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RUSVM LAM1 > Epistaxis > Flashcards

Epistaxis Flashcards

1
Q

What are etiologies of epistaxis?

A

Upper resp

  • Trauma
  • Guttural pouch myosis
  • Progressive ethmoid hematoma

Lower resp

  • EIPH
  • Pulmonary abscess rupture
  • Coagulopathies
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2
Q

In what horses do you more commonly see guttural pouch mycosis?

A

Stabled horses during warmer months of the year

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3
Q

Clinical signs associated with guttural pouch mycosis?

A

Small amounts of frank blood from nares in a horse at rest

Can be preceded by mucopurulent unilateral discharge
Serosanguinous discharge can be present for days following frank hemorrhage

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4
Q

What is the pathogenesis of guttural pouch mycosis?

A

Fungal invasion of tissue —> erosion of wall of arterial structures (internal carotid artery)

Results in aneurysm and eventually rupture
Partial thrombosis present but no occlusion of vessel

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5
Q

The predisposition for guttural pouch mycosis to infiltrate the internal carotid artery is thought to be related to what factor?

A

High oxygen tension in these areas

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6
Q

Clinical signs associated with guttural pouch myosis?

A

Epistaxis - usually several bouts of mild unilateral epistaxis preceding fatal hemorrhage

Usually unilateral

Dysphagia (slow or sudden onset) — associated with pharyngeal branch of vagus and glossopharyngeal nerve

Head shyness, abnormal position, nasal discharge, abnormal respiration, horners syndrome

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7
Q

How can you diagnose guttural pouch mycosis?

A

Endoscopy

  • plaque/ diphtheria membrane in guttural pouch
  • necrotic tissue and debris
  • brown, yellow, white, or black
  • granuloma like lesion
  • blood in lesions or pouch
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8
Q

What are the medical treatments for guttural pouch mycosis? When is this treatment indicated?

A

Antifungals - miconazole, amphotericin B, mystatin, or ketoconazole

Topical infusion through indwelling catheter for 4-6weeks

Indicated if there is no bleeding

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9
Q

What are the surgical techniques used for guttural pouch mycosis?

A

Occlusion of affected vessels.

  • ligation
  • balloon catheter occlusion
  • transarterial coil
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10
Q

What are complications to occlusion of the affected vessel as treatment for guttural pouch mycosis?

A

External carotid - blindness

—> incidence of blindness if higher if both internal and external carotid are occluded

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11
Q

What is the prognosis for guttural pouch mycosis?

A

Incidence of fatal hemorrhage is 50%

If horse develops ..
laryngeal hemiplegia … usually permanent
Dysphagia … 6-8months recovery
Horner’s and facial nerve paralysis … 6-8months recovery

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12
Q

What is the most important criteria in guttural pouch mycosis that will determine therapy?

A

If the horse has manifested bleeding at any point —> you will want to occlude blood supply so they dont have fatal hemorrhage

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13
Q

Do you give topical antifungals if you have done surgical obliteration of the vessels to treat GP?

A

No

If you do the obliteration, the lesion will resolve on its own because of lack of O2

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14
Q

What is an ethmoid hematoma?

A

Progressive (slowly expanding) and locally destructive angiomatous masses of unknown cause in the ethmoid and paranasal sinus, NOT neoplasia

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15
Q

Signalment associated with ethmoid hematoma?

A

Older than 4yrs, >8yrs most often

Thoroughbred, warmblood Arabians

Males> females

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16
Q

What is the pathophysiology of an ethmoid hematoma?

A

Angiomatous mass composed of respiratory epithelium and fibrous tissue —> expansion —> ulceration of capsule —> epistaxis

Acts as space occupying mass in the nasal passage

17
Q

Clinical signs of an ethmoid hematoma?

A

Mild, spontaneous, intermittent, unilateral epistaxis

Blood tinged mucoid- mucopurulent discharge (depending on infection and degree of necrosis)

Inspiratory and expiratory sounds can be present if space occupying mass
Malodorous

Present for months to years

18
Q

T/F fulminant and fatal hemorrhage is common in ethmoid hematoma

A

False

Can occur but very rare

19
Q

Diagnosis of an ethmoid hematoma can be done by??

A

Endoscopy - direct visualization

Skull rads- extent of hematoma involvement

CT
Biopsy and histopathology

20
Q

DDX for a mass like lesions in the nasal/ distal nasal passages?

A 
Ulcerative/mycotic rhinitis 
Nasal polyps 
Neoplasia 
Fungal granuloma 
Botryomycosis 
Trauma to nasal passages
21
Q

What is the preferred treatment for ethmoid hematomas?

A

Surgical ablation

  • laser
  • standard blade resection (high intraop hemorrhage)
22
Q

What is the medical therapy for ethmoid hematomas?

A

Intralesional formalin —> necrosis

23
Q

What is the recurrence rate for ethmoid hematomas?

A

30-50%

24
Q

T/F: if EH is large enough, you can have a differential nasal airflow

A

True

25
Q

How common is EIPH in racehorses.?

A

Up to 75% or more racehorses affected

26
Q

Incidence of EIPH horses is (intensity/duration) of exercise related

A

Intensity

  • high speed races >14 sec

Prevalence increases with age

27
Q

What are risk factors for EIPH?

A

High intensity exercise
Previous episode of EIPH
Age >5yrs

28
Q

What are the three theories for pathogenesis of EIPH?

A

Capillary stress theory

Lower airway inflammation theory

Concussive lung injury theory

29
Q

What is the capillary stress theory?

A

Disruption of pulmonary capillaries due to high cardiac output

-> stress failure of vessel wall because of high pulmonary capillary pressure AND due to negative pressure pulling outward on the vessel walls ——> additive forces

30
Q

What is lower airway inflammation theory?

A

Some implication to previous respiratory disease and recurrent fibrosis causing “weak” area prone to disruption

31
Q

What is the concussive lung injury theory?

A

Impact or hoof on ground force is transmitted as a wave to scapula —> chest wall —> lung

Force at caudodorsal area then causes shearing of lung

(One study shown this to not be true)

32
Q

T/F: incidence of epistaxis associated with EIPH is low

A

True

33
Q

Clincial signs with a grade 3/4 EIPH?

A

Exercise intolerance

34
Q

Clinical signs in low grade EIPH horses?

A

None to acute collapse

35
Q

You can see evidence of EIPH _______ days following strenuous exercise

A

7

36
Q

What is the typical location for EIPH on radiographs

A

Caudodorsal lung lobes

always think EIPH is you have a clinically normal horse with radiographic changes in the caudodorsal lung fields.. all other conditions that causes lesions in this area will cause clinical signs*

37
Q

How do you diagnose EIPH?

A

Endoscopy - observation of blood in tracheobronchial tree

Transtracheal wash or bronchoalveolar lavage —> hemosiderophages

Radiographs —> interstitial pattern in caudodorsal lung field

38
Q

Treatment of EIPH? Why is this treatment controversial?

A

Furosemide
-given preface

Causes profound diuresis and reduction of weight —> faster racing times

But has been shown to help horses with higher grade EIPH because of the reduced blood volume —> decreased pulmonary arterial pressures and less rupture

RUSVM LAM1 (17 decks)

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