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LAM 1 > Epistaxis > Flashcards

Epistaxis Flashcards

1
Q

The external location of epistaxis, unilateral vs bilateral, can be determined by what 2 factors?

A
  • Actual location of lesion (rostral or not to nasal septum)
  • Volume
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2
Q

What are 2 possible causes of bilateral bleeding?

A
  • Nasogastric intubation

- Ethmoid hematoma

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3
Q

What is a possible cause of unilateral bleeding?

A

Guttural pouch mycosis

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4
Q

What are 7 variable characteristics that can be used to describe epistaxis?

A
  • External location (uni/bilateral)
  • Appearance of bloody discharge
  • Time (acute/chronic)
  • Frequency (constant/intermittent)
  • Odor (non-odorous/malodorous = ozena)
  • Volume (mild/profuse)
  • Associated systemic signs
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5
Q

What are the 3 main differentials for epistaxis?

What are 4 other possible causes?

A
  • Ethmoid hematoma, guttural pouch mycosis, EIPH (exercise induced pulmonary hemorrhage)
  • Sinus hemorrhage, coagulopathies, trauma (FBs), fungal granulomas
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6
Q

What are 5 important features of ethmoid hematoma?

A
  • Older males
  • Often ozena
  • Can have purulent discharge associated
  • Airway obstruction can be seen
  • Facial deformity can be seen
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7
Q

What are 2 diagnostic procedures that can be used for ethmoid hematomas?

A
  • Radiography

- CT/MRI

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8
Q

What are 2 general forms of treatment for ethmoid hematomas?

A
  • Medical

- Surgical

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9
Q

What is an example of a form of medical treatment for ethmoid hematomas?

A

Intralesional formalin

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10
Q

What are 2 forms of surgical treatment for ethmoid hematomas?

A
  • Laser ablation

- Standard surgical ablation

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11
Q

What are 4 important features of guttural pouch mycosis?

A
  • Generally younger horses
  • Some report, especially if in stall/barn
  • Recurrent episodes of mild, frank epistaxis until unpredictable major bleeding episode
  • Although recurrent, do not usually have small episodes for several months
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12
Q

What is the second most common clinical sign of GPM?

A

Dorsal displacement of the soft palate

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13
Q

What is the primary clinical sign for guttural pouch mycosis?

A

Epistaxis

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14
Q

What type of therapy is indicated for guttural pouch mycosis?

A

Surgical therapy

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15
Q

What are 4 types of surgical therapy that can be used for guttural pouch mycosis?

A
  • Ligation
  • Balloon catheterization
  • Detachable self-sealing latex balloons
  • Transarterial coil embolisation
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16
Q

Guttural pouch mycosis can be treated medically if what clinical sign is absent?

A

Epistaxis

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17
Q

What are 2 examples of topical antifungal therapies for guttural pouch mycosis?

A
  • Indwelling flush system

- Endoscope guided flush

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18
Q

What is the prognosis for guttural pouch mycosis with epistaxis?
What percentage of these patients will succumb to a fatal bleeding episode?

A
  • Guarded

- 50%

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19
Q

What type of nasal discharge is seen with ethmoid hematomas?

With guttural pouch mycosis?

A
  • Intermittent purulent

- Mucoid type between episodes of epistaxis

20
Q

What is a common age signalment for ethmoid hematomas?

Guttural pouch mycosis?

A
  • Older male

- Younger

21
Q

Less airflow in the affected nasal passage can be seen with which condition?

A

Ethmoid hematomas

22
Q

What is a clinical sign that can be seen with advanced and long standing ethmoid hematomas?

A

Facial deformity

23
Q

What is the second most common clinical sign seen with guttural pouch mycosis?

A

Dysphagia

24
Q

Up to what percentage of race horses exhibit exercise induced pulmonary hemorrhage?

A

75%

25
Q

Exercise induced pulmonary hemorrhage is typically seen at speeds greater than what?
Not seen in sports less than what?

A
  • Speeds greater than 14 m/sec

- Sports less than 7 m/sec

26
Q

What is the number one theory behind exercise induced pulmonary hemorrhage?
What is another theory?

A
  • Capillary stress theory

- Trauma following locomotory impact

27
Q

In horses with high intensity exercise, what levels of pulmonary arterial pressure can be seen?

A

80-90 mmHg

28
Q

Why might rupture occur in horses even though their alveolar walls and pulmonary capillaries are stronger than other species?

A

Wall stress in the alveolus exceeds the mechanical strength of the capillary.

29
Q

Concussion of hoof landing on ground (lead hoof) causes wave of force repercussed through thorax and lung traveling caudally such that force is basically all take by caudodorsal lung field leading to shear stress resulting in rupture is the basis to what theory for EIPH?

A

Trauma following locomotory impact.

30
Q

Due to the shape of the lungs, waves from trauma can become amplified and most intense in what part of the lung?

A

Rear and upper part (caudodorsal)

31
Q

Epistaxis is seen in what percentage range of EIPH affected horses?

A

1-10%

32
Q

When is there a higher likelihood of epistaxis with EIPH?

A

With high grade bleeders (grade 4)

33
Q

It is expected that horses with what grade of EIPH will have significant exercise intolerance?

A

Severe grade EIPH (3 and 4)

34
Q

Clinical signs of EIPH can range from what to what?

A

None to acute collapse

35
Q

Is there much impact on exercise performance seen with low grade EIPH bleeders?

A

No impact

36
Q

Is acute collapse and fatality common with EIPH?

A

No

37
Q

When is endoscopy performed for EIPH post-race?
Some within?
Up to how long?

A
  • 30-90 minutes post-race
  • Within 2-4 hours
  • Up to 7 days
38
Q

A grade of 0 for EIPH involves what amount of blood?

A

No visible blood

39
Q

A grade of 3 for EIPH involves what amount of blood?

A

Greater than 5 mm wide

40
Q

Where should radiographs be examined for EIPH?

A

Caudodorsal lung lobe

41
Q

What are 4 ways to diagnose EIPH?

A
  • Endoscopy
  • Radiography
  • TTW/BAL
42
Q

What can be seen on TTW/BAL with EIPH?
For how long post-race can these be seen?
What percentage of horses in training display this?

A
  • Hemosiderophages
  • Up to 150 days post-race
  • Greater than 90% of horses in training
43
Q

What can be used to treat EIPH?

A

Furosemide

44
Q

What is something that has been used to decrease but not prevent EIPH?

A

Equine nasal strips

45
Q

Do aminocaproic acid or premarin effectively reduce EIPH?

A

No

LAM 1 (8 decks)

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