Exam 2 Flashcards
Classify the Colic
Non-Strangulating Small Intestine
Gold Standard for Diagnosis of Equine Infectious Anemia
Coggins Test (AGID)
*AGID = Agar Gel Immunodiffusion Test
Coggins Test- Gold Standard and Only officially Accepted Test
What is the Common Heart Rate in a Horse with a Non-Strangulating Colic (Simple Obstruction)?
What is the Common Heart Rate in a Horse with Strangulation Colic?
Simple Obstruction = 40-70 BPM
Strangulating Colic = 50-90 BPM (Very Elevated)
*Heart Rate is Elevated to Reflect Anxiety/Stress Level of Animal, Degree of Pain, and Degree of Cardiovascular Compromise
*NORMAL Resting Heart Rate in Adult Horse = 28-44 BPM
Treatment for Laryngeal Hemiplegia in a Horse with Exercise Intolerance and Inspiratory “Roar”
Laryngoplasty- “Tie Back”
*If the Horse ONLY shows Inspiratory Roar without Exercise Intolerance, what is the Treatment? Ventriculectomy/Ventriculocordectomy. Vast majority of the noise is associated with the vocal Fold. These Procedures are Performed as the only Procedure in those in which noise is the issue
Signalment for which Valvular Disease in Horses:
Age: Commonly Less than 4 Years of Age
More Common in Males
Common Valves Affected: MITRAL and AORTIC
Multiple Sites can be affected in a Single Animal
Vegetative Endocarditis
*Most Frequently affecting the MITRAL VALVE
In Suspected Cases of Equine Infectious Anemia that we consider to be Infected LESS than 45 Days ago, what other Diagnostic Tests should be Run in addition to Coggins Test
ELISA
*ELISA: More Specific and Sensitive. Can Detect Pior to Development of a Positive AGID
Pathophysiology associated with which Classification of Pericarditis:
Accumulation of Fluid within the Pericardial Sac
Acute/Rapid Accumulation of Fluid can Result in Sudden Cardiac Tamponade and Cardiovascular Collapse
Severity of Clinical Signs directly Related to the Amount of Fluid present and the Rate of Accumulation
Decreased Diastolic Filling
Effusive
*Effusive Pericarditis- As the Heart is filling, the Fluid that is Surrounding the Heart is going to exert a Higher and Higher Pressure against the Ventricular Walls as they are trying to Expand
*Slow Increase in Pressure and the Heart is Fighting to Fill against the Higher Pressure
Most Commonly used Beta2 Adrenergic Agonist used in Horses described Below:
Short-Acting, Rapid Onset within 5 Minutes
Duration of Effective Dilation is 1-3 Hours
Pure R-Isomer is Preferred
Albuterol (Torpex)
Two Bronchodilator Agents used in Therapy for Horses with Cough:
B2 Adrenergic Agonists
Anticholinesterases
Clinical Signs seen with Which Viral Respiratory Disease:
Cough
Abortions
Neurologic Syndrome
Diarrhea
Equine Herpes Virus
*If you have a Facility where you are seeing Abortions and Viral Respiratory Disease, top Differentials should be EVA and EHV
Respiratory and Neuro Disease = Equine Herpes Virus
Bronchodilator used to Treat Cough in Horses Described Below:
Rapid to Immediate Relief
Rapid Local Effect with Minimal Side Effects
Most commonly used in the Horse is Albuterol
Beta 2 Adrenergic Agonists
*Most Commonly used Bronchodilator used in Cases of Recurrent Airway Obstruction
*Beta 2 Adrenergic Agonists used with Steroids- Most Common Combination used in Recurrent Airway Obstruction (RAO)
Classify this Colic
Strangulating Small Intestine
Nasogastrically Intubate this Horse to Find:
18 Liters of Malodorous Fluid
pH = 7.6
Physical Exam Findings:
Heart Rate: 106 BPM
Respiratory Rate = 48/min
Temperature = 99.2 F
Mucous Membranes Congested with CRT = 3.5 Seconds
Thoracic Auscultation: Within Normal Limits
GIT Auscultation
Negative in All Four Quadrants (Silent Abdomen)
What is the Next Step?
Perform a Trans-Rectal Palpation
Pathogenesis of which Lower Airway Disease in Horses:
Small Airways Collapse during Expiration due to High Pleural Pressure Resulting in EXPIRATORY Difficulty
Recurrent Airway Obstruction (Heaves)
*Because its Terminal Airway Disease, the Component of the Difficulty is primarily EXPIRATORY
*The Greatest Resistance on Expiration is in the Small Airways
Review Card: Strangulating versus Non Strangulating
*Strangulating = Gut Wall Compromise
Three Pathophysiologies leading to Epiglottis Entrapment in Horses
Aryepiglottic and Subepiglottic Tissue Envelopes the Epiglottis
Redundant Loose Tissue
Hypoplastic Epiglottis
*Epiglottic Entrapment can be Concurrent with DDSP- many of these conditions are related to eachother or can occur at the same time
Idiopathic Laryngeal Hemiplegia is a Term only used for ____ Sided Laryngeal Hemiplegias that can be Partial or Complete
Left
*Idiopathic Laryngeal Hemiplega- Damage to the Left Recurrent Laryngeal Nerve
*Majority of Hemiplegias which are Left-Sided are Idiopathic
Laryngeal Hemiplegias can be Right Sided Only or Bilateral. If it is a Right Laryngeal Hemiplegia, it is NOT considered Idiopathic
Most common Cause of Anemia in Horses is that Associated with Depression of RBC Production (Inadequate Production), More Particularly Anemia of _____ Disease
Chronic
*What Etiology should be at the Top of your List for Decreased RBC Production resulting in Anemia? Anemia of Chronic/Inflammatory Disease!!!- Number one Cause of Anemia in the Horse
*Anemia of Chronic Disease- Decreased Production as a Result of Iron Sequestration
Pathophysiology of which Muscle Disease in Horses:
Voltage Gated Sodium Channels of Skeletal Muscle have Increased Sodium Permeability
Results in Potassium (K) Efflux = Hyperkalemia
Resting Potential of Sodium Channels are Closer to Firing
Hyperkalemic Periodic Paralysis (HYPP)
*Sodium (Na) Channels Resting Potential Closer to Firing (Normal = 70mV, HYPP = 55mV)
*Clinical Signs are associated with Episodic Hyperkalemia
A 5-yr-old Warmblood Mare is Presented with a History of Exercise Intolerance and Intermittent Stridor for the last 3 weeks manifested only when used for Jumping. An Inspiratory and Expiratory Noise is Heard
What is the Diagnosis?
Epiglottic Entrapment
Four Pathophysiologies leading to Dorsal Displacement of the Soft Palate (DDSP)
Excessive Negative Intrapharyngeal Pressures- In the Face of very Negative Pressures, the Soft Palate gets Sucked into the Airway. If there is any other concurrent Upper or Lower Airway disease, it can Predispose the animal to DDSP
Excessive Poll Flexion- Poll: Area Immediately behind the Ears
Epiglottic Shortening (Hypoplastic Epiglottis)
Caudal Retraction of Larynx
Upper Respiratory Disease with Nasal Discharge Described Below:
Highly Contagious Disease
Causative Agent: Streptococcus Equi Var Equi
ALWAYS PATHOGENIC
Mainly in Younger Horses: YEARLINGS
Strangles
Treatment for Babesiosis/Piroplasmosis
In Endemic Area- Suppress Clinical Signs WITHOUT eliminating organism from the Body. DO NOT Clear Organisms. Only Treat to Alleviate Clinical Signs. You want to Leave these Animals with a Low Level Infection in order for the Horse to have Continued Immunity
In Non-Endemic Area- Completely Eradicate Organism. Clear and Repeat Serology for Reversion of Negative Status
*For Importation to the US from Positive Countries, Horse needs to be Seronegative!
