Equine Med- Respiratory 1

kelseyfmeyer's version from 2016-10-03 18:58

Case 1

Question Answer
When you stick an endoscope down a horse throat, how is the soft palate positioned compared to the epiglottis?soft palate under it- hence obligate nasal breathers
what does a normal guttural pouch look like? What is the bone in it?Stylohyoid bone
how many sinuses does a horse have?7 pairs
If you have a snotty nosed horse-- how might your rule out list change depending on if they are <2 mo, versus older foal/weanling, versus adult?<2mo: Pneumonia (sepsis, aspiration – cleft palate), Congenital malformations of nasal passages/sinuses. OLDER FOAL: Rhodococcus equi (remember SCIDs are normal till moms Abs wear out), Viruses as maternal antibodies decline. Adult: basically anything
where is the anatomical line between upper and lower resp tractbefore the trachea and after
where do you put the endoscope in a horse?NOSE. NOT THEIR MOUTH. LOL.
what instrument do you use to do oral exam on hose?speculum
you look in a neonates mouth and see this. whats your dx? cleft palate
what are the 3 tests for resp fluid assessment in equine pts?(1) Trantracheal Wash (TTW) (2) Bronchoalveolar Lavage (BAL) (3) Thoracocentesis
you test pulmonary function testing with what test?Treadmill exam
If you need to resp ascult a horse better, what kinda exam do you do?rebreathing exam
where does the gutteral pouch live relative to the outside of the horse?big portion in viborgs triangle.
you should ascult the trachea and _________ itpalpate it-- see if there is an inducible cough
**#1 test for lower airway problems?REBREATHING EXAM
if mucus is clear/cloudy to serous/mucoid, what are the most likely causes?Allergies or virus
if mucus is white/yellow what is the most likely cause?bacteria (or milk)
green stuff coming out of should suspect?choke! prolly food.
stinky bacterial snot could be coming from what possible 3 places?sinuses, gutteral pouches, lungs.
if you suspect sinus infections, what dx test is useful, and how?RADIOGRAPHS! Can look for fluid line in sinuses.
What are the sinuses in the horse (how do they look when viewed from the front)?7 pairs: The Dorsal, Ventral, and middle conchal, the rostral and caudal maxillary, the frontal, the sphenopalatine
what are the two sinuses we care the most about, why?Frontal and maxillary- these are the ones we percuss. They have a complex communication system which can very slightly.
where do sinuses drain?All drain through small nasomaxillary opening
which teeth occupy which sinus?Last 3 cheek teeth occupy the maxillary sinus
explain diff between primary and secondary sinusitisPRIMARY: Nasomaxillary opening blocked so fluid and bacteria build up. Usually a streptococcus species. SECONDARY: due to a Tooth root infection. remember that 3 molar roots extend into maxillary sinus. RARELY could be due to tumors, sinus cysts, hematoma, trauma, foreign body
what are the clinical signs of sinusitis?Unilateral and bilateral nasal discharge, foul smelling, +/- epiphora, might see systemic effects. If chronic you might see facial bone deformities
what are the areas you can trephine?You can trephine the caudal and rostral maxillary sinuses
usual asshole that likes to grow in sinusesStrep species

