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Equine > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Unilateral discharge localisation?

A

usually = rostral to the nasal septum (nasal passages and sinuses)

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2
Q

Bilateral discharge localisation?

A

usually = caudal to the nasal septum (guttural pouch, pharynx, larynx, trachea, bronchi and lungs), but sometimes these can present as unilateral discharge

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3
Q

What structure distinguishes URT from LRT?

A

Upper respiratory tract refers to structures rostral to the larynx.
Lower respiratory tract refers to structures caudal to the larynx.

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4
Q

History for respiratory cases

A
  • Age*, use of horse, ownership
  • Onset (sudden* or insidious), duration, progression
  • Contact with other horses*
  • Other horses affected*
  • Management (pasture or stabled, type of feed and bedding**)
  • Seasonality**
  • Effect of exercise
  • Previous / concurrent diseases
    *Infectious **Asthma
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5
Q

Clinical signs in respiratory cases

A
  • Unilateral/bilateral (anatomical location)
  • Type of discharge (type of disease)
  • Swelling, pain, lymph node enlargement (URT)
  • Respiratory noise (URT)
  • Cough (pharynx/larynx or LRT)
  • Exercise tolerance
  • Appetite, demeanour
  • Respiratory rate and effort (LRT)
    Check for other clinical signs, e.g. abortion and neurological disease with Herpes, peripheral oedema with Equine Viral Arteritis, cranial nerve neuropathies with guttural pouch disease
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6
Q

Clinical signs with upper airway disease

A
  • Unilateral or bilateral discharge
  • Localising signs to head/pharyngeal region
    Submandibular or retropharyngeal lymph node enlargement~
    Guttural pouch swelling
    Draining tracts
    Dental abnormalities
    Respiratory noise
    +/- Cough
    +/- Systemic signs (Strangles, neoplasia)
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7
Q

Clinical signs with lower airway disease

A
  • Cough
  • Increased respiratory rate
  • Increased respiratory effort
  • Increased respiratory noise on auscultation
  • Stance and demeanour (pneumonia)
  • Exercise intolerance
    +/- Systemic signs (Herpes, EVA, pleuropneumonia, neoplasia)
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8
Q

Causes of haemorrhagic nasal discharge

A

Trauma - injury, foreign body

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9
Q

Causes of mucoid or serous nasal discharge

A

Viral infection, non infectious inflammatory disease (asthma)

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10
Q

Causes of purulent (no odour) nasal discharge

A

Bacterial +/- viral infection

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11
Q

Causes of purulent (odourous) nasal discharge

A

Usually mixed bacteria with anaerobes - check for underlying cause (dental disease, neoplasia, mycosis, foreign body

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12
Q

Causes of food material nasal discharge

A

Breakdown of pharyngeal anatomy (cleft palate, oral fistula, dental disease)
Choke
Grass sickness

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13
Q

Nasal passages differentials

A

cleft palate, cysts, polyps, ethmoid haematoma, trauma, foreign body, fungal rhinitis, neoplasia

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14
Q

Sinuses differentials

A

primary and secondary (inc. dental) bacterial sinusitis, cysts, neoplasia, ethmoid haematoma, trauma, fungal sinusitis, foreign body

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15
Q

Guttural pouch differentials

A

empyema, mycosis, tympany, trauma, neoplasia

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16
Q

Pharynx/larynx differentials

A

pharyngitis, URT bacterial or viral disease, arytenoid chondritis, foreign body

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17
Q

LRT differentials

A

Lung disease: Inflammatory conditions (RAO/Asthma), Infectious conditions (pneumonia, pleuropneumonia, equine influenza, equine herpes virus, equine viral arteritis, Dictylocaulus arnfieldi), neoplasia, exercise induced pulmonary haemorrhage (EIPH)

