LA exam 2

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LA exam 2
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LA exam 2
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  1. Tracheal aspirate
    • septic
    • loclalized pulm dz
    • aseptic
    • samples pooled secretions form entire lung
    • invasive
    • poor correlation btw cytologic findings of TTW and histo
  2. BAL
    • diffuse
    • non-septic
    • pulm dz
    • representative of lower airway
    • good correlation btw cytology and histo
    • samples caudodorsal lung region usually
    • sample good for 24hr if in fridge
    • can do with scope also
    • fluid normally clear with layer of foam (surfactant)
  3. trans-endoscopic tracheal wash
    • less invasive than TTA
    • assess upper airway
    • potential contamination
  4. Cytologic signs of sepsis
    • predominance of neutrophils
    • degenerative neutrophils
    • bacteria
    • pos culture alone does not necessarily indicate infection
  5. thoracocentesis
    • only if fluid in pleural cavity
    • use ultrasound
    • causes- pleuropneumonia, neoplasia
  6. lung biopsy
    • only if essential
    • performed after all other dx efforts
    • not if inc RR or effort
    • cloudstorm on rads (miliary pattern)
  7. Pulmonary scintigraphy
    • Krypton
    • can see bronchoconstriction, airway edema, inflammation
  8. Strangles agent
    • Strep equi
    • gram +
    • not normal flora
  9. Strangles transmission
    • via purulent discharge from active or recovering horses
    • direct and fomite
    • mouth or nose
    • attach to cells in tonsils or pharynx
    • translocate in hrs to mandibular and retropharyngeal LN
    • can get from subclinical carriers- in guttural pouch
  10. Strangles pathology
    • neut fail to phagocytose bac due to hyaluronic acid capsule, antiphagocytic SeM protein, Mac protein
    • spread via blood or lymph- bastard strangles
  11. swelling ddx
    • abscess
    • parotid gland
    • guttural pouch
    • neoplasia
    • Strangles
  12. clincial signs of Strangles
    • fever- 3 to 14 d after exposure
    • inc WBC
    • abscess dev
    • nasal shedding 2-3wk after onset fever
    • bilat nasal discharge
    • acute swelling
    • abscess
    • anorexia
    • neck extended
    • depression
  13. post-infection with Strangles
    75% dev immunity
  14. Strangles epidemiology
    • migh morbidity
    • low mortality
    • morbidity lighest in young
  15. env persistence of S. equi
    • not long
    • few days
  16. diagnosis of Strangles
    • clinical signs
    • hx
    • culture nasal swabs, washes, pus from abscess
    • gold standard= isolation of S. equi
    • PCR 3x more sensitive than culture- detect asymptomatic
    • serology (ELISA)- recent exposure, cross rxn with vacc
  17. SeM ELISA
    • dx S. equi
    • neg- no Ab, no immunity, false if exposed less than 7d
    • weak pos- low Ab, repeat in 7 to 14d to confirm exposure
    • mod pos- int Ab, 2 to 3 wks post exposure or 6 mth to 2 yrs post exposure
    • high pos- high Ab, post exposure or post vacc, vacc CI
    • very high pos- very high Ab, metastatic abscess, seen with purpura after exposure or vacc
  18. Stages of Strangles and tx
    • exposed but no signs- Ab prevent seeding of LN
    • early signs- isolate, AB may cure but inhibit immuity
    • LN abscess- isolate, Ab prolong maturation, want rupture, NSAIDs
    • partial URT obstruction- Ab to dec size of abscess,, tracheostomy, fluids, tube feed, sx drainage
    • strangles associated complications- Ab
    • guttural pouch empyema- repeated lavage
    • Ab of choise is Penicillin
  19. Vacc for Strangles
    • natural exposure protects for 5yrs
    • SeM Ab titer >1:1600 no vacc
    • during outbreak only exposed vacc
    • intranasal vacc
  20. prevention of Strangles
    • quarantine for 3 wks
    • screen incoming horses- culture and PCR
    • hygiene
  21. complications from Strangles
    • mortality
    • metastatic spread
  22. Bastard Stranlges
    • metastatic spread
    • infect any site
    • lung, mesentery, liver, spleen, kidney, brain
    • cranial mediastinal LN abscess
    • pneumonia
    • septic arthritis
    • paravertebral abscess
    • SeM titers >1:12,800
  23. Guttural pound empyema from Strangles
    dx- endoscopy (chondroids), rads (fluid line)
  24. immune mediated sequelae of strangles
    • purpura hemorrhagica
    • acute rhabdomyolysis
    • myopathy
