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Large animal medicine I > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What are some factors that the presentation of equine respiratory disease is dependent on?

A

Location, duration, severity, specific pathology, type and level of athlete

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2
Q

T/F: Equine are obligate nasal breathers

A

True

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3
Q

T/F: The presence of CxS at rest is a sign of a more severe involvement of disease

A

True

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4
Q

What % of sport horses that have poor performance were tied with respiratory disease?

A

70%

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5
Q

What anatomical structures of the respiratory system have small airways?

A

Small bronchi and bronchioles

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6
Q

What is the pulmonary arterial pressure of a horse at rest?

A

25-30 mmHg

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7
Q

What can the pulmonary arterial pressure get to at exercise?

A

125 mmHg

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8
Q

The pulmonary system has _____ pressure, ____ volume; the bronchial system has _____ pressure, ____ volume.

A

low, high; high, low

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9
Q

What is the pressure of air in the lungs at rest? exercise?

A

100 mmHg, 220 mmHg

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10
Q

Why does Pa02 decrease in the face of intense exercise?

A

The increased blood flow from the work results in decreased exchange time

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11
Q

How high can the negative intrathoracic pressure get with exercise?

A

-30 to -45 cm H2O

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12
Q

What % total airway resistance does the upper airway account for during exercise and why?

A

80% from dynamic collapse as the airway pressure becomes more negative

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13
Q

What is the normal respiratory rate at rest?

A

8-12 bpm

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14
Q

If you see abdominal press, and expiratory difficulty, is this a lower or upper airway dysfunction?

A

Lower airway

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15
Q

If you see the head and neck extended and an inspiratory noise, is this a lower or upper airway obstruction?

A

Upper airway obstruction

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16
Q

What are some noises that you would hear from an upper respiratory issue?

A

Stridor, Roar, Snore

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17
Q

How can you test for exudate in the trachea?

A

You can shake the trachea and hear a rattling noise

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18
Q

What are the two abnormal lung sounds heard from auscultation?

A

Crackles and wheezes

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19
Q

What would a dullness in the percussion of the thorax potentially indicate?

A

Fluid accumulation, increased tissue density

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20
Q

What method is the most relevant in diagnosing upper airway diseases and involvement?

A

Endoscopy

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21
Q

What method can be used to analyze both upper and lower airway dysfunction?

A

Radiographs

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22
Q

What are somethings ultrasound can pick up on the thoracic cavity?

A

Masses, trauma, foreign bodies, pleural effusion, fibrosis, fluids, inflammation, pus, lung shape

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23
Q

Where do you inject your tube for a transtracheal wash?

A

The bifurcation of sternothyrohyoideus muscle

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24
Q

What is TTW limited to?

A

Can only see cell types but can be cultured

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25
Q

T/F: TTW is non-sterile while BAL is sterile

A

False

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26
Q

When would BAL be indicated to use?

A

Diffuse pulmonary disease

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27
Q

T/F: Lower airway disease leads to bilateral nasal discharge

A

True

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28
Q

Upper airway disease is almost always dealing with ________ as lower airway disease almost always deals with ________.

A

Inspiration; expiration

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29
Q

What are some examples of non-infectious upper airway disease?

A

Allergic rhinitis, DDSP, LLH

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30
Q

What are some examples of infectious upper airway disease?

A

Infectious sinusitis, strangles, viral respiratory disease

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31
Q

What are some examples of non-infectious lower airway disease?

A

Recurrent airway obstruction, smoke inhalation

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32
Q

What are some examples of infectious lower airway disease?

A

Pleuropneumonia, foal pneumonia

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33
Q

What are the most common causes of epistaxis in horses?

A

Upper: Trauma, guttural pouch mycosis, progressive ethmoid hematoma

Lower: EIPH, pulmonary abscess rupture

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34
Q

T/F: Guttural pouch mycosis is primarily seen in older quarterhorse females

A

False. No age, breed, or gender predilections

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35
Q

T/F: Guttural pouch mycosis formed a delayed chronic epixtaxis

A

False. Spontaneous, though several initial bouts of minor hemorrhage

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36
Q

How does guttural pouch mycosis lead to epixtaxis?

