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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
How do we diagnose guttural pouch mycosis?
Guttural pouch endoscopy.
26
How do we treat guttural pouch mycosis?
Surgical occlusion of the vessels May need topical anti-fungal Might not recover from cranial nerve deficits
27
Describe strangles.
``` URT bacterial infection Streptococcus equi equi Very common Highly contagious pus Often seen as outbreaks ```
28
What are the clinical signs of strangles?
Dull Fever Purulent nasal discharge Enlarged, abscessing submandibular/retropharyngeal lymph nodes
29
What complications can be seen with strangles infection?
Difficulty breathing Abscesses seen around the body Immune-mediated complications
30
How do we manage/treat strangles?
``` Isolation PCR/culture from abscesses Endoscope and guttural pouch lavage for culture Penicillin in some Drain abscessed lymph nodes ```
31
Describe influenza.
Inhalational, spreads in common airspaces Virus replicates in URT and LRT Prevent with vaccination Strict rules for competition horses and import/export
32
What are the clinical signs of influenza?
``` Coughing Pyrexia Serous nasal discharge Submandibular lymphadenopathy Inappetence Depression ```
33
How do we diagnose influenza?
Virus detection (ELISA/PCR on nasal/nasopharyngeal swab) Virus isolation Serology (need rising titre)
34
How do we treat influenza?
Rest | NSAIDs
35
Describe pleuropneumonia.
'Shipping fever' History of long-distance travel Usually Streptococcus zooepidemicus Can be very sick
36
What are the clinical signs of pleuropneumonia?
``` Fever Dull Nasal discharge Difficulty breathing Weight loss ```
37
How do we diagnose pleuropneumonia?
Chest X-ray Chest ultrasound Tracheal wash sample Pleural fluid sample - culture/cytology
38
How do we treat pleuropneumonia?
Aggressive treatment Penicillin Chest drains
39
Describe asthma.
Allergic airway disease Usually to dust in stables/straw/hay Increased mucus, bronchoconstriction
40
What are the clinical signs of asthma?
Coughing and wheezing Increased respiratory effort Heave line
41
How do we diagnose asthma?
Endoscopy, tracheal wash, bronchoalveolar lavage | Airway neutrophils BUT no bacteria on culture
42
How do we manage asthma?
Environmental management | Inhaled/nebulised steroid and bronchodilator
43
Which surgical procedures of the equine URT are elective?
``` 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
Which surgical procedures of the equine URT are emergency?
Emergency tracheostomy Occlusion of artery for guttural pouch mycosis cases Trauma Thoracic drain placement
45
What pre-op considerations should we have regarding the patient?
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
What pre-op considerations should we have regarding planning?
Surgical procedure - what kit required? Position - standing or left/right/dorsal recumbency? Contingency plan Recovery plan Post-op plan - specific considerations, feeding, stabling
47
Describe standing sedation.
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
What are the advantages of standing sedation?
Reduces GA risks May reduce costs Anatomical advantages - access/position, reduced haemorrhage Less facilities/experts needed (e.g. theatre/anaesthetist)
49
What are the disadvantages of standing sedation?
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
What are the advantages of general anaesthesia?
``` 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
What are the disadvantages of general anaesthesia?
Cost, expertise, time, facilities Risk of GA mortality - 1% in healthy horses Airway supervision required at all times Duration
52
What do we need for laser surgery?
``` 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
What intra-operative considerations should we have?
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
What post-op surgical complications can occur?
Swellings may compromise airway - emergency tracheostomy kit Inhalation pneumonia - monitor breathing/temperature post-op
55
How do we feed horses post-op?
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
What pain management can we provide post-op?
Analgesia - NSAIDs/topical throat spray
57
How do manage a laryngostomy (hobday) post-op?
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
How do we place/care for chest drains in horses?
Placed surgically Position = ventral thorax if fluid, dorsal if gas, unilateral/bilateral Monitor fluid/gas level - marker pen/clip marks
59
Describe a thoracoscopy.
Standing sedation Setup as laparoscopy Suction + oxygen essential To investigate and/or treat plural/pulmonic disease (exudate, neoplasia, pneumo/haemothorax)
60
What are the differences between a tracheotomy and a tracheostomy?
``` 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
Why would we carry out an emergency tracheotomy?
``` 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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