Medical aspect of upper airway disease Flashcards
Physical examination of the upper airway
check the respiratory rate: 8-12
effort to breath? is there any?
examine the horse at different angles, at rest and during exercise
Definition of rhinitis?
infection of the nasal passage, independent of the sinuses
What can cause rhinitis (generally)
a variety of virus, bacteria, fungal and parasitic agents
Viral agents causing rhinits
Equine influenza
Equine herpesvirus 1-4
Equine rhinovirus and adenoviruses
Bacterias causing rhinitis
uncommon
can be secondary to trauma (locus minoris)
Fungi causing rhinitis
aspergillus spp
condidobolus
cryptococcus
Parasites that can cause rhinitis
Habronema (muscae)
Draschia (mega)
What diagnostic measures can be used to diagnose rhinitis?
physical exam
endoscopy: sampling for culture, PCR
radiography
treatment: systemic or local
Different sinusitis
primary and secondary
Causative agents of primary sinusitis?
bacterial and fungal
Causative agents of secondary sinusitis?
Dental disease (molar teeth)
Sinus cysts
Neoplasia
PEH - progressive ethmoid hematoma
Trauma
sinonasal polyps
How is the nasal discharge when there is a rhinits?
usually unilateral discharge
it an be mucopurulent/serosanguineus with a fetid (bad) odor
General clinical signs of rhinits?
facial swelling
respiratory noise
head shaking
unilateral nasal discharge
Is there a secific sign shown when the rhinits is involving the frontal/maxillary sinuses?
lacrimal and exopthalmus
Diagnosis of rhinits, steps (alternatives)
- history
- percussion
- oral examinaion
- endoscopy/sinus scopy
- radiography
- CT
- MRI
What are the most common bacteria causing rhinits?
streptococcus, staphylococcus, polymicrobial infections
What treatments are used agains rhinits?
antibiotics - if bacterial
debridement
flushing
Methods of debridement in rhinits?
trephination (make a hole into bone)
sinus flap - drilling to get room for ndoscope/flushing
drainage
Diseass of the guttural pouch
Mycosis
empyema
Where is the fungal plaque of the guttural pouch?
it is typically located in the dorsal aspect of the medial compartment
What are the dangers of fungal plaque in the medial compartment of the guttural pouch
within the medial compartment of the guttural pouch lies a nervovasular bundle: 3 cranial nerves and arteries
if the arteris are affected they can rupture and give a nasty bleed
What are the most frequent fungi infecting the guttural pouch
aspergillus spp
mucor
fusarium
trichosporon
Clinical signs of guttural pouch mycosis
epistaxis - nosebleed
dysphagia
recurrent laryngeal neuropathy
nasal discharge
coughing
horners syndrome
fungal encephalitis
Different treatments for mycosis of guttural pouch
Medical
Lavage
Local antimycotic treatment
supportive treatment
systemic antimycotic treatment
supportive therapy
How is lavage performed on guttural mycosis?
with sterile infusion solutions
What are the local antimycotic treatment of guttural mycosis?
nystatin
enilconazole
ketokonazol
thiabendazole
natamycin
Supportive treatment to guttural mycosis
NSAID
Vitamin B1, C, E, selenium
nutritonal support because of their dysphagia
potassium iodine
ethylene diamine
immunomodulants: levamisole (cheap anthelminitc), zylexis
DMSO
Which drugs can be used systemically to treat mycosis of guttural pouch?
Ampetricin-B
Itrakonazol
Flukonazol
Voriconazole - very good
What can cause guttural pouch empyema?
bacterial infection of the pouch
ruptured retropharyngeal abscesses
stenosis of GP opening - impaired drainage
inspissanted purulent material forming chondrosis
which bacteria often cuases empyema of guttural pouch?
streptococcus equi - strangels of horses
what can cause stenosis of the GP?
neoplastic grwth
fluid accumulation
Clinical signs of GP empyema
intermittent chronic discharge
submandibular lymphadenopathy
parotis enlargement
increased respiratory noise
neuropathy/dysphagy are uncommon
how can empyema of GP be diagnosed?
endoscopy
radiography: fluid lines
ultrasound: abscesses
How is a bacterial GP empyema handled/treated?
it is highly contagious so there need to be strict biosecurity protocols
removal of exudate, fluishing iwth saline
sedating the horse to achieve a low head position
local AB - penicillin mixed with gelatin catheter or endoscope
How are chondroid removed from GP in case of empyseam
endoscopy (surgery)
Define pharyngeal lymphoid hyperplasia
common in younger horses, but in older: chronic inflammtion of the pharyngeal lymphoid tissue
What are some causative agents of pharyngeal lymphoid hyperplasia?
