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96 Cards in this Set
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Equine Resp Tract Surgical Problems 1 (MARTA)
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Lecture 1
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What are some common problems of the nasal passages?
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Redundant alar fold
Nasal septum thickening/deviation |
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Describe the clinical presentation, diagnosis and treatment of redundant alar folds.
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Clinical presentation
- Loud noise - Expiratory - Heard during exercise Diagnosis - Put a temporary suture through the tissue and pull it up tight against the nostril Treatment - Remove the excess tissue |
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Describe the aetiology, diagnosis, and treatment of nasal septal thickening.
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Aetiology
- Congenital - Neoplasia - Fungal - secondary to trauma - cystic degeneration Diagnosis - Endoscopy - Rads (DV view) - Biopsy (if suspect fungal) Treatment - Septal removal (MAJOR surgery) - Lots of bleeding - Granluation tissue post-op can be a problem for athletic horses - Pack septum for 2-3days after (stop bleeding) --> remember, the won't be able to breathe, so put a tube in their trachea!! |
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What paranasal sinuses are most commonly affected in the horse?
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- Frontal
- Caudal maxillary - Cranial maxillary |
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What are the diagnostic tools when it comes to sinuses?
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- Rads
- Percussion - PE - Sinoscopy - CT - Endoscopy (to rule out other conditions) |
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Describe which sins communications.
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Frontal and caudal maxillary communicate via the frontmaxillary aperture.
Cranial and caudal maxillary do not communicate. Cranial maxillary sinus communicates with nasal passages. |
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Describe the locations for sinus trephination.
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Frontal:
- 0.5cm caudal to medial canthus - 60% of the way b/w midline and medial canthus Caudal maxillary: - 2cm rostral to medial canthus - 2cm ventral to medial canthus Cranial maxillary: - Half way b/w medial canthus and facial crest - Ventral to infraorbital canal |
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Discuss paranasal cysts.
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- Unilateral
- Young animals - Can be dental in origin - Considered to be space occupying lesions - Treatment = surgical removal - Recurring problem (come back) |
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What is the clinical presentation and diagnosis of oromaxillary communication?
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Communication b/w mouth and sinuses!!
NOTE: this is a potential complication after sinus surgery Presentation: - Smell really bad - Green stuff comes out nose - Unilateral discharge - Older horses Diagnosis: - Oral exam - Rads - Sinoscopy - Scintigraphy |
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Which teeth lie in the maxillary sinuses?
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PM4
M1 M2 M3 |
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What are the common contributing problems to dental disease?
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- Apical tooth root infections
- Patent infundibulum - Fractured tooth - Periodontal disease |
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How do you treat dental problems?
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- Antibiotics
- Tooth removal $$$ and complication rates are high |
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Discuss paranasal neoplasia
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- SCC is most common
- Often very malignant and locally invasive - Prognosis pretty poor - Just keep them going as long as they are happy, then euthanase |
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Discuss ethmoid haematoma.
General info Diagnosis Treatment |
- Space occupying lesions in sinuses or ethmoid turbinate
- Can be uni or bilateral - On histopath you see normal resp epi, haemorrhage, giant cells Diagnosis: - Mild epistaxis - Rads - Endoscopy (see characteristic green mass) - Sinoscopy - Biopsy (BUT THEY BLEED HEAPS) Treatment - Intralesional formalin (repeated) --> causes necrosis and sloughing - Surgical resection (if in sinuses) - Recurrence rate is really high |
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What diagnostics can we use when it comes to guttural pouches?
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- Endoscopy
- Rads |
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Describe the anatomical significant structures around the guttural pouches.
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Stylohyoid bone separates pouches into medial and lateral (medial is bigger)
Medial compartment - cervical symp trunk - cranial cervical ganglion - CN 9, 10 and 12 - Pharyngeal branch of CN 10 - Internal carotid Lateral compartment - CN 7 - External carotid - Maxillary artery |
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Discuss GP empyema
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- Pus in pouch
- Uni or bilateral nasal discharge - Usually a result of strangles (strep equii) - Usually young horses Treatment - Lavage (repeated) - Long term antis |
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Discuss GP chondroids
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- Result of chronic GP empyema
- Bad when it gets to this stage - Usually require surgical removal - Inspissated pus |
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Discuss GP mycosis.
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- Presents with severe epistaxis
- Fungus grows on the side of the vessel - Aspergillus is most commonly involved - Often internal or external carotid that is involved Treatment (basically cut off nutrients to the fungal plaques) - Ligate artery - Balloon |
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Discuss the clinical signs of temporohyoid osteoarthropy.
