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MODULE 15 - Cardiorespiratory and Haematopoietic Disease > PATHOLOGY - Equine Upper Respiratory and Sinonasal Disease > Flashcards

PATHOLOGY - Equine Upper Respiratory and Sinonasal Disease Flashcards

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1
Q

Label the anatomical structures on the normal equine pharynx and larynx

A
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2
Q

Why does disease affecting the upper airways result in poor performance?

A

Horses require low resistance airways with a high capacity for air to achieve their athletic performance. The majority of the resistance comes from the upper airways, and this resistance will be exacerbated with disease

If upper airway diameter decreases by 20%, resistance doubles

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3
Q

What are the potential clinical signs of upper respiratory disease in horses?

A

Asymptomatic
Abnormal respiratory noise
Dysphagia
Nasal reflux of food
Coughing

Dysphagia, coughing and reflux tend to be in more severe cases

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4
Q

When does the abnormal respiratory noise occur in horses with upper respiratory disease?

A

Abnormal respiratory noise can occur during inspiration and expiration and only be evident at rest or exercise, or occur during inspiration only at exercise

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5
Q

How can you determine if respiratory noise is inspiratory or expiratory?

A

When the horse is galloping, when their limbs strike the ground they are exhaling whereas when their limbs are in flight phase, they are inhaling

This DOES NOT apply to trotting and walking

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6
Q

How should you approach investigation of upper respiratory disease in horses?

A
  1. Full clinical examination
  2. Rule out other causes of poor performance (cardiac and musculoskeletal disease)
  3. Lunge in both directions
  4. Exercise test
  5. Endoscopy
  6. Rebreathing test
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7
Q

How do you carry out endoscopy in the horse?

A
  1. Restrain the horse appropriately (twich and stocks)
  2. You can do resting, nasal occlusion, post exercise or overground endoscopy
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8
Q

Why should you avoid sedating a horse for endoscopy?

A

Sedating a horse for endoscopy can alter any dynamic abnormalities of the upper respiratory tract which can obscure the diagnosis

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9
Q

What is overground endoscopy?

A

Overground endoscopy is a technique which allows for real-time endoscopic assessment of the upper airways whilst the horse is exercising

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10
Q

What questions should you be asking yourself (and your owners) when investigating upper respiratory disease in a horse?

A

Is there abnormal respiratory noise?
When does the noise occur?
Are there changes on endoscopy at rest?
Is there poor performance? (determine if the horse has ever performed well or has recently declined)
What is expected of the horse? (i.e. racing, jumping, eventing etc.)

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11
Q

What is the typical signalement for pharyngeal lymphoid hyperplasia?

A

Young horses

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12
Q

What is pharyngeal lymphoid hyperplasia?

A

Hyperplasia of the pharygeal lymphoid tissue as a result of a combination of the immune response and exposure to infection. This can result in turbulent airflow

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13
Q

How do you treat pharyngeal lymphoid hyperplasia?

A

Pharyngeal lymphoid hyperplasia is often an incidental finding which doesn’t require treatment, however in severe cases, rest and anti-inflammatories may be required

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14
Q

What is epiglottic entrapement?

A

Epiglottic entrapement is where the aryepiglottic folds (which are usually attached ventrally to the epiglottis) are displaced and entrap the epiglottis

Watch video on lecture slide to help visualise this

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15
Q

What are the potential clinical signs of epiglottic entrapement?

A

Asymptomatic
Abnormal respiratory noise
Coughing

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16
Q

How do you definitively diagnose epiglottic entrapement?

A

Endoscopy

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17
Q

Which condition does epiglottis entrapement increase the risk of?

A

Dorsal displacement of the soft palate

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18
Q

What is idiopathic laryngeal neuropathy?

A

Idiopathic laryngeal neuropathy is the unilateral paralysis of the arytenoid cartilages (the left one) caused by neurogenic atrophy of the dorsal cricoarytenoid muscles due to damage/dysfunction of the recurrent laryngeal nerve, resulting in failure of abduction of the arytenoid cartilages

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19
Q

What are the clinical signs of idiopathic laryngeal neuropathy?

A

Characteristic inspiratory noise (sounds like whistling)
Variable exercise intolerance/poor performance

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20
Q

How is idiopathic laryngeal neuropathy diagnosed?

A

Endoscopy (overground is the best for this)

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21
Q

How can idiopathic laryngeal neuropathy be treated?

A

Laryngoplasty (tieback) surgery
Ventriculocordectomy (Hobday)
Arytenoidectomy
Laryngeal reinnervation

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22
Q

What is a laryngoplasty (tieback) surgery?

A

A permanent suture is placed through the cricoid cartilage and the base of the arytenoid cartilage to mimic the action of the dorsal cricoarytenoid muscle

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23
Q

What are the complications associated with laryngoplasty (tieback) surgery?

A

Dysphagia
Aspiration pnuemonia
Persistent coughing
Infection
Failure to restore laryngeal function

Infection particularly problematic as this procedure involves placing a permanent suture which may need to be removed if infection persists

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24
Q

Which factors should you consider when selecting horses for laryngoplasty (tieback) surgery or laryngeal reinnervation?