  25. Purpura hemorrhagica
    • vasculitis
    • type III hypersensitivity
    • pitting edema
    • skin sloughing
    • ecchymosis
    • epistaxis
    • leukocytosis, hyperfib, hyperalb, hyperglob, normal platelets
    • dx- skin biopsy, >12,800 on SeM titers
    • tx- dex, pred, NSAIDs
    • ddx: equine influenza, herpes virus 1, Strep zoo, R. equi, C. pseudotuberculosis, idiopathic, EIA, thrombocytopenia, A. phagocytophilum, EVA
  26. maxillary sinus
    communicates with middle nasal meatus by nasomaxillary opening
  27. frontal sinus
    communicates with caudal maxillary sinus via frontomaxillary opening
  28. Primary Bacterial Sinusitis
    • Streptococcus
    • unilateral nasal discharge
    • facial swelling
    • epistaxis
    • dx- rads, fluid line, soft tissue mass
    • tx- lavage via trephination, systemic Ab, NSAIds
  29. Secondary Sinusitis
    • from dental dz- 1st upper molar or 4th upper premolar
    • unilateral nasal discharge
    • dx- oral exam, rads, CT
    • tx- tooth extraction, trephination, flap sinusotomy
    • post op care- dental plug, sinus avage, Ab
    • complications- persistent drainage, root remains, sequestrum
  30. Maxillary Flap Sinus
    • rostral border- rostral facial crest to infraorbital foramen
    • dorsal border- infraorbital foramen to medial canthus of eye
    • caudal border- medial canthus to caudal facial crest
    • ventral border- facial crest
  31. Ethmoid Hematoma
    • bening, slowly expanding
    • originates from ethmoid turbinates
    • middle aged horses
    • unilateral epistaxis or sersangunious discharge that is intermittent, low volume, and not exercise induced
    • dx- hx, endoscopy (dark red to green mass), rads
    • tx- frontomaxillary flap, formalin inj (#1), laser
  32. rhinophycomycosis
    • differnet than leg fungus
    • cryptococcus, coccidiomycosis, aspergillus
    • usually bilateral nasal discharge
    • tx- sx, laser, systemic antifungals
    • recurrence common
    • phycomycosis- Conidiobolus coronata
  33. Guttural Pouch Mycosis
    • often Aspergillus
    • unilateral
    • epistaxis- internal carotid or maxillary aa.
    • dysphagia- pharyngeal branch of vagus n
    • horners
    • laryngeal hemiplegia- usually permeanent
    • plaques on roofof medial compartment
    • dx- endoscopy
    • tx- stop internal or external carotid aa from bleeding
    • 50% with hemorrhage will die
  34. Idiopathic laryngeal hemiplegia (ILH)
    • roarer
    • flapper problem
    • distal axonopathy of left recurrent layngeal n
    • paralysis of criarytenoid dorsalis muscle (CAD mm)
    • etiology- trauma, lead poisoning, , guttural pouch mycosis, idiopathic
    • inspiratory dyspnea
    • exercise intolerance
    • dx- hx
    • grades 1-4
    • tx- laryngeal tie back (extra laryngeal approach in which two non absorbable sutures are placed btw muscular process of arytenoid cartilage and cricoid cartilage)
    • complications- cough
    • 70% success
  35. Grading of ILH
    • done with horse at rest
    • grade 1- normal
    • grade 2- asynchronous movement, maintain full abduction
    • grade 3- asynchronous movement, not able to achieve or maintain full abduction
    • grade 4- paralysis
  36. arytenoid chondropathy
    • progressive dz
    • arytenoid cartilage and corniculate process
    • unknown etiology
    • exercise intolerance
    • noise at exercise
    • tx- topical steroid spray, laser, partial arytenoidectomy (remove rytenoid cartilage except muscular process), permanent tracheostomy
    • complications- dyspnea
  37. Dorsal Displacement of the Soft Palate (DDSP)
    • airflow resistance inc causes gurgling and exercise intolerance
    • secondary to generalized pharyngeal or guttural pouch inflammation- pharyngeal branch of vagus n- paresis of soft palate
    • hypoepiglottis
    • elongation of soft palate
    • dx- treadmill endoscopy, can displace at rest
    • tx- sternothyroid myectomy (strap mm resection), staphylectomy (trim caudal free margin of soft palate- approach via laryngotomy thru criothyroid cartilages), epiglottic augmentation (inj with paste)
  38. Subepiglottic cyst
    • resp noise
    • exercise intolerance
    • cough
    • dx- hx, endoscopy
    • tx- laryngotomy, transoral
  39. Guttural pouch
    • right and left separated by median septum
    • each pouch divided into medial and lateral by stylohyoid bone
  40. medial compartment of guttural pouch
    • internal carotid a.
