呼吸系统大小3.33g-呼吸困难鉴别诊断

MichaelE.HerrtageUniversityofCambridgeDIFFERENTIALDIAGNOSISOFDYSPNOEA呼吸困难的鉴别诊断EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性Difficultyinbreathing 呼吸困难Suddenonset,48hourspriortoreferral 急性发作后48小时就医Unwillingtoliedown 不愿躺下Nohistoryoftrauma 无创伤史History病史Dullandlethargic 迟钝，嗜睡Rectaltemperature39.5oC 直肠温度39.5度Heartrate120bpm 心率120Respiratoryrate60brpmdyspnoeic 呼吸60次/分，呼吸困难Muffledheartsounds,absentrespiratorysoundsventrally 心音减弱，腹側無呼吸音Percussionrevealedafluidline

叩诊發現有液線Clinicalexamination临床检查EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性Fibrinogen5g/l(refrange2-4g/l)纤维蛋白原（参考范围“”）EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性Parameter参数Patient患畜Referencerange参考值范围pH7.367.35-7.46PCO237.630.8-42.8mmHgpO287.280.9-103.3mmHgHCO3-26.718.8-25.6mmol/lBaseexcess3.00-4EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性Parameter参数Patient患畜Referencerange参考值范围Protein(g/l)蛋白质29.0<25truetransudate25-75modtransudate>30exudateNucleatedcells有核细胞(109/l)152<1.5truetransudate1.0-7modtransudate>7.0exudateEnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性Directsmearswereextremelycellular 直接涂片示全为细胞>98%neutrophilsshowingmoderatedegenerativechanges 98%以上的中性粒细胞表现为中度退行性变化Intracellularbacteriawereseen 观察到细胞内细菌Cocciandsomerods 球菌和某些杆菌EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性PuregrowthofPasteurellamultocida Pasteurellamultocida的药敏生长Co-amoxycillin–S 阿莫西林（敏感）Enrofloxacin–S 诺氟沙星（敏感）Oxytetracylcine–S 土霉素（敏感）Ampicillin–S 氨苄西林（敏感）Cephalexin–S 头孢氨苄（敏感）Clindamycin–R 克林霉素（耐药）MetronidazoleR 甲硝唑（耐药）注：S表示敏感，R表示耐药EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性EnglishSetter4yrF“Lucy”

英国雪达犬，4岁，雌性RESPIRATORYDISTRESS’

呼吸困难Tachypnoea-increasedrateofbreathing 呼吸急促：呼吸频率加快Orthopnoea-difficultyinbreathingwhenlyingdown 端坐呼吸：躺下时呼吸困难Dyspnoea-difficult,labouredorpainfulbreathing 呼吸困难：呼吸困难，费力或疼痛INVESTIGATIONOFDYPNOEA

呼吸困难的诊断History 病史Physicalexamination 全身检查Radiography X光片Ultrasonography 超声Thoracocentesis 胸腔穿刺Laboratoryexaminations 实验室检查DYSPNOEA呼吸困难HISTORYOFDYSPNOEA

呼吸困难的病史Acuteonset 急性发作Possibilityoftrauma 可能有创伤Questioncloselyregardingchronic,insidiousdisease:weightloss,dullness,anorexiaetc. 一般与某些慢性隐性疾病相关：体重下降，精神不佳和食欲减退等Anyneoplasia 肿瘤DIFFERENTIALDIAGNOSISOFDYSPNOEA

呼吸困难的鉴别诊断Reductionofthoraciccapacity胸腔缩小Lossofpulmonaryexchangecapacity 肺换气量减少Airwayobstruction 气道阻塞Reducedhaemoglobin 血红蛋白减少Associatedwithgeneralisedconditions 与全身身体状况有关CAUSESOFAREDUCTIONOFTHORACICCAPACITY

胸腔缩小的原因Pleuraleffusions 胸腔積液Pneumothorax 气胸Diaphragmaticrupture/hernia膈破裂/疝Cardiacenlargement 心脏扩大Intrathoracicmasses 胸腔内肿块Abdominalmasses/fluid 腹部肿块/腹水DIFFERENTIALDIAGNOSISOFPLEURALEFFUSIONS

胸膜渗出的鉴别诊断Hydrothorax 胸腔积水Transudate 渗出液Modifiedtransudate變更性渗出液Haemothorax 血胸Pyothorax 脓胸Chylothorax 乳糜胸Neoplastic 肿块Inflammatory 炎症FORMATIONOFPLEURALFLUID

胸腔積液的形成PLEURALFLUID胸水Pleuralfissures胸膜裂缝Pleuralfissures胸膜裂缝PLEURALFLUID胸水Pleuralfissures胸膜裂缝LRPLEURALFLUID胸水Pleuralfissuresandroundingofthecostophrenicangle胸膜裂缝和肋膈角圆钝PLEURALFLUID胸水UNILATERALPLEURALEFFUSION

单侧性胸水DSHunilateralpyothorax单侧脓胸FIBROSINGPLEURITIS

纤维性胸膜炎Dalmatianpyothoraxpost-drainage大麦町引流后脓胸THORACICULTRASOUND

胸部超声IrishWolfhoundchylothoraxBoxerpyothoraxLabradorretrieverpyothoraxSimplethoracocentesis 简单的胸膜穿刺Collectionoffluidfordiagnosis 采集胸膜液以诊断Reliefofrespiratorydistress 缓解呼吸困难Thoracostomytube 胸廓造口术插管Reliefofrespiratorydistress 缓解呼吸困难Necessaryfortreatment 是治疗必须的PLEURALFLUID胸膜液AETIOLOGYOFPYOTHORAX

