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LAM RESPIRATORY DISEASES

LAM RESPIRATORY DISEASES. A: dorsal pharyngeal Recess B: openings to the Gutteral pouches C: larynx D: end of nasal septum. EPIGLOTTIC ENTRAPMENT. Pathophysiology: aryepiglottic and subepiglottic tissue envelops the epiglottis

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LAM RESPIRATORY DISEASES

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  1. LAM RESPIRATORY DISEASES

  2. A: dorsal pharyngeal Recess B: openings to the Gutteral pouches C: larynx D: end of nasal septum

  3. EPIGLOTTIC ENTRAPMENT • Pathophysiology: aryepiglottic and subepiglottic tissue envelops the epiglottis • CS: may be asymptomatic, exercise intolerance, chronic cough (especially when eating) • Dx: CS, Hx and endoscopy • Tx: • stall rest (will recur when training is resumed) • Surgery (division of entrapped membrane with YAG laser)

  4. ETHMOID HEMATOMA • Signalment: older than 4 years • Thoroughbreds, arabians, warmbloods • Enlarges over time

  5. ETHMOID HEMATOMA • CS • Bilateral in 15-20% of cases • Usually mild spontaneous intermittent unilateral epistaxis • Fatal hemorrhage is not common • Dx: endoscopy, skull rads etc • Tx: • Surgical ablation with YAG laser (preferred) • Intralesional formalin

  6. GUTTURAL POUCH EMPYEMA • Etiologic agent: Strep equi or zooepidemicus • Risk factors: previous resp tract dz • CS: intermittent nasal discharge • Concretions of inspissated pus • Dysphagia- difficulty breathing • Dx: skull rads, endoscopy Chondroids

  7. GUTTURAL POUCH EMPYEMA • Tx • Flush pouches • Sedation (xylazine) • Keep head lowered • Place a catheter in pouch • Flush with LRS with or without iodine • Parenteral antibiotics • Will result in relapse without direct treatment of pouch • Surgery • Usually necessary if there are chondroids

  8. GUTTERAL POUCH MYCOSIS • Spontaneous epistaxis in a mature horse at rest • Pathogenesis • Fungal invasion of tissue resulting in erosion of the wall of internal carotid • CS • Epistaxis (usually only CS) • Several bouts before fatal hemorrhage

  9. GUTTURAL POUCH MYCOSIS • CS: dysphagia to X and XI • Dx: CS, Hx, endoscopy • Tx: • topical infusions of antifungal agents • Surgical therapy (emergencies) • Balloon catheter occlusion • Transarterial coil

  10. EIPH • Signalment/risk factors • Incidence related to INTENSITY of exercise • Prevalence increases with age

  11. EIPH • Pathogenesis • Capillary rupture theory: disruption of pulmonary capillaries due to high cardiac outputs required- stress failure of the vessel wall • Concussive lung injury theory: impact of hood on the ground causes the force to be transmitted to the chest wall • Lower airway inflammation theory: previous resp dz and fibrosis causes weak area prone to disruption • CS • Poor performance • Epistaxis (minimal volume) • Many studies cant show associated between occurrence and severity of EIPH or racing success

  12. EIPH • Dx: endoscopy, hemosiderophages in resp secretions (TTW), radiology (caudodorsal) • Tx • Furosemide • Improves racing times • May not improve EIPH • Nasal strip

  13. DDSP • 2 types • Intermittent • Only seen at exercise • Causes: thyrohyoid muscle dysfunction, inflammation, retraction of tongue, hypoplastic epiglottis • Persistent • Usually neurogenic problem associated with GPM • CS: “quitting”, loud gurgling noises • Dx • CS and Hx • Endoscopy

  14. DDSP • Tx • Tongue Tie • Cornell DDSP collar • Surgery

  15. LARYNGEAL HEMIPLEGIA • H cannot fully dilate the larynx on the affected side • ILH- idiopathic damage to LEFT recurrent laryngeal nerve • R and L LH can result from perivascular injection of jugular (common), guttural pouch dz; bilateral LH think systemic dz (neurologic dz, bilateral guttural pouch dz etc) • All ages affected (2-3 year old racehorses) • CS: exercise intolerance, abnormal inspiratory noise (“roar”)