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CN 7 and 8 defects
- Head tilt - Ataxia - Nystagmus - Corneal ulcers - Ear droop - Dysphagia |
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How do you diagnose temporohyoid osteoarthropy?
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Endoscopy
Rads |
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What are the potential complications of temporohyoid osteoarthropy?
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- Otitis externa/media
- Guttural pouch infection - Haematogenous spread leading to nonseptic osteoarthritis (DJD) - Ankylosis (fusion of the joint) --> petrous temporal bone and stylohyoid bone |
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How do you treat temporohyoid osteoarthropy?
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- Stabilise
- Antibiotics - NSAIDs - Surgery (ceratohyoidectomy) |
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What is temporohyoid osteoarthropy?
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Arthritis affecting the articulation between the stylohoid bone with petrous portion of the temporal bone
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Equine Resp Tract Surgical Problems 2 (MARTA)
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Lecture 2
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What are the diagnostic tools we use to diagnose laryngeal diseases?
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Mainly endoscopy (do not sedate)
Rads rarely |
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Describe Idiopathic Left Laryngeal Hemiplegia (ILLH).
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Usually the left recurrent laryngeal nerve that is involved
Leads to progressive atrophy of the cricoarytenoideus dorsalis muscles |
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What are the clinical signs of ILLH?
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- Exercise intolerance
- Inspiratory noise when exercising |
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How do you diagnose ILLH?
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Slap test (someone looks down the throat and the other person slaps the horse on the whithers... if the nerve is active, you will see a twitch or the cartilage)
Treadmill candidates (those with a higher grade) Palpate the CAD muscle (see if there is atrophy Also nasal occlusion (endoscopy) |
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How do you treat ILLH?
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Surgical treatment
Tie back - Prosthetic suture used to recreate the action of the CAD muscle Nerve pedacle graft - Try and regrow the nerve Arytenoidectomy |
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What is significant about arytenoid chondritis?
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Must be differentiated from ILLH (treatment is very differenty)
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Discuss arytenoid chondritis.
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Infection or inflammation of the cartilages
Presentation - Often present with respiratory distress, and a noise - Often cartilages are paralysed, but may not be perm - Can be uni or bilateral |
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Discuss artenoid chondritis treatment
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May respond to medical treatment (though not likely_
- Anti-inflamms - Antibiotics - Rest Surgical treatment may be necessary - Arytenoidectomy (laser assisted debridement) |
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What are some common epiglottis problems?
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- Epiglottic entrapment
- Sub-epiglottic masses - Epiglottitis - Deformities ** unforgiving structure |
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What is an epiglottic entrapment, and how is it treated?
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Aryepiglottic fold entraps
Treatment - Divide or resect the fold |
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Discuss epiglottitis, including treatment
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- Often secondary to op
- Can be idiopathic - Also inflammatory due to FBs - Epiglottis looks small and nobbly - Treated mecially (anti-inflamms and antibacterials) |
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Discuss subepiglottic cysts (who do we see it in? what is the treatment?)
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- Young animals
Treatment - Laryngotomy - Laser through endoscope |
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Treatment for vocal cord collapse?
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Treatment - remove cords
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What is the treatment for rostral displacement of the palatophalyngeal arch?
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No treatment
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Discuss axial deviation of aryepiglottic folds.
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- Folds move into airway when horse is breathing at speed (exercise)
- Associated with poor performance - Cut off the folds using laser surgery - Can be seen with other problems - Prognosis depends on concurrent problems |
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Discuss pharyngeal lymphoid hyperplasia
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- Young horses
- Causes inflammation of surrounding nerves - Usually self limiting - Responds really well to anti-inflamms - Does NOT cause poor performance |
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Discuss DDSP.
Types Clinical presentation Causes Treatment (medical, equipment, surgical) |
2 types
- Intermittent (seen at exercise) --> more common - Persistent (seen at rest) Leads to an expiratory noise (gurgle) Causes include: - neuromuscular dysfunction of thyrohyoideus muscle) - epiglottic hyperplasia - Guttural pouch inflammation (affects CN 10) Medical intervention can work (rest and anti-inflamms) Equipment you can use to treat includes tongue tie, figure 8 nosebands and cornell collar Surgical treatment includes: - myectomy/tenectomy (sternothyrohyoideus) - Staphylectomy/laser - tie forward (prosthetic suture to keep larynx in a more forward position) |
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Discuss dynamic pharyngeal collapse.
