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Y3 MOD Cardiology > Diagnostic approach to lower respiratory tract disease in horses > Flashcards

Diagnostic approach to lower respiratory tract disease in horses Flashcards

1
Q

What are the main presenting signs indicating LRT disease?

A
  • Cough
  • Bilateral nasal discharge
  • Tachypnoea
  • Dyspnoea
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2
Q

What causes stimulation of irritant receptors in LRT disease?

A
  • Foreign material
  • Turbulent air
  • Mucus
  • Chemical irritant
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3
Q

How does stimulation of irritant receptors visibly affect breathing?

A

High velocity expiration

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4
Q

How does airway inflammation lead to bilateral nasal discharge?

A

Increased mucus production and altered mucus composition

Caudal head problems cause bilateral discharge

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5
Q

Why do tachypnoea and dyspnoea present as signs of LRT disease?

A

Hypoventilation, ventilation-perfusion mismatch and impaired gas diffusion at the alveolus lead to hypercapnia, acidaemia and hypoxaemia

  • > leads to the aortic, carotid and medullary chemoreceptors to activate the respiratory centre in the medulla
  • > increased respiratory rate and effort
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6
Q

What needs to be thought about when considering respiratory issues in horses?

A
  • Horses are supreme athletes
  • They have a huge respiratory capacity so often don’t show abnormalities until a large proportion of the capacity has been affected
  • Signs of respiratory disease aren’t always apparent at rest
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7
Q

What questions must be asked when collecting the history of a horse with a LRT issue?

A
  • Disease time course and features
  • Herd or individual problem
  • Age and use of horse
  • Management and environment
  • Coexisting problems
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8
Q

What can be observed from a distance when diagnostically approaching a horse with suspected LRT disease?

A
  • Posture (extended head and neck severe respiratory distress)
  • Abdominal effort (a horse at rest hardly needs to use its abdomen compared to a dyspnoeic horse)
  • Respiratory Rate
  • Respiratory Depth
  • Pattern – biphasic?
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9
Q

Hypertrophy of which muscle can be used diagnostically in LRT disease?

A

External abdominal oblique

  • indicates chronic respiratory disease
  • ‘Heave line’
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10
Q

Abnormalities on inspiration are indicative of…?

A

Upper respiratory tract collapse

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11
Q

Abnormalities on expiration are indicative of?

A

Lower respiratory tract collapse

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12
Q

Where is the auscultation window on a horse to examine for LRT disease?

A
  • Start at the base of the trachea
  • Move to thorax
  • Noise at the bifurcation of the trachea is the loudest
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13
Q

What are some examples of adventitious breath sounds?

A

Abnormal

  • Crackles
  • Wheezes
  • Pleural rubs
  • Cough
  • Expiratory grunts/groans
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14
Q

Describe a wheeze

A

= Airway narrowing and vibration

  • High velocity air through a narrower space creates a wheeze
  • Polyphonic wheezes = more than one sound
  • Monophonic wheeze = single note coming from a single place
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15
Q

Give examples of factors that could cause a wheeze?

A
  • Thickened wall – oedema / inflammation
  • Intraluminal obstructions – e.g. mucus/foreign body
  • Bronchospasm
  • Extra luminal compression
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16
Q

Describe coarse crackles

A
  • Bubbling mucus
  • Inspiration or expiration
  • Radiate widely
17
Q

Describe fine crackles

A
  • Popping open of collapsed small airways
  • Most common: early inspiration
  • Indicator of narrow, lower airways
18
Q

Describe pleural friction rubs

A
  • Inflamed parietal and visceral pleural membranes rubbing together
  • Variable – fine crackles to sandpaper rubbing together
  • Usually insp. and exp. at same point in respiratory cycle
19
Q

What is the purpose of using a rebreathing bag during auscultation?

A

Rebreathes its own CO2 to make it breathe harder
– creates a temporary acidaemia
- Allows adventitious lung sounds to be heard

20
Q

What does thoracic percussion allow identification of?

A

Air vs fluid

21
Q

What laboratory tests can be carried out as further diagnostic tests for LRT disease?

A
  • Blood sample
  • Inflammatory profile
  • Lactate (tissue hypoxia)
  • Blood gas profile (hypoxaemia, hypercapnia)
  • PCR
  • Virus isolation
  • Bacterial culture
22
Q

What are some other diagnostic approaches to LRT disease?

A
  • Nasopharyngeal swab
  • Endoscopy and transendoscopic tracheal aspirate
  • Percutaneous tracheal aspirate
  • Bronchoalveolar lavage
  • Thoracocentesis
  • Imaging
  • Lung biopsy
  • LRT samples
23
Q

What are the advantages and disadvantages of transendoscopic tracheal aspirate?

A 
Advantages: 
- Easy
- Non-invasive
- Sample representative of whole lung
Disadvantages:
- Sample contaminated  by nasopharyngeal  flora and equipment
- Specialist equipment  required
24
Q

What is a Transtracheal aspirate?

A

Puncture through the skin to obtain a sample

25
Q

What are the advantages and disadvantages of a Transtracheal aspirate?

A

Advantages
- no pharyngeal contamination
- no specialised equipment
- useful in young foals when endoscopes too large
Disadvantages
- Horse may cough catheter into pharynx and contaminate sample
- Invasive

26
Q

What can a sample from a transtracheal aspirate be analysed for?

A
  • Differential cell counts
  • Mucus
  • Gram stain
  • Bacterial culture and sensitivity
27
Q

What would be abnormal findings on analysis of a sample from a transtracheal aspirate?

A

More then 20% neutrophils

Any mast cells or eosinophils

28
Q

A bronchiolar lavage is suitable for … and unsuitable for…?

A

Suitable for cytology and unsuitable for bacteriology

29
Q

When collecting a sample via bronchiolar lavage, what must be present in the sample to show its been done correctly?

A

Must get Foam (surfactant) on your sample to show you’ve gone into the terminal airways

30
Q

What are the advantages and disadvantages of bronchiolar lavage?

A

Advantages
- sample obtained from DISTAL airways = most commonly affected
- Best correlation with pulmonary function and histopathology
- equipment cheap and accessible
Disadvantages:
- Site may not be appropriate in animals with localised pulmonary abscesses or pneumonias
- Pharyngeal contamination
- Invasive

31
Q

How does the lung surface appear on ultrasound?

A

Bright white line

32
Q

When is thoracentesis indicated?

A

Indicated whenever there is a pleural effusion

Y3 MOD Cardiology (7 decks)

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