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Equine Respiratory Diseases Flashcards

(128 cards)

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1
Q

what are the overarching types of respiratory disease?

A

URT

LRT

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2
Q

are horses always systemically unwell when they have respiratory diseases?

A

no

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3
Q

what are disorders of the respiratory system second only in importance to in limiting athletic performance?

A

musculoskeletal

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4
Q

what issues would you expect to present at birth?

A

congential

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5
Q

what respiratory issues would you expect to present at 1-6 months?

A

Rhondococcus infection

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6
Q

what respiratory issues would you expect to see in weanlings/yearlings?

A

viral and bacterial URT infections

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7
Q

what respiratory issues would you expect to see in performance horses?

A

exercise induced pulmonary haemorrhage (EIPH)

inflammatory airway disease (IAD)

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8
Q

what respiratory issues would you expect to see in middle aged horses?

A

asthma

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9
Q

what about a horses environment or the environment it was exposed to help may be useful when looking at history?

A

mixing with new horses
local endemic infections
vaccination history (if so and when)
exposure to dust (bedding, feed or that of their neighbor)

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10
Q

what about prior medical issues may help to diagnose current respiratory issues?

A

may be related to current complaint e.g. viral disease may precede bacterial

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11
Q

what questions should be asked when gaining history about the presenting respiratory problem?

A

last normal
slow or quick onset
signs
did signs come on after strenuous exercise or following long distance travel
are there any new arrivals on the yard who have not been quarantined
signs seen at rest or only at exercise

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12
Q

what elements must be assessed in the physical exam of a patient with suspected respiratory disease?

A 
demenour
stance
nasal discharge
SM lymph nodes
RR
respiratory effort
heave line
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13
Q

what will the horses stance be like if they are finding it difficult or painful to breathe?

A

head and neck extended with elbows abducted

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14
Q

what is normal RR in horses?

A

8-10 brpm

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15
Q

what should respiratory effort be like in a healthy horse?

A

difficult to see breathing occurring - if visible there is probably an issue

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16
Q

what is rectus abdominus hypertrophy?

A

increased definition of rectus abdominus due to chronically increased respiratory effort

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17
Q

when auscultating the lungs may the horse appear normal at rest even if unwell?

A

yes

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18
Q

what should be done if a horse isn’t showing increased respiratory effort and sounds normal at rest?

A

rebreathing

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19
Q

describe the process of rebreathing to assess horses respiratory function

A

cover nose with a bag to increase CO2 levels and cause them to breathe harder and more deeply
auscultate throughout and then as bag is removed

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20
Q

what is the purpose of rebreathing during auscultation?

A

patient will breathe more deeply which will enable you to hear any crackles more clearly

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21
Q

why should you continue to auscultate the chest after bag is removed during rebreathing?

A

there will be a large breath after rebreathing ends which is useful to hear any lung sounds

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22
Q

what sampling techniques are available when testing for respiratory disease?

A

nasal swab
naso-pharyngeal swab
tracheal wash
brochoalveolar lavage

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23
Q

what imaging techniques are available to test for respiratory diseases in horses?

A

endoscopy
x-ray (head, thorax)
CT (head)
ultrasound (larynx, thorax)

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24
Q

when is endoscopy useful?