Two Abnormal Variations that can be Felt during Transrectal Palpation
Loops of Sausage- Small Intestine or Small Colon
Large Balloon like Structures- Cecum or Large Colon
*How to Differentiate Small Intestine from Small Colon- Small Colon has a Band that can be Palpated
How to Differentiate Cecum from Large Colon- Cecum should be Limited to the Right side of the Horse (Fixed to the Right Side)
F. Right Ventral Colon, Sternal Flexure, Large Ventral Colon
*Ventral Colon is the Beginning of the Large Colon- When food comes out of the Cecum it “Drops to the Floor” into the Right Ventral Colon
Classify this Colic
Rectal Palpation:
Multiple Loops Tightly Distended “Sausages”/Tubular Structures
No Bands
Nasogastrically Intubate this Horse to Find:
18 Liters of Malodorous Fluid
pH = 7.6
Physical Exam Findings:
Heart Rate: 106 BPM
Respiratory Rate = 48/min
Temperature = 99.2 F
Mucous Membranes Congested with CRT = 3.5 Seconds
GI Auscultation:
Negative in All Four Quadrants (Silent Abdomen)
Strangulating Small Intestine
Only Intraerythrocytic Parasitic Disease that affects Horses. They Appear as Pyriform Bodies in Groups of 2-4 organisms within RBC’s
Piroplasmosis/Babesiosis
Clinical Signs of which Airway Disease:
20-27% show No Clinial Signs
COUGH
Inflammatory Airway Disease (IAD)
*20-27% Present with No Exercise Intolerance or Overt Signs and were diagnosed via Endoscopy and Cytologic Findings
*85% of Horses with a Cough have Inflammatory Airway Disease. If you take 100 Young Racehorses who are Coughing, 85% have IAD. Inflammatory Airway Disease is the Major Differential for a Cough in a Young High Performance Animal (Racehorses)
*Cough is an Insensitive Indicator of IAD- If you take 100 Horses with IAD, only 30-40% of them will have a Cough
Type _____ Inflammatory Airway Disease (IAD) is Described Below on BAL:
> 2% of Cells in BAL are MAST CELLS
Responds BEST to Mast Cell Stabilizers- Cromolyn Sodium
Type 2 IAD
*Some Cases you may see up to 25-30% of Cells being Mast Cells
*Cromolyn Sodium- Can be Given by Nebulization (10-15 Puffs BID or TID)
Review Card: Bands in Large Colon
Pelvic Flexure Band = Mesenteric Band (Clinically we say there are No bands in the Pelvic Flexure because the Mesenteric Band is NOT Identifiable on Rectal Palpation
Clinically- Identify the Pelvic Flexure during Rectal Palpation by virtue of the Fact that is a Component of the Large Intestinal Tract and has No bands
Small Colon- Antimesenteric Band and Mesenteric Band. From Clinical Perspective only One band since you can only Palpate the Antimesenteric Band
Etiology of which Muscle Disease Described Below:
Familial Disease of Autosomal Dominant Inheritance
Point Mutation Resulting in Phenylalanine/Leucine Substitution in Key location of Alpha Subunit
Voltage Gated Sodium Channel of Skeletal Muscle Affected
Hyperkalemic Periodic Paralysis (HYPP)
*AKA Impressive Disease
Significant Structures to assess in the _____ Quadrant
Left Dorsal
*Left Dorsal Quadrant- Spleen, Caudal 1/3rd of the Kidney, and Nephrosplenic Ligament
*MEMORIZE THIS PICTURE
Muscle Enzyme Described Below:
Muscle Specific Enzyme- Predominantly in Skeletal and Cardiac Muscle
Reflects Degree of Muscle Damage
Increases Rapidly after Insult (Peaks within 6-8 Hours)
Short Half Life- Decreases Rapidly (Return to Normal within 3 Days)
CK (Creatinine Kinase)
*Reflects Degree of Muscle Damage- The Higher the CK, the more Muscle Damage Present
*Signficant Increases Involve Levels in the Tens and Hundreds of Thousands- Severe Muscle Damage
_Major Presenting Complain_t for Horses with Recurrent Airway Obstruction (RAO)
Seasonal Episodic Distress at REST
*RAO = Seaosonal Episodic Distress in a Febrile Horse at Rest
*These Horses are Classically DISTRESSED so we often see an Anxious Horse with Incredible Nasal Flares- Obvious Difficulty Breathing AT REST
Review: Therapy for Recurrent Airway Obstruction
Treatment for Horses with Strangles
Consider Goal of Client- Do we just consider this a Childhood Disease and allow Yearling to develop disease then Recover?
If Not Depressed and Eating OK with NO Complications- Best to Let Disease Run its Course
Strict Isolation of Affected Animals- Typically 6 Months to 1 Year
In ALL COMPLICATED (Retropharyngeal LN Enlargment/Purpura) Horses- PENICILLIN
*Penicillin is ONLY Recommended in Complicated Course of Disease
Mainstay of Therapy In Horses with an Underlying Immune Mediated Pathophysiology of Recurrent Airway Obstruction (RAO)
Maximized Corticosteroids
Minimized Bronchodilators
*In Most cases of Recurrent Airway Obstruction (RAO) we will Likely be Treating with BOTH Corticosteroids and Bronchodilators. However, if the Underlying Cause is Mainly Inflammation, we will Maximize the Amount of Steroids Given. If the Underlying Cause is Bronchoconstriction, we will Maximize the Amount of Bronchodilators Given
In Horses with Colic, Reflux of Large Volumes typically Indicative of ______Involvement
Small Intestinal
*ALL SMALL INTESTINAL OBSTRUCTIONS tend to result in some degree of Refluxing in the Horse
Clinical Signs of which Condition on Horses:
Exercise Intolerance
INSPIRATORY NOISE- “Roar”
Possible EIPH
Idiopathic Laryngeal Hemiplegia
*What Clinical Signs do these horses show at rest? NONE
Treatment for Effusive and Constrictive Pericarditis
Effusive- Drainage/ Pericardiocentesis
Constrictive- Pericardectomy
*Effusive- Need to Drain Fluid because the Fluid is Exerting Pressure. Placement of Intrapericardial Catheter
Constrictive- Need to Remove a piece of Pericardium to Release the Pressure of the bag around the Heart
Both Effusive and Constrictive Pericarditis are _____ Problems
Preload
*The Failure is Associated with a PRELOAD Problem in Horses with Both Effusive and Constrictive Pericarditis
*The Preload will be Reduced, thus the Cardiac Output is Reduced
Anti-Inflammatory drug used to Treat Coughing in Horses Described Below:
Inhibit Mast Cell Degranulation
Used Preventively to Stop Further Mast Cell Degranulation
Preventative: Only Effective for Mast Cells that have Not Degranulated, they have No Effect on already Released Mediators
Mast Cell Stabilizers (Sodium Cromoglycate, Nedocromil Sodium)
*Really Helpful as a Preventative, because it is ONLY helpful if Mast Cells have not yet Degranulated
*Mainly used in Cases of Inflammatory Airway Disease (IAD)
*NOT used in Standard Therapy for Horse with RAO (Recurrent Airway Obstruction)- Mast Cell Stabilizers are Not effective Treatment for an Episode of Airway Obstruction
Purpura Hemorrhagica is an Aseptic Vasculitis occuring in Mature Horses. Which Two Airway Diseases lead to Purpura Hemorrhagica and what are their Clinical Manifestations?
