Epistaxis Flashcards
Name 3 UPPER respiratory epistaxis disorders:
- Trauma - most common one
- Guttural Pouch Mycosis
- Progressive Ethmoid Hematoma
Name a LOWER respiratory tract epistaxis disorder:
EIPH [exercise induced pulmonary hemorrhage]
Guttural Pouch Mycosis signalment:
- age
- sex
- breed
Stabled horses in warm months
Spontaneous epistaxis in mature horse @ rest
No age/sex/breed specifications
GPM pathogenesis:
- fungal invasion [aspergillosis usually]
- erosion of internal carotid artery [b/c high O2 tension area]
GMP CS:
- epistaxis [uni/bilateral but usually uni]
- dysphasia
50% of the horses die!!
Which nerves is the dysphasia CS associated with?
- Pharyngeal branch of vagus [X]
2. Glossopharyngeal [IX]
T/F: bleeding and neuro signs occur simultaneously all the time
False!
They rarely ever occur together
How do we diagnose GPM?
CS
History
Endoscopy - plaque visualization
How do we treat GPM?
Medical vs surgical tx
**whenever we see bleeding/history of bleeding = SURGICAL
What is the medical tx for GPM?
Topical antifungal administration 4-6 weeks
What is the surgical tx for GPM?
Do we need topical meds with this too?
BEST tx = transarterial coil [obliterates blow through vessel]
No need for any topical meds
Balloon-cath occlusion is 2nd best
What is one major GPM treatment complication?
Blindness [from external carotid occlusion]
How long does bleeding last in GPM?
Weeks-months but not much longer because they usually die :(
What is EH [ethmoid hematoma]?
Locally destructive angiomatous masses of UNKNOWN cause in ethmoids
T/F: EH resembles tumor but it’s NON-neoplastic
True
EH signalment:
8+ yo
Male
Thoroughbred/Warmblood
T/F: EH can be both uni and bilateral
True!
Mostly uni though
EH pathophysiology
Explains in capsule and bleeds when ruptures but then closes up again and bleeding stops
Mild, spontaneous, intermittent epistaxis!
T/F: EH can be a large space occupying lesion which can result in noise @ breathing and airflow differences @ diff sides
True
can see facial deformity in EH — you will never see this with GPM/EIPH
T/F: EH presents with more hemorrhage than GPM. It can also be fatal.
False, GPM is more! Fatalities are also very rare!
T/F: In EH, there are some severe cases which can have both inspiratory and expiratory noise.
True — if expands into significant space occupying lesion
How do we diagnose EH?
Skull rads
CT
Endoscopy
check to see if there is cribriform plate involvement
How do we treat EH?
Surgical laser ablation is PREFERRED
But we can also do medical intralesional formalin
both are appropriate but it depends on size of mass and $$$
If you have a large space occupying lesion with EH, which tx method is preferred?
Surgical laser ablation
What is a major contraindication with medically treating EH?
If cribriform plate is NOT intact we CANNOT treat medically
[don’t want formalin getting to brain!!]
How long can EH bleeding last?
4+ months!! [longer than GPM]
EIPH [exercise induced pulmonary hemorrhage] signalment:
Racehorses and pulling draft horses
More prevalent in older animals [keep tearing lungs over time]
T/F: EIPH can be unilateral or bilateral.
False!
This is bilateral as it is a LOWER respiratory issue
What is the #1 theory for EIPH?
Capillary Rupture Theory
What is the Capillary Rupture Theory?
@ intense exercise the horse generates high CO and high pulmonary capillary pressures. The vessel walls rupture when wall stress goes beyond vessel strength
What are some other EIPH theories?
- Lower airway inflammation theory = continuous inflammation leads t more and more wall weakness
- Concussive lung injury theory = impact of hoof on ground gets transmitted to chest wall and shears lung tissue
EIPH CS:
most cases have NO CS!!!
CS mostly seen in higher grade EIPH: bleeding and exercise intolerance
How do we diagnose EIPH?
Endoscopy! Direct visualization of blood in tracheobronchoal tree
Can do rads but not done too often
How long after race should you scope them?
Evaluate within first few hours after exercise [usually visible 90min after and fro about 4-6h]
What is the pathognomonic EIPH lung pattern that we see @ rads?
Caudal-dorsal lung field
[this is the last place we usually see dz in horses]
How do we treat EIPH?
Furosemide [lasix] is #1 tx!
- performance enhancer in low grade bleeders
- helps high grade bleeders
We can also use nasal strips - reduces negative pressure @ inhalation
Is EIPH fatal?
Nope
What is the most common cause of epistaxis?
Trauma [NG tube intubation]
