Nasal Discharge: URT

Question 1

most horses have what type of nasal discharge?

Answer 1

seromucoid discharge

Question 2

seromucoid discharge

Answer 2

• inflammation of the nasal cavity
• increased glandular secretions
• acute viral disease: would expect to have a fever
• dust/environmental irritants

Question 3

if you have a horse with nasal discharge, what should you do?

Answer 3

take a temperature

Question 4

purulent discharge

Answer 4

• more severe inflammation
• bacterial invasion
• increased neutrophils in airway secretions: creates a milky, white, yellow green color

Question 5

T/F: nasal discharge is often a combo of multiple types

Answer 5

true, esp epistaxis can be present with any type

Question 6

what key question should you ask an owner who says their horse has nasal dc?

Answer 6

• malodorous or not?
  ^ gives indication of anaerobic or not, as well as duration! takes a while for an anaerobic process to come out

Question 7

what are sources of seromucoid discharge?

Answer 7

• nasal passages
• sinus drainage or nasomaxillary aperture
• ethmoid turbinates
• guttural pouch
• pharynx
• larynx
• trachea/lower airways

Question 8

when viewing the upper respiratory tract, do you want the horse to be sedated or non sedated?

Answer 8

ideally non sedated, because sedation makes everything loose and flappy

Question 9

what are the 2 options when dealing with oro-maxillary fistula and sinusitis?

Answer 9

1. obstruction
2. dysphagia

Question 10

esophageal obstruction

Answer 10

emergency!! horses will develop aspiration pneumonia. choke
- distress
- retching
- stretched out neck
- copious nasal and oral secretions

Question 11

dysphagia has what 2 types

Answer 11

1. mechanical
2. functional

Question 12

mechanical dysphagia

Answer 12

• defect (cleft palate)
• swelling
• extraluminal compression

Question 13

functional dysphagia

Answer 13

nerve damage

Question 14

why is choke a major emergency?

Answer 14

aspiration pneumonia. need to get a sedative on board fast. if it has been 3 days then prognosis super bad

Question 15

the prognosis with aspiration pneumonia is poorer with more __________

Answer 15

bacteria present

Question 16

when creating a list of differentials for a horse with mucopurulent discharge, the examiner needs to consider what

Answer 16

1. age of animal
2. history of disease in other animals on property
3. characteristics of nasal dc: onset, duration, unilateral, vs bilateral, consistent, color and odor

Question 17

what question is important to ask if a horse has had unilateral nasal discharge?

Answer 17

does it change sides or is it always on the same side

Question 18

what are other clinical signs you can see with nasal discharge?

Answer 18

• fever
• inappetance
• coughing
• difficulty swallowing
• exercise intolerance
• resp noise/difficulty
• concern for dental disease

Question 19

what biosecurity considerations do you have with a horse with nasal discharge?

Answer 19

• susp infx dz
• fever
• hx of fever
• other horses affected?
• history of dz in other horses
• signalment, history, clinical signs
• if unsure, wear PPE or do healthy horses first

Question 20

what does a general exam of a horse with nasal dc consist of?

Answer 20

• PE
• CV status: amount of blood loss, clotting factors
• cranial nerve exam

Question 21

what does the respiratory system exam of nasal discharge consist of?

Answer 21

• symmetry of neck/head
• lymph nodes
• airflow/odor at nostril
• sinus percussion
• larynx/trachea palpation
• rebreathing examination

Question 22

tooth problems can become ________

Answer 22

sinusitis

Question 23

what are the main sinuses that have problems?

Answer 23

maxillary sinuses

Question 24

what is between maxillary sinuses that can be tricky for diagnosing issues?

Answer 24

a septum

Question 25

what is the best diagnostic to examine sinuses of the horse?

Answer 25

CT: best info on sinuses, brain, etc. much more comprehensive than radiographs

Question 26

what is primary sinusitis?

Answer 26

no detectable predisposition to bacterial infx other than possible respiratory infection don't know why there is sinusitis. tricky to deal with. susp related to viruses or bacteria

Question 27

what are causes of secondary sinusitis?

Answer 27

- dental dz: most common cause - oro maxillary fistula - progressive ethmoid hematoma - sinus cysts - traumatic sinusitis - sinus neoplasia - mycotic sinusitis

Question 28

what is the most common cause of sinusitis in the horse?

Answer 28

dental disease: causing secondary sinusitis

Question 29

does dental disease cause unilateral or bilateral sinusitis?

Answer 29

unilateral- problem is where that tooth is. uncommon to have 2 spots causing that severe of a problem

Question 30

what is a key characteristic about sinusitis caused by dental disease in horses?

Answer 30

IT SMELLS REALLY BAD!! can smell them a while away

Question 31

neoplasia causes what type of discharge?

Answer 31

bloody serous discharge

Question 32

is sinusitis more commonly unilateral or bilateral?

Answer 32

unilateral

Question 33

what clinical findings are often seen with sinusitis?

Answer 33

- unilateral mucopurulent or purulent nasal discharge - ipsilateral submandibular lymphadenopathy

Question 34

what clinical signs are less commonly seen with sinusitis (but can be seen)

Answer 34

- epistaxis - facial swelling - epiphora (abnormal tears forming and going down on face) - nasal airflow obstruction - abnormal resting resp noises - head shaking

Question 35

what ancillary diagnostics can you do with a horse with sinusitis?

Answer 35

- aspiration - trephination - fine needle aspirate - scintigraphy - MRI - sinoscopy

Question 36

what is trephination?

Answer 36

poking a hole in the horse's sinus to get a sample directly from the cavity

Question 37

how do you perform trephination?

Answer 37

- standing sedation - local anesthesia - Steinmann pin - sample collection - drainage

Question 38

what are ways to treat sinusitis?

Answer 38

- abx - lavage thru existing openings - tooth extraction - surgery: standing or general anesthesia

Question 39

sinus neoplasia has what kind of prognosis?

Answer 39

poor: by the time diagnosed, have already invaded into many areas. don't do well unless found early; only 22% cured

Question 40

prognosis of all other types of sinusitis

Answer 40

excellent long-term response to treatment - more conservative treatments (removal of pus, sinusotomy) are effective for chronic primary sinus disease - standing sinusotomy, suitable for most cases in mature horses

Question 41

what is empyema?

Answer 41

- accumulation of exudate (pus) in the guttural pouch - secondary to resp tract infection - RARE - failure of emptying mechanism - STRANGLES is the cause of most cases - may accompany guttural pouch tympany

Question 42

what disease in horses do you think of with empyema

Answer 42

STRANGLES lymph node abscessation into guttural pouch do a scope and see pus draining in. don't need any other diagnostics

Question 43

99% of empyema is associated with what disease process

Answer 43

STRANGLES

Question 44

what are clinical signs of empyema?

Answer 44

- unilateral or bilateral nasal dc - thick purulent - continuous/intermittent - external enlargement not always noticeable

Question 45

how do you diagnose guttural pouch empyema?

Answer 45

- endoscopy - radiographs