Strangles- Localized Purpura of the Upper Airway leading to Pharyngeal Collapse (Nasopharynx Collapse)
Equine Influenza Virus- Edema of Distal Limbs which is Hot/Painful
Pathophysiology of which Disease leading to Anemia in Horses:
Infects Macrophages- Integrates into the Host Genome
INDIRECT DESTRUCTION- NOT Infection of RBCs
Immune Mediated Hemolysis
Thrombocytopenia Common
Equine Infectious Anemia
Five Prognostic Factors that are associated with a Poor Prognosis in Horses with Pleuropneumonia
Systemic Fibrinogen Value > 1000 = Poor Prognosis
Isolated Organism: Worse if E. Coli
Amount of Fibrin in Chest- The More Fibrin, the Harder the Treatment
Foul Odor to Pleural Fluid or Breath- Presence of Anaerobes
Gas Bubbles on Ultrasound- Presence of Anaerobes
*Presence of Anaerobes WORSENS the Prognosis
What is the Degree of Colic Manifested by this Horse?
Severe
_*Multiple Facial Abrasions!!!_
*Never had a Previous Episode- One of the main Risk Factors for development of a Colic is having a Previous Episode of Colic
Treatment for Rhodoccocus Equi
Antimicrobials- ERYTHROMYCIN Estolate, Rifampin
Anti-Inflammatories- Flunixin Meglumine
Antiulcer Medication- Controversial
Supportive Treatment- Oxygen, Fluid Therapy
*Antimicrobials - Must be Lipophilic (Lipid Soluble) to penetrate Abscesses
General Clinical Signs for _______ Colic:
Non- Strangulating
Reflux:
None: Non-Strangulating Large Intestinal Lesion
Minimal: Non-Strangulating Small Intestinal Lesion
Which Muscle Disease is Described below:
Reports of Heavily Muscled Quaterhorse Foals with upper Airway Stridor and Spasm or Paralysis of Laryngeal Muscles
Hyperkalemic Periodic Paralysis
*Common to see Bilateral Laryngeal Hemiplegia
Complications associated with which Upper Respiratory Tract Disease of Horses:
Dyspnea/Distress
Can Result in Guttural Pouch Empyema- Extension of Ruptured Lymph Node into Guttural Pouch
PURPURA HEMORRHAGICA
Brain Abscessation
Immune Mediated Myopathy
Strangles
*Purpura Hemorrahgica- Main Underlying Cause Associated with Purpura: Strep Equi Infections
*Not Many Horses with Strangles, will develop Brain Abscesses- Very small percentage of Animals develop this Complication. HOWEVER if you look at Brain Abscessation in Horses, the Number one Organism causing Brain Abscessation in Horses is Strep. Equi. Strep Equi is the MAJOR cause of Brain Abscesses
Airway Disease Leading to Chronic Cough in Horses Described Below:
Clinical Signs- Severe Cough (Same as RAO)
Risk Factor: Housing with Donkeys or on Pasture where Donkeys were Previously Kept
Lungworm (Dictyocaulus Arnfeldi)
*Clinical Disease is Indistinguishable from COPD (RAO)
*On TTW or BAL- Increased Eosinophils and Occasionally Larvae or Parasites
A 5-yr-old Warmblood Mare is Presented with a History of Exercise Intolerance and Intermittent Stridor for the last 3 weeks manifested only when used for Jumping. An Inspiratory and Expiratory Noise is Heard
How would you Treat this Horse?
Laser Tissue Resection
*Complete Epiglottic Entrapment- Must be Treated Surgically
Clinical Signs of which Equine Condition:
Exercise Intolerance
Inspiratory and Expiratory Noise
Chronic Cough Especially when Eating
May be Asymptomatic and not show Clinical Signs
Epiglottic Entrapment
*How do Epiglottic Entrapment Horses look at Rest? NORMAL
How does a DDSP Horse Look at Rest? NORMAL
*Noise is only Generated when the turbulance in the Airway is High Enough to create Factors Favorable to produce a Noise. We Do NOT Expect Noise at Rest
*You will NOT see CHEEK PUFFING with Epiglottic Entrapment
Airway Disease characterized by Dyspnea WITH Distress leading to Chronic Cough Described Below:
Chronic, Progressive Disease Occuring Rarely in Adult Horses
Clinical Signs are Indistinguishable from RAO, However Horses are Unresponsive to Conventional Therapy for RAO
Following the use of Repeated IV injections of “EquImmune”
Thoracic Radiographs- Interstitial to Reticulonodular Pattern
Lung Biopsy- Confirms Diagnosis
Adult Interstitial Pneumonia
*There is Nothing we can do to Treat this!- Therapy is Largely Unsuccessful
Treatment for a Horse with Recurrent Airway Obstruction with a Secondary Bacterial Infection
Antibiotics- Penicillin/Trimethoprim Sulfa
*What organisms do we predict are going to be involved in this case Scenario? We have a Pretty good Idea of what Organims we’re thinking are responsible for the Pneumonia in this Secondary Bacterial Infection- STREPTOCCOCUS
#1 Organism in the Equine Patient leading to Generic Pneumonia and Bacterial Pneumonia secondary to Viral Respiratory Disease or Reccurent Airway Obstruction is STREPZOOEPIDEMICUS
Intracellular Facultative Aerobic, Gram Positive, Pleiomorphic, Coccobacillus Organism that Results in Subacute to Chronic Bronchopneumonia and Pulmonary Abscessation in Foals
Rhodococcus Equi
General Clinical Signs for _______ Colic:
Strangulating
*Severe Unrelenting Pain is often Present
Reflux:
Mild- Strangulating Large Intestinal Lesion
Severe- Strangulating Small Intestinal Lesion
Technique that is Anecdotally Effective for Treatment of Rhodococcus Equi, but is mainly used in Prevention of R. Equi in Foals
R. Equi Hyperimmune Serum
Pathophysiology associated with which Classification of Pericarditis:
Initial Diastolic Filling is Unimpaired but when Critical Volume is reached expansion is Restricted and Filling Ceases Abruptly, Resulting in General Decrease in Preload and thus Cardiac Output
Sudden Cessation in Late Diastolic Filling with a Sudden Increase in Ventricular and Atrial Pressures
Constrictive
*Constrictive Pericarditis- In the Initial Phases of Filling, it will look like a Normal Heart, Until the walls of the Ventricle get to the Edges of the Pericardium. When the Ventricles exert Pressure on the Pericardium the Pressure will Skyrocket because the Pericardium is unable to Expand
You are Presented with a 6-yr-old Holsteiner Jumper Mare for the generation of a Noise in the show Ring
What is your Diagnosis?
Idiopathic Laryngeal Hemiplegia
*Left Laryngeal Hemiplegia
Physiologic Arrhythmia Most typically Heard in the Horse
Mobitz Type I Second Degree AV Block (Wenkenbach)
Upper Respiratory Tract Disease with Nasal Discharge Described Below:
Recurrent Unilateral Purulent Nasal Discharge
Nasal Discharge Worsens when Head is Lowered
Waxes and Wanes with Antimicrobial and Anti-Inflammatory use
Dysphagia- Difficulty Breathing
Concretions of Desiccated Pus- Chondroids
Guttural Pouch Empyema
*Two Airways Diseases where Nasal Discharge Worsens when the Horse Lowers its Head- Gutteral Pouch Empyema and Sinus Disease
*Horse Presents with Purulent Nasal Discharge- Administer Antimicrobials and the Nasal Discharge Stops. Once you stop the Antimicrobials , a few days later the Purulent Nasal Discharge Returns (Waxes and Wanes). Will not be able to Treat completely until you FLUSH the Guttural Pouch
A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance
What is the Most Likely Diagnosis?
