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Veterinary Nursing > Equine Respiratory Disease > Flashcards

Equine Respiratory Disease Flashcards

1
Q

What history do we need about a horse?

A

Age - congenital defects/URT infections (young)/asthma (middle-aged)
Environment - new horses/local endemics/vaccination history/dust exposure
Prior medical problems
Present medical problems - when started, what signs, at rest or only at exercise?

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2
Q

What should we check in a physical exam of a horse?

A 
Demeanour
Stance
Nasal discharge
Submandibular lymph nodes
Respiratory rate/effort
Heave line?
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3
Q

How can we auscultate a horse using rebreathing?

A

If sounds normal at rest and not showing increased respiratory effort
Bag over nose, then keep stethoscope on after bag removed
Slow to recover, crackles, wheezes?

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4
Q

How do we carry out endoscopy on a horse?

A

Pass up ventral meatus of nose
Examine URT down to tracheal bifurcation
Guttural pouches
Resting/exercising endoscopy

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5
Q

What is sinoscopy?

A

Endoscope sinuses via a trephine or a flap.

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6
Q

What radiography should we carry out in these horses?

A

Variety of views of the head
Lateral-lateral thorax
Need about 5 plates to fit in all the chest

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7
Q

What can we CT scan in standing sedated horses?

A 
Nasal turbinates
Paranasal sinuses
Teeth
Nasopharynx
Guttural pouches
Skull
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8
Q

What swabs can we do in these horses?

A

Nasal
Nasopharyngeal
(Bacterial culture, viral, PCR)

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9
Q

What tubes do we use for samples from washes?

A

EDTA tube - cytology

Plain tube - culture

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10
Q

Describe a tracheal wash.

A

At the level of the trachea
Respiratory secretions/cells that accumulate in trachea are a collection from entire LRT
General sample but cells can have degenerated so may not be accurate
Most frequently used in practice

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11
Q

Describe bronchoalveolar lavage.

A

At the level of the lungs
Samples a specific peripheral lung segment only
More invasive (requires sedation)
More accurate
But only samples specific area so could miss disease

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12
Q

How do we carry out a bronchoalveolar lavage in a horse?

A

Sedate
Either use long scope or BAL tube
Horse will cough!
Once in the lung and stuck, need to keep pressure (scope) or inflate cuff (tube)
Instil 300-500ml saline
Then draw back up 50-80%
Froth is surfactant - shows you have a good sample

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13
Q

What can we use ultrasound for in these horses?

A

Peripheral lung disorders.

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14
Q

Describe Dorsal Displacement of the Soft Palate (DDSP).

A

Most commonly occurs in racehorses during strenuous exercise
Can be seen in sport/pleasure horses
Associated with poor performance and abnormal expiratory noise (gurgle) - reduced air supply
Cause not clearly understood

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15
Q

How do we diagnose DDSP?

A

With exercising endoscopy.

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16
Q

How do we treat DDSP?

A

Rest

Surgery - soft palate cautery / laryngeal tie-forward

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17
Q

Describe arytenoid cartilage collapse.

A

Recurrent laryngeal nerve innervates CAD muscle, which opens the larynx (abducts arytenoid cartilages)
Left nerve really long so end dies off
Affects left side of larynx in large horses

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18
Q

What are the clinical signs of arytenoid cartilage collapse?

A 
Inspiratory noise (whistling/roaring)
Exercise intolerance
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19
Q

How do we diagnose arytenoid cartilage collapse?

A

Resting endoscopy - gives some information

Exercising endoscopy - best

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20
Q

How do we treat arytenoid cartilage collapse?

A

Ventricolochordectomy (‘Hobday’) removes the noise

If exercise intolerant, then prosthetic laryngoplasty (tie-back) to hold open cartilages (risk of aspiration pneumonia)

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21
Q

Describe sinusitis.

