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Equine II > Lower respiratory tract diseases > Flashcards

Lower respiratory tract diseases Flashcards

1
Q

Clinical examination of lower respiratory tract

A

Rebreathing exam
- cover horses nose with bin bag to increase effort
- improves sensitivity of auscultation

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2
Q

Haematology/biochemistry for lower respiratory tract

A

Useful for pneumonia but not asthma

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3
Q

Blood gases for lower respiratory tract diseases

A

Have to be run within a few minutes of obtaining a sample

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4
Q

Endoscopy for lower respiratory tract diseases

A

Mucus grading

Visualisation of airway

Collection of samples

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5
Q

Lower respiratory samples collected by endoscopy

A

Guided BAL (cytology)

Transtracheal wash (cytology)

Triple lumen tracheal washes (culture)

Transtracheal wash

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6
Q

Guided BAL

A

For cytology, samples one region of lung (diffuse disease)

Sedate with opioid to suppress cough - butorphanol or morphine

Long flexible tube passed blindly up ventral meatus

Approx. 250-300ml saline instilled

Aspirate sample
® Discard first syringe

Good sample should be foamy

EDTA tube to submit

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7
Q

Tracheal wash

A

For cytology, samples everything washed up into trachea (all of lung)

Via endoscope

Using triple lumen catheter if for culture
® Can be used for cytology, but BAL more reliable

Instil 20-30ml sterile saline

Plain (culture) and EDTA (cytology) for submission

Some bacteria v. likely to be contaminants
E.g. Pseudomonas, S. aureus, Bacillus…

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8
Q

Transtracheal wash

A

Performed transcutaneously, aseptically

Samples everything washed up into trachea (all of lung)

Best for culture

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9
Q

Ultrasound for lower respiratory tract

A

Useful for pleural surface

Consolidation, abscesses

Pleural effusions

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10
Q

Radiography for lower respiratory tract

A

Useful for the rest of the parenchym

Less easy than ultrasound

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11
Q

Equine asthma

A

(Formerly known as heaves, COPD, RAO, SPARAO, IAD…)

RAO – recurrent airway obstruction
○ Severe asthma

IAD – inflammatory airway disease
○ Mild/moderate asthma

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12
Q

Pathogenesis of equine asthma

A

Not well defined

Lower respiratory tract inflammation, obstruction, hyperresponsiveness

Phenotype differs according to cell type
§ TH-1 or Th-2 driven -> different cell type dominates

Airway remodelling (esp. severe/RAO)
§ Mild-moderate/IAD seem to recover

Mild (IAD) and moderate to severe (RAO) aren’t necessarily a continuum

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13
Q

Presentation of RAO/severe asthma

A

> 7 years old

Coughing

Increased respiratory effort at rest

Life long management, not cured

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14
Q

Presentation of IAD/mild-moderate asthma

A

Any age (usually young to middle aged)

No signs at rest

Occasional cough/exercise intolerance

Seem to resolve

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15
Q

Diagnosis of IAD/mild-moderate asthma

A

BAL

increase in neutrophils most common +/- mast cells (triggered by exercise), eosinophils

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16
Q

Diagnosis of RAO/severe asthma

A

More marked increase in non-septic neutrophilia

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17
Q

Environmental management for equine asthma

A

Low dust

Damp all feed

Feed from ground

Turn out as much as possible

Turn out during mucking out

Ventilation

No straw/dusty bedding
□ Use dust extracted hay

Not near muck heap/neighbours with dusty bedding

Leaf blowers really bad for the horses but makes clearing the yard really easy so owners don’t want to get rid of them

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18
Q

Exercise induced pulmonary haemorrhage (EIPH)

A

Common in horses undergoing strenuous exercise (race horses, elite event horses)

Rupture of pulmonary capillaries during high intravascular and low airway pressures
○ Pulmonary capillary walls +++ thin

If severe may affect performance
○ But many horses perform well with EIPH

Worse if working in colder weather

+/- epistaxis

19
Q

Diagnosis of EIPH

A

Endoscopy 30-120 min after exercise (usually for a fading horse)
§ 0 – 4 grading system for blood in airway
§ Subjective
§ May change from one observation to the next for single animal

BAL haemosiderophages
§ Macrophages that have digested historic bleeding
§ Overestimates prevalence, normal/common finding
§ Persist for weeks/months

20
Q

Management of EIPH

A

Nasal diltor (flair) strips
- low quiality/conflicting evidence

Furosemide only preventative meication with good evidence
- cannot compete on furosemide