A

The fungal invasion of the pouch leads to the erosion of the artery walls in that chamber

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37
Q

What artery is most common affected by guttural pouch mycosis?

A

Internal carotid artery, thought to be from high oxygen tension

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38
Q

What is the most common CxS with guttural pouch mycosis? Second most common?

A

First - Unilateral Epistaxis

Second - Dysphagia

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39
Q

What will you see with guttural pouch mycosis with endoscopy?

A

Plaque of necrotic tissue. Brown, yellow, white, black color with visualization of blood

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40
Q

What are the ways to treat guttural pouch mycosis?

A

Medical - Topical antifungals

Surgical - Ligation of affected blood vessel, balloon catheter, transarterial coil

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41
Q

What complication may occur with external carotid occlusion?

A

Blindness

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42
Q

What is the chance of fatal hemorrhage occurring with guttural pouch mycosis?

A

50%

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43
Q

What types of horses do you normally see with progressive ethmoid hematoma?

A

Older (>4 years), thoroughbred and Arabians

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44
Q

What % of ethmoid hematoma cases are bilateral?

A

15-20%. Most are unilateral

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45
Q

T/F: Ethmoid hematoma cases usually require emergency attention because the can be fatal

A

False. Mild, spontaneous, intermittent

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46
Q

T/F: Progressive ethmoid hematoma typically has less blood than a guttural pouch mycosis case

A

True

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47
Q

How can you diagnose ethmoid hematoma?

A

Endoscopy to visualize mass directly.

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48
Q

What are skull radiographs used for with ethmoid hematoma?

A

To check the extent of the mass and its involvement

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49
Q

Why would you biopsy an ethmoid hematoma? What ddx would there be?

A

To differentiate from other masses. Nasal polyps, neoplasia, fungal, etc

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50
Q

What is the preferred treatment for ethmoid hematoma?

A

Surgical ablation of the mass - YAG procedure

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51
Q

How would you medically treat ethmoid hematoma?

A

Intralesional formalin to cause necrosis from protein hydrolysis.

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52
Q

What are the chances of recurrence after surgery?

A

40% after a few months or years

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53
Q

T/F: Exercise induced pulmonary hemorrhage is associated more with the breed of the exercise rather than the intensity and duration.

A

False. INTENSITY MATTERS

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54
Q

What are some risk factors for EIPH?

A

High intensity exercise, previous EIPH episodes, older age, amount of mucus and material in tracheobronchial area

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55
Q

What is the most popular theory on the pathogenesis behind EIPH?

A

Capillary rupture theory. Stress on pulmonary capillaries from high cardiac outputs exceeding the tensile strength of the vessels, rupturing them and causing hemorrhage

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56
Q

What is the pressure on the pulmonary capillaries on a horse during intense exercise?

A

Up to 110 mmHg (that’s high)

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57
Q

What pressure can the left atrium get to with intense exercise?

A

70 mmHg (that’s high)

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58
Q

What is the biggest clinical sign you will see for EIPH?

A

Poor performance - quitting

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59
Q

What % of EIPH cases exhibit epistaxis?

A

1-10% (low)

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60
Q

What is the best way to diagnose EIPH?

A

Endoscopy.

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61
Q

Define the grading system of EIPH with epistaxis.

A

Grade 0 - No blood detected anywhere

Grade 1 - Couple flecks of blood, <1/4 of trachea circumference

Grade 2 - One-three streams of blood, 1/3-1/2 trachea circumference

Grade 3 - Multiple streams, 1/3 trachea circumference

Grade 4 - Lots of blood. 90% of trachea surface. Pooling of blood

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62
Q

What kinds of cells will you see in the respiratory secretions in a horse with EIPH?

A

Hemosiderophages

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63
Q

What is the grading system for alveolar macrophage hemosiderin?

