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what are clinical signs seen with EIPH?
- epistaxis NOT common
- blood in trachea 45 minutes post race + hx of poor performance
Horses with what grades of EIPH are 4 times more likely to win races?
grade 0 and 1 (compared to 2-4)
what is seen on grade 2, 3, and 4 of EIPH?
- 2: single stream of blood in trachea
- 3: 1/3 trachea has blood
- 4: >90% covered in blood
what is tx for EIPH?
- no known tx - try to decr. inspiratory obstructions
- some try furosemide or FLAIR nasal strips
what is medical term for Heaves and what is it? what age horse is affected?
- recurrent airway obstruction - lower airway obstruction dt mucous plugs, fibrosis, bronchospasm, chronic changes in alveolar wall
- older horse problem (>12)
what are clinical signs seen with heaves?
- 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?
- bronchointerstitial pattern
- 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?
- dictocaulus arnfieldi
- 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?
- 5-6 weeks
- 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)
- +/-ventral/peripheral edema
- *sick horse*
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?
- fungal pneumonia
- 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