    • pharyngeal branch vagus
  41. lateral compartment of guttural pouch
    • external carotid a.
    • maxillary a. (from external carotid a.)
  42. guttural pouch tympany
    • air in guttural pouch
    • flap acts as one way valve
    • days old to one yr
    • nonpainful swelling in parotid area
    • ddx- strangles
  43. guttural pouch empyema
    • pus in guttural pouch
    • younger horse
    • upper resp tract inf
    • intermittent nasal discharge
    • swelling
    • pain in parotid region
    • tx- indwelling catheter, flush with dilute PI, systemic Ab
  44. Paranasal Sinus Cyst
    • solitary or multiple fluid filled cyst in sinus
    • 1-2 yr old horses
    • tx- sinus flap
  45. Dental tissues
    • cementum
    • dentin
    • enamel
    • pulp
  46. cementum
    • similar to bone
    • anchor for periodontal lig
    • protects dentin
    • deposited in alveolus in response to trauma
  47. Dentin
    • living tissue
    • tubules
    • odontoblasts form
    • primary during toothe dev
    • secondary stained from cantact with grass
    • tertiary in response to noxiuous stimuli
  48. Enamel
    • hardest
    • ameloblasts form
  49. Pulp
    • lined by odontoblasts
    • communicates with dentin thru tubules
    • cavity smaller with age
  50. infundibulum
    blind pouch of enamel containing cementum
  51. anisognathia
    • maxilla is wider then mandible
    • in horse
  52. diastema
    widened interproximal space that allows packing of feed material btw teeth
  53. dental radiography indications
    • unilateral nasal discharge
    • trauma
    • facial swelling
    • supernumerary teeth
    • periodontal dz
    • fractured tooth
    • decay/damaged tooth
    • retained deciduous teeth
  54. rediographic signs of tooth root dz
    • apical luceny
    • alveolar sclerosis
    • blunted apices
    • widened, roughened periodontal lig space
    • reduced crestal bone height
  55. percent of foot lesions that cause lameness in cattle
    85-90%
  56. percent of foot lameness in rear limb
    80-90%
  57. percent of rear limb lameness in lateral claw
    80-90%
  58. grades of lameness
    • I normal
    • II slight abnormality- uneven gait
    • III slight lameness- obvious lameness
    • IV abvious lameness- difficulty in turning
  59. most wt carried on which claw in fore and hind limb
    • fore- medial claw
    • hind- lateral claw
  60. anatomy of flexor tendon in cattle
    • the two do not communicate after bifurcation
    • during tenosynovitis only one affected
  61. anatomy of dorsal interdigital cruciate lig
    must stay intact when amputating digits (remove at 45 degree angle at distal 1/3 P1)
  62. anatomy of axial interdigital skin
    • closest point to the distal interphalangyeal jt
    • infection can easily extend into jt
  63. anatomy of digital flexor tendon
    • attaches to P3 at junction of heel and sole
    • see sole ulcers here
  64. treatments for lame ruminants
    • trimming- 45 degrees in rear, 55 degree in front
    • curretage- tourniquet, lidocaine
    • wooden blocks- on sound digit
    • jt lavage- remove bac, inf mediators
    • arthrotomy- remove fibrin
    • amputation
    • topical therapy
    • systemic Ab- consider withdrawal time
    • NSAIDs- phenylbut illegal in dairy over 20 mth
    • prevention
  65. foot rot in cattle
    • Fusobacterium necrophorum- necrosis, leukotoxin, endotoxin
    • Bacteroides melanogenicus- spreads dz, proteolytic and collagenolytic anzymes
    • inhabitants of GI tract
    • swelling, redness, necrotic tissue
  66. interdigital dermatitis
    • heel horn erosion
    • Bacteroides nodosus
    • F. necrophorum
    • Dichelobacter necrosis
    • acute or chronic inflammation of interdigital skin
    • not as lame as foot rot
    • "melting" of horn
    • no necrosis
  67. Contagious Foot Rot in Sheep
    • Dichliobacter nodosus- protease to disolve hoof
    • Fusobacterium necrophorum- leukotoxin
    • sever lameness
    • tx- Ab (penicillin), radical hoof trim may do more harm
  68. Papillomatous Digital Dermatitis
    • Hairy heel warts
    • F. necrophorum
    • proliferative
    • superficial
    • above heel bulb
    • ddx- contagious interdigital dermatits
    • tx- topical spray (same as int derm)
    • lame
    • pain
  69. subsolar abscess
    • puncture in horn- trauma
