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CVSOH1 Clinical Cardiorespiratory > Equine Nasal Passages > Flashcards

Equine Nasal Passages Flashcards

1
Q

Clinical presentations of nasal, sinus, guttural pouch disorders.

A

Nasal discharge (commonly unilateral if disorder rostral to caudal edge of nasal septum) - may be haemorrhagic w/ ethmoidal disease and some guttural pouch diseases.
Head swelling/abnormality.
Reduced airflow.
Abnormal respiratory noise (obstructive dyspnoea if nasal/sinus mass).
Dysphagia (difficulty swallowing w/ some guttural pouch diseases).

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2
Q
  1. Types of nasal discharges seen in the horse?
  2. What does a bilateral nasal discharge indicate generally?
A
  1. Serous, mucoid, purulent, haemorrhagic, feed contaminated.
  2. Originating anywhere caudal to nasal septum.
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3
Q
  1. Ethmoid haematoma aetiology.
  2. What is ethmoid haematoma?
  3. What can be seen clinically?
  4. Tx of ethmoid haematoma?
A
  1. Unknown - any age.
  2. Benign polypoid soft tissue mass that grows from ethmoids.
  3. Unilateral epistaxis that is intermittent and low volume - can be fresh trickle or dirty/old blood.
  4. Varied but resection or repeated injection w/ formalin endoscopically most common.
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4
Q
  1. Why do the rostral maxillary sinus and caudal maxillary sinus get larger as the horse ages?
  2. How can dental abnormalities lead to a sinusitis?
A
  1. Because the cheek teeth shorten due to wear.
  2. Upper dental arcade is very closely related to the maxillary sinuses.
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5
Q
  1. In which sinus do the reserve crowns of the maxillary 3rd and 4th teeth triadan 08/09 lie?
  2. In which sinus do the reserve crown of the maxillary 5th and 6th teeth triadan 10/11 lie?
A
  1. Rostral maxillary sinus.
  2. Caudal maxillary sinus.
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6
Q

How is sinusitis categorised?

A

Primary and secondary.

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7
Q
  1. Common feature of sinusitis?
  2. What causes primary sinusitis?
  3. What causes secondary sinusitis?
    4.
A
  1. Accumulation of exudate w/in sinus and ipsilateral nasal discharge.
  2. URT infections.
  3. Dental infections, intrasinus benign and malignant growths, head trauma.
  4. Purulent nasal discharge (can have slight blood).
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8
Q

Clinical signs of sinusitis?

A

Most commonly purulent nasal discharge.
+/- slight blood.
Sometimes facial swelling (more common w/ sinus cysts and neoplasia).
Rarely airway obstruction.
Smell of discharge - dental or fungal.
Ipsilateral submandibular lymphadenopathy.

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9
Q
  1. What does primary sinusitis arise from?
  2. Acute primary sinusitis.
  3. Chronic primary sinusitis.
A
  1. Obstruction of mucociliary clearance and inoculation w/ bacteria.
  2. Follow URT infection.
    Self-limiting or responds to antimicrobials.
  3. Thickening of sinus mucosa leads to obstruction of mucus drainage.
    Inspissation occurs (becomes more solid).
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10
Q

Primary sinusitis Tx?

A

Often resolves spontaneously when the generalised infection resolves.
Short corse antimicrobials and feed from ground to facilitate drainage may be helpful.
- 2 courses ABX of <2wks duration = max length tx for primary sinusitis w/o reassessing why such cases are non-responsive.

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11
Q

How do longer term sinus problems occur?

A

If inflammation remains in one or more sinus compartments.
- shorter term due to restricted drainage caused by mucosal deciliation and/or mucosal thickening of the ostium.
- longer term due to inspissation of pus, making the sinusitis chronic or even permanent.

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12
Q
  1. What is it important to examine if a horse presents w/ a bilateral nasal discharge? - why?
  2. What if the sinusitis does not respond to tx or discharge recurs quiclky?
A
  1. Dental / oral exam.
    - close association of cheek teeth w/ the sinuses.
  2. Need further investigations to identify reasons and potentially further Tx options to lavage and establish drainage.
    - repeat oral exam.
    - radiographs.
    - CT.
    - search for underlying cause.
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13
Q
  1. Age affected by dental secondary sinusitis?
  2. How does dental secondary sinusitis arise?
  3. Smell of discharge and why?
  4. Dx of dental secondary sinusitis?
A
  1. younger horses.
  2. Inoculation of maxillary sinuses w/ bacteria from dental pulpitis affecting caudal maxillary teeth (08s-11s).
  3. Malodourous as the bacteria is often anaerobic.
  4. Oral exam, radiographs or CT scan.
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14
Q

Tx of dental secondary sinusitis?

A

Identification of afflicted tooth.
Extraction (or endodontic disease).
Irrigate (trephination) exudates from contaminated compartments.
Seal oral cavity from alveolus while mucosa granulates.

