EIPH

Question 1

Clinical signs of exercise-induced pulmonary haemorrhage (EIPH)?

Answer 1

• Most commonly no signs (most don’t bleed significantly enough to cause epistaxis)
• poor performance
• sudden onset exercise limitation
• swallowing after exercise
• epistaxis

Question 2

How does exercise-induced pulmonary haemorrhage develop?

Answer 2

• typically located in the caudodorsal lung lobes
• Capillary stress failure theory
• High pressures in pulmonary vasculature in the galloping horse due to CO and it ruptures

Question 3

Why does EIPH occur generally in the caudodorsal lobes?

Answer 3

• Higher blood flow
  
  • lower intrinsic vascular resistance
• Displacement of the diaphragm causes transient falls in alveolar pressure
• Lower alveolar pressure leads to greater transmural pressure

Question 4

EIPH - Predisposing conditions?

Answer 4

• Prevalence increases with age
• Lower airway disease
• Upper airway disease
• Cardiac disease
  
  • Increases pulmonary artery pressure

Question 5

EIPH – diagnosis?

Answer 5

• Clinical evidence of EIPH (in severe cases)
• Endoscopy
• Bronchoalveolar lavage
  
  • RBCs, haemosiderophages
• Radiography
• Scintigraphy (experimental)

Question 6

EIPH: case management?

Answer 6

• Identify and address any predisposing diseases
• Break haemorrhage-inflammation cycle
  
  • Modify training programme to reduce episodes
  • Dust-free environment
  • Furosemide (Not allowed in racehorses in the UK)
  • ?antibiotics

Question 7

Effects of Furosemide on EIPH?

Answer 7

• Diuretic effect
  
  • Reduce circulating volume
  • Reduce weight
• Vasodilator effect
• Not allowed in racehorses in the UK

Question 8

How are nasal strips used for EIPH?

Answer 8

• Not allowed in UK racing
  
  • Can train with them - Improve fitness and ability
• Work by dilating the nostril thereby reducing airway pressures and promoting oxygen uptake

Question 9

EIPH: prognosis?

Answer 9

• GOOD TO FAIR
  
  • If having minimal impact on performance
  • If you can identify a primary cause and address it
• POOR
  
  • for idiopathic bleeders with performance limitations

Question 10

Infectious causes of URT disease?

Answer 10

• VIRUSES
  
  • Equine influenza
  • Equine Herpes Virus 1&4
  • Equine Viral Arteritis
• BACTERIA
  
  • Streptococcus equi equi

Question 11

Viral causes of LRT disease?

Answer 11

• Equine influenza
• Equine Herpes virus 1&4
• Equine Rhino virus
• Equine Viral Arteritis

Question 12

Bacterial causes of LRT disease?

Answer 12

• Streptococcus zooepidemicus
  
  • The most important
• Streptococcus pneumoniae
• Pasteurella/actinobacillus
• Rhodococcus equi
• Streptococcus equi equi

Question 13

Which mycoplasma species is associated with inflammatory airway disease?

Answer 13

• Mycoplasma felis. Implicated as a cause of IAD
• Isolated less commonly than other bacteria

Question 14

Which antibiotic is Mycoplasma felis sensitive to?

Answer 14

Sensitive to oxytetracycline

Question 15

Strains of equine herpes virus and what they cause?

Answer 15

• EHV1 - respiratory disease, abortion, neonatal, neurological
• EHV2 - respiratory disease in foals
• EHV3 - penile vesicles
• EHV4 - respiratory disease
• EHV5 – Equine Pulmonary Nodular Fibrosis

Question 16

Transmission of equine viral arteritis ND?

Answer 16

• Transmission by respiratory and venereal routes
  
  • direct contact with an infected horse and its secretions
• Reservoir of infections
  
  • Stallions that are chronic shedders
  • Until they are castrated will continue to spread disease

Question 17

Clinical signs of equine viral arteritis ND?

Answer 17

• abortion and still birth
• peripheral oedema
• rhinitis and bronchitis/brochiolitis
• conjunctivitis and periorbital oedema

Question 18

General supportive treatment for equine lung disease?

Answer 18

• Rest
• Improve environement - dust free management
• Anti-pyretics

Question 19

How should you ideally manage an outbreak of EHV-1?

Answer 19

• Impose isolation policy on premises (Identify high and low risk animals and separate them)
• Serology on all in-contacts
• Separate negative and positive horses, re-test two weeks later
• Repeat until all horses have two negative samples
• Handlers and vets are important fomites so good hand hygiene is vital

Question 20

Risk factors for neonatal respiratory disease?

Answer 20

• Placentitis
• Placental insufficiency
• Maternal illness
• Early lactation
• Poor colostrum
• Prematurity
• Dystocia
• Premature placental seperation
• Failure of passive transfer
• Other neonatal illness

Question 21

What is respiratory distress syndrome in neonates?

Answer 21

• Atelectasis (collapse/failure of the lungs to expand due to lack of surfactant) due to
  
  • Inadequate surfactant function
  • Structurally immature lung and muscles of respiration
• Associated with prematurity and dysmaturity

Question 22

How does meconium aspiration occur in neonates?

Answer 22

• Stress in utero or during parturition leads to defecation,
• meconium enters airways with fetal fluid,
• aspirated when foal is born and starts breathing
• secondary bacterial pneumonia

Question 23

Clinical signs and diagnosis of meconium aspiration?

Answer 23

• Clinical signs: respiratory distress, nasal discharge
• Diagnosis: meconium staining

Question 24

What can cause aspiration pneumonia in neonates?

Answer 24

• Dysphagia
  
  • neurological - uncommon, transient, manifestation of NMS
• Cleft palate
• Inappropriate bottle feeding

Question 25

How does pneumothorax & haemothorax occur in neonates?

Answer 25

* due to trauma at birth causing rib fractures

Question 26

How does Perinatal Asphyxia Syndrome develop?

Answer 26

* Ischaemia, oedema and reperfusion injury to foal’s brain, kidneys, intestine and other organs due to lack of oxygen (especially CNS depression) * *In utero* hypoxia * Interruption of oxygen supply during birth

Question 27

Clinical signs of Perinatal Asphyxia Syndrome?

Answer 27

* May not be apparent until the foal is 12-24 hours old * Severe cases may have central respiratory depression * Almost stop breathing completely

Question 28

Management and prognosis of perinatal asphyxia syndrome?

Answer 28

* Require lots of 24 hour nursing care, especially by the time they are severe. (very expensive) * Prognosis of this condition is dependent on whether they receive this intensive nursing * Without this they will die * With this they will either die or recover 100% and regain full athletic function and be able to be a performance animal as they should have been, no in between

Question 29

Why is lung auscultation not a sensitive diagnostic tool in foals?

Answer 29

Normal foal lungs have harsh bronchovesicular sounds (don’t have normal lung sounds like adults)

Question 30

Signs of sepsis in the mucous membranes of a foal?

Answer 30

* Signs of sepsis: congestion/injection, petechiae * Congested mucous membranes – dark red not pink * Inside the ear pinna is showing the petechiae

Question 31

How is *Rhodococcus equi* transmitted?

Answer 31

* Inhaled pathogen * Ingested from soil (via faeces) * Lives in environment * Farms that have it tend to get it year to year

Question 32

When does *Rhodococcus equi* tend to be seen in foals?

Answer 32

* Foals 2-6 months of age * As MDA reduces