21
Q

Interstitial pneumonia

A

Parenchymal disease

22
Q

Bronchopneumonia

A

Parenchhyma + bronchi

23
Q

Pleuropneumonia

A

Parenchyma + bronchi + extension to pleural space

24
Q

Bacterial pneumonia

A

Commonly opportunistic infection involving bacteria from naso/oropharynx

Muco-cilliary escalator is not good enough to work when the horses head is up all the time

25
Q

Risk factors for bacterial pneumonia

A

Long distance transport without letting head down/breaks

Cross tying

Concurrent respiratory tract disease

Aspiration

26
Q

Signs of bacterial pneumonia

A

Tachypnoea/respiratory distress

Weight loss

Pyrexia

Lethargy

Cough

Nasal discharge
□ Mucopurulent, haemorrhagic (necrosis)

Pleurodynia

27
Q

Diagnosis of bacterial pneumonia

A

Clinical exam

Haematology/biochemistry

Thoracic ultrasound

Radiography

Bacteriology

28
Q

Haematology/biochemistry for bacterial pneumonia

A

Leukocytes (+/- left shift), increased acute phase proteins… anaemia

29
Q

Thoracic ultrasound of bacterial pneumonia

A

Consolidation, pleural effusion

Fibrinous effusion - true pleuropneumonia

30
Q

Radiography of bacterial pneumonia

A

Broncho-interstitial pattern,

alveolar pattern,

abscesses,

effusion

31
Q

Bacteriology for bacterial pneumonia

A

Culture and sensitivity
- Transtracheal wash/triple lumen catheter sample
- Tracheal samples vs pleural fluid

Mixed growth common
- S. qui zooepidemicus
- Empirical antimicrobial selection needs to cover +/-/anaerobes
- Don’t delay treatment initiation to wait for bacteriology

32
Q

Treatment of bacterial pneumonia

A

Appropriate antimicrobial selection
□ Penicillin, gentamycin, and something to treat the anaerobes

Consider draining effusions/rtPA use for fibrinous effusions
□ Antimicrobial efficacy improved

Some may require surgical intervention
□ Thoracotomy

33
Q

Complications of bacterial pneumonia

A

Abscessation

Bronchopleural fistulae

Pericarditis

Cranial thoracic masses

Thrombophlebitis

Laminitis

34
Q

Prognosis of bacterial pneumonia

A

Dependent on severity

Worse with anaerobic bacteria

35
Q

Fungal pneumonia

A

Rare in UK

Either primary respiratory pathogen species
§ Histoplasma, Coccidiodes, Cryptococcus etc.

Or secondary to immunocompromise
§ Aspergillus, Candida etc.

36
Q

Treatment of fungal pneumonia

A

Challenging and very expensive

Azoles generally best

37
Q

Prognosis of fungal pneumonia

A

Variable but often poor

38
Q

Parasitic pneumonia

A

Dictyocaulus arnfieldi (adult)
§ Faecal flotation

P. equorum (migrating larvae)
§ Not producing eggs yet

Exercise intolerance, coughing, nasal discharge, (fever)

Neutrophilic/eosinophilic tracheal wash

Bronchointerstitial pattern on radiography

39
Q

Pathogenesis of interstitial pneumonia

A

Acute parenchymal changes and alveolar disease

Ventilation-perfusion changes due to loss of surface area

Reduced lung compliance and progressive fibrosis

40
Q

Signs of interstitial pneumonia

A

Exercise intolerance

Increased effort at rest

Pulmonary hypertension/cor pulmonale

41
Q

Causes of interstitial pneumonia

A

Not always clear, often not identified

Infectious
□ Viral (EHV-1,4/2,5, influenza, EVA etc.)
□ Secondary bacterial pathogens?

Toxins (none common in UK)

Smoke inhalation
□ Barn fires

Oxygen toxicity
□ Ventilation with FIO2 >50%, ventilation injuries

42
Q

Equine multinodar pulmonary fibrosis (EMPF)

A

Interstitial fibrosis and inflammatory infiltrate

EHV-5 associated with disease
□ Unclear exact aetiopathogenesis
□ Also EHV-2?

Don’t respond well to bronchodilators
□ C.f. asthmatics

Radiographs: large discrete, or multiple smaller coalescing opactities

Poor prognosis for survival (14% survive 6mo after discharge)
Often severe at time of diagnosis

43
Q

Diagnosis of interstitial pneumonia

A

Rule out asthma

Rule out bacterial pneumonia

Radiography helpful, especially EMPF

Biopsy only definitive diagnosis

Steroids

44
Q

Pneumothorax

A

Bronchopleural fistulae
○ Secondary to pneumonia

Penetrating thoracic injuries
○ Clingfilm!

Other
○ e.g. oesophageal perforations etc.

Might be well tolerated if unilateral

Drain

Equine II (28 decks)

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