A

What is the function of the horse?
How severe are the clinical signs?
What are the long term aspirations for the horse?

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25
What are the two classifications of dorsal displacement of the soft palate?
Permanent dorsal displacement Intermittent dorsal displacement
26
What is the prognosis for permanent dorsal displacement of the soft palate?
Poor prognosis
27
What are the potential causes of permanent dorsal displacement of the soft palate?
Permanent dorsal displacement of the soft palate is secondary to neuronal damage *(i.e. guttural pouch disease, peripheral neuropathies, neoplasia etc.)*
28
What are the clinical signs of permanent dorsal displacement of the soft palate?
Severe dysphagia Severe exercise intolerance
29
What is intermittent dorsal displacement of the soft palate?
This is when the dorsal displacement of the soft palate occurs when the horse is exercising | More common in race horses
30
What are the clinical signs of intermittent dorsal displacement of the soft palate?
Abnormal expiratory noise at exercise *(gurgling, choking noise)* Exercise intolerance/poor performance Open mouth breathing Fluttering of the cheeks
31
How can you diagnose intermittent dorsal displacement of the soft palate?
Endoscopy *(overground is the best for this, but can be done with resting endoscopy)*
32
What should you be aware of if using resting endoscopy to diagnose intermittent dorsal displacement of the soft palate?
Many normal horses will dorsally displace their soft palate during resting endoscopy so this can result in false positives. Squirt some water down and they should correct this if a normal horse
33
(T/F) Horses with intermittent dorsal displacement of the soft palate often have concurrent disease
TRUE. These horses often have concurrent upper and lower airway diseases which when resolved can sometimes improve their soft palate displacement
34
Which surgical procedure for intermittent dorsal displacement of the soft palate can be done?
Laryngeal tie-forward surgery
35
What is laryngeal tie-forward surgery?
Laryngeal tie-forward surgery moves the larynx rostrally and dorsally to increase the contact between the palate and the epiglottis
36
How should you approach management of intermittent dorsal displacement of the soft palate in horses under 4 years old?
Management including improving fitness, reducing work/pasture rest, NSAIDs and/or conservative management with a tongue tie, z-bit or drop nose band
37
How should you approach management of intermittent dorsal displacement of the soft palate in horses over 4 years old or ones that don't respond to conservative management?
Laryngeal tie-forward surgery
38
What is the typical signalement for tracheal collapse?
Minature horses and ponies
39
How do you manage tracheal collapse?
Often these patients have a normal quality of life, they will just have an abnormal respiratory noise and should be retired from an exercise
40
What is arytenoid chondritis?
Arytenoid chondritis is a progressive inflammatory chondritis which can progress to granulomatous and discharging tracts
41
How do you manage arytenoid chondritis?
Often antibiotics are ineffective for arytenoid chondritis due to the poor blood supply to the cartilage so surgical excision is required
42
What are the differential diagnoses for upper respiratory masses?
Congenital palatal cyst Pharyngeal cyst Granuloma Neoplasia Foreign body
43
How do the equine paranasal sinuses change with age?
As horses age, the paranasal sinuses get larger as the teeth erupt from the sinus ## Footnote This is important as in younger horses, damage to the sinuses can affect the tooth roots
44
Which structure directly and indirectly drains the equine paranasal sinuses? | Remember the sinuses are all connected with a septum between the two sides
Nasomaxillary aperture
45
What is primary paranasal sinusitis?
Primary paranasal sinusitis is an upper respiratory tract infection or fungal infection which causes the sinuses to fill with fluid
46
What is the typical signalement for primary paranasal sinusitis?
Young horses
47
What is the typical signalement for secondary paranasal sinusitis?
Older horses
48
What are the potential causes of secondary paranasal sinusitis?
Tooth root infection Trauma to the facial bone Expanding mass *(neoplasms and cysts)* Inspissated exudate
49
What is inspissated exudate?
Inspissated exudate is where a primary sinusitis has become chronic and the pus/exudate dries out and can no longer drain from the nasomaxillary aperture
50
What are the differentials for unilateral nasal discharge in the horse?
Unilateral paranasal sinusitis Nasal cavity disease
51
What are the differentials for bilateral nasal discharge in the horse?
Bilateral paranasal sinusitis Guttural pouch disease Nasopharyngeal disease Lung disease
52
What are the clinical signs of paranasal sinusitis?
Purulent uni- to bilateral nasal discharge Facial distortion Stertor Halitosis Epiphora Conjunctivitis Obstructed nostril airflow Enlarged regional lymph nodes Decreased resonance on percussion
53
How can you diagnose paranasal sinusitis?
Radiography CT Percussion Oral exam Endoscopy and Sinoscopy
54
What are the benefits of CT for diagnosing paranasal sinusitis compared to radiography?
CT is more accurate and is less expensive as you only need to do one CT however you would have to do multiple radiograph views
55
What are key signs of paranasal sinusitis on radiography?