DDSP
Four Patterns seen on Thoracic Radiograph that are very Supportive of a Diagnosis of Rhodococcus Equi
Abscessation Pattern
Miliary Pattern
Broncho-Pneumonia Pattern
Intersitial Pattern
*Multiple Abscesses Pattern- Most Indicative of R. Equi
*Pulmonary Abscessation and Miliary Pattern very Indicative of R. Equi and typically they are not seen with general Foal Pneumonia
True/False: This Depicts a Normal GIT Auscultation
True
*Impossible for there to be Motility on the Right Side of the Large Colon and not on the Left Side
*Unless Total Absence of Motility in all Four Quadrants (Silent Abdomen), NO Conclusive Statement can be made of a Single Silent Quadrant
Treatment for Purpura Hemorrhagica
Corticosteroids (At least 7 Days)
Topical Therapy: Hydrotherapy (15-20min. Per Day), Bandages Sweat Wraps
*Possibly put on Antimicrobials- If the Horse has a Strep. Equi or Strep. Zooepidemicus Infection they will be put on Antibiotics
In Horses with Anemia of Chronic Disease, the PCV is NEVER less than _____
18-19%
Three Typical Complications associated with Mitral Insufficiency
HEART FAILURE
Rupture of the Chordae Tendinae- Loud Honking Murmur
Rupture of Pulmonary Artery- Sudden Death
In a Horse with Strangulation Colic, describe the Sequence of Changes that will be seen on Abdominal Fluid via Abdominocentesis
Within 1 Hour: Increase in Protein
Within 3-4 Hours: Increase in RBC
Within 6 Hours: Increase in WBC
*Expectation: Strangulating Lesions will commonly present with Increased Protein, RBC, and WBC all to the same Degree at the same Time
Common Placement for Electrocardiography Leads in Equine Patients
Positive Lead- Left Thorax
Negative Lead- Right Jugular Furrow
Ground Lead- Any Point Remote from the Heart
*Most commonly used Lead is the Bipolar Lead: Base-Apex
What Drug is used in the Treatment of Babesiosis/Piroplasmosis
Imindocarb Dipropionate
*Adverse Effects- Imidocarb Causes Cholinesterase Inhibition and can result in Diarrhea and Colic
*DEADLY in Donkeys
In Horses being Treated for Atrial Fibrillation, ______ is Highly Protein Bound and therefore can Displace Digoxin leading to an Increased Incidence of Digoxin Toxicity
Quinidine
Two Anti-Inflammatory Agents used in Therapy for Horses with Cough:
Mast Cell Stabilizers- Inflammatory Airway Disease (IAD)
Corticosteroids- Recurrent Airway Disease (RAO)
History and Clinical Presentation for which Lower Airway Disease:
Middle Aged or Older Afebrile Horse with Recurrent Seasonal Episodes of Expiratory Dyspnea/Distress
Recurrent Airway Obstruction (Heaves)
Afebrile = No Fever
Two Causative Agents for Babesiosis/Piroplasmosis
Babesia Caballi
Theleria Equi
Classify this Colic
Nasogastric Intubation- Little/No Reflux
Severely Distended Abdomen- Obvious External Flank Distension
Strangulating Large Colon
*Explain why Strangulating Cecal Disease would be Incorrect- With Cecum Distension you may have Distended the Right Flank but there is No way you would have distended the abdomen as a Whole
For which Airway Disease will we see this on BAL?
Recurrent Airway Obstruction
Mainstay of Therapy In Horses with an Underlying Bronchoconstriction Pathophysiology of Recurrent Airway Obstruction (RAO)
Maximized Bronchodilators
Minimized Corticosteroids
*Ex. B2 Adrenergic Agonists and Anticholinesterases
True/False: We can Completely Eradicate Theleria Equi (T. Equi) with Treatment for Babesiosis
False
*Cannot Completely Eradicate Theleria Equi from the Horses Body when Treating for Babesiosis
How do we Check for Reflux in a Horse with Colic?
Nasogastric Tube
*Horses cannot Vomit, if you do not place a Nasogastric Tube the Horse is at risk of Rupturing its Stomach (Fatal)
*Usually in Horses with any Significant Colic, we are putting and Leaving a Nasogastric Tube in the Horse. Should be First Procedure attempted when Evaluating a Horse with Colic
Horse with Atrial Fibrillation, That Resolves on its own/Only Occurs during Racing. You have done a Physical Exam, which Shows signs of Cardiovascular Compromise. You then assess the Heart Rate and the Heart Rate is Greater than 60 bpm. You continue an evaluation and Perform and Echocardiogram. The Echocardiogram is Abnormal. With a Heart Rate > 60 bpm and an Abnormal Echocardiogram. What is the Treatment in this Animal?
First Dixogin
Followed by Quinidine
*If HR > 60 AND Underlying Heart Disease- Treat for Heart Disease with Digoxin. Conversion of these Cases with Quinidine is Highly Unlikely and would be very Case Dependent
Classify the Colic
Strangulating Small Intestine
Complication of Strangles described Below:
Thoracic/Abdominal Abscesses
Systemic Manifestation of Strangles
Metastasis to Lymph Nodes throughout the Body- Typically Involves the Abdomen
Bastard Strangles
Technique used in Treatment of DDSP Described below:
Commonly uses Nylon Stalkings (Pantyhose)
Prevents Caudal Retraction of the Larynx- Increases the contact Surface of the Palate and Epiglottis
Tongue Tie
*If you are tying the Tongue Forward then you are Conterbalancing the Caudal Retraction of the Larynx
Describe Typical Horse Behavoir in Mild, Moderate, and Severe Pain due to Colic
Mild
Playing in Water, Looking at Flanks
Pawing Occasionally
Moderate
Kicking Abdomen with Hind Limbs
Frequent and Purposeful Pawing
Getting Up and Down
Severe
Rolling and Thrashing
Up and Down Constantly
Typical Abdominocentesis Findings for _____ Colic:
Increase In Total Protein, WBC, and RBC at the Same Time to the Same Degree
Strangulating
In a Horse with Non Strangulation Colic, describe the Sequence of Changes that will be seen on Abdominal Fluid via Abdominocentesis
First: Increase in Protein
Second: Increase in WBC
Third: Increase in RBC
*This is the Presentation Expected in a Non-Strangulating Lesion
If a Horse is Manifesting Second Degree AV Block, what can you do in order to determine if the Block is Purely Physiologic?
Jog the Horse
*Second Degree AV Blocks are a Manifestation of High Vagal Tone. Generally Physiologic thus resolves with Increased Sympathetic Tone- JOGGING Horse
True/False: Hyperkalemic Periodic Paralysis is commonly seen in Exercising Horses
False
*HYPP is Atypical to see with Exercise- Tends only to occur when the Horse is at Rest
Which Upper Respiratory Tract Infection can cause Retropharyngeal Abscesses in Horses?
Strangles
*Infection of Retropharyngeal Lymph Nodes- Can lead to Respiratory Distress and Rutpure of Lymph Nodes into Guttural Pouch (Guttural Pouch Empyema)
In Order to see the Retropharyngeal Lymph Nodes affected you will most likely have to do a Radiograph
Diagnosis Based on these ECG’s
Multifocal Ventricular Tachycardia
4 Or More Ventricular Premature Contractions (VPC’s) are Diagnostic for Ventricular Tachycardia
*We don’t Necessarily treat the VPC’s per say. We treat the Underlying Condition- Toxemia, Electrolyte Abnormality ect.