A 
0 - No blue coloration
1 - faint blue stain
2 - Dense blue in small portion of cytoplasm
3 - deep blue in most of cytoplasm
4 - Dark blue throughout all cytoplasm
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64
Q

What is the most characteristic feature with thoracic radiographs in a horse with EIPH?

A

Increased interstitial patterns in caudo-dorsal lung fields

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65
Q

T/F: Radiographs on EIPH cases are often disappointing

A

True

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66
Q

How do you treat EIPH and how does it work?

A

Furosemide. Reduces blood volume -> reduction in weight and work and pressure.

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67
Q

What does furosemide do with regards to epistaxis related EIPH?

A

Most report that it does nothing, but maybe reduces severity.

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68
Q

What are the increased chances of a horse winning a race when given furosemide?

A

140%

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69
Q

What physical object can you place on a horse to potentially prevent EIPH?

A

Nasal strips

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70
Q

By how much do nasal strips chance the pulmonary arterial pressure? Furosemide?

A

Nasal strips - 0

Furosemide - 7 mmHg

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71
Q

What are some causes of stridor that are not related to distress?

A

Dorsal displacement of the soft palate, Epiglottic entrapment, Laryngeal hemiplegia

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72
Q

Which type, intermittent or persistent, is most represented in horses with DDSP?

A

Intermittent

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73
Q

When do you see IDDSP?

A

When the horse exercises

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74
Q

What is usually the origin of persistent DDSP?

A

Neurogenic

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75
Q

T/F: IDDSP causes are usually multifactorial and varied

A

True

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76
Q

What are some of the causes of DDSP?

A

Thyroid muscle dysfunction, inflammation, retraction of tongue or larynx, hypoplastic epiglottis, respiratory disease

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77
Q

What are the CxS of DDSP?

A

Quitting at the last half of the race, breathing noises when running

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78
Q

T/F: DDSP can be difficult to notice, especially when the horse is at rest

A

True

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79
Q

How can you diagnose DDSP?

A

Endoscopy

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80
Q

What will you with endoscopy on a horse with DDSP?

A

Ventral placement of the epiglottis relative to the soft palate during exercise

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81
Q

How can you treat DDSP medically?

A

Treat any underlying causes

Tongue tie (retracts tongue to prevent retraction of larynx)

Throat support device (TSD) - holds the larynx in place so it does not displace

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82
Q

How can you treat DDSP surgically?

A

Laryngeal tie-forward
Sternothyrohyoid myectomy (strap muscle resection)
Staphylectomy - resection of part of soft palate

Combinations of these occur too

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83
Q

What CxS does epiglottic entrapment cause?

A

Exercise intolerance, respiratory noise, coughing

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84
Q

What happens with epiglottic entrapment?

A

The epiglottis is enveloped by the aryepiglottic and subepiglottic tissues

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85
Q

What % of EE case are associated with hypoplastic epiglottises?

A

30%

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86
Q

T/F: Epiglottic entrapment often concurrently occurs with DDSP

A

True

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87
Q

T/F: Much like DDSP, epiglottic entrapment is usually intermittent.

A

False. Persistent

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88
Q

What do you see on endoscopy on horses with EE?

A

Loss of scalloped edge of epiglottis

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89
Q

Can you typically diagnose EE with endoscopy at rest?

A

Yes

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90
Q

What is currently the preferred method of treatment for EE?

A

Transendoscopic laser correction

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91
Q

What is happening with the larynx in a horse with laryngeal hemiplegia?

A

The horse cannot fully dilate the larynx on the affected side, producing an obstruction of airflow and a noise

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92
Q

Idiopathic laryngeal hemiplegia is also associated with damage to _______________________.

A

left recurrent laryngeal nerve

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93
Q

What are some causes of LH?

A

Perivascular jugular injections

Guttural pouch inflammation

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94
Q

What is the most common complaint with LH?

A

Exercise intolerance

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95
Q

T/F: LH delivers an abnormal expiratory noise.

