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EQUINE > 8.2.2: Introduction to nasal discharge > Flashcards

8.2.2: Introduction to nasal discharge Flashcards

1
Q

How do you localise where nasal discharge is coming from?

A
  • Unilateral discharge = usually rostral to the nasal septum/ larynx (nasal passages and sinuses)
  • Bilateral discharge = usually caudal to the nasal septum/ larynx (guttural pouch, pharynx, larynx, trachea, bronchi, and lungs - occasionally these can present as unilateral)
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2
Q

History to take into account with nasal discharge

A
  • Age (consider if infectious disease likely)
  • Use of horse, ownership
  • Onset (sudden = likely infectious disease compared to insidious), duration, progression
  • Contact with other horses / other horses affected (infectious?)
  • Management (pasture of stabled, type of feed, bedding - consider asthma)
  • Seasonality (consider asthma)
  • Effect of exercise
  • Previous/ concurrent disease
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3
Q

Upper airway diagnostic techniques

A
  • Oral/ dental exam
  • Head radiography
  • Endoscopy (resting and exercising, sinoscopy)
  • CT
  • Haematology and biochemistry
  • Infectious disease tests (culture, PCR, ELISA)
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4
Q

Lower airway diagnostic techniques

A
  • Endoscopy
  • Tracheal wash (culture and cytology)
  • Bronchioalveolar lavage (culture and cytology)
  • Ultrasonography
  • Radiography
  • Haematology and biochemistry
  • Specific tests for infectious disease e.g. serology, ELISA
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5
Q

Clinical signs of respiratory disease and where these localise to

A
  • Unilateral vs bilateral discharge (rostral vs caudal to larynx)
  • Type of discharge (consider type of disease)
  • Swelling, pain, LN enlargment -> URT
  • Respiratory noise -> URT
  • Cough (pharynx/ larynx or LRT)
  • Exercise intolerance
  • Appetite, demeanour
  • RR and effort (LRT)

Also check for other clinical signs:
* Abortion and neuro disease (herpes)
* Peripheral oedema (Equine viral arteritis)
* Cranial nerve neuropathies (guttural pouch disease)

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6
Q

Clinical signs of upper airway disease

A

Unilateral or bilateral discharge
Localising signs to the head/ pharyngeal region
* Submandibular or retropharyngeal LN enlargment
* Guttural pouch swelling
* Draining tracts
* Dental abnormalities
* Respiratory noise
* ± cough
* ± systemic signs (strangles, neoplasia)

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7
Q

Clinical signs of lower airway disease

A
  • Cough
  • Increased RR
  • Increased resp effort
  • Increased resp noise on auscultation
  • Stance and demeanour (pneumonia)
  • Exercise intolerance
  • ± systemic signs (herpes, EVA, pleuropneumonia, neoplasia)
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8
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12
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13
Q

URT differential list: nasal passages

A
  • Cleft palate
  • Cysts
  • Polyps
  • Ethmoid haematoma
  • Trauma
  • Foreign body
  • Fungal rhinitis
  • Neoplasia
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14
Q

URT differential list: sinuses

A
  • Primary and secondary (inc dental) bacterial sinusitis
  • Cysts
  • Neoplasia
  • Ethmoid haematoma
  • Trauma
  • Fungal sinusitis
  • Foreign body
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15
Q

URT differential list: guttural pouch

A
  • Empyema
  • Mycosis
  • Tympany
  • Trauma
  • Neoplasia
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16
Q

URT differential list: pharynx/ larynx

A
  • Pharyngitis
  • URT bacterial or viral disease
  • Arytenoid chondritis
  • Foreign body
17
Q

LRT differential list: lung disease

A
  • Inflammatory conditions: asthma
  • Infectious conditions: pneumonia, pleuropneumonia, equine influenza, equine herpes virus, equine viral arteritis, Dictyolcaulus arnfieldi
  • Neoplasia
  • Exercise-induced pulmonary haemorrhage (EIPH)
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22
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23
Q
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Frontal sinus draiage

24
Q
A

Guttural pouch tympany

25
Q

Diagnostics used for URT

A
  • Radiography
  • (CT for dental disease, head lesions)
  • Endoscopy
  • Haematology and biochemisty
  • Infectious disease tests
26
Q

Pros and cons of radiography for imaging of URT

A

✅ Good for dental, sinus, and guttural pouch conditions (bony lesions and fluid lines)
❌ Not so good for soft tissues, lower airway disease

27
Q

Pros and cons of endoscopy for imaging in respiratory disease

A

✅ Good for most URT and LRT lesions, visualising inside spaces, soft tissue, mucosal lesions
❌ Not so good for bony lesions, severe epistaxis (red out)

28
Q

When are haematology and biochemistry useful in respiratory disease investigations?

A

✅ Useful for identifying infectious processes/ systemic involvement
* Do not use indiscriminantly in all cases; consider whether it would change you decisions and treatment
* Haematology, fibrinogen, serum amyloid A most useful

29
Q

What infectious diseases might you test for in investigation of respiratory disease and how will you do this?

A
  • Strangles - options include nasal swab, guttural pouch lavage, can also do serology
  • Equine influenza - nasal swab, serology
  • Equine herpes viurs - nasal swab, serology
  • Equine viral arteritis - serology, tissue samples
30
Q

What diagnostics could you use for detecting disease of the LRT?

A
  • Tracheal wash
  • BAL
  • Ultrasonography
  • Thoracic radiography
  • Can also aspirate of pleural fluid
  • (CT for head lesions)
31
Q

Pros and cons of ultrasonography for investigation of LRT disease

A

✅ Good for pleural disease, diseases affecting periphery/ surface of lung
❌ Not so good for diseases deeper within lung tissue, due to acoustic shadowing for air

32
Q

Pros and cons of thoracic radiography of LRT disease

A

✅ Good for large masses, fluid line, foals/ small equids
❌ Not so good for most diseases and larger horses

33
Q

Pros and cons of CT for LRT disease

A

✅ Great for difficult head lesions/ dental disease
❌ Expensive, only available in some referral hospitals

34
Q

When could you use aspiration of pleural fluid to investigate LRT disease?

A
  • Use in cases where there are pleural fluid lines
  • Use in cases with neoplasia e.g. melanoma
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EQUINE (59 decks)

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