A

Accumulation of exudate within sinus cavities
Primary = sequela of viral or bacterial URT
Secondary = usually to dental disease
Main clinical sign = nasal discharge

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22
Q

How do we diagnose sinusitis?

A

Endoscopy (check for other causes)
X-ray
CT
Sinoscopy - can treat / lavage at same time
Need to treat underlying cause if secondary

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23
Q

Describe guttural pouch mycosis.

A

Fungal infection of guttural pouch

Can be life-threatening

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24
Q

What are the clinical signs of guttural pouch mycosis?

A

Epistaxis (nosebleed) - 50% die with repeated bleeds

Some have cranial nerve dysfunction

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25
Q

How do we diagnose guttural pouch mycosis?

A

Guttural pouch endoscopy.

26
Q

How do we treat guttural pouch mycosis?

A

Surgical occlusion of the vessels
May need topical anti-fungal
Might not recover from cranial nerve deficits

27
Q

Describe strangles.

A 
URT bacterial infection
Streptococcus equi equi
Very common
Highly contagious pus
Often seen as outbreaks
28
Q

What are the clinical signs of strangles?

A

Dull
Fever
Purulent nasal discharge
Enlarged, abscessing submandibular/retropharyngeal lymph nodes

29
Q

What complications can be seen with strangles infection?

A

Difficulty breathing
Abscesses seen around the body
Immune-mediated complications

30
Q

How do we manage/treat strangles?

A 
Isolation
PCR/culture from abscesses
Endoscope and guttural pouch lavage for culture
Penicillin in some
Drain abscessed lymph nodes
31
Q

Describe influenza.

A

Inhalational, spreads in common airspaces
Virus replicates in URT and LRT
Prevent with vaccination
Strict rules for competition horses and import/export

32
Q

What are the clinical signs of influenza?

A 
Coughing
Pyrexia
Serous nasal discharge
Submandibular lymphadenopathy
Inappetence
Depression
33
Q

How do we diagnose influenza?

A

Virus detection (ELISA/PCR on nasal/nasopharyngeal swab)
Virus isolation
Serology (need rising titre)

34
Q

How do we treat influenza?

A

Rest

NSAIDs

35
Q

Describe pleuropneumonia.

A

‘Shipping fever’
History of long-distance travel
Usually Streptococcus zooepidemicus
Can be very sick

36
Q

What are the clinical signs of pleuropneumonia?

A 
Fever
Dull
Nasal discharge
Difficulty breathing
Weight loss
37
Q

How do we diagnose pleuropneumonia?

A

Chest X-ray
Chest ultrasound
Tracheal wash sample
Pleural fluid sample - culture/cytology

38
Q

How do we treat pleuropneumonia?

A

Aggressive treatment
Penicillin
Chest drains

39
Q

Describe asthma.

A

Allergic airway disease
Usually to dust in stables/straw/hay
Increased mucus, bronchoconstriction

40
Q

What are the clinical signs of asthma?

A

Coughing and wheezing
Increased respiratory effort
Heave line

41
Q

How do we diagnose asthma?

A

Endoscopy, tracheal wash, bronchoalveolar lavage

Airway neutrophils BUT no bacteria on culture

42
Q

How do we manage asthma?

A

Environmental management

Inhaled/nebulised steroid and bronchodilator

43
Q

Which surgical procedures of the equine URT are elective?

A 
Ventriculocordectomy ('Hobday')
Aryepiglottic fold resection
Prosthetic laryngoplasty ('tie back')
Laryngeal advancement ('tie forward')
Soft palate cautery (SPC)
Epiglottic entrapment release
Arytenoid chondritis excision
Sinus surgery
Tracheotomy
44
Q

Which surgical procedures of the equine URT are emergency?

A

Emergency tracheostomy
Occlusion of artery for guttural pouch mycosis cases
Trauma
Thoracic drain placement

45
Q

What pre-op considerations should we have regarding the patient?