A

False. Inspiratory

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96
Q

What are the grades of LH via endoscopy?

A

Grade I & II - full abduction of arytenoid cartilages during exercise and rest

Grade III - 77% have significant dysfunction during exercise

Grade IV - paralysis evident during rest

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97
Q

What is the ‘slap’ test?

A

Slap the saddle area of the horse to cause an adduction flicker on the other side. Both arytenoids should reponse symmetrically

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98
Q

What treatments can be done for LH?

A

Laryngoplasty for grade III and IV, ventriculectomy, laryngeal re-innervation, arytenoidectomy

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99
Q

What are etiologies for stridor associated with respiratory distress?

A

Upper airway obstruction (strangles, LH, lymphosarcoma, GP tympany, hyperkalemic periodic paralysis)

Tracheal collapse

Pulmonary Disease (RAO, viral pneumonia, interstitial pneumonia, diaphragmatic hernia, pneumothorax)

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100
Q

What is the main agent associated with guttural pouch empyema?

A

Steptococcus equi var zooepidemicus

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101
Q

What do you see when you lower the head of a horse with guttural pouch empyema?

A

The nasal discharge worsens

102
Q

What CxS are seen with guttural pouch empyema?

A

Lymphadenitis, parotid swelling, dysphagia, chondroids

103
Q

How can you diagnose guttural pouch empyema?

A

X-rays, endoscopy, percutaneous centesis

104
Q

How do you treat GPE?

A

Flush the pouch - sedate, lower head, tube with catheter, flush with LRS

105
Q

T/F: Parenteral antibiotics are not preferred to treat GPE

A

True. Give oral TMS

106
Q

When is surgery indicated for GPE?

A

If flush doesn’t work and if chondroids are present

107
Q

What agent causes strangles?

A

Streptococcus equi var equi

108
Q

T/F: Strangles is highly contagious

A

True

109
Q

What age of horses are most susceptible to strangles?

A

Young horses

110
Q

What CxS are seen with strangles?

A

Fever, yellow green purulent nasal discharge, cough, swelling of submandibular lymph nodes

111
Q

What is the general crystallization of lymph node drainage called?

A

Bastard strangles

112
Q

What is the first symptom that emerges with strangles?

A

Fever for first 3 days.

113
Q

At what stage of the disease does strangles become the most contagious?

A

When the lymph nodes are ruptured and drained into the environment.

114
Q

What other problems can strep equi cause?

A

Retropharyngeal lymph node edema and compression -> respiratory distress, GP empyema, laryngeal hemiplegia

115
Q

What organisms are associated with guttural pouch empyema?

A

Streptococcus equi var zooepidemicus

Streptococcus equi var equi

116
Q

What are the CxS seen with guttural pouch empyema?

A

Intermittent nasal discharge that is worsened when the head is lowered

Dysphagia

Chondroids

117
Q

How do you diagnose guttural pouch empyema?

A

Endoscopy

118
Q

How to treat guttural pouch empyema?

A

Sedation, repeated flushing, penicillin, TMS oral

119
Q

What are retention catheters used for in regards to guttural pouch empyema?

A

Repeated daily treatments

120
Q

T/F: Purpura hemorrhagica is a form of septic vasculitis that occurs in young horses, typically secondary to strangles.

A

False. Form of ASEPTIC vasculitis in OLDER horses

121
Q

What are the common CxS with purpura hemorrhagica?

A

Demarcated areas of edema (limbs, abdomen, head)

122
Q

T/F: PH has a low mortality.

A

True

123
Q

How do you treat PH?

A

Penicillin, NSAIDS, hydrotherapy, DMSO, steroids (all for inflammation treatment)

124
Q

What are the three most common causes of pneumonia?

A

Secondary bacterial infection (form viral), primary bacterial infection, aspiration pneumonia

125
Q

What is the most common form of pleural effusion seen in the horse

A

Parapneumonic pleural effusion

126
Q

What agent is the most common cause of pneumonia in the horse?

