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Resp and Thoracic sx (LA) Flashcards

1
Q

Upper airway function

(nostrils to trachea)

A
  • conduit for airflow
  • olfaction
  • phonation
  • thermoregulation
  • filters and conditions air
  • protects lower airway
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2
Q

Lower airway function

(bronchi to alveoli and pulmonary tissue)

A
  • Gas exchange
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3
Q

normal function UA

A
  • horses obligate nasal breather
  • Inspiration: negative pressure
  • Expiration: positive pressure
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4
Q

UA primary sources of resistance to airflow

A
  • nasal valve
  • rostral nasopharynx and larynx
  • Oral cavity tremendous resistance
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5
Q

Resistance

A
  • proportional to inverse radius4
    • a very small change in radius dramatically increases resistance
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6
Q

Increased resistance

A
  • decreased ventilation
  • increased noise
  • poor performance
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7
Q

Diagnostics

A
  • Signalment and history
  • performance level and intended use
  • Occurence of clinical signs
    • rest/exercise
    • freq
    • progression
  • presenting complaints
    • noise and poor performance
    • nasal d/c
    • cough/dysphagia/halitosis
    • anatomic distortions
    • fever, inappetance, weight loss
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8
Q

Physical exam

A
  • General PE
  • Observe
    • symmetry
    • discharges
    • airflow from each nostril
  • palpate
    • larynx
    • jugular furrow
  • Percuss sinuses
  • auscult
    • heart and lungs
  • +/- oral exam
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9
Q

Endoscopy

A
  • resting
    • epiglottis
    • aretynoid cartilages
    • vocal fold
    • pharynx
    • soft palate (bottom)
    • Guttural pouch
  • when pulling out observe
    • nasal passage
    • ethmoid turbinates
    • drainage angle (nasal maxillary aperture)
  • Then go in other nostril
  • Look at trachea last
    • feed mat (dysphagia)
    • discharges
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10
Q

Exercising endoscopy

A
  • looks for functioning abnormalities
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11
Q

Other endoscopies

A
  • oral endoscopy
  • sinoscopy
    • minor surgical procedures
    • frontal sinus scopable
    • maxillary sinuses not scopable (tooth roots take up space
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12
Q

Radiography

A
  • Anatomy
    • paranasal sinuses
    • dental arcades
    • guttural pouches
    • pharynx
    • larynx
    • trachea
  • fluid lines
  • magnification
  • contrast
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13
Q

Ultrasonography

A
  • Laryngeal ultrasound
    • abnormal anatomy
      • congenital
      • distortion due to disease
    • muscle atrophy
  • bone limits other locations
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14
Q

On ultrasound atretic muscles are

A

hyperechoic

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15
Q

Cross-sectional imaging

A
  • No superimposition
  • Computed Tomography
    • method of choice for
      • dental arcades
      • paranasal sinus dz
      • +/- contrast
      • preop planning
  • MRI (take a long time)
    • soft tissue detail
      • masses
    • contrast
    • flow artifact
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16
Q

Other diagnostics

A
  • nuclear scintigraphy
  • clinical pathology (CBC/Chem)
  • Microbial culture and sensitivity
  • Bronchoalveolar lavage
  • Histopath
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17
Q

Nasal passage Anatomy

A
  • Nares
    • alar cartilage
      • alar fold
    • nasal diverticulum
  • Nasal Cavity
    • nasal septum
    • dorsal and ventral concha
    • dorsal, middle, ventral meatus
    • Nasomaxillary apperture
    • ethmoid turbinates
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18
Q

Nasal Passage diseases

A
  • Epidermal inclusion cyst (atheroma)
    • in nasal diverticulum, good prog
  • Redundant alar fold
  • Nasal lacerations
  • Nasal septal disease (uncommon)
    • thickening of nasal septum
  • Engorgement of nasal mucosa
    • Horner syndrome: pooling of blood and obstruction
  • Wry nose
    • deviation of maxilla in lateral plane
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19
Q

Paranasal Sinuses

A
  • Drain by either
    • middle meatus
    • nasomaxillary opening apperature
  • size and shape change with age
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20
Q