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- Only occurs under strenuous exercise
- Young horses - Dorsal and lateral sides of pharynx collapse in and decrease O2 intake - Leads to poor performance - Linked to inflammation (affects the nerves that innervate the pharynx) - If seen in older horses, more guarded prognosis Diagnosis - Treadmill endoscopy diagnosis Treatment - No surgical treatment - Rest for 4-6 months |
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Discuss Exercise induced pulmonary haemorrhage (EIPH)
Clinical signs Diagnosis Treatment |
Common in race horses
Clinical signs - Poor performance - Coughing after exercise - Epistaxis (in 80% of horses) Diagnosis - Clinical signs - Endoscopy (within half hr of work) - BAL (look for RBCs and erythrophagocytosis --> indicates chronicity) - Rads Treatment - Improve ventilation (if concurrent inflamm in lungs --> fix that) - Diuretics (decreases pressure in the lungs, but not permitted when racing) - Treat concurrent IAD - Open up nostrils (using nasal strips) |
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Equine LRT Disease 1 (LIZ)
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Lecture 3
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What questions should you ask when taking a history in a respiratory diseased horse?
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- Fever
- Appetite - Attitude (lethargic) - Nasal discharge - characterise - Cough (rest, or exercise) - Dyspnea - Exercise intolerance - Swellings - Weight loss - Environment - Vaccination status - Diet - De-worming - Vaccination - Contact with other horses - Any other horses affected - Any treatment |
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What aspects of the PE do you need to focus on?
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- General demeanour
- Nostril flare - MM - HR, Temp, RR - Nasal discharge - Sinus percussion - Facial deformities? - Smell breath - Palpate LNS - Tracheal palpation - Characterise breathing pattern - Lung auscultation - Rebreathing bag |
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What diagnostic tests should you do?
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- Haematology
- Biochem - Blood gas analysis (arterial) - URT endoscopy Resp tract fluid sample (cytology and culture) including: - Tracheal aspirate - BAL - Thoracocentesis - US - Rads - Lung biopsy |
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What can you see with endoscopy?
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- Nasal passages
- Sinuses (if you make hole first) - Larynx/pharynx - Guttural pouches - Ethmoid region - Trachea |
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What secretions can you send off for bacterial culture and sens?
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- Nasal/nasopharyngeal wash or swab
- Guttural pouch was - LN aspirate - Sinuses - Tracheal wash - BAL |
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When is tracheal wash indicated and what info can you gain from it?
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Indications
- LRT secretions - Any infectious LRT diseases Info: - Cytology - Bacterial culture - Gram stain (guides initial antibiotic therapy) |
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When is BAL indicated and
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Indications
- When diffuse pulmonary disease is suspected - Anything that's non-infectious - Samples the caudodorsal lung area Normal numbers on cytology include - Macros (40-75%) - Lymphocytes (20-30%) - Neutros <7% - Eosinophils <3% - Mast cells <5% - Squamous cells <10% |
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What is thoracic US ideal for?
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Pleural/peripheral lung disease
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What is thoracic radiography ideal for?
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Pulmonary parenchymal lesions
- bronchopneumonia - abscesses - interstitial pneumonia - pneumothorax - EIPH - pulmonary oedema |
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What are the common bacterial resp diseases in the horse?
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- Bacterial pneumonia (adults)
- Pleuropneumonia - Juvenile pneumonia - Strep equii equii (strangles) - Rhodococcus equii (rattles) |
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What are the predisposing factors of bacterial pleuropneumonia?
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Usually occurs secondary to immunocomprimisation of the lungs
Predisposing factors include - Viral URT infection - Transport - GA - Poor housing - Strenuous exercise - Dense stocking densities |
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What are the clinical signs of bacterial pneumonia?
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- Fever
- Lethargy - Inappetence - Occasionally moist, productive cough - Rebreathing bag may produce cough and abnormal lung sounds cranioventrally Generally, signs tend to be non-specific - Nasal discharge uncommon - Lung sounds normal - Resp difficulty is uncommon at rest |
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How do you diagnose and treat bacterial pneumonia?
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Diagnosis (often a mixed bacterial infection)
Bacteria include - Step zooepidemicus - Actinobacillus - E. coli - Klebsiella - Enterobacter - Staph - Pasteurella - Anaerobes Treatment - Broad spectrum antibiotics - Anti-inflamms - Supportive care - Rest - Monitor |
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What is pleuropneumonia?
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- Pleuritis which is secondary to bacterial pneumonia
- Large amount of pleural fluid |
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What are the clinical signs seen with pleuropneumonia?
