螨、人类皮屑、羽毛,

皮革、猫沙,

都會引起此病FELINE

BRONCHIAL

DISEASE猫的支气管疾病Dry

cough

of

variable

severity,

often

paroxysmal干咳程度不一，通常是陣发性的Wheezing

and

dyspnoea,

whi

ay

be

inspiratory

orexpiratory吸气或呼气时可能出现喘鸣和呼吸End-expiratory

grunting,

wheezing

and

crackling

maybe

heard

on

auscultation肺部听诊：呼气末呼噜音,喘鸣和破裂音FELINE

BRONCHIALDISEASE猫的支气管疾病FELINE

BRONCHIALDISEASE猫的支气管疾病BRONCHO-INTERSTITIALPATTERN支气管-间质模式BRONCHO-INTERSTITIAL

PATTERNFELINE

BRONCHIAL

DISEASE猫支气管疾病FELINE

BRONCHIAL

DISEASE猫支气管疾病BAL

支氣管肺泡Eosinophils嗜酸粒细胞Degenerativeneutrophils中性粒细胞退变TREATMENT

OF

FELINEBRONCHIAL

DISEASE猫支气管疾病的治疗Control

obesity

控制體重Control

secondary

infection

控制继发

染Glucocorticoid

therapy

(often

dramatic)糖皮质激素治疗(通常效果较显著)BronchodilatorsTheophylline

4

mg/kg

TIDTerbutaline

1.25

mg/kg

TIDInhalation

therapy支气管扩张剂茶碱4

mg/kg

TID特布他林1.25

mg/kg

TID吸入性治疗Supplemental

oxygen

in

a

severe

attack急性发作时补氧TREATMENT

OF

FELINEBRONCHIAL

DISEASE猫支气管疾病的治疗Inhaler

therapy吸入性治疗PULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)嗜酸性粒细胞肺浸润withBronchial,

interstitial

and/or

alveolar

infiltrationeosinophils支气管、间质和/或肺泡都伴有嗜酸性粒细胞浸润Variable

severity

of

clinical

signs临床征象严重程度不一Coughing

is

usually

the

primary

complaint咳嗽通常是主诉Tachypnoea,

dyspnoea,

weight

loss,

depression,

andanorexia

may

occur、体重下降、精神沉郁和表现为：呼吸急促、呼吸食欲减退PULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)嗜酸性粒细胞肺浸润PULMONARY

INFILTR

TIONWITH

EOEosinophilic

bronchoponiaPULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)EOSINOPHILIC

GRANULOMA嗜酸性粒细胞肉芽肿Not

all

nodules

aretumoursPULMONARY

INFILTRATIONWITH

EOSINOPHILS

(PIE)嗜酸性粒细胞肺浸润Prednisolone

1

mg/kg

BID

initially

首剂：

龙1

mg/kgBID

Repeat

radiographs

toassess

responseX光片复查Reduce

to

lowest

effective

dose减量至最低有效剂量Mayrequire

alternate

day

dosing可根据需要隔日给药Prognosis

for

control

is

good

except

for

the

moresevere

granulomatous

form

of

thedisease预后控制较好，除非是形成严重

芽肿BRONCHIEIS

支气管扩张BRONCHIEIS

支气管扩张DIFFERENTIAL

DIAGNOSIS

OFCHRONIC

COUGHING慢性咳嗽的鉴别Left-sided

heartfailurePulmonarycongestion/oedemaCompression

of

mainstem

bronchiParasitic

lung

diseaseOslerus

(filaroides)

osleriAngiostrongylus

vasorumAelurostrongylus

abstrusisInhaled

tracheal/bronchial

f.b.左侧心衰肺充血/肺水肿壓迫主支气管性肺病（类丝虫属）脉管圆线虫

猫圆线虫病吸入性气管/支气管異物LEFT-SIDED

HEART

FAILURE左侧心衰Pulmonary

congestion

andoedema肺充血/肺水肿Compression

of

mainstembronchi壓迫主支气管OSLERUS

(FILAROIDES)OSLERI（类丝虫属）OSLERUS

(FILAROIDES)

OSLERI类丝虫属Endoscopic（内窥镜）

view

of

Oslerus(Filaroides)nodulesANGIOSTRONGLUS

VASORUM

INFECTION脉管圆线虫Majority

of

cases

are

youngadults

often

reared

outdoors多数病例发生在青壮年犬，通常養在户外Clinical

signs

are

variable

and

many

are

subclinical临床表现不一，亚临床表现亦多见Weakness,

haematoma

formation,

bleeding

anaemia,exercise

intolerance,

collapse,

weight

loss,

stunted

growth虛弱、形成血肿、 性贫血、运动耐力差、虛脫、体重下降、發育遲緩ANGIOSTRONGYLUS

VASORUM脉管圆线虫AELUROSTRONGYLUSABSTRUSUS

INFECTION猫圆线虫Bronchiolar

parasite

of

cats猫细支气管Intermediate

host

(slugs

and

snails)

may

be

eaten

by

birds

and

smallmammals中间宿主（鼻涕蟲、蜗牛）可被鸟和小型哺乳动物所食

Infection

usually

asymptomatic,but

may

cause

coughing,wheezingand

dyspnea通常是无症状的，但可导致咳嗽、喘鸣和呼吸Usually

self-limiting

with

spontaneous

resolution通常有自限性,能自行恢复Fenbendazole20

mg/kg

daily

for

5

days芬苯达唑：20

mg/kg/天，连续服用5天AELUROSTRONGYLUS

ABSTRUSUS猫圆线虫BRONCHIAL

FOREIGN

BODY支气管异物Spanner

板手in

tracheaTooth

牙齿in

tracheaBRONCHIAL

FOREIGN

BODY支气管异物Ear

of

wheat

in

right

caudallobebronchus支气管右後叶发现麥穗BRONCHIAL

FOREIGN

BODY支气管异物Ear

of

wheat

in

right

caudallobebronchus支气管右後叶发现麥穗DIFFERENTIAL

DIAGNOSIS

OFCHRONIC

COUGHING慢性咳嗽的鉴别性或继发性肿瘤肺脓肿/肉芽肿气道的壓迫左心房扩大肺部肿瘤Primary

or

secondary

neoplasiaPulmonary