Paranasal sinus dz

A
  • Primary: strep
  • Secondary: dental dz
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21
Q

DX of paranasal sinusitis

A
  • HX and PE
    • primary sinusitis doesn’t stink, secondary does
  • Endoscopy
    • drainage from middle meatus
  • Rads
    • fluid lines
    • space occupying lesion
  • CT
  • Sinocentesis
    • culture and sensitivity
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22
Q

Sinusitis treatment

A
  • Primary
    • irrigation (trephine)
    • Abx
    • +/- debridement
  • Secondary
    • address cause
    • then treat as primary sinusitis
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23
Q

Landmarks for trephination of frontal sinus

A
  • Frontal sinus
    • draw a line from midline to medial canthus
    • 60% of distance from midline along this line, and 0.5cm caudal to the line
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24
Q

Paranasal sinus cyst

A
  • fluid filled masses
  • facial deformation
    • inspiratory airway obstruction
    • secondary sinusitus possible
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25
Q

DX, TX paranasal sinus cyst

A
  • DX
    • radiographs
  • TX
    • surgical debridement
  • PX
    • excellent, unless deformation of nasal cavity
26
Q

Sinus neoplasia

A
  • SCC most common
  • facial deformation
  • older horse
27
Q

Sinus neoplasia

DX, TX, PX

A
  • DX
    • rads
    • biopsy
    • CT, MRI
  • TX
    • surgical debridement
    • radiation
    • chemo
  • PX
    • usually poor unless benign
28
Q

Progressive ethmoid hematoma

A
  • mass arising from ethoids or sius
  • mild intermittent epistaxis
    • unilateral > bilateral
  • rarely any facial deformation/airway obstruction
29
Q

Progressive Ethmoid Hematoma

DX, TX, PX

A
  • DX
    • endoscopy
    • rads
    • +/- CT
  • TX
    • intralesional formalin
    • Laser photoablation
    • Surgical removal (sinus)
  • PX
    • good
    • recurrence possible
30
Q

Trauma

A
  • open vs closed
  • depression fx
    • assume it’s open into sinus cavity
  • epistaxis
  • emphysema
  • dyspnea
  • CNS signs
31
Q

Trauma

DXs

A
  • Radiographs
  • CT
    • helpful for repair
  • endoscopy
    • evaluate patency of airway
32
Q

Trauma

TX

A
  • Stabilize patient
  • abx
  • Analgesia
  • wound therapy
  • sinus lavage
    • to remove blood clots
  • surgical repair
33
Q

Trauma

PX

A
  • good
    • face has good blood supply
  • dependant on other concurrent prob
34
Q

Pharynx

Anatomy

A
  • Pharyngeal walls
  • dorsal pharyngeal recess
  • soft palate
  • no rigid support
    • susceptible to negative pressure
35
Q

Pharynx

Lymphoid hyperplasia

A
  • bumps in pharynx
  • young horses
  • immune stimulation
  • usually no clinical signs
36
Q

Lymphoid hyperplasia

DX, TX

A
  • DX
    • incidental finding of bumps on endoscopy
  • TX
    • rarely needed
    • rest and antiinflammatories (not really needed tho)
37
Q

Pharynx

Dorsal Displacement of the soft palate

A
  • Intermittent > persisten
  • intermittent: dynamic lesion
  • persistent
    • neuro cause?
  • one lesion that causes noise on expiration
38
Q

DDSP

DX

A
  • Resting endoscopy
  • exercising endoscopy
  • +/- rads
  • +/- ultrasound
39
Q

DDSP

TX

A
  • Conservative
    • tongue tie
    • figure 8 noseband
  • SX
    • Laryngeal tie-forward
      • gold standard
      • 80-9-% success
    • ST myectomy
    • ST tenectomy
    • Staphlectomy
    • Palatoplasty

* 60% success for other procedures

40
Q

The Larynx

Anatomy

A
  • Epiglottis
  • Arytenoid cartilage
    • corniculate process
    • muscular process
  • Thyroid cartilage
  • Cricoid cartilage
  • Cricoarytenoideus dorsalis
41
Q