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Clinical signs
- Fever - Anorexia - Depression - Endotoxaemia - Reluctant to move - Sweating - Anxious - Nasal discharge - Shallow breathing - Pleurodynia (pain in the chest due to inflamm of intercostals) - Dyspnea - Decreased lung sounds - Tachycardia - Tachypnea - Weight loss - Pectoral oedema |
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How do you diagnose pleuropneumonia?
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- Often a history of travel, stress or viral infections
- Thoracic US - Thoracocentesis - Culture TTW and pleural fluid - Thoracic rads (after drainage) - Blood work (reflects inflamm, CV status, endotoxaemia, protein loss) |
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How do you treat pleuropneumonia?
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- Drainage
- Antibiotics - Anti-inflamms - Supportive care |
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What are the complications of pleuropneumonia?
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- Laminitis
- Thrombophlebitis - Pulmonary/pleural abscesses and adhesions (treat with intercostal myotomy or rib resection) - Necrotising pleuropneumonia (will see cough, foul smelling breath, bloody nasal discharge) - Bronchopulmonary fistula (can lead to pneumothorax) |
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What is the prognosis for pleuropneumonia?
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Variable for racehorses
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Equine LRT disease lecture 2 (LIZ)
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Lecture 4
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What are the common infectious diseases?
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- Strep (strangles)
- Rhodococcus (rattles) - Equine herpesvirus - Equine influenza - Hendra |
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Describe the organism associated with strangles
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- Organism = strep equii equii (beta haemoltyic, gram +ve cocci)
- highly contagious - obligate parasite - primary pathogen |
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What are the clinical signs for strangles?
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- Lethargy
- Fever - Swollen LNs - Nasal discharge - Common in young horses (6months - 3years) |
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What is the pathogenesis of strangles?
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- Infected via contact/inhalation of resp secretions
- Direct contact and indirect (via fomites) - Incubation period = 3-14days - Bacteria adheres to epithelial cells or URT and spread to LNs of head (submandibular, retropharyngeal, parotid) - LNs become abscessed, rupture, drain - Typically self limiting, confined to URT, rapid recovery - Shedding for 6 weeks post infection - Chronic carriers shed for months |
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What are the clinical signs seen with strangles?
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- Pyrexia (<41), lethargy, anorexia
- serous-purulent nasal discharge - enlarged, painful LNs - abscess drainage (internal and external) - head/neck extended, dysphagia, stridor, upper airway obstruction - duration = 2-3weeks |
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What are the complications seen with strangles?
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- Guttural pouch empyema
- Bastard strangles (metastatic abscessation) - Purpura haemorrhagica (associated with re-exposure) - immune-mediated myositis |
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How do you diagnose strangles?
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- Clinical signs
- Isolation of S equii from secretions (nasal swab, GP wash) or abscess fluid - Direct gram smear - PCR - Serum SeM protein titer (serology) |
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How do you treat strangles?
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Non-complicated cases
- Anti-inflamm - Nursing care - Abscess drainage Complicated or acute cases - Antibiotics (penicillin) - temporary tracheostomy - IV fluids - NG feedings - GP lavage - Steroid therapy (purpura) |
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How do you control strangles?
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- Cease movement of horses on/off property
- Isolate infected horses, or those showing signs - Strict hygiene (separate staff, clothing, equipment, wash hands etc.) - Test recovered and in contact horses - Confirm horses are free of infection before exposing to other horses - Endoscopy of carrier suspects |
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How do you prevent strangles?
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- Isolate all new arrivals for 2 weeks (monitor temp, test for disease)
- Vaccinate (doesn't guarantee free from infection) --> also, high complication rate. Injection site abscess, fever, immune mediated complications etc. |
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What is rattles? Discuss the organism involved.
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- Causes pneumonia
- Life-threatening disease - Affects young horses, 1-5months old The organism - Rhodococcus equii - Facultative intracellular bacteria - Gram positive - Pleomorphic - Organism is environmental, found widespread - Survives in harsh environmental conditions - It replicates in the intestines of foals less than 3months old - virulent and avirulent strains exist - Pathogenecity of organism is related to intracellular survival - Coccobacilli |
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Discuss the epidemiology of rattles
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- Found in dry, hot, dusty environments
- High stocking rates - Pulmonary infection occurs via inhalation of organism - Faecal contamination of environment |
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What are the clinical signs associated with rattles?
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- slowly progressive disease (weeks-month)
- chronic, suppurative bronchopneumonia, abscessation, lymphadenitis - fever - lethargy - anorexia - tachypnea - cough - resp. distress - variable lung auscultation (can hear crackles and wheezes) Extrapulmonary signs such as: - Diarrhoea - Immune-mediated (polysynovitis, uveitis, anaemia, thrombocytopaenia) - Septic osteomyelitis, physitis (bone disease of young animals) - Colic - Weight loss (mesenteric abscessation) |
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What is the pathogenesis of rattles?