Diagnosis based on this Endoscopic View
Pharyngitis
*Pharyngitis- Lumps and Bumps all over (Inflammation)
*This is the type of Airway that we may see Associated with DDSP- Caused by Upper Airway Disease (Pharyngitis)
Pathogenesis of which Lower Airway Disease in Horses:
Immune Mediated Disease
Allergic Disease- Inhalation of Molds, Notably Faenia Rectivirgula aerosoloized from Hay and Bedding
Inhalation of Endotoxins
Hereditary Predisposition
Recurrent Airway Obstruction
Clinical Signs seen with which Viral Respiratory Disease:
Acute COUGH
Purpura Hemorrhagica- Immune Mediated Vasculitis
Myalgia- Pain in Muscles
Arthralgia- Pain in Joints
Myocarditis- Arrhythmias
Equine Influenza (Flu)
*Horses with Equine Influenza have MORE COUGHING than in Horses with Herpes or EVA
*Example- If you enter a Barn Facility and there a several Horses Coughing at the same time (Lots of Coughing), Equine Influenza (Flu) should be at the top of your list
*Possible for some Flu Horses to Manifest Arrhythmias
Purpura Hemorrhagica in cases of Equine Influenza can also lead to Edema
Two most Common Organisms leading to General Pneumonia (Lower Respiratory Tract Disease) in Horses
Streptococcus Zooepidemicus
Actinobacillus Equuli
*Strep. Zooepidemicus- Treated with Penicillin
Strep Zooepidemicus and Actinobacillus Equuli- Treated with Penicillin and Trimethoprim Sulfa (TMS)
*Anti-inflammatory used for Treatment- Flunixin Meglumine
Pathophysiology of which Lower Respiratory Disease in Horses:
Diseaes of YOUNG Horses- Mean Age 2-4 Months
Soil Organism
Opportunistic- Role of Immunosuppression
Certain Strains are Pathogenic- Carry Plasmid which allows it to Escape Destruction after Phagocytosis
Rhodococcus Equi
*Adults and Foals greater than 6 Months of age DO NOT get this Disease- Seem to be Protected
*Disease Causing Strain carries a PLASMID, which makes it more Resistant to Destruction
*Although the Foal Manifests Disease at several Months of Age, they Acquire the Disease within the First Week of Life
Horses with Hyperkalemic Periodic Paralysis are Identified according to their genome as NN = Normal, HN = Carriers (Heterozygote), which are affected but to a lesser extent than the Homozygotes, denoted as _____
HH
*Both HH and HN Horses are Affected
*HH (Homozygote)- Expected to Start Episodes at a Younger age, usually will have more Severe Episodes and are more likely to have Episodes that are associated with Clinical signs such as Acute Respiratory Distress
HN (Heterozygote)- Show Clinical Signs after 1 year of age and are NOT likely to have acute distress type Episodes
Severe Pain
*Facial and Head Abrasions- When horses begin getting Abrasions it is because they are very violently Thrashing. Just by virtue of these Injuries you know they are very severly painful
Which Causes of Anemia cause an Intravascular Hemolysis versus an Extravascular Hemolysis
Extravascular Hemolysis- Equine Infectious Anemia, Babesia Caballi
Intravascular Hemolysis- Babesia Equi (aka Theleria Equi)
*Intravascular Hemolysis more Typical of Theleria Equi Infection but RARELY in Babesia Caballi Infections
Mechanisms for Anemia in which Disease:
Immune-Mediated Hemolysis- INDIRECT HEMOLYSIS
Decreased Intravascular Erythrocyte Survival Time
Decreased Bone Marrow Erythrocyte Production
Equine Infectious Anemia
*The Infection is NOT Infecting the Red Blood Cells. The Anemia is associated with Immune-Mediated Hemolysis. INDIRECT Mechanism of Action
Review Card
Diagnosis based on this Lung
Rhodococcus Equi
*Significant Infiltration of Abscesses within the Lung Fields
A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance
What is the Diagnosis?
DDSP
Important Structures found in the Left Dorsal Quadrant on Transrectal Palpation
Spleen
Caudal 1/3rd of Kidney
Nephrosplenic Ligament
Breed Predisposition in Horses with Hyperkalemic Periodic Paralysis (HYPP)
Heavily Muscled Quarter Horses
*WITH Large Muscle Masses- Heavily MUSCLED Quaterhorses
4
*“Four on the Floor”
*One of these Bands is not Palpable: Mesenteric Band is in between the Two components of the Colon. You cannot feel the Mesenteric Band of the Ventral Colon
A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance
Which of the Following is NOT a Recommended Treatment for this Horse?
Tie-Back
*Diagnosis: DDSP- Tie Back has no place in the Treatment in this Horse. Tie Back is a Treatment option for Horses with Idiopathic Laryngeal Hemiplegia
Horse is in Dorsal Recumbancy. Which Two Pathologies are Most Likely?
“Cast” in Stall (Stuck in Stall)
Gastric Ulcers (Most Common)!
*Horses with Gastric Ulcers will adopt this position because it makes them more comfortable- Dorsal Recumbancy or Dog Sitting Position
True/False: As you are Moving Further Down (Aborally) the Gastrointestinal Tract, you should have Less and Less Expectation for Reflux
True
*If the Obstruction is anywhere past the Large Colon, you don’t have an expectation for Reflux in those cases
*HOWEVER, as you are moving through the Small Intestine (Aborally) the Reflux Volume is Expected to Increase. As you go more distally in the Small Intestine you have an expectation for Greater and Greater amounts of Reflux
In Order to Prevent Foals from Developing Rhodoccocus Equi, we Treat Foals within First Week of Life with ______
R. Equi Hyperimmune Serum
*Has been shown to greatly reduce the number of foals Effected or the Severity of the Disease
During Transrectal Palpation, Fixed Structure attached to the Right Dorsal Abdominal Wall by a very short Mesentery
Cecum
Clinical Signs for which Lower Respiratory Disease in Horses:
Significant Dyspnea: marked Crackles, Wheezes and Cough
Fever, Anorexia and Depression
Mesenteric Lymphnode Involvment- Diarrhea and Abdominal Abscessation
***Polysynovitis- Effusion of Multiple Joints
Osteomyelitis and Septic Physitis- Vertebrae and Long Bones
Rhodococcus Equi
*Normal Presenting Complaint- Foal seemed Fine until the last day or so, when the Foal developed obvious Respiratory Disease
*Rhodococcus Equi is a very Particular Type of Pneumonia in the Foal
Gut Wall Compromise
Surgical Treatment of Dorsal Displacement of Soft Palate
Laryngeal Tie-Forward
*Most Recent of Surgeries with Good Success
Coggins Test, used for Diagnosis of Equine Infectious Anemia, can take up to ___ days to Produce Detectable Levels of Antibody
45
*If Suspected Disease and Coggins is Negative (
Which of the Following best Represents Expected Reflux?
A. Large Volume, Acidic
B. Large Volume, Alkaline
C. Small Volume, Acidic
D. Small Volume, Alkaline
B. Large Volume, Alkaline (Strangulating Small Intestine)
*2-4 Liters = Small Volume (Gastric, Large Intestine)
10-13 Liters = Large Volume (Small Intestine)
*At What point do we consider Reflux Significant? Greater than 2 Liters. If you are getting Reflux less than 2 Liters it is not Considered Clinically Significant
B. Prophylactic Antibiotics for Close Contact
When Placing a Nasogastric Tube in a Horse with Colic, we always ____ the Tube with Water, which Creates the Siphoning Action, as Fluid Rarely Exits the Tube Spontaneously
Prime
*Always Prime the Tube. If not Primed the Fluid will not Run out the Tube
1 Organism in the Equine Patient leading to Generic Pneumonia and Bacterial Pneumonia secondary to Viral Respiratory Disease or Reccurent Airway Obstruction (RAO) is _______
Strep Zooepidemicus
Treatment for Strep Zooepidemicus- Penicilin Alone (Generally 5-7 Days)
Treatment for Strep Zooepidemicus and Actinobacillus- Pencillin and Trimethoprim Sulfa (TMS)
*Strep Zooepidemicus and Actiobacillus are the Number One Organisms that we will see affecting the Respiratory Tract of the Horse
What does the pH of the Reflux tell us about the Location of Obstruction?