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18
Q

Diagnosing respiratory disease

A

History and physical exam +/- oral and neuro exam

Radiography
Endoscopy
Haematology and biochemistry
Infectious disease tests

Lower
Tracheal wash/ BAL
Ultrasonography
Radiography
CT
Aspiration of pleural fluid

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19
Q

When to use radiography for diagnosing respiratory disease

A

Dental, sinus, guttural pouch disease (bony lesions and fluid lines)

Not for - soft tissues and lower airway disease

Lower
Large masses, fluid lines, small equids
Not for - most diseases, larger horses

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20
Q

When to use endoscopy for diagnosing respiratory disease

A

Most URT and LRT lesions, inside spaces, soft tissue, and mucosal lesions

Not for - bony lesions, severe epistaxis (red out)

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21
Q

When to use haematology and biochemistry for diagnosing respiratory disease

A

Infectious processes or systemic involvement
Haematology, fibrinogen, and SAA (serum amyloid A) most useful

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22
Q

What infectious disease tests are there?

A

Strangles - nasal swab, guttural pouch lavage and serology
Equine influenza - nasal swab and serology
Equine herpes virus - nasal swab, placenta, fetus, serology
Equine viral arteritis - serology, tissue samples

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23
Q

Tracheal wash vs bronchioalveolar lavage (BAL)

A

Tracheal wash - focal or diffuse disease, poorer cytology, unsedated, easy, no lay off

BAL - diffuse disease only, better cytology, sedation, moderate ease, lay off for 4 days

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24
Q

When to use ultrasound to diagnose respiratory disease

A

Pleural disease, periphery, surface of lung

Not for - diseases within lung - accoustic shadowing for air

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25
Q

What bacteria causes strangles?

A

Streptococcus equi equi

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26
Q

Clinical manifestations of strangles

A

Sudden pyrexia (24 - 48h pre-shedding)
Mucopurulent nasal discharge
RF and SM LN abscessation
Pharyngitis
- Nasal discharge
- Dysphagia
- Cough
- Laryngeal associated pain
- Extended head
Right – moderate lymphoid pharyngeal hyperplasia – inflammation
Can see dorsal displacement of soft palate in severe inflammation with dyspnoea
LN abscessation
- Abscessation 3-14 days after infection
Retropharyngeal – can rupture into guttural pouch
Submandibular
Parotid
Cranial cervical
Can be drained externally
Guttural pouch empyema – pus in body cavity

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27
Q

Complications of strangles

A

Pneumonia to bronchal pleural fistula
Distant abscesses in different body systems - lymphatic or haematogenous spread

Severe dyspnoea - severe retropharyngeal abscessation, guttural pouch empyema

Immune mediated ascites - uncommon
Type 3 hypersensitivity reaction

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28
Q

Diagnostic testing - acute strangles

A

History - onset, exposure, travel, new horses?
Clinical signs - variable, non specific, but vital
Endoscopy, US, radiography
Pathogen identification

Culture - 30-40% sensitivity - false negative tests - PCR of nasopharyngeal lavage is optimal - nasopharyngeal swab then nasal swab

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29
Q

Persistent strangles infection

A

Culture
PCR of endoscopic guttural pouch lavage 3x 7 days apart

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30
Q

Strangles treatment

A

NSAIDs - pyrexia and pain, inflammation
Soft, calorific diet
Abscess management - hot packing, drainage, lavage
Isolation
Nursing care
Do not lance until mature abscess

GP lavage for empyema

Antibiotics for severe persistent infection - benzylpenicillin
For with severe dyspnoea, dysphagia or persistent fever

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31
Q

Define pneumonia
Bronchopneumonia
Exudative stage
Fibrinopurulent stage
Organisation stage

A

Infection of lower respiratory tract
Broncho - bronchi and parenchyma
If in pleural space - pleuropneumonia

Exudative stage - sterile transudate in pleural space
Fibrinopurulent stage - bacterial invasion and fibrin deposition
Organisation stage - fibroblasts in exudate - pleural peel