Viral: EHV 1-2-4, influenza
Bacteria: streptococcus
How is Pharyngeal lympoid hyperplasia diagnosed
endoscopy and graded from 1-4
Clinical signs of Pharyngeal lympoid hyperplasia
nasal discharge
enlarged lymhnodes
coughing
poor performance
Treatment of Pharyngeal lympoid hyperplasia
mild:reduce training
antiinfammtory treatment: dexamethasone, throath spray iwth nitrofurazone, dexamethasone, DMSO
systemic immunomodulators: interferon alpha
Causative agent of strangles of horses
streptococcus equi spp equi
Whate age groups does strangles usually affect?
younger horses 1-5y
morbidity and mortality of starngles?
morbidity: 100%
mortality: 10%
For how long is the virus of strangels shedded?
4-6w
how long is the incubation period for strangels?
2-12d
clinical signs of strangles?
fever, lethargy
serous to mucopurulent nasal discharge
hyperaemic nasal/ocular mucous mmbranes
mucopurulent ocular dicharge
firm then fluctuant lymph nodes
sowllen/painful throatlatch - stands with a stretched neck
refuse to eat
Diagnosis of strangles?
clinical sign
bacterial cultur and PCR
Treatemtn for strangels?
supportive care
soft palatable feed
NSAID: fluxin, bute
antibiotics after consideratoin
How is AB considered for strangels case with no abscess formation?
early clinical signs, but no abscess formation - penicillin for 5 days - should be isolated
how should horses with strangles that get abscess oframtion be treated with AB?
is they are stable: it is contraindicated,
horses that are systemically ill or have complications from strangles - how should they be treated?
supportive care, IV penicillin, broad spectrum antibiotics
What are some complications that can occur from strangels?
abscess formation in the mesentery/organs
purpura hemorrhagica
GP empyema/chondroid
septicaemia/septic arthritis
pneumonia
DNS disease
infarctive purpura hemorrhagica
immune mediated myositis
What is purpura hemorrhagica?
leakage from the vessels, forming red spots on membranes and skin. edema of limbs
General clinical signs of inflammatory airway diseases (IAD)
- general?
secretions?
auscultation?
respiratory rate?
abdomnial breathing?
often subclinical
poor performance
chronic cough
increased airway secretion: mucous, muco-purulent nasal discharge
thoracic auscultation often noral
slighlt ucreased resp rate
abdomnial breathing increased
What can be the cause if there is tracheal secretion at rest?
lower airway inflammation
What causes horses with IAD to have poor performance(findings?
airway mucus
impaired gas exchange: hypoxaemia
BALF neutrofilia
How would you check if the horse has IAD?
history and clinical signs
endoscopy
BALF cytology
throacic ultrasonography
Thoracic radiography
lung function test
respiratory endoscopy after work
what is tracheal mucus scoring?
quantifying mucus accumulation
grading:
- 2-5: poor performance in race horses
- 3-5: poor performance in sport horses
What is expected to find when performin BALF cytology in IAD case?
elevated nucleated cell count
mild neutrophilia, lymphocytosis and monocytosis
eosinophilia
mastocytosis
abnormal BALF - poor performance
What is tracheal wash? and how is it as a diagnostic tool for IAD?
Collection of tracheal respiratory secretions for cytology and bacteriology using a fiberoptic endoscope or videoendoscope and collection catheter, to aid in the investigation of pulmonary disease.
not suitable to diagnose IAD
How will a thoracic ultrasound look like in a ultrasound?
normal or comet tail artefacts (marked acoustic mismatch between small fluid-filled lung spaces and surrounding air.)
How ill IAD look on the radiography
bronchial pattern
poor sensitivity
What are the differential diagnosis of of IAD?
RAO
Upper airway disease
pleuropneumonia
viral infection
EIPH
Neoplasia
Lungworm infestation
What is a simple treatment to fight IAD?
environmental management
change to shavings instead of hay
proper ventilation of the stable
What medical treatment can be applied to treat IAD
Antibiotics
glucocorticoids
sodium-chromoglycate
interferon-alpha
bronchodilators
omega-3 FA
When is glucocortiocids given in IAD case?
if infectious cause could be ruled out
how long is usually the treatment of IAD?
2-4w
what are the names of inhalational GGC?
fluticasone
beclomethasone
Systemic GGC given to trat IAD
prednisolone
dexamethsone
name a mast cell stabilizer given to treat IAD
sodium chromoglycate
how is interferon alpha used in IAD case, what is its properties
one week rest treatment for 5 days
anti inflammatory properties
Clenbuterol, salbutamol and salmeterol are?
B2 adrenergic agonists