pH
pH 6-7 : Typically Gastric
pH > 7 : Reflux from the SMALL INTESTINE
Classify this Colic
Nasogastric Reflux- None
Rectal- Very Firm Slightly Indentable Structure in Left Ventral Quadrant. Filled Structure coming across Pelvic Inlet
Non-Strangulating Large Intestine
Muscle Enzyme Described Below:
Not Muscle Specific
Tends to Increase More Slowly (Peak in 12-24 Hours)
Longer Half Life- Remains Elevated Longer (Can take 2 weeks to retrun to Normal Levels)
AST
Treatment for Hyperkalemic Periodic Paralysis (HYPP)
Breeding Managment- want to Eliminate Disease from Gene Pool
During Hyperkalemic Episode- Administer IV Calcium Gluconate and Dextrose Drip
Managment Changes- Dietary: Avoid High Potassium Feeds (Most Notably Alfalfa), Exercise Regularly, Avoid Fasting
*Dextrose Drip- Enhances Intracellular Movement of Potassium
Treatment for Horses with Valvular Endocarditis
Antimicrobials (IV Penicillin and Gentamycin)- Minimum of 4-6 Weeks (Risk of Relapse High if Discontinued too Early)
Antiinflammatories- Flunixin Meglumine and ASPIRIN (QOD)
*Mainstay of Therapy is Antimicrobial Treatment- IV Protocol with Penicillin and Gentamycin
*Very Important to use ASPIRIN- Decreases Platelet Aggregation and Minimizes the Growth of the Lesion. Aspirin is Given Once Every Other Day (QOD)
Disease also known as “Swamp Fever” that is a REPORTABLE Disease in Horses
Equine Infectious Anemia
Diagnosis based on this Endoscopy
Left Laryngeal Hemiplegia
*Whats on the Right of your image, is on the Left of your Horse
On Exam- Find anything with a straight edge and line it up with your image. Bisect the larynx going from the top of the larynx where the two aryetnoids join, straight down. You will Notice that one space is smaller than the other- tells you which side is effected (smaller space)
Term used to Describe “Noisy Breathing”
Stridor
*Audible Noise during Breathing
*Respiratory Noise may or may not be associated with Respiratory Distress
Non Invasive Treatments for Dorsal Displacement of Soft Palate (DDSP)
TSD- Throat Support Device (Cornell DDSP Collar): Holds Larynx in Place such that Displacement does not occur. Positions Larynx Rostral and Dorsally
Tongue Tie
Change Poll Flexion- If Horses are “Checked” or “Collected”, tell Owners to do it less and see if that Resolves the Problem
Treat Other Respiratory Conditions
*Before you Decide on Treatment, you need to make sure there are no Other Lower or Upper Respiratory Diseases. If you find Respiratory Disease, then Treat it prior to Treating DDSP
Etiology of Anemia caused by Increased Red Cell Destruction Described Below:
Clinical Signs: Hemolytic Anemia, Fever, Icterus
Clinically Recovered Horses Become Infected Asymptomatic Carriers where Stress may Precipitate Relapse
Soure of Infection: Primarily Tick Vectors (Dermacentor Nitans)
Babesiosis/Piroplasmosis
Most Common Pathologic Arrhythmia of the Horse
Atrial Fibrillation
*Irregularly Irregular”
*#1 Pathologic Arrhythmia in Horses
Three Recommendations for Horses that Test Positive for Equine Infectious Anemia on Coggins Test
Euthanasia (Most Recommended)
Donate to Apporved Research Facility
Permanent Quarantine- Isolate for LIFE
*If the Horse is Transferred of the Facility they must be Tattoed with an “A” on their Neck or Shoulder- Identifying them as an EIA Positive Animal
Clinical Signs of which Lower Respiratory Disease of Horses:
Fever (Febrile)
Respiratory Disease- Nasal Discharge
Anorexia/Weight Loss
Pectoral Edema
Pleuropneumonia
*Horse Following Long Distance Transport- Horse gets off and seems normal but within 24-48 Hours is ADR (Ain’t Doing Right), Two Major Differentials: Pleuropneumonia, or GI Disease
Diagnosis based on this Endoscopic View
Dorsally Displaced Soft Palate
*We do not see the edge of the Epiglottis, the Scalloped Edges or the Vasculature
Ask yourself this question on every one of these- If you follow the wall down to the floor is it one continuous Structure that is Obliterating your view of the Epiglottis? If Yes, then it must be DDSP
Predominant Cell Type found on BAL or TTW of Horse with Recurrent Airway Obstruction
Neutrophils (> 20% of Total Cell Count)
Normal Look for Electrocardiography (ECG) in an Equine Patient
Notched (Biphasic) P Wave
Negative QRS (Interventricular Septum Depolarization)
Large T Wave
Clinical Signs of which Lower Airway Disease in Horses:
Seasonal and Episodic Dyspnea- Mostly Fall and Winter when Housed in a Barn
CHRONIC COUGH
Flared Nostrils
Typically Afebrile (No Fever)
Heave Line- Hypertrophy of External Abdominal Oblique
Recurrent Airway Obstruction
*Seasonal- Housing in a Barn: Clinical Signs are Typically Associated with Confinement Housing, Feeding Hay, Bedding with Straw and Storage of Forages over Stalls
Classic RAO horse will have Dyspnea in Fall and Winter when it is Housed within a Barn
Aortic Insufficiency is typically an ______ Finding in Older Horses leading to Pathologic Murmur
Incidental
Clinical Signs associated with which Pathological Murmur:
Mild: Exercise Intolerance
Signs of Congestive Heart Failure- Sudden Death, Jugular Vein Distension, Respiratory Distress, Subcutaneous Edema
Spontaneous Rupture of Chordea Tendinae- Very Loud Honking Murmur
The Most Likely Valvular Dysfunction that will Lead to Heart Failure in Equine Patient!!
Dependent on Severity of Valvular Dysfunction and Horses Function (Competing, Riding, Back yard Horse)
Mitral Insufficiency
*Most Likely Valvular Dysfunction that will lead to Heart Failure in Horses!!!!- Mitral Insufficiency
*Severe Damage of Valves can Result in Spontaneous Rupture of Chordae Tendinae
Very Specific Genetically Based Diseases that predispose to Exertional Myopathy/Rhabdomyolysis
Polysaccharide Storage Myopathy (PSSM)- Quater Horses, Draft Horses
Recurrent Exertional Rhabdomyolysis (RER)- Thoroughbreds
*Underlying Genetic Defects that predisposes to the Development of Exertional Myopathies
Review Card: Reflux Expectations
Gastric Lesions: Small Volume, Acidic pH (6-7)
Small Intestinal Lesions: Large Volume, Alkaline pH ( > 7)
Examples:
Horse with a Large Colon Impaction. Nasal Gastric Tube placed which results in a Small Volume of Reflux of a 6.8 pH Fluid. How do we Reconcile this Reflux in view of the Lesion? Large Colon comes right behind the Stomach as it curves. As the Large Colon gets Distended it will compress the stomach in the Pyloric Area and Therefore create a Gastric Outflow Obstruction. Results in Small Volumes of Reflux that is compatible with Fluid coming from the Stomach
Strangulating Obstruction in the Mid Small Colon. The horse presents to you with Colic. You Place a NG Tube and get a Large Volume of Alkaline Reflux. How do we Reconcile that Reflux with that Location of Lesion? Bad lesions that have been there for a While the Horse may develop a Global/Generalized Ileus. Now the Ileus is affecting the Small intestine leading to the Fluid accumulation
Diagnosis based on this Endoscopic View
Inflammatory Airway Disease
*Mucopurulent Exudate (Mucous Trail) in Tracheobronchial Tree
Three Head Positions associated with Dorsal Displacement of Soft Palate (DDSP)
Collecting- Pulling Horse in
Holding Back
Checked (Standardbred Horses)
*Client will say: “He makes a Noise when I Collect him for the Jump”
*Check: Strap that hooks the Poll of the Head to the Withers. Prevents the Horse from Extending its head and Neck
Clinical Signs seen with Which Viral Respiratory Disease:
Cough
Abortions
Bleeding Problems
Periorbital Edema!!