32
Q

Risk factors for pneumonia

A

After viral infections
Strenuous exercise
Transportation and prolonged elevation of head - mucocilliary clearance
GA
Overcrowding
Inclement weather
Dysphagia - aspiration

33
Q

Aspiration pneumonia

A

Dysphagia - pharyngeal and postpharyngeal
Oesophageal obstruction
GA
Cleft palate

34
Q

Aitiology of pneumonia

A

Streptococcus equi zooepidemicus – normal commensal
Staphylococcus aureus and S. pneumonia
Actinobacillus (gram negative non enteric)
Escherichia coli, Pasteurella, Enterobacter, Klebsiella, Bordetella
Bacteroides fragilis
Fusobacterium and Peptostreptococcus anaerobius

35
Q

Clinical signs of pneumonia

A

Tachycardia/tachypnoea
Respiratory distress
Fever
Anorexia, depression
+/- nasal discharge
Exercise intolerance
Auscultation – crackles, dull areas – use rebreathing bag to auscultate

Crackles and wheezes
Dull areas
Dull area follows flat line – pleuropneumonia
Pleural ribs – pleuropneumonia
Radiation of cardiac sounds

36
Q

Pleuro-clinical signs

A

Pain intercostal spaces – palpate
Reluctance to walk, colic
Grunting during respiration
Abduction of elbows
Ventral oedema

37
Q

Diagnosis of pneumonia

A

Physical exam and rebreathing bag
Haematology and biochemistry
Endoscopy
TTW and BAL - hugely useful
- Aerobic and anaerobic (do not refrigerate)
US - white line pleura and surface of lung
- Comet tails - pathology
Radiography
Thoracocentesis
Thoracoscopy

CBC
- Neutrophilia leukocytosis
- Leukopenia
- Anaemia - chronic cases

Increased fibrinogen and SAA

Decreased Fe2+

38
Q

Pneumonia treatment

A

Penicillin and Gentamycin IV
Penicillin and Gentamycin and Metronidazole in aspiration pneumonia
Adjust based on C+S

Inhaled drugs
Gentamycin
Ceftiofur
Cefquinome

39
Q

Equine influenza A

Clinical signs

Diagnosis

Treatment

A

Infection of respiratory epithelial cells URT, nasopharyngeal shed, destroyed cilia

Clinical signs
- Fever
- Cough
- Nasal discharge - serous, may become purulent - secondary bacterial infection

Diagnosis
- Nasal swab - ELISA, PCR
- Serum - antibodies, ELISA, haemagglutination inhibition -

Treatment
- Nursing care and anti-inflammatories
- Antibiotics for secondary infection
- Vaccine available

40
Q

Equine herpes virus 1 & 4

Transmission

Clinical signs

Diagnosis

Treatment

A

Transmission - inhalation of aerosol, contact with infected fomites, reactivation from latency
Infection of respiratory epithelial cells - nasopharyngeal shed
Abortion - rare
Spiral cord - neuro disease - rare

Clinical signs
Common
- Fever, mild cough, slight nasal discharge, poor performance
Occasional - abortion, sick neonatal foal, neurological disease - equine herpes myoencephalopathy - EHM

Diagnosis
- Nasal swab (and placenta/fetus) - PCR
- Blood sample - anticoagulated blood acute
- Antibodies - complement fixation test - serum

Treatment
- Rest in athletic animals
- EHM - nursing care and antiinflammatories
- Vaccine available

41
Q

Equine viral arteritis

Transmission
Clinical signs
Diagnosis
Treatment

A

Respiratory, venereal, congenital, fomite spread
URT and LRT, to regional lymph nodes, and replicates into bloodstream

Clinical signs
- Often asymptomatic, fever, nasal discharge, loss of appetite, respiratory distress, skin rash, muscle soreness, conjunctivitis, depression
Relatively rare in UK

