兽医b超心包疾病

Pericardial

Disease

心包疾病Pericardial

effusions

心包积液Haemorrhagic

血性的Transudates

漏出液Exudates

渗出液Constrictive

pericarditis

缩窄性心包炎Pericardial

neoplasia

心包肿瘤PPDH

腹膜心包疝Pericardial

cyst

心包囊肿Pathology

病理学Tough

sac

in

which

theheartsits

在heartsits时碰到心包Small

amount

of

pericardialfluid有少量心包液Attached

to

diaphragmbyligament以韧带与横膈相连Restricted

filling

–

preloadimportant充盈受限制－前期负荷很重要Disease

caused

by

compressionof

right

side

of

heart由压迫右侧心脏导致的疾病Pericardial

Disease

心包疾病Collapse

of

right

atrium

右心房塌陷Cardiac

tamponade

心脏填塞Right

ventricle

may

also

collapse右心室也有可能塌陷Systemic

venous

pressures

rise全身性静脉压上升Speed

of

development

important发展的速度很重要Cats

–

often

incidental

finding猫－通常是偶然发现的Pericardial

Effusion

心包积液Haemorrhagic

血性的Idiopathic

pericardial

haemorrhage自发性心包出血Neoplasia

肿瘤Trauma,

coagulopathy

外伤，凝血障碍Rupture

of

LA

右心房破裂Transudates

漏出液RHF

右心衰竭Hypoproteinaemia

低蛋白血症PPDH,

renal

failure

腹膜心包疝，肾衰Pericardial

Effusion

心包积液Exudates

渗出液FIP

猫传染性腹膜炎Infection

感染Foreign

body

异物Clinical

Signs

临床表现Jugulardistension

颈静脉驽张Ascites

腹水Hepatomegaly

肝肿大Weakness

and

lethargy虚弱和嗜睡Muffled

heart

sounds心音低沉Weak

rapid

pulses脉搏弱而快Pulsus

paradoxus

–

ventricular

interdependence奇脉－心室相互依赖Differential

diagnoses

鉴别诊断Large

round

cardiac

silhouette心脏轮廓大而圆Large

heart

–

DCM

and

TVD心脏大－扩张性心肌病和三尖瓣疾病Pericardial

effusion

心包积液Peritoneopericardial

diaphragmatic

hernia腹膜心包疝Ascites

腹水Numerous!

量多！ECG

心电图Small

complexes

小的复合波Electrical

alternans

电交换RadiographyLarge

cardiac

silhouetteGloboid

–

no

individual

chamberenlargementStill

outlineDistended

caudal

vena

cavaPneumopericardium

–

not

used

nowEchocardiography

超声心动Diagnostic

test

诊断测试Look

for

underlying

cause

–

neoplasia寻找潜在的病因－肿瘤Cardiac

tamponade

can

be

visualised心脏填塞可见Check:

检查Right

auricular

appendage

右心耳Heart

base

tumours

心基瘤Echocardiography

超声心动Short

axis

短轴Right

Atrium

右心房Tamponade

填塞Masses

团块Masses

团块Left

ventricular

mass

左心室团块Echocardiography

超声心动Fluid

analysis

积液检查Rarely

helpful

很少能有帮助Occasional

lymphoma

偶见淋巴瘤Difficult

to

differentiate

mesotheliomafrom

reactive

mesothelial

cells很难区别间皮瘤和反应性间皮细胞pH

not

helpful pH值没什么帮助Troponin

assay

肌钙蛋白测定Management

控制和治疗Do

NOT

give

diuretics

or

vasodilators不要用利尿药或血管扩张药May

give

intravenous

fluids

in

short

term可短期输液Sedate

–

ACP

and

opiate镇静－ACP和阿片制剂Drain

pericardium心包穿刺Pericardial

Drainage

心包穿刺14

or

16

g

OTN

catheter

14-16号OTN导管Cut

extra

ports去除其余部分Use

ultrasound

to

guide

needle

用超声引导Three

way

tap

三通管Attach

suction

and

advance

needle连通吸引器并进针When

hit

fluid

stop

and

advance

catheter碰到液体即停止进针并推入导管Wait

while

spin

down

/

wait

for

clot等离心/等凝结Pericardial

Drainage

心包穿刺Causes

病因Idiopathic

pericardial

effusion自发性心包积液?reactive

blood

vessels

血管反应？?immune

mediated

免疫介导？Neoplasia

肿瘤Right

atrial

a

右心房血管肉瘤Chemodectoma

化学感受器瘤Lymphoma

淋巴瘤Left

atrial

rupture

左心房破裂Idiopathic

Pericardial

Haemorrhage

自发性心包出血Younger

dogs幼小的犬Golden

retrievers金毛巡回猎犬50%chance

will

recur

50％的可能性再发If

recurs

can

drain

2nd

time如再发可再次排液Risk

of

developing

constrictive

pericarditis有发生缩窄性心包炎的可能Neoplasia

肿瘤RA

ahopelessChemodectomaallow

fluid

to

drain

into

pleural

cavitythoracotomyballoon

dilation

of

windowLeft

Atrial

Rupture

左心房破裂Advanced

DMVD

？？Very

poor

prognosis预后不良Try

draining

small

volumes

to

keep

out

oftamponade

but

not

enough

to

encouragebleed试着排出少量液体，以解除心包填塞，但不要排出太多，以免继续流血Don’t

buy

any

large

bags

ofdog

food不要买大包狗粮Others

其它Transudates

漏出液继发于右心衰竭Secondary

to

right

heart

failureFIP

in

cats

–

high

SG

and

protein猫传染性腹膜炎－比重和蛋白质均高renal

failure

–

small

volumes肾衰－少量Purulent

pericardial

effusion化脓性心包积液Cattle,

cats

rarely牛，猫少见drain

and

antibiotics排出并用抗生素surgery

for

FB手术取出异物Peritoneopericardial

DiaphragmaticHernia

腹膜心包膈疝Congenital

先天性Incidental

finding

偶然发现Vague

fort,

rapid

breathing

GI

signs隐约感觉不舒服，呼吸快，有胃肠道症状Long

haired

cats

and

Weimaraners长毛猫和德国魏犬Muffled

displaced

heart

sounds心音低沉，不在其原来的位置Large

cardiac

silhouette

心脏轮廓大Surgery?

手术？PPDHRadiographs腹膜心包膈疝的X光片Pericardial

cyst

心包囊肿Large

cyst

in

pericardium

心包内有大的囊Remnant

of

omentum

from

PPDHPPDH后遗留的网膜Can

give

signs

of

RHS

failure可表现为右心衰竭Surgery

手术Usually

straight

forward

通常直接进行Sally

MartinConstrictive

pericardial

disease缩