Edema
Equine Viral Arteritis (EVA)
*EVA Horses will very Likely have EDEMA
*Respiratory Disease in a Horse and you Notice Periorbital Edema = Equine Viral Arteritis
Recommended Protocoal in DISTRESSED Horses with Severe Recurrent Airway Obstruction
Inhalant Bronchodilator
Systemic (Injectable) Steroids
*Inhalant Bronchodiltors with Injectable Steroids- Only used Protocol in Horses with Severe Recurrent Airway Obstruction (RAO)
Horse with Atrial Fibrillation, That Resolves on its own/Only Occurs during Racing. You have done a Physical Exam, which is Normal. You then assess the Heart Rate and the Heart Rate is Less than 60 bpm. You continue an evaluation and Perform and Echocardiogram. The Echocardiogram is Normal. With a Heart Rate
Quinidine
*Administer Quinidine to Correct its Arrhythmia. In a Horse with a Heart Rate
If HR
Diagnoses based on this ECG
Atrial Fibrillation
*Irregular Baseline associated with a irregular Contractions through the Atria- F Waves
*Baseline Fibrillation waves are called “F Waves” . F Waves can be Described as Coarse (Large) or Fine (Small)
Clinical Signs associated with which Condition in the Horse:
Exercise Intolerance: Due to Functional Obstruction (Temporary Suffication) at High Speed
Speed Slowed Dramatically during Racing- Quitting
Noise Generated by air turbulence in Inspiration and EXPIRATION
Choking Noise- Loud Gurgling or Fluttering Noise
Coughing when Eating
Puffing of Cheeks
Intermittent Dorsally Displaced Soft Palate
*Mostly Expiration Component
*Do we see a Noise at Rest in these Animals? NO!- You see nothing in these Horses at Rest
Puffing of Cheeks- Horses are Obligate Nasal Breathers so they should never have air going into or coming out of mouth- Soft Palate must not be in correct position
A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance
Which of the Following is Removed from your Differential List?
A. Epiglottic Entrapment
B. Laryngeal Hemiplegia
C. DDSP
D. Idiopathic Laryngeal Hemiplegia
Epiglottic Entrapment
*Epiglottic Entrapment- Not Dynamic. Disease will also be Present at Rest
*Nothing Abnormal about Endoscopy except some Pharyngitis
Genetic Rhabdomyolysis Described Below:
Autosomal Dominant- Glycogen Synthase 1 Gene Point Mutation
Increased Clearance of Glucose in Circulation
Accumulation of Glycogen and Abnormal Polysaccharides in Muscle Cells
Predisposition- Quaterhorses and Drafts
Polysaccharide Storage Myopathy (PSSM)
Risk Factors associated with which Lower Respiratory Disease in Horses:
1. LONG DISTANCE TRAVEL (> 2 Hours)
2. Exposure to Viral Respiratory Disease Pathogens
3. Eating while Trailering especially with Head Tied
Pleuropneumonia
*Reduced Pulmonary Defenses with Greater than 2 Hours of Transport. Results in Decreased Mucociliary Function and Decreased Phagocytic Ability of Macrophages
*Eating while Trailering- Chronic Aspiration of Feed Material leading to Abscessation. Pleuropneumonia occurs when these Abscesses Rupture
What is Pictured Below in this case of Guttural Pouch Empyema
Chondroids
*Desiccated, Inspissated Pus
Diagnosis based on this Endoscopic View
Epiglottic Entrapment
*Normal Epiglottis should have “tongue like” appearance with scalloped edges coming to a point
In this View, we do not see any vasculature or Scalloped Edges
Classify the Colic
Strangulating Small Intestine
*KNOW the Normal Values for TP, WBC, and RBC
Anemia of Chronic Disease, the Most common Cause of Anemia in the Horse, Primarily Results in _____ from Circulation into Storage Forms which become Unavailable for Erythropoiesis
Iron Sequestration
*Functional Iron Deficiency- Not Technically Deficient in Iron. The Animal has all the Iron it needs, its just not easily accessable
*Iron is Taken out of the Readily Available Pool and put into the Storage Pool- Leading to Functional Iron Deficiency
Which of the Following is False about Equine Infectious Anemia:
A. REPORTABLE
B. Negative Coggins Required for all Interstate or International Travel
C. Regulations Governing Foal and Young Horse Testing are Variable
D. Horses that are Found to be Positive: Euthanasia is Recommended
All of the Above are True
Two Treatments for Epiglottic Entrapment
Conservative- Can Correct Spontaneously through Stall Rested 1 week and local/topical Anti-Inflammatory Administration
Surgery- Transendoscopic Laser Correction (Preferred Method)
*Difference between DDSP and Epiglottic Entrapment- DDSP is Intermittent, while Epiglottic Entrapment is Continuous (It doesn’t come and go)
Clinical Signs of which Pathologic Arrhythmia in Horses:
Exercise Intolerance: Quitting at the 3/4 Post, Racing Poorly
Dependent on Underlying Cause: EIPH, Myopathy, Collapse, CHF
Atrial Fibrillation
*Common Presenting Complaint: Quitting at 3/4 Post
What Segments can be Palpated Normally on Transrectal Palpation?
Base of Cecum
Inguinal Rings
Bladder/Reproductive Segments
Pelvic Flexure
Spleen, Nephrosplenic Ligament
Caudal 1/3 of Left Kidney
Small Colon with Fecal Balls
*Cannot Palpate Small Intestine unless Abnormal (Distended)
*Do not Feel all Bands of each Banded Structure as you cannot easily palpate entire Circumfrence of GIT Segment
Type _____ Inflammatory Airway Disease (IAD) is Described Below on BAL:
Eosinophilic Inflammation: > 3% of Total Cell Count in BAL
Respond Best to Corticosteroids
Type 3 IAD
*Eosinophils- Underlying Cause most likely Parasitic
*Corticosteroids- Helpful Especially if Eosinophilic Inflammation
Treatment for Recurrent Airway Obstruction when NO Clinical Signs are seen
Preventative Therapy: keep OUTSIDE at all times
Soak Hay
*In Horses with “Summer Pasture associated RAO” caused by Molds Growing on Pastures, respond best to Stall Confinement. So In order to Treat these Horses you would keep them Indoors and Cut Feed
Two possible Causes of Respiratory DISTRESS (Dyspnea) in Horses with Strangles
Retropharyngeal Lymph Node Enlargement
Purpura of the Upper Airway (Pharyngeal Collapse)
*Retropharygneal Lymph Nodes are sitting on the Ventrum of the Guttural Pouch. If these Lymph Nodes Enlarge, they are going to End up Enlarging into the Nasalpharynx- Retropharyngeal Lymph Node Enlargement Results in Edema and Compression of Upper Airway (Nasopharynx)
In Horses with Retropharyngeal Lymph Node Enlargment, they Either Manifest as Respiratory Distress or Guttural Pouch Empyema. Infection of Retropharyngeal Lymph Nodes_- Can lead to Respiratory Distress and Rutpure of Lymph Nodes into Guttural Pouch = Guttural Pouch Empyema_
Purpura Hemorrhagica- Immune Mediated Vasculitis. These Horses can Develop a Purpura that is Limited to the Upper Airway leading to Pharyngeal Collapse
Signalment and History associated with which Valvular Dysfunction:
Age- Most Common in OLDER Horses
Often Incidental FInding on Clinical Exam- Usually Asymptomatic
Diastolic Mumur
Aortic Insufficiency
*Aortic Insufficiency is Classically and Incidental Finding seen in an Older Horse
Treatment for Guttural Pouch Empyema
Antimicrobials- usually Penicillin
Repeated Guttural Pouch Flushing with Endoscopic Reevaluation- with Saline or LRS
Surgery- Necessary if Chondroids
*Without Direct Treatment of Pouch- Usually results in Relapse. Must Flush Guttural Pouch
*Retention Catheter- Used for Daily/Repeated Flushing
Type _____ Inflammatory Airway Disease (IAD) is Described Below on BAL:
5-20% Neutrophils
Respond BEST to Alpha-Interferon
Type 1 IAD
*Normally you should have Less than 5% Neutrophils in a BAL
*Type I Inflammatory Airway Disease- These are the Cases where the Horses are More likely to Present with a Cough. Cough is More Associated with Type 1 IAD, than with the Other Types
Alpha Interferon- Antiviral Immunomodulator- Given Orally as 5 Day Therapy
Treatment for Long Term Managment of Exertional Myopathies/Rhabdomyolysis
Dietary Managment:
Low Carbohydrate Diet, HIGH FAT Diet (RICE BRAN)
*This Amount of Fat is 2.5-3 times the Typical Horses Diet
*3-6 Months of New Diet necessary for Adequate control of Muscle Injury
Etiology of which Airway Disease leading to Cough:
Irritants of the Airway combine to Result in the Initiation, Exacerbation and or Propagation of Airway Inflammation
Inflammatory Airway Disease (IAD)
*Hypersensitivity of the Airway
Belgians (Draft), Ponies and Percherons (Draft)
*Drafts and Ponies- Less Pain Sensitive/Expressive
*In General some consider Arabians more Pain Sensitive/Expressive
Horse with Atrial Fibrillation, That Resolves on its own/Only Occurs during Racing. You have done a Physical Exam, which is Normal. You then assess the Heart Rate and the Heart Rate is Greater than 60 bpm. You continue an evaluation and Perform and Echocardiogram. The Echocardiogram is Normal. With a Heart Rate > 60 bpm and a Normal Echocardiogram. What is the Treatment in this Animal?