A

Bacteria

127
Q

What are the risk factors associated with pleuropneumonia in the horse?

A

Long distance travel from transport, environmental stress, disease, exercise

128
Q

What will you see on a BAL of a horse that has traveled over 1200 miles?

A

Decreased numbers of macrophages, neutrophils, and lymphocytes

129
Q

What are the CxS seen with pleuropneumonia?

A

Fever, weight loss, pectoral edema

130
Q

What will you hear on thoracic auscultation on a horse with pneumonia?

A

absent lung sounds on the ventral part of the body and louder cardiac auscultation

131
Q

How can you determine the level of fluid in the lungs in a horse?

A

Thoracic percussion

132
Q

What will you see on the CBC of a horse with pleuropneumonia in the early stages? Late stages?

A

Early: normal fibrinogen, looks like acute endotoxemia

Late: elevated fibrinogen, neutrophilia

133
Q

What will you see on ultrasound of a horse with pleuropneumonia?

A

Fluid, fibrin, abscesses

134
Q

What are the factors that contribute to the prognosis for pneumonia?

A

Amount of systemic fibrinogen (>1000 is poor)

Type of organism (E.coli is bad)

About of fibrin in the pleural space

Odor & Gas = anaerobes (bad)

135
Q

How do you treat pneumonia?

A

Systemic antimicrobial therapy - metronidazole

Drain the thorax (large chest tube)

anti-inflammatories (Banamine, DMSO)

136
Q

T/F: Strangles is highly contagious, especially in older horses

A

False, younger horses

137
Q

What is the causative agent responsible for strangles?

A

Strep equi var equi

138
Q

What lymph node is abscessed with strangles?

A

Submandibular lymph node

139
Q

How long is the development phase of strangles?

A

0-7 days

140
Q

When is the maturation and rupture of lymph nodes in strangles?

A

7-14 days (1 week after development)

141
Q

What is are the CxS for strangles?

A

Fever*, nasal discharge, swelling and draining of lymph nodes, brain abscesses can happen too

142
Q

What lymph node can strangles spread to, which can cause a severe complication?

A

Retropharyngeal

143
Q

What is happens with bastard strangles?

A

The infection spreads systemically and forms abscesses to lymph nodes throughout the body - lung, mesentery, liver, spleen, kidney, brain

144
Q

T/F: Strangles is extremely important to treat

A

False. If the animal is not depressed and eats okay, let the disease run its course

145
Q

How can you treat strangles?

A

Hot pack for abscesses, ISOLATION, penicillin*, symptomatic treatment

146
Q

How can you prevent strangles?

A

Quarantine new horses, test new horses, isolate, and vaccine

147
Q

What is the new vaccine that should be used for strangles prevention called?

A

Intranasal - Pinnacle vaccine

148
Q

T/F: Horses older than 6 months do not get disease from R. equi

A

True

149
Q

How does R. equi evade the immune system?

A

they prevent macrophages from fusing their phagosomes and lysosomes

150
Q

What are the CxS seen with R. equi?

A

Fever, dyspnea, depression,

POLYSYNOVITIS - immunemediated

Osteomyelitis and septic physitis

Mesenteric lymph node enlargement

151
Q

What are the 4 patterns of radiography in a horse with R. equi?

A

Abscess pattern
Miliary pattern
Broncho-pneumonia pattern
Interstitial pattern

152
Q

What will you see on CBC with R. Equi?

A

Marked inflammatory response (neutrophils and fibrinogen)

153
Q

What are other methods, besides radiographs and CBC, to diagnose R. equi?

A

ELISA for antibodies, AGID, ultrasound

154
Q

T/F: R. equi is difficult to treat

A

True

155
Q

What meds do you for R. equi?

A

Erythromycin estolate, rifampin, anti-inflammatories, antiulcers, hyper immune serum (prevention)

156
Q

What are some tests to run to monitor the progression of disease and treatment?