Diagnosis
PCR
ELISA for prebreeding or sales

Treatment
Supportive when acute, no treatment for persistent infection in stallions
Vaccine available

42
Q

Lungworm - Dictocaulus arnfieldi

Transmission
Clinical signs
Diagnosis
Treatment

A

Parasitic roundworm
Ingestion of L3 larvae from faeces, pasture - donkeys

Mucupurulent exudate, hyperplastic epithelium, lymphocytic infiltrate in lamina propria - alveolitis, brochiolitis, bronchitis
Moderate to severe coughing - exercise

Diagnosis
Larvae in faeces - rarely
Tracheal wash for eggs, larvae and WBC
Failure of antiobiotic therapy, season, history

Treatment
Moxidectin and Ivermectin - stable to treat

43
Q

LRT risk factors in foals

A

Systemic sepsis - FPT
Congenital abnormalities
Meconium aspiration
Milk aspiration
Birth trauma

44
Q

Acute respiratory distress immediately following birth - extrapulmonary disorders causing URT obstruction

A

Bilateral choanal atresia
Stenosis of nares
Severe laryngeal oedema or collapse
DDSP (dorsal displacement soft palate)
Subepiglottic cyst
Severe pulmonary abnormalities
Congenital cardiac abnormalities

45
Q

Acute lung injury and acute respiratory distress syndrome - foals

Clinical signs
Treatment
Prognosis

A

Respiratory failure syndrome - non cardiogenic pulmonary oedema, decreased pulmonary compliance, ventilation/perfusion mismatch

Exaggerated inflammatory response - severe tissue damage
Surfactant deficiency - progressive atelectasis (partial/total lung collapse)

Treatment
- Intranasal oxygen
- Ventilation - mechanical due to lung collapse
- Anti-inflammatories - corticosteroids
- Broad spectrum antibiotics - gentamycin

Poor prognosis

46
Q

Meconium aspiration foals

A

Aspirate material from nasal passages and pharynx
Nasotracheal intubation and careful suction
Intranasal oxygen supplementation +/- mechanical ventilation
Anti-inflammatory therapy
Pentoxyfylline - improves circulation
Secondary bacterial pneumonia treatment - broad spectrum - pencillin, gentamicin, TMPS

47
Q

Milk aspiration foal

A

Secondary to -
Generalised weakness, poor suckle reflex
Dysphagia - prematurity or neonatal maladjustment
Congenital abnormalities

Diagnosed with history of milk regurgitation

Abnormal lower respiratory sounds
systemic inflammation
pulmonary dysfunction

Endoscopic examination of URT
Thoracic radiography

Treatment
- correct cause of aspiration
- naso-oesophageal feeding tube
- Broad spectrum antimicrobial therapy - TMPS, penicillin, gentamicin

48
Q

Foal rib fractures

Diagnosis
Treatment

A

Diagnosis
Physical exam
- Crepitus
- Auscultation - grinding or clicking
Ultrasonography

Treatment
- Conservative
Box rest - avoid pressure on handling

Surgical repair may be necessary if multiple fractures and risk thoracic viscera
Haemothorax - address primary cause of haemorrhage and patient stabilisation and support

49
Q

Viral pneumonia in foals

A

Uncommon
EHV1, EHV4, Equine influenza, Equine arteritis, equine adenovirus
Older foals

Dry cough, fever, +/- mucopurulent nasal discharge (secondary bacterial infection)

Usually self limiting
EAV - ventral and limb oedema due to vasculitis

50
Q

Equine herpes virus in foals

A

Severe and typically fatal in neonatal foals
Presents similarly to neonatal sepsis

Cardiovascular and respiratory insufficiency
Congested MMs

Leukopenia, neutropenia, lymphopenia

PCR testing of nasal secretions or whole blood

Treatment
Antivirals - Acyclovir, valacyclovir - some efficacy in less affected foals
Supportive care