Recurrent laryngeal neuropathy

(roarers, laryngeal hemiplasia)

A
  • demyelination and axonopathy of RLN
  • Paresis to paralysis of intrinsic laryngeal muscles
    • CAD - ONLY ABDUCTOR
  • Inspiratory obstruction and noise at exercise
  • Mostly left side
  • large horses
    • TB, draft
42
Q

Recurrent laryngeal neuropathy

DX

A
  • Laryngeal palpation
    • prominent Muscular Process
      • muscle atrophy
  • Resting endoscopy is dx
    • grading: 1 (normal) - 4 (complete paralysis)
  • Laryngeal U/S
  • +/- exercising endoscopy if not verified by other dxstics
43
Q

Recurrent laryngeal neuropathy

TX

A
  • TX
    • prosthetic laryngoplasty (tie-back)
    • partial arytenoidectomy
      • last resort
    • Neuromuscular pedicle graft
      • takes like a year
    • ventriculectomy, vocalcordectomy, ventriculocordectomy (usually done at same time as tie-back)
44
Q

Recurrent laryngeal neuropathy

PX

A
  • Tie-back
    • racehorses: 50-70% improved performance
    • performance horse: 85-95% improved performance
45
Q

Guttural pouch

Anatomy

A
  • Paired extension of Eustachian tubes
  • Stylohyoid bone
    • medial and lateral compartments
46
Q

Guttural pouch

Lateral compartment

A
  • smaller
  • structures
    • external carotic
    • maxillary a.
    • facial n.
47
Q

Guttural Pouch

Medial compartment

A
  • Larger
  • structures
    • internal carotic a.
    • cranial cervical ganglion
    • sympathetic trunk
    • CN IX, X, XI, XII, pharyngeal branch of X
    • ventral straight muscles
48
Q

Guttural Pouch mycosis

about

A
  • rare but life threatening
  • focal funcal infection with predilection for
    • arteries - ICA, ECA, MA
    • nerves - CN IX-XII, sympathetic trunk
  • aspergillus species (probs, usually)
49
Q

Guttural pouch mycosis

Clinical signs

A
  • epistaxis
    • ddx: rupture of ventral straight muscles
  • dysphagia
  • horners
  • abnormal resp noise
  • nasal d/c
50
Q

Guttural pouch mycosis

DX

51
Q

Guttural pouch mycosis

TX

A
  • if in shock
    • blood transfusion/fluids
    • vascular occulsion if vessel involved
  • if nerve involved
    • nutritional support
    • treat topically
52
Q

GPM

Vascular occlusion

A
  • Ligation Plus
    • balloon catheter
    • Detachable balloon
    • Microcoils
    • Nitnol plaque: under angiography (need fluorscopy)
  • ligating blood supply usually causes infection to regress on its own
53
Q

GPM

PX

A
  • Guarded
  • 50% of horses that hemorrhaged will survive
54
Q

Trachea

anatomy

A
  • incomplete hyaline cartilage rings
  • 4 layers of tissue
    • adventitia
    • musculocartilagenous layer
    • submucosa
    • mucosa
55
Q

Tracheotomy

A
  • Provide airway for horses with life-threatening upper airway obstruction
  • emergency or pre-emptive
56
Q

Permanent tracheostomy

A
  • Good prognosis
57
Q

Tracheotomy procedure

A
  • longitudinal incision at level of junction of prox and mid 1/3 of neck
  • transverse incision between tracheal rings
  • PUT YOUR FINGER IN THE HOLE TO SAVE YOUR PLACE
  • place temp trach tube
58
Q

Tracheostomy procedure

A

2nd - 5th tracheal rings

59
Q

Thorax indications for sx

A
  • pleuritis
  • pleuropneumonia
  • pulmonary abscess
  • trauma
  • diaphragmatic hernia
60
Q

Thoracic SX procedures

A
  • Rib fracture repair (foals)
  • Rib resection and thoracotomy
  • Thoracoscopy

Surgery final (9 decks)

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