A

Elite athlete - may pose behavioural considerations (standing vs GA)
What surgery do they need?
What pathology exists?
Clinical exam - whole horse but particular attention to resp. system
Starve for 2 hours pre-op

46
Q

What pre-op considerations should we have regarding planning?

A

Surgical procedure - what kit required?
Position - standing or left/right/dorsal recumbency?
Contingency plan
Recovery plan
Post-op plan - specific considerations, feeding, stabling

47
Q

Describe standing sedation.

A

Sedated but conscious, often in stocks
IV catheter for sedation (a2 agonists, opioids, +/- ACP)
Regional local anaesthetics
Requires multiple pieces of equipment/monitors - set up before horse arrives

48
Q

What are the advantages of standing sedation?

A

Reduces GA risks
May reduce costs
Anatomical advantages - access/position, reduced haemorrhage
Less facilities/experts needed (e.g. theatre/anaesthetist)

49
Q

What are the disadvantages of standing sedation?

A

Not all horses have suitable temperament
Less control of entire situation if complications arise
Need control of environment (noise/movement)
Duration limited, so speed critical - careful planning/organisation
May need to change to GA if complications

50
Q

What are the advantages of general anaesthesia?

A 
More control of horse - safer in fractious patients
Generally good access/visualisation
Less time pressure (but takes longer)
Less noise/movement sensitive
Oxygen available
51
Q

What are the disadvantages of general anaesthesia?

A

Cost, expertise, time, facilities
Risk of GA mortality - 1% in healthy horses
Airway supervision required at all times
Duration

52
Q

What do we need for laser surgery?

A 
PPE - goggles and signage
Usually locking device - key
Spare fibre, ceramic scissors, fibre stripper
NO nitrous oxide - fire hazard
Suction (hoover) as toxic gases
53
Q

What intra-operative considerations should we have?

A

Patent airway essential (oro-/naso-/larygno-tracheal tube, tracheostomy tube)
Protect airway from aspiration (cuffed tube, suction/absorption/drainage) - from haemorrhage/pus/lavage etc.
Obstructions - may exist pre-op, care not to puncture airway

54
Q

What post-op surgical complications can occur?

A

Swellings may compromise airway - emergency tracheostomy kit
Inhalation pneumonia - monitor breathing/temperature post-op

55
Q

How do we feed horses post-op?

A

Moist (soaked hay/haylage) for all procedures
High up for ‘tie forward’ - avoids pressure on sutures
Low for ‘Hobday’ and other procedures - allows drainage from airway

56
Q

What pain management can we provide post-op?

A

Analgesia - NSAIDs/topical throat spray

57
Q

How do manage a laryngostomy (hobday) post-op?

A

After surgical entry, larynx left open to drain as is contaminated surgery
Laryngostomy tube placed at end of surgery for recovery and left in situ overnight
Always occlude before removal

58
Q

How do we place/care for chest drains in horses?

A

Placed surgically
Position = ventral thorax if fluid, dorsal if gas, unilateral/bilateral
Monitor fluid/gas level - marker pen/clip marks

59
Q

Describe a thoracoscopy.

A

Standing sedation
Setup as laparoscopy
Suction + oxygen essential
To investigate and/or treat plural/pulmonic disease (exudate, neoplasia, pneumo/haemothorax)

60
Q

What are the differences between a tracheotomy and a tracheostomy?

A 
Tracheotomy = emergency, temporary, speed is of vital importance, kit outside stable if potential need, plastic tube usual
Tracheostomy = long standing (duration of treatment), stoma or metal tube
61
Q

Why would we carry out an emergency tracheotomy?

A 
Direct airway obstruction - laryngeal obstruction/paralysis/spasm/oedema, tracheal collapse
External obstruction (space-occupying lesion) - abscess (retropharyngeal LN in strangles) / oedema following trauma e.g. snake bite to head

Veterinary Nursing (65 decks)

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