51
Q

Parasitic pneumonia foals

A

Following ingestion of lavated eggs of parascaris - ineffective larvae emerge in intestinal lumen - through liver and lungs - cough up and ingested
Substantial inflammation with migration through lungs
Clinical signs of LRT disease

Usually self limiting
Anthelmintic treatment
- Widespread resistance - treat with pyrantel or fenbendazole

52
Q

Bacterial pneumonia in foals

A

Haematogenous spread secondary to bacteraemia or in utero infection. Can be aspiration - milk or meconium
Typically gram negative - e.coli
Most common cause of death in 1-6 month foals
Strep equi zooepidemicus, Rhodococcus equi
Stress of weaning, change in environment

53
Q

Rhodococcus equi foals

A

Pneumonia
Gram positive coccibacillus
Ubiquitous
Inhalation

Clinical disease
- Insidious
- LRT infection
- Fever
- Lethargy
- Coughing
- Tachypnoea
- Dyspnoea - nostril flaring and prominent abdominal expiratory effort

Intrapulmonary abscesses
Interstitial or alveolar pattern
Tracheobronchial lymphadenopathy
Pleural effusion

Diagnosis
TTW - cytology and PCR

Oxygen insufflation
NSAIDs
Cool shade
Macrolide and rifampin - azithromycin and clarithromycin

Prevent
Hyperimmune plama
No vaccine yet

54
Q

Equine asthma
mEA - mild
Age
Clinical signs
Progression
History
Diagnostic confirmation

A

Young (any age possible)
Clinical signs
- Decrease performance
- No resting dyspnoea
- Occasional cough
- >3 weeks
Spontaneous improvement, response to treatment, no reccurence
History of stabled

Diagnostics
- Endoscopy - tracheal mucous +1 +3
- Cytology - increased neutrophils
- Pulmonary function - 0

55
Q

Equine asthma
sEA

A

> 7 year old
Big decrease in perfomance
Frequent cough
Resting dyspnoea
Variable duration
Long term treatment/management/recurrence

History - stabled or pasture, familial history, seasonality

Diagnostics
Treacheal mucus - +1+5
Marked increase neutrophils
Marked effect on pulmonary function

56
Q

Equine asthma

A

ARD - airborne respirable dust
Steamed hay
Much more dust from nets
Breathing zone- 30cm from horses nose

Type I and III hypersensitivity

Bronchospasm secondary to inflammation - bronchodilators

Activation of macrophages
Airway neutrophilia

Mucus accumulation
Tissue remodelling

Look for tolerance on rebreathing bag - cough, recovery
Wheezes, crackles, tracheal rattles

Endoscopy - rule out upper airway disease, tracheal mucous - 1h post exercise

BAL - diagnostic of EA

57
Q

Scant epistaxis - differentials

A

Foreign body
Fungal granulomas
Neoplasms

58
Q

Profuse epistaxis differentials

A

Iatrogenic
Ethmoid haematoma
Trauma - variable

59
Q

What will we see with nasal cavity bleeding

A

Rostral to caudal border of nasal septum so usually unilateral
Spontaneous
Highly vascular structures - ethmoid turbinates - so could be profuse

60
Q

Paranasal sinus epistaxis causes

A

Trauma
Neoplasia
Ethmoid haematoma
Coagulation disorders

61
Q

Guttural pouch epistaxis causes

A

Mycosis - fungal plaques penetrate into carotid artery and erode wall
Foreign body
Neoplasia
Purpura haemolytica
DIC - disseminated intravascular coagulation - very serious overactive clotting proteins
Rectus capitis muscle rupture - fall back and hit back of head - stretch muscle - can fracture base of skull

62
Q

Bleeding from pharynx, larynx, oral cavity causes

A

Foreign body
Neoplasia
Purpura
DIC
Clotting defects
Trauma
Iatrogenic

63
Q

Trachea and lungs bleeding - haemoptysis - causes

A

Pulmonary haemorrhage - EPIH - exercise induced pulmonary haemorrhage
Trauma
Neoplasia
Foreign body
Iatrogenic
- Lung biopsy
- NG tube

