4.Examination of respiratory tract of horses Flashcards
General impression
- Behaviour
- Posture
- Gait
- Body condition
- Abnormal sounds/noises, breathing
What is dyspnoea?
shortness of breath or breathlessness
Steps of the physical exam (which parts do we examine)
- Nose and paranasal sinuses
- Guttural pouches
- Cough
- Larynx
- Trachea
- Thorax
Physical examination methods:
- Inspection
- Smell
- Palpation
- Auscultation
- Percussion
Normal findings of the physical examination of the nose:
Temperature of the region is equal to the surroundings
Palpation is not painful
Percussion sound is sharp, bone-like
How is the nasal discharge describes?
-Continuous or temporary
-Uni- or bilateral
-Amount and grade of discharge
(mild, moderate, severe)
-Quality, colour and smell of discharge:
(Serous, mucous, purulent, haemorrhagic, frothy, containing food particles)
-Origin:
(Nose, paranasal sinus, pharynx, guttural pouch, trachea, lung, stomach)
Examination of the nose:
How do we examine the expired air and what are the normal findings?
- Intensity of airflow
- Temperature of airflow
- Smell
Normal findings:
- Medium strength and temperature
- Odour is characteristic, not unpleasant
- Airflow is symmetrical bilaterally
Examination of the paranasal sinuses
• Sinuses almost totally communicate • Thin septum separates the rostral and caudal maxillary sinus • Maxillary sinus is affected most frequently • Primary disease • Diseases of the upper cheek teeth
Examination of the paranasal sinuses: physical methods
Inspection
Palpation
Percussion (flexed middle finger)
Examination of the paranasal sinuses: normal findings
- Skin is intact, no alopecia or abnormal shape
- Temperature is equal to the surroundings
- Palpation is not painful
- Percussion sound is sharp, bone-like
Examination of the guttural pouches
Location: Between the base of the skull, atlas and pharynx
- Stylohyoid bone splits it, smaller lateral and larger medial compartment
- Left and right pouches do not communicate
Examination of the guttural pouches: physical methods
Inspection
Palpation
Percussion (finger-to-finger or plessimeter and hammer)
Examination of the guttural pouches: Normal findings
- The skin is intact, no alopecia is seen
- Temperature is equal to the surroundings
- Palpation is not painful
- Percussion sound is resonant
What do we examine/look for when we examine the cough ?
- Mode of emergence
- Spontaneous, induced
- Frequency
- Intensity
- Tone
- Occurance (e.g. at rest, during exercise)
- Duration
- Amount of secretion
- Pain
Induction of cough
- Press the arytenoid cartilages of larynx
* Press the first tracheal rings
normal finding: cough
- No spontaneous cough
- Difficult or impossible to induce cough
- The induced cough is strong, sharp, low, short, dry, non-painful, snapping, does nor recur
Examination of the larynx: physical methods
Inspection
palpation
auscultation
Examination of the larynx: normal findings
- Skin is intact, no alopecia, shape is normal
- Temperature is equal to the surroundings
- No alterations on palpation
- Very mild stridor on auscultation
Examination of the trachea:
physical methods
• Inspection, palpation, auscultation
Examination of the trachea: normal findings
- Skin is intact, no alopecia, shape is normal
- Temperature is equal to the surroundings
- No alterations on palpation
- Laryngeal noise is audible in a weaker form on auscultation
Examination of the thorax: physical methods
• Inspection, palpation, auscultation, percussion
Examination of the thorax: inspection
- Shape, size, symmetry of hemithoraces
- Breathing
- Respiratory rate, rhythm, type, depth
- Dyspnoea
- Inspiratory, expiratory and mixed types
Examination of the thorax: auscultation
• Respiratory noises of the horse are weak
Examination of the thorax: systemic approach
- Start cranially behind scapule
- Move 2-4 intercostal spaces (ICS) caudally
- Start dorsally in each ICS, move ventrally by 5-10 cm
- Check at least one inspiration and expiration at each spot
- Auscultate longer if you detect abnormal sounds
- Examine both hemithoraces
Examination of the thorax: auscultation, basic respiratory noises
- Basic respiratory noises: weak and soft
- Weaker than normal (decreased airflow, superficial breathing)
- Missing (pleural effusion, consolidated lung)
- Increased in intensity, louder, harsher (dyspnoe, increased airflow)
Examination of the thorax: auscultation, adventitious respiratory sounds
- Musical (wheezes): whistling
* Non-musical (crackles): clicking, rattling, crackling noises
Examination of the thorax: percussion sounds
- Noise created by instruments
- Sound of the chest wall
- Resonant sound of the air-filled lung
Features of the percussion sound
- Intensity: strong/sharp or weak
- Frequency: high or low
- Tone: sonorous/resonant or dull
- Duration: short or long
Examination of the thorax: percussion, normal finding
Normal finding: strong/sharp, low, resonant, short
Examination of the thorax: percussion, normal lung border
Normal lung border • Deltoid tuberosity: 7th ICS • Point of shoulder: 10th ICS • Ischiadic tuber: 14th ICS • Tuber coxae: 16th ICS
Ancillary diagnostic methods:
• Endoscopy -Resting endoscopy -Dynamic endoscopy --Treadmill --Telemetric (overground) • Ultrasonography • Radiography • CT • Thoracocentesis • Thoracoscopy • Lung function tests • Nasal and pharyngeal swabs • Tracheal wash • Bronchoalveolar lavage • Arterial blood gas analysis