    • no swelling, pain
    • tx- curettage, wooden block
    • tenosynovitis
    • usually extension of digital dz into deep digital flexor tendon
    • tx takes long time so careful with Ab selection
  70. septic Arthritis/physitis
    • penetration of jt, extension from adjacent inf
    • e. coli- most common isolated from foals and claves with navel inf
    • early tx- jt lavage with Ab
    • chronic (2-3d) tx- arthrotomy
  71. osteomyelitis
    • hematogenous- secondary to FPT
    • sequela to trauma
    • watch for sequestrum
  72. P3 fracture
    • lame
    • no swelling
    • ddx- subsolar abscess, FB
  73. sole ulcer
    • ulcer thru horn at jxn of heel and sole
    • no signs in beginning
    • long toes- more strain on deep digital flexor tendon
    • rads, foot trim, wooden block, salvage, amputste
  74. sand crack
    • 85% front lateral claw
    • vertical hoof fissure
  75. thimble claw
    • horizontal hoof fissure
    • usually in all 4 due to nutrition
  76. laminitis
    • high conc diet
    • pain, heat, lame
    • ddx- hardware dz
  77. white line dz
    • separation of sensitive and insinsitive laminae
    • lame, pain, medial claw fore, lat claw hind
  78. corkscrew claw
    • heritable
    • deviation of P 2&3
    • lifetime hoof trims
  79. interdigital fibroma (corns)
    • usually not primary cause of lameness
    • heritable
    • overfeeding
  80. Stifle injury
    • medial femoropatellar jt, lateral femoropatellar jt, and medial femorotibial jt communicate
    • foot lameness may resemble stifle lesion- use hoof testers
    • hip crepitation can appear to be from stifleavoids flexing stifle, fixed position, weight on toe
    • no more pasture breeding
  81. main infectious agent causing bronchopneumonia
    M. heamolytica
  82. tx bronopneumonia
    • Flunixin meglamin- IV
    • ketoprofen (extra label)
    • phenylbut (extra label)
    • must consider withdrawal, delivery method, legal issues, stress, cost
  83. bronchopneumonia low vs high risk
    • low= low stress + good immune response + low exposure
    • high= high stress +/- poor immune response +/- high exposure
  84. supportive therapy for bronchopneumonia
    early intervention most important
  85. when to mass tx for bronchopneumonia
    • sudden drop in feed consumption in high risk calves
    • pull rate of 10% in one day
    • pul rate of 25% in 3-5d
    • use top tier drug (macrolide)
    • enrofloxacin not good for mass tx (ok for currently sick)
    • effective if 2 degree dec in temp and dec in illness score
  86. top tier Ab for bronchopneumonia
    • Tilmicosin- not in sm rum or swine
    • Tulathromycin- safer
    • Florfenicol- can knock off feed or get diarrhea
    • penicillin- chronic dz
    • oxytetracyclline- mod
    • enro/danofloxacin- resp dz, not in sm rum
  87. Acute Bovine Pulmonary Emphysems and Edema (ABPEE)
    • change in plane of nutrition
    • seasonal incidence
    • adult cattle
  88. ABPEE risk factors
    • move from poor grazing pasture to lush pasture
    • Ltryp to 3-methyl leads to toxicity
  89. ABPEE signs
    • 4-10d after move
    • resp distress
    • morbidity <50%
    • mortality >50%
  90. ABPEE tx
    • STRESS MAY WORSEN
    • may not help to move off lush pasture
    • do nothing is ok
    • feed poor hay
    • relapses do not occur
    • prevention- transition to higher plane of nutrition
  91. Acute Interstitial Pneumonia (AIP)
    • feedlot cattle
    • ddx- ABPEE
    • resp distress
    • multi-factoral
    • waste money with Ab
    • acute onset- over night
  92. Ovine Progressive Pneumonia (OPP)
    • transmit via secretions
    • few in Tx
    • thin ewe syndrome
    • exp dyspnea
    • death 6-12mth later
    • no tx
    • test and cull or isolate infected and raise young separately
    • ddx- chronic bronchopneumonia, CL, lungworms, neoplasia
  93. Caseous Lymphadenitis (CL)
    • Corynebacterium pseudotuberculosis
    • transmit via resp droplets and direct contact with draining abscess
    • long life in env
    • internal abscess= chronic poor doer
    • external abscess
  94. Allergic rhinitis
    • dyspnea, stridor
    • ddx- bronchopneumonia, retropharyngeal trauma, FB, viral rhinitis
    • tx- change env, anti histamine, SAIDs (Dex or Isoflupredone if preg), NSAIDs

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