Image, Trailer, Endoscopy

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Image, Trailer, Endoscopy
2011-04-07 16:09:47
Image Trailer Endoscopy

Spring Image, Trailer, Endoscopy
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  1. Endoscopy
    • Use of a fiber optic camera to view into body cavities or organs
    • Can be rigid or flexible
    • Flexible scopes can be much longer, more adaptable and easier to manipulate
    • Arthroscopes, rhinoscopes, laparoscopes
  2. Endoscopy output
    • Can send image to eyepiece (fiber optic), TV screen, VCR or digital camera
    • Can save images to paper, tape or computer disc
    • Uses: upper and lower respiratory exams, stomach exams (ulcers), sinus and gutteral pouch(air-filled out-pouching of the auditory or Eustachian tube) exams, abdominal and thoracic surgery, joint surgery
  3. Flouroscopy
    • “Real time” xray with images projected to a TV screen
    • Useful because 3-D image can be gained very quickly, no xray retakes and extra farm calls, can do a quick scan of an entire leg for the cost of a computer disc
    • VERY HIGH levels of radiation to operator’s hands and arms (40X reg. Rads)
    • Negative images (black vs white)
  4. Scintigraphy
    • “Nuc med”, “bone scan”
    • Use of a radioactive isotope (Technetium 99) to locate areas of active inflammation and bone turnover
    • Inject intravenously, wait 2-3 hours and scan for “soft tissue” phase, 3-4 hours for “bone phase”
    • Images gathered using a gamma camera and saved to film similar to radiograph film
    • Background and non-inflammed areas appear white, inflammed areas appear black, intensity of the black indicates severity of the inflammation
  5. Scintigraphy - uses
    • Uses - vague lameness exam, lameness diagnosis in an uncooperative patient, indicates area to focus radiographs/UltraSound
    • Isotope is excreted through urine, horse remains radioactive for 24 hours; must be cleared with a Geiger counter before release to the owner. Bedding and urine must be disposed in accordance with state and federal law
    • No danger just being in vicinity of horse, wear rubber gloves if handling it, try to not sedate if possible
  6. Ultrasound
    Pleisomorphic crystals in probe vibrate to produce sound waves which enter tissue, the amount of waves that bounce back are collected and turned into a grey scale

    • White - all waves returned (bone, air)
    • Grey - some waves returned (soft tissues)
    • Black - no waves returned (fluid)
  7. Ultrasound - uses
    • Useful for examining soft tissue structures and determining density of certain tissues (pneumonia), ultrasound guided procedures, reproductive exams, pregnancy diagnosis
    • Best pictures are obtained if area is shaved (no air trapped under skin), but showhorse owners will object! Can soak hair with alcohol or ultrasound gel
    • Increasing wavelengths cause decreasing penetration - 3 MHz probes penetrate very deeply but picture has less resolution(definition) than a 7.5 MHz
  8. Trailering
    • Often called to help when it is too late - owner has been fighting with horse for a long time and everyone is tired and upset, horse is scared and tired
    • Trailering issues are: problem loader, trailer accident, horse through floorboards
  9. Types of Trailers
    • stock vs straight loads vs slant loads
    • Bumper pull vs gooseneck vs Semi’s
    • Ramps vs step up
  10. Trailering Isuues
    • Common injuries - head bangs on roof of a trailer that is too short, body/head bangs on edge as the horse backs out or refuses to go in
    • Lower legs - stumbles as loading, trying to keep balance in trailer, stumbling as unloading, “scramblers”
    • Prevent these injuries by ensuring trailer is the proper size/type for the horse, head bumpers, shipping boots
  11. Chronic Obstructive Pulmonary Disorder (COPD)
    • AKA “heaves”
    • Horse version of asthma
    • An allergic airway response to an environmental allergen, usually mold or dust in the hay or barn
    • Seen mainly in older horses kept inside or ridden in indoor arenas
    • Clinical signs - chronic dry coughing, especially when eating hay or starting exercise; intermittent white runny nose with no fever, mild to moderate dyspnea especially on expiration that may progress into “attacks” of severe dyspnea; formation of a heave line (hypertrophy of the diaphragm muscles) along the abdomen due muscles making extra effort to expire a breath
  12. COPD - diagnosis
    • Diagnosis - clinical signs, endoscopic exam, bronchoalveolar lavage, response to treatment
    • Endoscopy - increased mucous in trachea and bronchi
    • Bronchoalveolar lavage - pass a flexible silicone catheter into the lungs until it wedges in a brochus; lavage with 240 ml saline in 60ml aliquots (60 in, aspirate as much as possible) - look at color, consistency and cytology
    • Not a sterile sample, so culture is no good
  13. COPD - Tx
    • Treatment - removal from the stimulus - keep outside as much as possible, remove moldy or dusty hay, soak hay in water for 20 minutes before feeding or take off hay completely, do not ride indoors
    • Medical treatment – prednisone/azium pwd, bronchodilators (clenbuterol, albuterol), atropine for emergency attacks
    • This is a progressive disease that will not go away and will get worse as the horse ages
  14. Laryngeal Hemiplegia
    • Paralysis of one of the arytenoid cartilages in the larynx of the horse
    • Usually the left side is paralyzed
    • Most commonly diagnosed in racehorses and higher level sport horses
    • Most likely caused by damage to the left recurrent laryngeal nerve where it wraps around the left jugular vein
  15. Laryngeal Hemiplegia - Diagnosis and tx
    • Racehorses are never given IV injections on the left to prevent possible lawsuits if the horse becomes affected later on
    • Clinical signs - loud inspiratory “roaring”, especially at speed or when head and neck are severely flexed, poor performance
    • Diagnosis - endoscopy at rest for severe cases or on a high speed treadmill
    • Treatment - surgical correction - prosthetic laryngoplasty (AKA “tie back”)
    • Tie arytenoid cartilage in the fully open position - this will not scar, so the suture must hold for the animal’s entire career (it usually doesn’t)
    • 50-70% of success
    • With the cartilage tied open, the horse cannot completely cover the trachea during swallowing, so these horses may develop aspiration pneumonia
  16. Laryngeal Hemiplegia - grades
    • Grade 1 - all movements are equal and normal
    • Grade 2 - mild or intermittent failure to fully open cartilages
    • Grade 3 - asynchronous, incomplete opening
    • Grade 4 - complete paralysis