coughing in 12+ yr old and bilateral nasal discharge
incr. respiratory rate, flared nostrils
normal appetite, no fever
"heave line" = muscle hypertrophy from forced expiration
what is heard upon thoracic auscultation of heave horse?
may be normal
prolonged recovery and wheezes/crackles with rebreathing bag
what will thoracic rads show with heaves? endoscopy?
tracheal mucus (even in absence of nasal discharge)
what is seen on BAL of horse with heaves?
*neutrophilia* >10-15% neutrophils
what does atropine challenge show with heaves patient?
dilation of constricted airways - so see improved breathing effort for about 30 minutes
(buscopan works too since both are parasympatholytics)
atropine is a helpful diagnostic tool for heaves, but why is it not used as treatment for this condition?
unwanted side effects from regular use - ileus, dry airways, tachycardia
what is the single most effective treatment for horses with heaves?
environmental change - keep *outside in fresh air*
prevent exposure to Ag that cause inflammation
what is the lungworm in horses? who is the carrier?
asymptomatic carrier = donkey/mule
what happens in horse after ingesting L3 lungworm larvae?
L3 penetrates GIT wall - becomes L4 in lymph node - carried to lung/burrow into alveoli - mature, lay eggs in bronchi - cough/swallow - pass eggs or L1 in feces
how long is prepatent period for lungworm? what pathology is caused in respiratory tract?
excess mucus, cough, pulmonary edema,
crackles/wheezes, 2nd bacterial infection
what is seen on tracheal aspirate with lungworm? how is this treated?
eosinophils and larvae
ivermectin or moxidectin
what type of pneumonia do adults get? who is most common victim?
pleuropneumonia (NOT in foals)
training/show horses traveling long distance (shipping fever) or those exposed to viruses, strenuous exercise, or general anesthesia
how does viral infection lead to pleuropneumonia?
decr. mucociliary clearance, damaged epithelium
decr. surfactant levels w/destroyed type II alveolar cells - anaerobic environment
how does exercise lead to pleuropneumonia?
dirt and debris breathed in deeper with exertion
how does post GA lead to pleuropneumonia?
ET tube can introduce bacteria
GA compromises mucocilliary clearance
compression/atelectasis of lungs
improves local bacterial growth
what is #1 reason long transports lead to pleuropneumonia?
traveling with head tied up - can't clear
what are clinical signs of young horse with pneumonia?
fever, lethargy, inappetant, wt loss
cough, resp. distress
pleurodynia (pain may resemble colic)
what etiology may be indicated if nasal discharge is foul smelling or there is halitosis?
what will CBC show in pneumonia case?
neutropenia or philia - with left shift
anemia of chronic inflammation
20 year old horse with no recent history of shipping presented with classic signs of pneumonia. He is not responding as expected to the treatment plan. What are 4 things on your differential list you should reconsider?
granulomatous lung disease
esophagus ruptured in thorax
What is expected neutrophil count and specific gravity of thoracic fluid in pneumonia patient?
nucleated cells >10,000 w/neutrophils >70%
SG: >3 g/dL
what antibiotics are good choices for pneumonia?
long term beta-lactam + aminoglycoside +/- metronidazole for anaerobes
what is prognosis for pneumonia patient?
guarded even with aggressive therapy
can remain chronically ill, only 50% return to race