Increased opacity Fluid lines on lateral radiography
56
Where is very important to look on oral examination?
Is is very important to look at the back of the hard palate as this is where early neoplastic changes tend to occur | Remember neoplasia can expand into the sinuses and cause sinusitis
57
What can you identify that can indicate paranasal sinusitis on endoscopy?
Drainage from the nasomaxillary aperture
58
How do you carry out sinoscopy?
Sedate the horse, clip and steile prep, local anaesthetic, make a linear skin incision and make a hole in the bone using a trephine and pass the scope into the sinus
59
What is this structure within the paranasal sinuses?
Maxillary septal bulla
60
What is the relevance of the maxillary septal bulla when you are doing sinoscopy?
You will have to break down the maxillary septal bulla in order to see within the ventral conchal sinus where there is often inspissated pus that needs to be removed
61
How does primary paranasal sinusitis appear on sinoscopy?
Watery mucopurulent material which can sometimes be blood tinged, with no evidence of a cause of the sinusitis *(i.e. something that would indicate a secondary sinusitis)*
62
How do you treat primary paranasal sinusitis?
Primary paranasal sinusitis should be treated with broad spectrum antibiotics and sinus lavage with saline or water. You should leave the foley catheters in for approximately five days and they should be flushed twice daily either by the owner or yourself. Remove the catheters after five days and allow the wounds to heal by second intention ## Footnote If the horse does not respond to antibiotics and flushing, it is NOT primary sinusitis - it is likely secondary
63
How do you treat secondary paranasal sinusitis?
Secondary paranasal sinusitis should be treated with broad spectrum antibiotics, sinus lavage with saline or water and **management of the inciting cause**. You should leave the foley catheters in for approximately five days and they should be flushed twice daily either by the owner or yourself. Remove the catheters after five days and allow the wounds to heal by second intention
64
How do you manage dental secondary paranasal sinusitis?
Remove the affected tooth, administer broad spectrum antibiotics and do sinus lavage
65
What is cystic sinus disease?
Cystic sinus disease is secondary paranasal sinusitis caused by an expanding cyst which usually originates in the maxillary sinus | Usually dentigerous cysts or cysts due to trauma
66
How does cystic sinus disease cause facial swelling?
These cysts contain some prostaglandin E2 which has an effect on osteoclasts and results in thinning of the bone which allows the cyst to expand and push agaisnt the bone, resulting in facial swelling
67
How does the cystic fluid appear with cystic sinus disease?
The cystic fluid will usually be honey-coloured unless they are infected and they will be full of pus
68
How does cystic sinus disease appear on radiography?
Cystic sinus disease appears as a fluid/soft tissue mass in the paranasal sinuses
69
How can you treat cystic sinus disease?
Removal of the cyst through a frontonasal or maxillary sinusotomy via a osteoplastic flap or trephine hole. Or you can do more minimally invasive sinus surgery | In addition to broad spectrum antibiotics and sinus lavage
70
What is the most common neoplastic cause of secondary paranasal sinusitis?
Squamous cell carcinomas | Often originate on the hard palate
71
How do you treat paranasal sinusitis secondary to neoplasia?
Euthanasia
72
What are the advantages of sinus surgery with standing sedation over general anaesthetic?
Reduced expense Eliminates risks associated with general anaesthesia Better visualisation due to decreased haemorrhage
73
What are the potential complications of sinus surgery?
Haemorrhage Infection Suture periostitis
74
What is suture periostitis?
Suture periostitis is a hard swelling along the suture lines between the horse's skull which should resolve itself
75
What is an atheroma?
An atheroma is a congenital epidermal inclusion *(sebaceous)* cyst which is usually level with a nasal diverticulum *(false nostril)*
76
How do you treat an atheroma?
Usually atheromas can be left alone or they can be removed with a burr
77
What is wry nose?
Wry nose is congenital deviation of the maxillary and nasal bones and nasal septum
78
What is the prognosis for wry nose?
Euthanasia is usually the treatment of choice however surgery can be done in some cases
79
What are the main abnormalities of the nasal septum?
Nasal septum deviation *(will reduce airflow on one side)* Nasal septum thickening *(will reduce airflow on both sides)*
80
What can cause nasal septum thickening?
Trauma Neoplasia Infection
81
(T/F) Nasal septum thickening and nasal septum deviation can correct itself
FALSE. The nasal septum will have to be surgically removed
82
What are the clinical signs of nasal neoplasia?
Serosanguinous or mucopurulent, odorous nasal discharge Airway obstruction Facial distortion
83
How do you treat nasal neoplasia in horses?
Euthanasia
84
What is this nasal mass in the horse?
Progressive ethmoidal haematoma
85
What is a key clinical sign of a progressive ethmoidal haematoma?
Intermittent serosanguinous nasal discharge
86
How do you treat progressive ethmoidal haematomas?
Surgical ablation with formaldehyde

MODULE 15 - Cardiorespiratory and Haematopoietic Disease (21 decks)

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