64
Q

What to do with epistaxis or haemoptysis
History
Evaluation
Treatment

A

Duration, how many times, colour of blood (mucopurulent, frank), uni/bilateral, associated with exercise, URT disease, recent trauma, toxic plants

Physical exam
- MM, haematomas, prolonged bleeding
- Neuro exam
- Evidence of trauma
- Nasal and flat bones
- Exophthalmos or epiphora
- Symmetry of airflow, stridor
Evaluation of head and resp system

Complete blood count
Clotting profile and platelets - citrate tbe
Biochemical profile - liver enzyme and function tests

Radiography, US
TTW, BAL

Assess blood loss
- No change in PCV with whole blood for 4 hours
- Splenic contraction with hypoxia - increase in PCV
- Fluid from extracellular fluid - decline in TP, decline in PCV 4-6 hours

Determine transfusion need on CS, pathology, history
- Tachypnoea, tachycardia
- Thready or non-palpable pulse quality
- Cool extremities
- Pale MM
- mentation changes - anxiety, depressed, compulsive thirst
- Increased blood lactate - serial measurement increase
- Acute PCV drop >10% or <13%

65
Q

URT noise -external nares

A

Epidermal inclusion cysts
Redundant alar folds
Lacerations

Congenital conditions
Wry nose - maxilla deformation - euthanasia

66
Q

What tooth roots lie in maxillary sinuses?

A

4th 5th and 6th cheek teeth lie in maxillary sinus

Infection may cause sinusitis

Nasolacrimal canal and infraorbital canal also lie within maxillary sinus

67
Q

Which cheek tooth forms rostral wall of rostral maxillary sinus

A

3rd cheek tooth

Infection may cause sinusitis

68
Q

DDSP - dorsal displacement of soft palate
Treatment

A

Tie forward - prosthesis replacing thyrohyoid muscle - success rate 80%

69
Q

What is dynamic pharyngeal collapse?

A

Collapse of pharyngeal wall when negative pressure highest - maximum inspiration collapse in
Treatment limited

70
Q

Cleft palate in horses - diagnosis and treatment/prognosis

A

Nasal reflux of milk/food material and aspiration pneumonia
Endoscopy diagnosis
Poor prognosis - recurrent infections and poor athletic function - euthanasia

71
Q

Recurrent laryngeal neuropathy

A

Causes inspiratory stridor with laryngeal muscle paresis - due to recurrent laryngeal nerve paresis
Underlying cause - is it nerve pathology or physical problem - typically idiopathic - left sided hemiplegia

Tie back procedure - physically replicate the dorsal circoaryternodeus - coughing is common side effect as irritation of trachea or aspiration pneumonia as completely open permanently

72
Q

Arytenoid chondropathy

A

Inflammation of arytenoid cartilage
Racehorses - inhaled on kicking up
Diagnosis - endoscopy resting - size, mucosa, drainage and granulation tissue, palpation

Treatment
Medical - antimicrobials broad spectrum, antiinflammatories - systemic and local
Sugery
Local excision
Arytenoidectomy
Permanent tracheostomy (esp if bilateral)

73
Q

Intralaryngeal granulation tissue

A

Can be concurrent with chondritis and affect prognosis
Excision
Complications - loss of normal anatomy/function
ideally local excision only - laser

74
Q

Medial deviation of aryepiglottic folds

A

MDAF - laser to remove excess tissue - high inspiratory negative pressures

75
Q

Subepiglottic cysts or granulomas

A

Congenital or acquired
Treat by removal
- Excision through laryngotomy or snare wire
good prognosis

76
Q

Epiglottic entrapment

A

Clear distinction from DDSP needed
Typically expiratory noise
Resect transendoscopic laser

Equine (18 decks)

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