Lecture 19: Large Animal Cardiopulmonary Disorders (MacKay) Flashcards Preview

Cardiopulmonary (Estrada-Fall 2014) > Lecture 19: Large Animal Cardiopulmonary Disorders (MacKay) > Flashcards

Flashcards in Lecture 19: Large Animal Cardiopulmonary Disorders (MacKay) Deck (55):
1

importance of resp. diseases in LA

-2nd only to MS system in limiting athletic performance of horses
-sig. cause of morbidity and mortality in cattle

2

where is sterdor generated?

nose

3

where is stridor generated?

larynx

4

What should be included in a history of animal with resp distress?

-signalment
-intended use
-nature, duration, and progression of CS
-only 1 animal affected?
-previous tx and response to therapy
-vax history

5

unilateral nasal d/c typical of:

sinus infection

6

bilateral nasal d/c typical of:

pneumonia or guttural pouch issue

7

malodorous nasal discharge assoc. with

gram = bacteria

8

steps of resp. system exam

-observe from distance
-presence of nasal d/c?
-evaluate airflow at nose
-MM and CRT
-palpate larynx/trachea/regional lymph nodes
-percussion of paranasal sinuses
-observe ventral abd, muzzle, and limbs for edema

9

char. of normal bronchovesicular lung sounds

-produced by turbulent air flow in the central airways
-louder ventrally than dorsocaudally
-attenuated by aerated lung parenchyma

10

char. of abnormal (adventitious) lung sounds

-crackles (short, non-musical)
-wheezes (musical, high-pitched)
-friction rubs

11

rebreathing CO2

helps to hear lung sounds
-make horse breathe in bag, and they will breathe deeper
-if takes longer than 6-8 breaths to recover, implies resp. insufficiency

12

percussion use

-delineation of lung boundaries
-identify consolidation, abscesses and pleural effusion

13

structures evaluated in endoscopy

nasal cavities
ethmoid
pharynx
larynx and epiglottis
trachea and bronchi
guttural pouches

14

what do you hit with tube if you accidentally go up middle meatus?

ethmoturbinate

15

rima glottidis

opening to lower airways

16

tube usually goes into which bronchus?

R

17

upper airway rad can visualize what structures?

Head: nasal cavities, sinuses, ethmoid, teeth
Pharynx: epiglottis, soft palate, guttural pouches

18

lower airway rad can visualize what structures?

Lungs: normal/alveolar/interstitial/bronchial/mixed pattern
Heart

19

can you visualize whole lung field on rad in adult horse?

No. Requires about 4 rads on each side!

20

branching of pulmonary vessels over aorta and caudal heart in horses is a sign of cardiac health

:)

21

ad/disad. of ultrasonography

ad:
-technique of choice for evaluating pleural space and peripheral lung
-penetrates water filled structures very well
-widely available
disad:
-doesn't penetrate normal lung parenchyma
-can't detect deep lung lesions w/ overlaying normal lung

22

nasal washes useful for:

detection of microbes that don't normally colonize the upper airways such as viruses and strep. equi equi

23

Tracheobronchial aspirate (TBA)

technique of choice to obtain a culture of the lower airways when pneumonia is suspected. Collects from horizontal portion of trachea which collects secretions from the whole lung.
-Normal cytology has mainly macs and ciliated epithelial cells
-think video of cutting into trachea!
-not a sterile procedure

24

Bronchoalveolar lavage (BAL)

cytology correlates well with histopath. of the lungs when a DIFFUSE dz is present, but not useful when a FOCAL dz is suspected, such as pneumonia. Culture not sterile

25

when to perform thoracocentesis?

when pleural effusion suspected. Includes cytology and culture.