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Organism replicates and survives in alveolar macrophages
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How do you diagnose rattles?
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Lab
- High WBC count - Thrombocytosis - Elevated fibringoen Thoracic US - Areas of lung consolidation - Abscessation Thoracic rads - Multiple, discrete, nodular alveolar pattern Tracheal wash - Definitive diagnosis (see the bacteria) |
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How do you treat rattles?
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- Long term antibiotic therapy (4-9weeks)
- Supportive care (intranasal O2, anti-inflamms) - IV fluids/nutrition - Ambient temp control - Minimise stress |
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What is the prognosis for rattles?
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Limited for racing horses
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Describe the 2 different herpes viruses and what they cause.
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EHV 1
- Resp disease - Abortion - Myeloencephalitis EHV4 - Resp disease of young horses - Transmission is direct or indirect (nasal secretions, aborted foetus, placenta, fluids) - Incubation period = 2-10 days - Virus replicates in URT epithelium and LN |
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Describe EHV4 disease
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Clinical signs
- Biphasic fever - Lethargy - Inappetence - Serous nasal discharge - Pharyngitis - +/- cough Limited to URT Low morbidity, but often see secondary bacterial infections Latent infection and periods of recrudescence when stressed |
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Describe EHV1 disease
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Viraemia, spreads to other organs
Abortion during the last trimester (no premonitory signs) - Can be birth of a weak foal Herpes myelitis (neurological) - Follows outbreaks of resp infection - Ataxia - Hindlimb paralysis - Recumbency - Incontinent - Tail paralysis - Life threatening |
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How do you diagnose herpes?
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- Clinical signs of the resp disease is similar in both
- Viral isolation or PCR from a sample required (nasopharyngeal swab, blood, aborted foetus, CNS tissue) - Serology (4-fold rise in Abs) - Diagnostic tests often not performed as resp disease is self limiting |
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How do you treat herpes infections?
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- No specific treatment
- Rest (for 4-6 weeks) - Nursing car - NSAIDs - Monitor for secondary infections - Immunostimulants |
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How do you prevent herpes infections
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- Good management
- Vaccination (only good against EHV1 abortions) |
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Discuss equine influenza virus responsible for causing disease.
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- Called orthomyxovirus
- Highly contagious - Haemagluttinin and Neuraminidase (H7N7 and H3N8 are clinicall significant) - Affects young horses - Can affect any horse in a naive population - Most common source of infection is when you introduce a horse to the population - Transmission is via inhalation of respiratory secretions (can travel up to 8km on the wind) - Indirect transmission is via clothes, blankets, vehicles etc. - Can survive in the environment for certain periods of time |
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Discuss the clinical features of equine influenza virus
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- 1-5 day incubation period
- Virus replicates within resp epithelium and destroys it Clinical signs include: - Fever - dry, harsh cough (significant feature of EI) - Lethargy, inappetence, appear stiff - Mucoid nasal discharge Recover within 10-14days, takes resp epithelium 3-4 weeks to recover High morbidity, low mortality Complications occur in foals and older animals - bacterial pneumonia/pleural pneumonia - purpura haemorrhagica - chronic pharyngitis/bronchiolitis Complications can be minimised with lots of rest (1 week of rest for every 1 day of fever) Horses shed the virus for up to 14days (post recovery) |
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How do you diagnose EI?
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- Based on clinical signs (sudden fever, lethargy, anorexia, coughing)
- Definitive diagnosis done with viral isolation or Ag detection and serology - Nasopharyngeal swabs |
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How do you control and prevent EI?
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- Isolate all horses for 2 weeks
- Vaccination (not allowed in Australia, except in emergency situations) |
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Discuss hendra virus
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- Organism = paramyxoviridae
- From fruit bats to horses - Zoonotic - Not highly contagious - Rare - Potentially fatal - Route of infection from bat to horse = unknown - Route of infection from horse to person = via secretions |
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Discuss the 2 different clinical forms of hendra virus
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Respiratory infection
- Peracute illness - pyrexia - tachycardia - resp distress - pulmonary oedema - frothy nasal discharge - facial oedema - bloody discharge - rapidly fatal (1-3 days) Neurological infection |
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How do you diagnose hendra virus?
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- ELISA
- Viral isolation - Immunofluorescent testing (Ag detection) - Serology |