A

for all respiratory diseases

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25
where should the endoscope be passed through the nose?
up ventral meatus
26
what can be examined by endoscopy?
URT down to tracheal bifercation gutteral pouches URT during exercize
27
what is the function of gutteral pouches?
unknown - special adaption of horses
28
what happens during sinoscopy?
sinuses are scoped via a trephine or a flap
29
how many views of the head need to be taken if using radiographs to diagnose respiratory disease?
many views
30
what views of the thorax may be taken by radiographs?
lateral to lateral thorax
31
how many plates are needed to fit the entire equine chest on x-ray?
around 5
32
what is the best imaging modality for the head in the standing, sedated horse?
CT
33
what can be imaged with CT in the horse?
``` nasal turbinates para-nasal sinuses teeth nasopharynx gutteral pouches skull ```
34
what is the issue with MRI for horses?
they are mostly to big to fit their head into a scanner
35
what level of sedation is required for equine CT?
standing sedation
36
what are the main methods of sampling respiratory secretions?
nasopharyngeal or nasal swab | washes
37
what can samples of the respiratory tract gained by swabs be used for?
bacterial culture viral tests PCR
38
what sample tubes are needed to collect washes?
EDTA - cytology | plain - culture
39
where does tracheal wash sample cells from?
the level of the tracheal pull
40
what cells are sampled during tracheal wash?
respiratory secretions and cells that accumulate in the trachea and are a collection from the entire respiratory tract
41
where does bronchoalveolar lavage happen?
at the level of the lungs
42
what cells are sampled by bronchoalveolar lavage?
specific peripheral lung segment
43
where is the tracheal pull?
level of the neck where the trachea slopes less and so secretions collect
44
what is the most common wash used in practice?
tracheal wash
45
what are the benefits of tracheal wash?
general sample | less invasive
46
what is the disadvantage of tracheal wash?
cells have degenerated so less accurate
47
what is the advantage of bronchoalveolar lavage?
more accurate
48
what are the disadvantages of bronchoalveolar lavage?
more invasive sedation and LA required only samples a specific area so may miss disease
49
what equipment is needed for bronchoalveolar lavage?
long scope or a BAL tube
50
what signs will the horse show during a BAL?
will cough a lot
51
how far should the tube/scope be advanced for BAL?
should be as far into the lung as possible and stuck
52
what must be done once BAL tube/scope is stuck in the lung?
keep pressure (scope) or inflate the cuff (tube)
53
how much fluid needs to be instilled into the lung during BAL?
300-500ml
54
how much of the fluid should be drawn back to be sampled during BAL?
50-80%
55
what indicates a BAL sample is good?
froth (is surfactant)
56
what is ultrasound used for in respiratory medicine?
peripheral lung disorders
57
what may ultrasound need to be combined with in order to gain full picture when diagnosing respiratory disease?
x ray
58
what is the most common presenting complaint for horses with disorders of the nasopharynx and larynx?
abnormal respiratory noise during exercise
59
how can respiratory noise during exercise be heard?
audible stood near the horse while exercising without stetheoscope
60
depending on the severity of the disorder and the sue of the horse what are disorders of the larynx and pharynx likely to cause?
poor athletic performance | exercise tolerance
61
what is DDSP?
dorsal displacement of the soft palate
62
what happens during DDSP?
soft palate comes over the top of the epiglottis
63
when does DDSP most commonly occur?
racehorses during strenuous exercise but can be seen in sport or pleasure horses
64
what signs is DDSP associated with?
poor performance | abnormal expiratory noise (gurgle)
65
why is DDSP associated with poor performance?
reduced air supply as size of larynx is reduced
66
how is DDSP diagnosed?
exercising endoscopy
67
what causes DDSP?
not understood
68
what treatment is available for DDSP?
conservative treatment such as rest | surgery
69
what surgical options are available for DDSP?
soft palate cautery | laryngeal tie forward
70
what is the aim with soft palate cautery to treat DDSP?
idea is to stiffen soft palate so it can't flap about and displace
71
what occurs during a laryngeal tie forward?
larynx is pulled forwards
72
what is the benefit of a laryngeal tie forwards?
if the larynx is further forwards then it is harder for the palate to displace
73
what is arytenoid cartilage collapse also known as?
recurrent laryngeal neuropathy (RLN) laryngeal hemiplegia (LH) laryngeal paralysis
74
what is arytenoid cartilage collapse thought to be caused by?
recurrent laryngeal neurophathy
75
how does arytenoid cartilage collapse occur?
recurrent laryngeal nerve innervates cricoarytenoideus dorsalis muscle which abducts the arytenoid cartilages and so opens the larynx left nerve is really long so the end dies off leading to affected left side of larynx as muscle can no longer abduct cartilage
76