A

WBC count, fibrinogen levels, temperature, ultrasound

157
Q

What is the % survival for horses with R. equi?

A

70-80%

158
Q

T/F: Cough is a respiratory defense mechanism

A

True

159
Q

Besides the cough reflex, what other mechanism protects the horse from respiratory infection?

A

Mucociliary escalator - pushes things up and out of the lungs/respiratory tract

160
Q

What nerve is associated with the cough reflex?

A

Vagal nerve (also glossopharyngeal, and trigeminal)

161
Q

What are some things that stimulate a cough?

A

Bronchoconstriction, inhaled particles, inflammatory mediators, hot/cold air, mural pressure, edema

162
Q

What type of epithelium are responsible for mucociliary clearance?

A

Pseudostratified ciliated columnar epithelium

163
Q

How long do the airway epithelium take to heal?

A

7 weeks!

164
Q

What do clara cells do?

A

Produce surfactant to maintain patency of the airway, and metabolize airborne toxins

165
Q

What do you want to rule out first when you see a horse coughing?

A

Cardiovascular disease

166
Q

What are forms of auscultation to test for coughing?

A

Rebreathing (bag), and checking lung sounds

167
Q

What will you hear in a horse with pneumonia? Pleuropneumonia? Pleural effusion?

A

Pneumonia: increased lung sounds, crackles and wheezes

Pleuropneumonia: ventral dull sound

Pleural effusion: loud heart sounds from improved sound conduction

168
Q

What would palpation of the thoracic wall help find during physical examination?

A

Friction rubs of the pleura, and rib fractures

169
Q

What is a DDx for coughing if the horse is also febrile?

A

Infection

170
Q

What are some DDx for coughing without fever?

A

RAO, laryngeal issue, parasites, EIPH, foreign body, cancer, trauma

171
Q

T/F: Equine influenza is an uncommon form of respiratory disease

A

False

172
Q

What age of horses are usually affected by equine influenza?

A

Younger (~3 years old)

173
Q

What happens to the horses respiratory tract when infected by influenza?

A

Their ciliated epithelium is destroyed -> cough

174
Q

Which subtypes of equine herpes leads to coughing?

A

EHV 1 and EHV 4

175
Q

Which form of EHV also has reproductive symptoms? Neurologic?

A

Repro + resp = EHV 4

Neuro + resp = EHV 1

176
Q

How long is the virus incubate for with EHV?

A

3 days

177
Q

What other symptoms will you with with EHV?

A

Conjunctivitis, lymphadenopathy, edema, vasculitis, polysenovitis

178
Q

T/F: EHV2 - 5 are clinically important

A

False. Low pathogenicity

179
Q

What will you see with equine viral arteritis?

A

Respiratory disease, abortions, foal pneumonia

180
Q

Which viral disease has long lasting immunity after infection or vaccine administration?

A

Equine viral arteritis

181
Q

What type of horses get equine adenovirus?

A

SCID foals

182
Q

What CxS are presented with Hendra virus?

A

Fever, facial swelling, head pressing, recumbent

183
Q

T/F: Aerobic bacteria infections are commonly seen in horses undergoing physiologic stress from exercise, transportation, and anesthesia.

A

False. Anaerobic

184
Q

What is the lungworm associated with the horse?

A

Dictyocaulus arnfieldi

185
Q

What roundworm can affect the horse respiratory system?

A

Parascaris equorum

186
Q

What is the most common fungal organism that is secondary to bacterial infection?

A

Aspergillus

187
Q

What % of carboxyhemoglobin is detectable to diagnose disease?

A

> 10%

188
Q

How does anesthesia lead to respiratory distress and infection?

A

Excessive cuff pressure -> tracheal necrosis

Anesthetic drugs -> depression of defense mechanisms

189
Q

What are some symptoms seen with trauma to the thoracic region?

A

Fractured ribs, hemothorax, pneumothorax

190
Q

Where do you perform an abdominal tap in a horse?