26

complications of lung biopsy

hemorrhage, pneumonia

27

arterial blood gas analysis measures:

gas exchange (PaO2) and ventilation (PaCO2)

28

pulmonary function testing measures:

mechanical properties of lungs

29

2 obstructive dzs of the upper RT

laryngeal hemiplasia
dorsal displacement of the soft palate

30

4 infectious dzs of the URT

strangles
guttural pouch diseases
sinusitis
viral resp. diseases

31

5 dzs of the LRT

foal pneumonia
rhodococcus equi pneumonia
pneumonia/pleuropneumonia in adult horses
exercise induced pulmonary hemorrhage
heaves

32

most infectious upper airway disease still in the U.S.

Strangles

33

Strangles is caused by what bacteria

streptococcus equi subsp. equi

34

Strangles transmission

direct contact, fomites

35

morbidity and mortality of Strangles

high morbidity (30-100%), low mortality (<10%)

36

pathogenesis of Strangles

1) ingest/inhalation
2) attach. to tonsils and translocation below the mucosa in the lymphatics
3) multiply and abscess in local lymph nodes
4) possible dissemination via lymph or blood

37

CS of Strangles

-fever (1st)
-depression
-bilateral nasal d/c
-retropharyngeal and submandibular lymphadenopathy
-resp. distress
-abscesses throughout body

38

Which worse: retropharyngeal or submandibular abscesses from Strangles?

retrophar. Don't rupture to outside very easily and put pressure on larynx which can cause inspiratory dyspnea

39

Explain Strangles and chronic carriers

Most horses stop shedding 3-6 wks after resolution of CS, however some will become chronic asymptomatic carriers. Carry bacteria primarily in guttural pouch and can shed for months-years

40

Dx of Strangles

-presumptive based on CS and abscessed lymph nodes
-Culture or PCR (PCR 10x more sensitive!) amplification

41

How do you dx/detect chronic carriers of Strangles?

-abscess aspirate
-nasal or pharyngeal swab 3x
-nasal flush 3x
-guttural pouch flush
submitted for culture or PCR**

42

Tx of Strangles

-horses exposed or with early CS BEFORE abscess: penicillin
-horses with abscess: promote maturation/drainage, no Abx unless anorexic or in resp. distress, supportive therapy

43

Complications of Strangles

-pneumonia
-guttural pouch empyema and/or chondroids
-bastard strangles
-myocarditis, endocarditis
-glomerulonephritis
-purpura hemorrhagica

44

purpura hemorrhagica

acute necrotizing immune-mediated vasculitis

45

Path of purpura hemorrhagica in Strangles

immune complex formation --> deposition in blood vessels --> complement activation and mediator release --> vessel wall necrosis

46

CS/Dx of purpura hemorrhagica

-warm/painful edema of limb, ventral abd, face
-petechial hemorrhage
-fever
-stiffness
Dx: history, CS, skin biopsy

47

Tx of Purpura hemorrhagica

-systemic antimicrobials (penicillin +/- gram negs)
-steroids
-NSAIDs, hydrotherapy, bandages

48

Strangles vaccination

-not very effective, but decreases severity/incidence
2 types:
1)IM: uses M protein extracts
2) Intranasal (Pinnacle IN): uses altered live virus, use in outbreaks, can cause CS in young horses, generates nasal immunity

49

What can be visualized in medial compartment of guttural pouch?

internal carotid a.
cn 9,10,11,12
cranial cervical ganglion

50

What can be visualized in lateral compartment of guttural pouch?

external carotid a.
maxillary a.
cn 7

51

guttural pouch empyema

accumulation of exudate in the guttural pouch(es). May solidify to form chondroids

52

CS of guttural pouch empyema

-nasal d/c when head down
(rarely dysphagia, not usually malodorous)

53

dx/tx of guttural pouch empyema

dx:
-endoscopy
-rads (fluid line, chondroids)
-culture for Strep. equi
Tx:
-lavage with large volume of saline
-systemic abx

54

guttural pouch mycosis

fungal infection often over a major blood vessel (internal carotid most common)

55

CS of guttural pouch mycosis

-epistaxis**
-dysphagia
-Horner's, laryngeal hemiplasia, facial paralysis,etc.