  16. LH • Dx: CS, hx, endoscopy (grades I-IV) • Palpation of larynx, arytenoids depression test, grunt test, intermandibular width, electrolaryngeography • Tx: “tie back”- laryngoplasty (44-87% success), misc other surgeries

  17. ARYTENOID CHONDRITIS • Signalment: young thoroughbred racers • Risk factors: recurrent NG intubation • Pathophysiology: • Progressive cartilage enlargement (may have central abscess or granulomas around the opening) • CS: mild (cough, resp noise during exercise), severe (dyspnea to distress) • Dx: endoscopy or rads of the larynx • Tx:: sx only definitive tx (arytenoidectomy)

  18. RHODOCOCCUS EQUI • Facultative aerobic, Gram +, pleiomorphic. Coccobacillus • Bronchopneumonia and chronic abscesses • Only in H less than 6 months (usually 2-4 months) • Most strains non pathogenic- pathogenic strain carries a plasmid • Opportunistic pathogen • Transmission: inhalation of dust • CS: FEVER, dyspnea, cough etc • Possibly infections in GI, bones, joints etc

  19. R equi • Prevention: treat foals w/in 1st week of life with hyperimmune serum • Vaccine doesn’t work • Dx: • CBC (neutrophilia, hyperfibrinogenemia) • Radiography (perihilar pulmonary abscessation, military pattern, general bronchopneumonia pattern, interstitial pattern) • TTW • Serology: ELISA (low titer indicates susceptibility), AGID ( positive titer indicates active infection) • Ultrasonography

  20. R equi • Tx • Erythromycin + rifampin (6-8 weeks) • Continue tx 2 weeks after normalization of fibrinogen or rad resolution • Supportive therapy (antiulcer meds, flunixin meglumine, hyperimmune serum etc) • Monitor throughout 1st 4-6 months on endemic farms • WBC count, Fibrinogen, Thoracic ultrasound, CBC, Temp, serology

  21. STRANGLES • Etiologic agent: strep equi • Signalment: young horses, can be in immuno naïve adults • CS: fever, depression • nasal discharge (yellow green) • Cough • Swelling and draining of submandibular lnn • Can lead to resp distress • Rupture of lnn into guttural pouch (CAN LEAD TO GUTTURAL POUCH EMPYEMA)

  22. STRANGLES • Pathophysiology • Infects macrophages and replicates in pharynx • Fever w/o CS first few days • D 1-7 start of swelling of submandibular lnn • D 7-14 maturation of the lnn • D 10-14 rupture and drainage of lnn • Continue draining for 3-4 weeks • Dx: • Culture and sensitivity • CS and progression

  23. STRANGLES • Tx: • If eating and not depressed w no complications- benign neglect • Aid drainage of abscesses • Antibiotics only indicated if complicated course of dz (procaine pen) • ISOLATE ALL CASES • Vaccination controversial- may predispose to more serious infections and complications

  24. STRANGLES/ PURPURA HEMORRHAGICA • Purpura hemorrhagica • Allergic response to S equi, S zooepidemicus, or influenza virus • CS: demarcated areas of edema (limbs, ventral abdomen) • Dx: cutaneous biopsy: leukocytoclastic vasculitis • Neutrophilic infiltrates of small veins/venules • Low mortality unless complicated

  25. STRANGLES/ PURPURA HEMORRHAGICA • Tx: • Remove antigenic stimulus- treat with penicillin • Reduce vessel wall inflammation • Hydrotherapy, sweat bandages, NSAIDs, DMSO • Normalize the immune system • Corticosteroid therapy for severe cases • Supportive care • Complications: sloughing of skin on limbs, cellulitis, pneumonia, colitis etc

  26. STRANGLES/ BASTARD STRANGLES • Systemic manifestation of strangles • Mets to other lnn of the body • Difficult to treat, requires long term antimicrobials • High mortality

  27. PLEUROPNEUMONIA • Risk factors (stress related) • Transport: eating in trailer with head attached in fixed position, chronic aspiration of feed • Prior or concurrent viral infection, poor ventilation, general anesthesia, concurrent dz, • Pathophysiology • Infection • Pulmonary defenses lowered