A

Caudal to the 6th rib

191
Q

T/F: Thoracic cancer is common in horses

A

False. Low incidence

192
Q

What virus is associated with equine multinodular pulmonary fibrosis?

A

EHV-5

193
Q

What do you see with equine multinodular pulmonary fibrosis?

A

Diffuse bronchointerstitial pattern with multiple coalescing circular nodules in the lung field

194
Q

What do you see on PE and lab tests with EMPF?

A

Poor hair coat, increase RR, abnormal lung sounds, dry cough, increased WBC, fibrinogen, anemia

195
Q

What do you see on U/S with EMPF?

A

Multiple circular hypoechoic masses

196
Q

How might you treat EMPF?

A

Corticosteroids, NSAIDs, antibiotics, antivirals, bronchodilators, O2, immune modulators

197
Q

How can a horse get foal pneumonia when <1 month old?

A

In-utero, meconium, iatrogenic, viruses (EHV, adeno)

198
Q

How does a foal 1-6 months old get foal pneumonia?

A

S. zooepidemicus, R. equi

199
Q

What will you see in the blood work with acute foal pneumonia? Chronic?

A

Acute: Hyperfibrinogenemia and neutropenia

Chronic: neutrophilia, anemia of chronic disease

200
Q

What benefits do radiographs have over other endoscopy when dealing with pneumonia?

A

Evaluates deeper parenchyma, amount of consolidation, and progression

201
Q

How do you determine the appropriate treatment in a case of foal pneumonia?

A

TTW with cytology of sample

202
Q

What will you see on the arterial blood gas with foal pneumonia?

A

Hypoxemia, hypercapnia, respiratory acidosis

203
Q

How do you treat pneumonia?

A

Hydrate for acute infection, antimicrobials (broad spectrum first, then based on culture), NSAIDs, bronchodilators, palatable feed, rest

204
Q

What other method of anti-microbial administration is 12 times higher in concentration and much less toxic than IV admin?

A

Aerosolized anti-microbial therapy

205
Q

What are some complications with foal pneumonia?

A

May not respond to treatment, and might develop into pleuropneumonia

206
Q

How do you diagnose and treat pleuropneumonia?

A

Diagnose - thoracocentesis, C/S, cytology, ultrasound

Treat - rest, antimicrobials, NSAIDs, thoracic lavage

207
Q

When is a thoracotomy indicated?

A

If the patient does not respond to meds

208
Q

What is the prognosis for pleuropneumonia?

A

Fair - strep
Poor - mixed bacterial infection, anaerobes
Guarded - gram (-)

209
Q

What are some differences between Inflammatory airway disease and recurrent airway obstruction?

A

IAD - occasional cough, poor performance, no increase in resp effort

RAO - frequent cough, exercise intolerance, increase respiratory effort

210
Q

What ages are affected by IAD? RAO?

A

IAD - any age

RAO - older >7

211
Q

How long does IAD last in the system? RAO?

A

IAD - spontaneous improvement, minor treatment

RAO - lasts for weeks, strict control and treatment. cannot be cured

212
Q

Which disease, RAO or IAD, is seasonal?

A

RAO

213
Q

What are three similar traits between RAO and IAD?

A

Airway hyper-responsiveness, airway obstruction, airway remodeling

214
Q

What was the old name for RAO/heaves?

A

Chronic obstructive pulmonary disease (COPD)

215
Q

What does the ACVIM consensus call RAO and IAD? (hint: humans often have this)

A

Equine asthma

216
Q

Which case, RAO or IAD, is considered more mild?

A

IAD

217
Q

What types of horses most noticeably have IAD?

A

Athletic race horses

218
Q

What are some causes of IAD?

A

Exact cause unknown

Allergens, particles in the environment, infectious agents

219
Q

What kind of cells will you see on a BAL in case of IAD?

A

Mast cells increased

220
Q

T/F: You see increased levels of IgE with IAD

A

False.

221
Q

How do you diagnose IAD?