Administer Digoxin First
Then Quinidine
*Quinidine is Tachyarrythmogenic: You must Slow Heart Rate Down first with Digoxin prior to Administering Quinidine, or else the Horse will be at Risk of Developing Life Threatening Arrhythmias
Number One Complication in Rhabdomyolysis/Exertional Myopathy Horse
Acute Renal Failure
Most Important Diagnostic Technique used for Inflammatory Airway Disease (IAD)
BAL (Bronchoalveolar Lavage)
*Reveals the Specific Cell Type and Cell Counts- Helps Determine the Appropriate Therapy
Injections given to Horses that Results in Significant Non-Regenerative Anemia
Erythropoeitin Injections
*Leads to Development of Antibodies with Cross React with Horses own Erythropoietin thus leading to Life-Threatening Anemias
What is the Likely Diagnosis for the Noise Heard in this Mare?
Epiglottic Entrapment
*Main Differentials should be: Epiglottic Entrapment and DDSP
*Based on the Noise we should be Eliminating Laryngeal Hemiplegia- Would have Inspiratory Noise ONLY
*Since it Stated there was an Inspiratory and Expiratory Noise, without saying the Expiratory Phase was more Prominent, it leaves us more to assume it is Epiglottic Entrapment
While the Stridor is Intermittent, that does not mean the Disease is Intermittent
Genetic Rhabdomyolysis Described Below:
Inherited Disorder in 5% Thoroughbreds
Common Age: 2-4 Years Old
Young Fillies with Nervous Temperaments Particularly Prone
Heritable Stress- Related Defect in Intracellular Calcium Regulation!!!!
Recurrent Exertional Rhabdomyolysis (RER)
Clinical Signs of which Upper Respiratory Disease in Horses:
Acute Onset
Fever/Lethargy/Cough
Nasal Discharge- Yellow/Green and Purulent
Swelling and Draining of Submandibular Lymph Nodes
Infection of Retropharyngeal Lymph Nodes- Respiratory Distress
Usually Young Horses- Considered “Childhood” Disease
Strangles
High Morbidity Rate (100%)
Low Mortality Rate (2%)
Recommendations for Permanent Quarantine in a Horse Positive for Equine Infectious Anemia (EIA)
Barn- Double Screening, Insect (Vector) Control
Kept a Minimum of 200 yards (Meters) from Closest Horse
Disinfect all Instruments used on Affected Horses
Review of Treatment for Atrial Fibrillation based on Heart Rate:
Two Agents that Cause Guttural Pouch Empyema
Steptococcus Equi Var Zooepidemicus (Most Common)
Streptococcus Equi Var Equi (Very Infectious)
*Strep. Zooepidemicus is part of the Normal Flora of the Equine Skin and Respiratory Tract- Opportunistic Organism. Becomes Pathogenic in the face of Compromise
Strep. Equi- Causative Agent of Strangles
*Guttural Pouch Empyema is often a Sequelae to Streptococcus Equi Infections- STRANGLES
A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance
What is your Diagnosis?
Epiglottic Entrapment
Which Grade of Laryngeal Hemiplegia requires a Treadmill for its complete Evaluation?
Grade III
*If you take Two Grade III Horses and put them on a Treadmill, the Degree of Abduction can be completely Different. Use a Treadmill to Evaluate Degree of Incomplete Abduction
Treatment for Viral Respiratory Diseases (EHV, EVA, and Equine Influenza)
Do Not Treat!!
Rest- General Rule: 1 Week of Rest for Every day Horse is Febrile (Ex. Febrile 3 Days = 3 weeks of Rest)
Decrease Respiratory Stress and Challenge- Improve Ventilation and Decrease Dust Inhalation
NSAIDs- Only Indicated if Temperature is VERY Elevated (104-104.5): Flunixin Meglumine
Antibiotics- ONLY if Secondary Bacterial Infection
Review Card: Comparison of Anemia of Chronic Disease (AKA Functional Iron Deficiency) versus True Iron Deficiency
*True Iron Deficiency- Total Body Reduction in Iron
Anemia of Chronic Disease (Functional Iron Deficiency)- Not Technically Deficient in Iron. The Animal has all the Iron it needs, its just not easily accessable
True Iron Deficiency:
Decreases in Marrow Stores and Serum Iron
Increased Total Iron Binding Capacity (TIBC) = Capacity to Bind more Iron (Body wants to Pull in more Iron)
Anemia of Chronic Disease:
Decreased Total Iron Binding Capacity (TIBC)
Increased Serum Ferritin and Marrow Iron Stores- Iron Sequestration
Typical Abdominocentesis Findings for _____ Colic:
Non Strangulating
*Should basically have No Changes with Non Strangulating Lesions. However, if it has been going on for a while or Worsening: First you would have Increase in Protein, then an Increase in WBC, then Increase in RBC
True/False: We can Completely Eradicate Babesia Caballi with Treatment for Babesiosis
True
*We can Completely Eradicate the Babesia Caballi Organism
*You can Completely Clear Babesia Caballi, but You CANNOT Completely Clear Theleria Equi
What would you expect to hear on Auscultation of a Horse with Pleuropneumonia
Absence of Lung Sounds Ventrally
Clear Lung Sounds Audible Dorsally
Louder Cardiac Auscultation that Radiates
What will you hear on Auscultation in a Horse with Recurrent Airway Obstruction
Early Mild Cases: End-Expiratory Wheeze
Severe Cases: Expiratory Wheezes
*Expiratory Wheezes- High Pitched Musical Sounds associated with Narrow Airways
*Where are we Hearing these Abnormal Sounds on Expiration? Throughout the Entire Lung field because RAO is a Diffuse Disease
You are Presented with a 6-yr-old Holsteiner Jumper Mare for the generation of a Noise in the show Ring
How would you treat this Horse?
Ventriculochordectomy
*Idiopathic Laryngeal Hemiplegia
*The Problem the Horse is being Presented for is the NOISE. This Horse is NOT being presented for an exercise Intolerance