what are the clinical signs of arytenoid cartilage collapse?
``` inspiratory noise (whistling, roaring) exercise intolerance ```
77
how is arytenoid cartilage collapse diagnosed?
resting endoscopy may give some indication | exercise endoscopy is best
78
what is the treatment available for arytenoid cartilage collapse?
``` ventricolochodectomy (Hobday) - removes noise prosthetic laryngoplasty (tie back) - holds open arytenoid cartilage ```
79
what is the risk associated with prosthetic laryngoplasty?
aspiration pneumonia as can't close of the airway when swallowing food
80
what is sinusitis?
accumulation of exudate within sinus cavities
81
what is the primary cause of sinusitis?
follows bacterial or viral URT disease
82
what is sinusitis usually secondary to?
dental disease
83
what is the main clinical sign of sinusitis?
nasal discharge
84
how is sinusitis diagnosed?
endoscopy (check for other causes) x ray CT sinoscopy
85
what will often be performed at the same time as sinoscopy?
treatment for sinusitis
86
how is sinusitis treated?
lavage open and ensure better drainage treat underlying cause if secondary
87
what is found within the gutteral pouch?
lots of important structures
88
what is the issue with gutteral pouches?
don't always drain well
89
what is gutteral pouch mycosis?
life threatening fungal infection of gutteral pouch
90
what vessel may be affected by gutteral pouch mycosis?
carotid artery - lies very close to gutteral pouch and my be eroded
91
what are the signs of gutteral pouch mycosis?
epistaxis | some may have cranial nerve dysfunction
92
why may cranial nerves be affected by gutteral pouch mycosis?
located in gutteral pouch so may be invaded by fungus
93
how many horses will die following repeated epistaxis caused by gutteral pouch mycosis?
50%
94
how is gutteral pouch mycosis diagnosed?
gutteral pouch endoscopy
95
how is gutteral pouch mycosis treated?
surgical occlusion of vessels | topical antifungal
96
will patients all recover from any cranial nerve deficits caused by gutteral pouch mycosis?
no and may take up to 9 months | may have such a severe impact on function that it is unethical to wait and see (e.g. unable to eat)
97
what is strangles caused by?
streptococcus equi bacteria
98
what is strangles?
URT bacterial infection
99
where are strangles ulcers often seen?
near SML nodes
100
what are the clinical signs of strangles?
``` dull fever purulent nasal discharge enlarged, absecessing SML nodes enlarged, abscessing retropharyngeal lymph nodes (seen on GP endoscopy ```
101
what element of the strangles infection is hugely contagious?
the pus
102
what are the complications of strangles?
difficulty breathing abscesses may be seen around body immune mediated complication
103
what must happen to strangles patients and any close contacts?
must be isolated
104
how is strangles diagnosed?
culture or PCR from abscess | endoscope and GP lavage for culture
105
how is strangles treated?
penicillin in some | drain abscessed lymph nodes
106
how does influenza spread?
inhalation in common airspaces
107
where does influenza replicate?
URT and LRT
108
what are the signs of influenza?
``` coughing pyrexia serous nasal discharge submandibular lymphadenopathy inappetance depression ```
109
how is influenza diagnosed?
``` virus detection (PCR or ELISA on nasal or nasopharyngeal swab) virus isolation (nasal or nasopharyngeal swab) serology (rising titre of antibodies) ```
110
how is influenza treated?
rest | NSAIDs
111
how can influenza be prevented?
vaccination - strict competition and import rules
112
what are the various types of equine herpes virus?
different signs: respiratory neurological abortive
113
what are the most concerning types of EHV?
neurological and abortive
114
what types of EHV is there a vaccine for?
EHV 1 and 4
115
what is pleuropneumonia also known as?
shipping fever
116
which horses are at risk of pleuropneumonia?
horses travelling long distances
117
what is pleuropneumonia caused by?
opportunistic infection from the pharynx to the lungs by bacteria
118
what opportunistic bacteria often cause pleuropneumonia?
streptococcus zooepidemicus
119
what are the signs of pleuropneumonia?
``` history of long distance travel fever dull nasal discharge difficulty breathing weight loss ```
120
what tests are used to diagnose pleuropneumonia?
``` clinical exam chest x ray chest ultrasound tracheal wash sample pleural fluid sample (cytology and culture) ```
121
how are pleuropneumonia patients treated?
aggressive treatment penicillin chest drains
122
what is asthma also known as in horses?
RAO or COPD
123
what is asthma?
allergic airway disease
124
what is asthma usually caused by?
dust in stables, straw or hay
125
what are the signs of asthma?
``` increased mucous bronchoconstriction coughing and wheezing increased respiratory effort heave line ```
126
how is asthma diagnosed?
endoscopy tracheal lavage bronchoalveolar lavage
127
what are the white blood cell findings in equine asthma?
neutrophillia
128
how is asthma treated?
environmental management | inhaled or nebulised steroid and bronchodilator

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