脓胸的病因Migratingforeignbody 游走性异物Haematogenousspread 血行扩散Penetratingthoracicwound穿透性胸部创伤Oesophagealperforation 食管穿孔Iatrogenicfollowingthoracocentesisorthoracotomy 胸腔穿刺术或开胸手术后形成Extensionfrombronchopneumonia,pulmonaryabscessation,cervical,mediastinalorabdominalinfections 支气管肺炎，肺脓肿，颈部，纵隔和腹部感染等扩散而来GrassseedinmediastinumPYOTHORAX脓胸Youngtomiddle-aged,mediumtolargebreeddogs,particularlysportingandgundogs 多发于幼年、中年，中大型犬，特别是运动犬和枪猎犬Moremalesthanfemales 雄性多见MiddleagedtoolderDSHorDLH,oftenassociatedwithFIVorFIP 多发於中年至老年一般家庭短毛或長毛貓，通常与猫免疫缺陷症or猫传染性腹膜炎相关Nosexpredilection 无性别倾向MICROBIOLOGYOFPYOTHORAX

脓胸的微生物学Anaerobicbacteriaareimportant 厌氧菌很重要Mixedinfectionsarecommon 混合感染常见Bacteroidesspp 普通拟杆菌属Nocardiaspp 诺卡菌属Actinomycesspp 放线菌属Fusobacterium 梭杆菌属Peptostreptococcus 消化链球菌属Streptococcus 链球菌属Pasteurellamultocida 出血败血性巴斯德菌ANTIBIOTICTHERAPY

抗生素治疗Penicillins 青霉素类Ampicillin 氨苄西林Amoxycillin 阿莫西林Metronidazole 甲硝唑Clindamycin 克林霉素Erythromycin 红霉素PYOTHORAX脓胸MEDICALMANAGEMENTOFPYOTHORAX

脓胸的药物治疗Thoracicdrainageandantibiotictherapy 胸腔引流和抗生素治疗Tubethoracostomyandantibiotictherapy 胸廓造口术和抗生素治疗Intermittentsuction 间断抽吸Continuoussuction 持续抽吸Tubethoracostomy,thoraciclavageandantibiotictherapy 胸廓造口术插管，胸腔灌洗和抗生素治疗THORACICDRAINAGE

胸腔引流THORACICDRAINAGE

胸腔引流THORACICDRAINAGE

胸腔引流THORACICLAVAGE 胸腔灌洗20ml/kgofwarmedsalineorRinger’ssolutioninfusedintothoraciccavity 20ml/kg温生理盐水或林格液注入胸腔Manipulateanimaltohelpdistributefluid 翻动患畜使液体均匀分布Monitorpatientforrespiratorydistress 监测患畜呼吸困難的情况Lavagefluidremainsinthoraxfor10min 保持灌注液在胸腔10分钟Drainresiduallavagefluid 引流剩余的灌注液Repeatdailyortwicedailyuntilfluidcomesbackclean 每天重复1次或2次直至回收液清澈THORACICLAVAGE胸腔灌洗AETIOLOGYOFCHYLOTHORAX

乳糜胸的病因Neoplasia 肿瘤Trauma 创伤Congestiveheartfailure 充血性心衰Infectious 感染Congenital 先天性Lunglobetorsion 肺叶扭转Idiopathic 特发性AETIOLOGYOFPNEUMOTHORAX

气胸的病因Trauma 创伤性Spontaneous 自发性Pulmonaryemphysema,cysts,bullaeorblebs 肺气肿，肺囊肿，肺大泡Pulmonaryabscessornecrosis(infectiousorneoplastic) 肺脓肿或坏死(感染性或肿瘤性)Iatrogenic 医源性PNEUMOTHORAX气胸TENSIONPNEUMOTHORAX

壓力性气胸RECURRENTPNEUMOTHORAX

复发性气胸Goldenretriever3yrFchroniclobarpneumonia慢性大叶性肺炎HeimlechvalveHEIMLECHVALVERECURRENTPNEUMOTHORAX

复发性气胸Goldenretriever3yrFchroniclobarpneumonia慢性大叶性肺炎Germanshepherd5mthMlungbullaRECURRENTPNEUMOTHORAX

复发性气胸DIAPHRAGMATICRUPTURE

膈破裂Cockerspaniel3yrMLsideddiaphragmaticrupture左侧膈破裂DLH6yrFdiaphragmaticruptureWHWterrier2yrMdiaphragmaticruptureDIAPHRAGMATICRUPTURE

膈破裂CRANIALMEDIASTINALMASS

前纵膈肿块Irishwolfhound8yrMthymiclymphoma胸腺淋巴瘤Irishwolfhound8yrMthymiclymphoma胸腺淋巴瘤CRANIALMEDIASTINALMASS

前纵膈肿块CRANIALMEDIASTINALMASS

前纵膈肿块CAUSESOFLOSSOFPULMONARYEXCHANGECAPACITY

肺换气量减少的原因Bronchopneumonia 支气管肺炎Pulmonaryoedema 肺肿水Pulmonaryhaemorrhage/contusion 肺出血/挫伤Pulmonaryneoplasia 肺肿瘤Pulmonarythromboembolism 肺血样形成 Paraquatpoisoning 巴拉刈中毒Pulmonaryemphysema 肺气肿Idiopathicpulmonaryfibrosis 特发性肺纤维化

BRONCHOPNEUMONIA

支气管肺炎Bacterialbronchopneumonia细菌性支气管炎BRONCHOPNEUMONIA

支气管肺炎Pneumocystitiscarinii卡氏肺孢子虫PULMONARYOEDEMA

肺水肿Acuteorno