Page 11 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

instance, regurgitation is the most common clinical sign in Abnormal posture
patients with a vascular ring anomaly. However, the pres- Open-mouth breathing, abducted forelimbs and restless-
VetBooks.ir compromised and is a poor candidate for anaesthesia and ness indicate moderate to severe respiratory distress that
ence of emaciation indicates that the animal is nutritionally
may require emergency intervention. Severely dyspnoeic
surgery. Clinical signs indicating cardiorespiratory system
patients may be reluctant to adopt a recumbent position.
involvement should be given priority.
The client’s description of the clinical signs shown Abnormal respiratory sounds
should be noted. The time of onset, duration and progres-
sion of the signs should be established. The possible The following information may be gained from listening to
association with other events at the time of onset should the patient:
be determined. Trauma is a relatively common cause of
• Inspiratory stridor (a whistling-type noise) is common in
disorders of the head, neck and thorax, and the possibility
upper airway obstruction (e.g. laryngeal paralysis,
of a traumatic aetiology should always be considered even brachycephalic airway disease)
if no event has been observed. Factors that exacerbate • Stertor (a snoring-type noise) suggests a
the clinical signs (e.g. exercise, excitement or increased (naso)pharyngeal disorder (e.g. overlong soft palate,
environmental temperature) should be noted. The current nasopharyngeal stenosis)
health status of the animal should be ascertained. • Gagging and regurgitation are common with
The previous medical history of the patient should be (naso)pharyngeal, laryngeal and some tracheal
reviewed. For instance, an animal that suffered a traumatic diseases
episode some time ago may have developed a diaphrag- • Dysphonia (a change in the voice) may be present in
matic rupture, which is now causing clinical signs due to patients with laryngeal disease.
incarceration of a liver lobe and pleural effusion. Diseases
may be acute in onset (e.g. thoracic wall trauma following Abnormal response to handling
a road traffic accident) or chronic (e.g. otitis externa). The patient in severe respiratory distress may be oblivious
However, the potential for an acute exacerbation of a to the presence of the clinician, but will tend to resent any
chronic disease should always be considered (e.g. tracheal
kind of manipulation or attempts to change its posture.
collapse or laryngeal paralysis).
Abnormal breathing pattern
Physical examination The following information may be gained from watching the
patient breathe.
Although a complete general physical examination should
be performed, it will necessarily focus on those anatomical • Inspiratory dyspnoea is seen as difficulty in expanding
regions suspected of being involved. Once again, because the lungs, with a relatively easy expiratory effort. The
of its critical importance to the animal and the likelihood of lips are drawn back, the neck is extended, costal
it being involved in the disease process, the cardiorespir- margins protrude, the abdomen is drawn in (paradoxical
atory system should receive particular attention. The phys- abdominal movement) and inspiration is prolonged. It is
ical examination findings associated with diseases of the observed in upper respiratory tract obstruction, where it
ear, oral cavity and structures of the head and neck, is often accompanied by stertor and/or stridor.
excluding the airways, are dealt with in individual chapters. • Expiratory dyspnoea is seen as difficulty expelling air
A review of the important clinical findings in animals with from the lungs, with a prolonged expiratory time. The
cardiorespiratory disease is presented here. abdomen is actively lifted and plays a more active role
The following points are of critical importance for those in expiration. The anus may protrude. It is seen most
patients with disorders of the cardiorespiratory system: frequently in intrathoracic tracheal collapse and
obstructive lung disease; the obstruction may be inside
• Abnormal posture the bronchial lumen (bronchiectasis, aspiration of fluid),
• Abnormal respiratory sounds in the bronchial wall (bronchial asthma, oedema) or in
• Abnormal response to handling the region surrounding the bronchi (emphysema).
• Inspiratory and expiratory dyspnoea may be observed
• Abnormal breathing pattern
• Abnormal mucous membrane colour together in various diseases affecting the pulmonary
• Abnormal peripheral pulses parenchyma and in disorders resulting in a fixed upper
airway obstruction (e.g. laryngeal mass) rather than a
• Thoracic auscultation
dynamic airway obstruction (e.g. laryngeal paralysis).
• Thoracic inspection and palpation
Pulmonary oedema is often characterized by both
• Thoracic percussion.
inspiratory and expiratory dyspnoea.
• Rapid, shallow, choppy breathing is seen in animals
Patients with cardiorespiratory disease may show com-
with disease affecting the pleural space (e.g.
promise of the organs involved, and care should be taken
pneumothorax and pleural effusion) or the pulmonary
to avoid exacerbating these signs. The patient should be
parenchyma (e.g. pulmonary fibrosis), and in animals
initially observed from a distance with minimal restraint. If with painful lesions of the chest wall (e.g. rib fractures).
there are any clinical signs indicating respiratory or cardio- • Tachypnoea, dyspnoea and exercise intolerance may
vascular compromise, admitting and stabilizing the animal be found in more markedly affected individuals.
immediately, before proceeding any further, may be appro- • Severely affected patients may exhibit marked
priate. Minimal restraint should be used for severely dysp- dyspnoea, cyanosis and syncope.
noeic patients and they should be allowed to adopt the • Coughing indicates a disease affecting the larynx and/
position they find most comfortable. The emergency man- or tracheobronchial tree (tracheal collapse) or the
agement of the patient in respiratory distress is described pulmonary parenchyma (e.g. pneumonia, pulmonary
in Chapter 2. oedema, trauma, tumour or foreign body).

2

Ch01 HNT.indd 2 31/08/2018 10:22