A

BAL, pulmonary function test

222
Q

What are the main cells you will in the BAL of an IAD case?

A

Neutophils (>10%)
Mast cells (>5%)
Eosinphils (>5%)

223
Q

What do pulmonary function tests determine?

A

Pressure, volume, and flow of the lungs

224
Q

What instruments are used with a PF test?

A

Oscillometry, plethysmography

225
Q

What molecule is used with Pulmonary Function Test?

A

Histamine for bronchoprovocation

226
Q

How do you treat IAD?

A

Reduce dust in the air, change bedding, change feed, anti-inflammatories

227
Q

What is the main source of inflammation for recurrent airway obstruction?

A

The environment

228
Q

What four characteristics get determine a ddx for RAO?

A
  1. ) excessive mucus production
  2. ) neutrophil accumulation
  3. ) bronchial hyperreactivity
  4. ) reversible bronchoconstriction
229
Q

A case of RAO comes into your clinic. What would you expect to be the history of the horse?

A

Comes from a wet and cool climate, change in environment 1-3 months prior that had poor ventilation, dust exposure, pollen and mold

230
Q

T/F: RAO cases always have nasal discharge

A

False

231
Q

What is the respiratory rate on horses with RAO?

A

> 40 breaths/min

232
Q

What is the main CxS seen with RAO?

A

Heaves* - abnormal breathing effort

233
Q

What PE methods would you want to pursue when suspecting RAO?

A

Thoracic percussion

Auscultation - crackles, wheezes

Rebreathing bag

234
Q

How does the inflammation in RAO lead to the delayed clearance of the mucus in the respiratory system?

A

The epithelial cells are destroyed in the process which are responsible for mucus clearance

235
Q

Name five processes of pathology that occur with RAO

A
  1. ) Inflammation
  2. ) Bronchoconstriction
  3. ) Mucus accumulation
  4. ) Airway thickening
  5. ) Impaired gas exchange
236
Q

Name some inflammatory mediators and explain how they lead to bronchoconstriction.

A

Histamine and serotonin: release of Ach which acts on muscarinic receptors of smooth muscles -> constriction

237
Q

What does a narrow airway from RAO lead to?

A

Deficient gas exchange -> arterial hypoxia -> increased respiratory effort

238
Q

What will you see under the microscope with RAO?

A

Goblet cell hyperplasia, epithelial damage, smooth muscle hypertrophy and hyperplasia, scarring

239
Q

What cells will you see on a BAL of RAO?

A

Neutrophilia (>25%)

no change in mast cells or eosinophils

240
Q

What will endoscopy show you with RAO?

A

Edematous distal airways, inflammation and airway collapse

241
Q

T/F: Imaging is considered a good monitoring aid for RAO

A

True

242
Q

What is the Hay challenge test?

A

A tool for RAO diagnosis where you expose the horse to moldy hay and see their response

243
Q

What is the most important treatment for RAO?

A

Environmental management

244
Q

What are the three main classes of bronchodilators?

A

Anticholinergics, B2-agonists, Phosphodiesterase inhibitors

245
Q

Name an anticholinergic drug, how it works, and some side effects

A

Atropine (2 hrs) - blocks acetylcholine -> less smooth muscle contraction

S/E: ileus

246
Q

Name a B2-agonist and explain how it works. Any side effects?

A

Clenbuterol - increases intracellular cAMP levels

S/E (high doses): anxiety, tachycardia

247
Q

Name a phosphodiesterase inhibitor and its effects. Any side effects?

A

Aminophylline - inhibits breakdown of cAMP

S/E: none!

248
Q

T/F: Prednisone is indicated to treat RAO

A

False. Use Dex and PredniSOLONE

249
Q

T/F: Give the glucocorticoid meds before the bronchodilator when treating RAO

A

False. Give the bronchodilator first, then the steroids

250
Q

What are some good inhaled corticosteroids used to treat RAO?

A

Fluticasone, beclomethasone

Large animal medicine I (6 decks)

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