E2: Epistaxis and Nasal Discharge Flashcards
If you have unilateral nasal discharge, where is the discharge coming from?
Rostral to the caudal end of nasal septum or guttural pouch
What is the term for malodorous nasal discharge?
Ozena
What agents do you expect to see in a guttural pouch empyema? What is the difference between them?
- Streptococcus equi var equi* - always pathogenic (causes Strangles)
- Streptococcus equi var zooepidemicus* - opportunist
Guttural pouch empyema ususally presents as recurrent _____ (unilateral/bilateral) nasal disachrge which _____ and _____ with antimicrobial and antiinflammatory use.
Unilateral
Waxes and wanes
Involvement of what nerve causes dysfunction of the soft palate?
Pharyngeal branch of vagus nerve
What do you call concretions of inspissated pus?
Chondroids
T/F: Guttural pouch empyema is usually not contagious and patient’s with suspected of having this infectious process can be housed with other adult horse patients.
False, treat every case as if it is Strep equi
What antimicrobials are typically used parenterally for chondriods? Orally?
IV/IM: Penicillin (35cc BID q3+ days)
PO: TMS
What can you use to flush the guttural pouch in a horse suffering from empyema?
LRS or Saline
+/- Antibiotics
Acetylcystine (to dissolve disulfide bonds/chondroids)
A ________ catheter can ve used for daily treatment of guttural pouch empyema.
Retention/ self-retention
At what age are horses most susceptible to Strangles?
Younger weanlings - yearlings
T/F: Strangles has a low morbidity but a high mortality.
False, high morbidity (100%), low mortality (2%)
Fill in the blanks- Pathogenesis of Strangles
Organism infects macrophages from upper respiratory tract
Day 0-7:
Replicates in ________, horse shows fever without other CS for a few days
____________ lymph nodes start swelling
Day 7-14:
Bacteria matures and multiplies resulting in ________ and __________ of affected LN
________ can be transported to other lymph nodes when not kept limitted to upper respiratory tract
Fill in the blanks- Pathogenesis of Strangles
Organism infects macrophages from upper respiratory tract
Day 0-7:
Replicates in PHARYNX , horse shows fever without other CS for a few days
SUBMANDIBULAR lymph nodes start swelling
Day 7-14:
Bacteria matures and multiplies resulting in RUPTURE and DRAINAGE of affected lymph nodes
MACROPHAGES can be transported to other lymph nodes when not kept limitted to upper respiratory tract
T/F: Post-Strangles infection, a horse can harbour the organism for up to a year, making it a carrier for the disease.
True
What treatment is used in all complicated cases of Strangles?
Penicillin
What can you use to help maturation of Strangles abscesses?
Hot pack
Involement of which lymph nodes in a horse with a S. equi infection can result in edema and compression of the nasopharynx, resulting in respiratory distress?
What else (2 conditions) can develop?
Retropharyngeal
Guttural pouch empyema and laryngeal hemiplagia
What complication of Strangles can cause aseptic vasculitis in mature horses?
Purpura hemorrhagica
What is the systemic manifestation of Strangles called? Which body cavity is typically involved and how?
Bastard Strangles
Abdomen- diffuse peritonitis, adhesions, lesions
T/F: Strangles should always be treated, usually with a combination of antimicrobials and NSAIDs.
False, if uncomplicated then just let it run its course
What 4 patterns may you see when taking rads of the lungs of a horse with R.equi?
Abscessation
Miliary
Broncho-pneumonia
Interstitial
What are some non-lung related clinical signs or complications that may arise in a horse with R. equi?
Mesentaric LN involvement
Diarrhea
Abdominal abscesses
Osteomyelitits (vertebrae and long bones)
Septic physitis (vertebrae and long bones)
Immune-mediated polysynovitis
What is the treatment protocol for R equi?
Clarythromycn or Azithromycin
+
Rifampin
Surrportive: O2, IVF, antiinflammatories, gastroprotectants
What do you use to treat foals in facilities where R.equi is endemic? When do you treat them?
Hyperimmune serum
Within 1st week of life
A 10-yr old Standardbred stallion is noted to have intermittent spontaneous unilateral epistaxis of 3 months duration. You perform endoscopy and note an ethmoid hematoma. Which of the features of this case is least compatible with the disease?
a. Age of the horse
b. Breed of the horse
c. Sex of the horse
d. Spontaneous nature of the epistaxis
e. Duration of the epistaxis
B
Disease has not been reported in standardbreds
You are presented a horse whose epistaxis was just noted for the first time this morning. Endoscopy reveals a fungal plaque on the maxillary artery. What would be the best recommendation for treatment?
Transarterial coil or nititans intravascular plug placement into the maxillary artery
A 6 month old QH filly was presented with a history of unilateral epistaxis. The owners had notes intermittent episodes of blood dripping from the horses right nostril for 2 days, but no major episodes of bleeding had been observed. Upon endoscopy, you note blood coming from the left cartilagenous flap covering a nasopharyngeal opening. What of the following is the most likely diagnosis?
a. Coagulopathy
b. Trauma
c. Ethmoid hematoma
d. Guttural pouch myocsis
e. EIPH
D
What would the best treatment for a young horse with intermittent unilateral epistaxis due to guttural pouch mycosis be?
a. Emergency surgical ligation of vessel
b. Systemic antifungal administration
c. Transarterial coil placement
d. Balloon-tip catheter placement
e. Local topical antifungal therapy
f. Transarterial coil and local antifungal therapy
c. Transarterial coil
* No local antifungals because it will settle at the bottom 1/3 of the pouch and not be very effective.*
Which signalment is more typical for EH and which for GPM:
Older Male
Younger Horse
Older male- EH
Younger- GPM
Which disorder, EH or GPM, if significant enough can cause a difference in the differential air passage in the nostril, with the affected nasal passage having less airflow?
EH
EH or GPM?
Facial deformity can be seen in ___ cases especially if advanced and long standing.
Dysphagia is commonly seen with ____.
EH
GPM
Why does EIPH present distinctly differently from EH adn GPM?
It is exercise induced, while the others occur spontaneously
Is EIPH more prevalent in older or younger horses?
Older
What 2 factors contribute the most to the manifestation of EIPH?
Speed (>14m/sec)
Force (like pulling draft horses)
What is the basis of the Capillary Stress Theory pathophysiology of EIPH?
High PAP + High intrathoracic (negative) pressure) = EIPH
Wall stress in the alveolus exceeds the mechanical strength of the capillary
(Btw, this is the #1 theory for cause of EIPH)
Overall, approximately how many horses with EIPH will manifest epistaxis?
a. 1-10%
b. 10-20%
c. 20-50%
d. 50-100%
a. 1-10%
At what grade of EIPH will horses develope exercise intolerance?
Severe
Grade 3 and Grade 4
How can a racehorse be classified as EIPH positive? What does this mean the racing commission will allow?
Tracheal endoscopy 30-90 min post-race
Horse can race on treatment
If you radiograph a horse with EIPH, which lung field will appear opacified?
Caudodorsal lung lobe
What will you find if you perforam a TTW or BAL on a horse with EIPH?
Hemosiderophages
How can EIPH treated?
Furosemide
+/- FLAIR Nasal strips (decreases but does not prevent)