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15
Q

Tx of chronic sinusitis.

A

Warm isotonic saline best.
May need repeated lavage (BID several days).
Anti-inflammatories as causes irritation.
Inspissated material renders medical Tx and lavage ineffective.
- careful diagnostic imaging to reveal inspissated material.
- mechanical debridement essential followed by lavage +++ (flap options).

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16
Q
  1. What are sinus cysts?
  2. Sinus cysts unilateral or bilateral?
  3. Associated w/?
  4. Dx.
  5. Confirmation?
A
  1. Progressive, non-neoplastic expansile, mucus-producing lesion, lined by normal sinus epithelium which distort surrounding bone.
  2. Unilateral.
  3. Head swelling and nasal occlusion.
  4. Radiography or CT.
  5. By sinoscopy/biopsy.
17
Q
  1. Tx of sinus cysts.
  2. Px of sinus cysts.
A
  1. Surgical exposure via nasofrontal flap or trephine and resection of cysts lining.
    Often performed standing.
    Medical Tx ineffective.
  2. Good for non-recurring after surgery.
18
Q
  1. Aims of sinus surgery.
  2. Is trephine or flap easier for sinus sx.
  3. Haemorrhage control for sinus sx.
A
  1. Removal of physical lesions.
    Removal of solid exudates.
    Restore nasomaxillary drainage.
  2. Trephine.
  3. Packing nasal cavities for 24h.
19
Q
  1. Sinonasal neoplasia age affected.
  2. Common presentation of sinonasal neoplasia.
A
  1. Older horses.
  2. Chronic sinusitis w/ facial swellings.
20
Q

Head trauma in the horse.

A

Often not observed.
Bleeding from conchal venous plexus.
May be associated w/ head fracture:
- palpation and ultrasound better than radiographs, CT can be useful.
Assess neuro status.
Can develop secondary sinusitis from presence of blood in sinuses - may provide ABX to prevent this.

21
Q

What is the most common disease of the guttural pouch?

A

Guttural pouch empyema.

22
Q
  1. What is guttural pouch empyema?
  2. What does culture from horses with guttural pouch empyema yield?
  3. Clinical signs.
A
  1. Where retropharyngeal LN abscesses burst dorsally.
    Can progress to chronic presence of exudates which solidify into chondroids.
    - act as reservoir for infection of other horses w/ strep equi equi.
  2. Streptococcus equi equi or Streptococcus zooepidemicus.
  3. Nasal discharge.
    Pyrexia.
23
Q

Tx of guttural pouch empyema.

A

Lavage and drainage.
- lavage guttural pouch(es) daily for 7-10d via indwelling foley catheter.
Penicillin-gelatin mix stays in the guttural pouch for a longer time and may soften chondroids, easing their removal by flushing.
Chondroids can be removed using transendoscopic basket.

24
Q
  1. Presentation of guttural pouch mycosis.
A
  1. Epistaxis.
    - most common.
    - fatal if untreated.
    - first epistaxis often not fatal.
    - fungal plaque on internal carotid artery (most common), external maxillary or external carotid.
    Dysphagia.
    - inability to swallow.
25
Q
  1. What can be seen on endoscopy in a horse with guttural pouch mycosis?
  2. What if horse w/ guttural pouch mycosis presents w/ epistaxis?
A
  1. Mycotic plaques in the guttural pouch.
  2. Emergency referral to a surgical facility.
26
Q
  1. Principle of vascular occlusion w/ GP mycosis.
  2. Tx of GP mycosis.
A
  1. Occlusion on the cardiac and cerebral side of the lesion.
  2. Topical antifungal agent.
27
Q

GP mycosis Px.

A

Good if:
- no pharyngeal dysphagia.
- no bilateral laryngeal paralysis.
- limited haemorrhage.
Guarded if:
- severe haemorrhage.
- severe neuro dysfunction.

28
Q
  1. Age affected by GP tympany?
  2. Breed predisposition.
  3. What is GP tympany?
  4. Unilateral or bilateral more common?
  5. Presentations of GP tympany?
  6. Tx of GP tympany?
A
  1. Foals.
  2. Arab.
  3. Congenital dysfunction of ostia, allowing air into GP but not out of GP.
  4. Unilateral.
  5. Pharyngeal swelling and dysphagia.
  6. Indwelling foley catheter or laser fenestration to allow air to escape.
29
Q

Uncommon conditions of the nostrils and nasal passages.

A

False nostril cysts.
Alar fold abnormalities.
Mycotic rhinitis.
Nasal amyloidosis.
Nasal septum deviation.
Wry nose.
Nasal tumours.

30
Q

Uncommon conditions of the guttural pouches.

A

Temporohyoid osteopathy.
Rectus capitis ventralis rupture (differential for sig. epistaxis).

CVSOH1 Clinical Cardiorespiratory (33 decks)

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