Case 2

Question Answer
LNs you can palpsubmandibular, if theyre sick you can feel the retropharyngeal
what is the causative agent of strangles? (Gram status? shape?)Streptococcus equi, G+ cocci
how contageous is strangles?like woah
why is it that if the horse isn't systemically sick from the strangles, that you don't wanna give abx?desnt allow horse to develop immune defense (allowing them to be sick is like giving them a really good vx-- IgM titer important)
So you culture some strep equi and your attending clinician is like "how do you know this isn't the horses normal flora tho?" and you smile and reply"bruh Strep equi is never normal flora, if we find it, its a problem"
how does strangles infect other horses? Inhaled or ingested --> Colonizes the local lymphoid tissues within hours
clinical signs of strangles?Lethargic, inappetant, fever, Lymphadenopathy, +/- nasal discharge (depends on if it ruptures into the gutteral pouch)....there can be other severe respiratory complications such as: Respiratory distress, CN deficits (Dysphagia, Facial paralysis ), systemic infection ("bastard strangles"), Purpura hemorrhagica
Which side of the CNs is affected in this horse The horse's right side-- that ear is drooping, and if the nose is deviated to the LEFT, that means that the left side is still working to pull the nose up so its the right side that is bunk
how do dx strangles (2)(1) Collect purulent material and CULTURE/PCR it. Collect from the GP, abscess, nasal wash/swab. (2) Serology available: Antibodies to SeM protein.
why is serology useful for strangles, and what exactly is the Ab they are looking for?Ab against the SeM protein. Serology is Used in determining need for vaccination, recent infection & bastard strangles
how does treatment of strangles vary?(1) if not "Sick": NO abx, just do Symptomatic care (NSAIDs, pain meds), Soft feed, hot pack the abscesses. FLUSH the gp, antibiotic gp infusions. (2) SICK horse: ABX NECESSARY. (penicillin is drug of choice)
drug of choice (abx) for strangles?Penicillin (strep equi is a G+ cocci)
does strep equi like to live in environment?It can persist in enviro :(
assume all gutteral pouch empyema is _________ until proven otherwiseStrep equi (strangles)
So you should totes isolate strangles horses. When do they start shedding? when can you release them from isolation?shed bacteria for 2-3 days after fever (nice of them to give the fever warning before starting to shed!) and then continues for 2-3 weeks. Must have 3 negative cultures before release from isolation
So you find this strangles horse on a horse farm and isolate it-- what do you do with all the other horses?you need to MONITOR THEIR TEMPS (remember fever spike 2-3d before shedding), and isolate if they get a fever. Can also perform culture or PCR to check for carriers (Nasopharyngeal swab or nasal wash). All new horses get quarentined!
what is the prog of strangles?75% horses recover & develop strong immunity that can last >5 years. (10% become carriers which is a biosecurity nightmare)
is there a strangles vx?yes
what is a chondroid, how do you avoid thisbasically calcified puss rocks in the gutteral pouch, gotta flush those GPs out
you should NEVER give strangles vaccine to... (what type of vx is it?)(Extract and Attenuated live intranasal vx) NEVER GIVE TO: infected animal, exposed animal, titer of >1600 on elisa (check titer before vx!)
so you are going to give a horse a bunch of vaccines, and you were a good vet and made sure the horse wasnt infected/ didnt have a titer for strangles and the owner wanted a strangles vx. Which order do you give your Vxs in and why?you want to give your IMs first, and THEN the strangles because it is intranasal, and if you give the intranasal first they sneeze and spray it everywhere and then you inject IM and push that strangles crap into the mm

Case 3

Question Answer
3 most common reasons for epistaxis in a horse?(1) Ethmoid hematoma (2) GP mycosis (3) EIPH (Exercise Induced Pulmonary Hemorrhage)
what is an ethmoid hematoma, and why do they happen?Mass that originates on the ethmoids. Unknown cause- they are very vascular!
are ethmoid hematomas malignant?dont metastazise, but Can invade surrounding structures and mess them up a lot.
how do you dx ethmoid hematoma?endoscopy- see green-brown-black hematoma
tx of ethmoid hematomas? surgical removal, laser, formalin injection
why can GP myosis be fatal?fungi erode the blood vessels in the GP (internal carotids)
along with the BVs, what other things in the GP can be damaged by GP mycosis, leading to CSs like...some of the CNs run through there, can lead to dysphagia
how do you dx GP mycosis? What should you be careful about?ENDOSCOPY-- CAREFULLY!! If they move and you bump that plaque it can hge and be game over
medical vs sx tx of GP mycosis?Medical – anti-fungal infusions. Surgical – carotid artery ligation or coil embolization
what is the pathogenesis of Exercise Induced Pulmonary Hemorrhage (EIPH)? When does this hge happen?only happens with strenuous exercise. there is inc vascular pressure-->ruptured capillaries.
which breeds are prone to Exercise Induced Pulmonary Hemorrhage (EIPH)?VERY common in Thoroughbreds, can also see in standardbreds
how do you dx Exercise Induced Pulmonary Hemorrhage (EIPH) if they have just stopped bleeding?ENDOSCOPY right after a bleed-- trachea and bronchi. Grading system for amt of blood in trachea
If it has been 4 or more hours since the bleed due to EIPH, what can you use to dx?BAL (or TTW) most useful. You can find cytological evidence of bleeds, and hemosiderin laden macrophages.
if you take rads of a EIPH horse, what might you see?Densities in caudodorsal fields
explain TTW vs BALTTW is where you are coming in to the point you want to sample and you have sterile prep, and you collect a sample in a sterile fashion. BAL is when you sedate them and pass a tube through the nose and lodge it at the bifurcation, instill fluid and then retrieve it. can also be done through the endoscope (this is NOT sterile but TTW is)
when would you choose to do a TTW versus a BAL?You will want to do TTW for CULTURE, because it is sterile prep so the thing you get is probably what is causing the prob. BAL for CYTOLOGY because you are able to get more cells in your sample. So TTW for sterile stuff/culture, BAL you get more cells and it is less traumatic
EIPH--> tx after it has happened for the first time?REST (let the vessels heal)-- will prolly happen again tho
what drug can you give preemptively before a race to help avoid EIPH-- and how does this work? (what are some other meds you can also consider?)Give FUROSEMIDE! about 4 hours before a race. It decreases pulmonary pressures (and since the bleeding is caused by inc pulm pressures- this is hunky dory). Can also consider NSAIDs, Aminocaproic acid, Brochodilators, and flair nasal strips
prog of EIPH?Progressive dz- Not related to other lung diseases. There will be Fibrosis and vascular remodeling. If grade 4= shortened career