  28. PLEUROPNEUMONIA • Pathophysiology • Parapneumonic effusion results • Sterile protein rich fluid initially • Bacteria invade fluid • After 2-3 weeks: parenchymal necrosis develo • CS- rarely in overt distress • Acute: fever, anorexia, cough, depression • Chronic: dyspnea, sternal edema, resp distress • Thoracic auscultation: • Absence of lung sounds • Louder cardiac auscultation

  29. PLEUROPNEUMONIA • Dx • CBC, chem, Ultrasonography, Thoracentesis • Tx • Systemic antimicrobials: • Usually gram + and – • Gram – most likely • 25% have anaerobic bacteria • Drainage of thorax • Anti-inflammatories: NSAIDs and DMSO • Supportive therapy

  30. IAD • Non septic diseases in younger athletic horses without a clearly defined etiology • Prevalence:11-65% • Common cause of poor performance and premature retirement • Signalment : young performance horses

  31. IAD • Risk factors: • Intense exercise • Long distance transport • Exposure to infectious pathogens • EIPH • Stabling • Pathogenesis • Airway inflammation: small airways • Clinically obvious bronchoconstriction is NOT a significant component • Airway hyperreactivity

  32. IAD • CS: no Cs at rest • 3-5 sec reduction in race times • Chronic cough and prolonged recovery after exercise • May see nasal discharge, and tracheal sensitivity • Dx: endoscopy, BAL (3 types based on infiltrates seen) • Type 1: neuts, monocytes, lymphocytes • Type 2: mast cells • Type 3: eosinophils

  33. IAD • Tx • Decrease irritants • Antibiotics • Bronchodilators (of little help) • Corticosteroids (for type 3) • Mast cell stabilizers (for type 2) • Interferon alpha (for type 1)

  34. RAO/COPD • Risk factors • Confinement housing, feeding hay, bedding w straw, storage of forages over stalls • Usually in winter when horses are stabled • Can be in summer in southern US d/t molds in pasture • Pathogenesis • Allergic dz (molds, inhalation of endotoxin, hereditary predisposition) • Small airway obstruction • Bronchoconstriction, excessive production of inflammatory exudate

  35. RAO/COPD • CS • Middle aged horses, chronic cough, nasal discharge, exercise intolerance- dyspnea • Heave line- excessive expiratory effect • Dx • End expiratory wheeze • Afebrile, chronic cough • BAL • Endoscopy • Response to therapy

  36. RAO/COPD • Tx • Management- change environment • Systemic corticosteroids- dex or prednisolone • Systemic bronchodilators • Atropine/glycopyrrolate (for diagnosis) • Aminophylline/theophylline • Isoproterenol (not used therapeutically) • Terbutaline/albuterol/clenbuterol • Inhalation agents • Ipratropium • Beclomethasone • Albuterol

  37. RAO/COPD • Aerosol delivery systems • Equine aerosol drug delivery system • Small device fitting directly into left nostril • 23-45% of drug to lower airway • Only used with albuterol • Equine haler • Spacer fitting over 1 nostril • Can use for any MDI • Disadvantages- some nasal trapping and loss in device • equiPoudre • Dry powder inhaler

  38. RAO/COPD • Aerosol delivery systems • Metered dose inhaler • Rapid administration to area needed • Propellants- CFC or HFA • Dry powder inhaler • Placed in mouth and patient inhales with enough force to loosen part of powder med inside • Equine aeromask • Can be used with nebulizers, MDIs and dry powder inhalers • Don’t always fit well 6-15% of drug to lower airway

  39. EQUINE INFLUENZA • Predisposing factors: • young animals, impaired immunity, poor ventilation • CS: • pyrexia, lymphadenopathy, dry harsh non productive cough, serous to muco purulent nasal discharge • Complications • Chronic cough- up to 7 weeks • Secondary bacterial infection • Myositis, myocarditis • Purpura hemorrhagica

  40. EQUINE INFLUENZA • Tx • NSAIDs, rest, improve ventilation • Antibiotics if secondary bacterial infection • Dx • Virus isolation • ELISA (horse side test kit available) • Serology • Prevention: vaccination • Immunity short lived

  41. COUGH

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