Examination of the respiratory tract in horses...• Origin • Nose, paranasal sinus, pharynx, guttural pouch, trachea, lung, stomach Examinationof thenose • Expired air • Intensity

1

Examination of the respiratory tract in horses

Dr. Zoltan Bakos PhD, DipECEIM, MRCVS

Examination of the respiratory tract

•General impression

•Behaviour

•Posture

•Gait

•Body condition

•Abnormal sounds/noises, breathing

1

2

2

Dyspnoea

Dyspnoea

Abdominal respiratory component

3

4

3

Examination of the respiratory tract

•Steps of the physical exam• Nose and paranasal sinuses

• Guttural pouches

• Cough

• Larynx

• Trachea

• Thorax

• Inspection

• Smell

• Palpation

• Auscultation

• Percussion

5

6

4

Examination of the nose

• Physical methods

• All can be used

• Direct auscultation (PPE)

• Percussion on the bones with the tipof the middle finger

• Normal findings

• Temperature of the region is equal tothe surroundings

• Palpation is not painful

• Percussion sound is sharp, bone-like


7

8

5


• Nasal discharge

• Continuous or temporary

• Uni- or bilateral

• Amount and grade of discharge (mild, moderate, severe)

• Quality, colour and smell of discharge

• Serous, mucous, purulent, haemorrhagic, frothy, containing

food particles

• Origin

• Nose, paranasal sinus, pharynx, guttural pouch, trachea, lung, stomach


• Expired air

• Intensity of airflow

• Temperature of airflow

• Smell of expired air

• Normal findings

• Medium strength and temperature

• Odour is characteristic, not unpleasant

• Airflow is symmetrical bilaterally

9

10

6

Examination of the paranasal sinuses

• Sinuses almost totally communicate

• Thin septum separates the rostral and

caudal maxillary sinus

• Maxillary sinus is affected most

frequently

• Primary disease

• Diseases of the upper cheek teeth


11

12

7



• Inspection, palpation, percussion (flexed middle finger)

• Normal findings

• Skin is intact, no alopecia or abnormal shape

• Temperature is equal to the surroundings


• Percussion sound is sharp, bone-like

Examination of the guttural pouches

• Diverticulum of the Eustachiantube (300-500 ml)

• Between the base of the skull, atlas and pharynx

• Stylohyoid bone splits it, smallerlateral and larger medialrecess/compartment

• Left and right pouches do notcommunicate

13

14

8

Examination of the guttural pouches


• Inspection, palpation, percussion (finger-to-finger orplessimeter and hammer)

• Normal findings

• The skin is intact, no alopecia is seen



• Percussion sound is resonant

Cough

• Mode of emergence

• Spontaneous, induced

• Frequency

• Intensity

• Tone

• Occurance (e.g. at rest, during exercise)

• Duration

• Amount of secretion

• Pain

15

16

9

Cough

• Induction of cough

• Press the arytenoid cartilages of larynx

• Press the first tracheal rings

• Normal findings

• No spontaneous cough

• Difficult or impossible to induce cough

• The induced cough is strong, sharp, low, short, dry, non-painful, snapping, does norrecur

Examination of the larynx


• Inspection, palpation, auscultation

• Normal findings

• Skin is intact, no alopecia, shape is normal

• Temperature is equal to the

surroundings

• No alterations on palpation

• Very mild stridor on

auscultation

17

18

10

Examination of the trachea


• Inspection, palpation, auscultation

• Normal findings

• Skin is intact, no alopecia, shape is normal


• No alterations on palpation

• Laryngeal noise is audible in a weaker form on auscultation

Examination of the thorax


• Inspection, palpation, auscultation, percussion

• Inspection

• Shape, size, symmetry of hemithoraces

• Breathing

• Respiratory rate, rhythm, type, depth

• Dyspnoea

• Inspiratory, expiratory and mixed types

19

20

11

Dyspnoea


• Auscultation

• Respiratory noises of the horse are weak

• Systematic approach

• Start cranially behind scapule

• Move 2-4 intercostal spaces (ICS) caudally

• Start dorsally in each ICS, move ventrally by 5-10 cm

• Check at least one inspiration and expiration at each spot

• Auscultate longer if you detect abnormal sounds

• Examine both hemithoraces

21

22

12


• Auscultation

• Basic respiratory noises: weak and soft in normal horses

• Normal

• Weaker than normal (decreased airflow, superficial breathing)

• Missing (pleural effusion, consolidated lung)

• Increased in intensity, louder, harsher (dyspnoe, increased airflow)

• Adventitious respiratory sounds

• Musical (wheezes): whistling

• Non-musical (crackles): clicking, rattling, crackling noises


• Percussion

• Pleximeter and percussion hammer

• Percussion sound

• Noise created by instruments

• Sound of the chest wall

• Resonant sound of the air-filled lung

• Features of the percussion sound

• Intensity: strong/sharp or weak

• Frequency: high or low

• Tone: sonorous/resonant or dull

• Duration: shor or long

23

24

13


• Percussion

• Normal finding: strong/sharp, low, resonant, short

• Normal lung border

• Deltoid tuberosity: 7th ICS

• Point of shoulder: 10th ICS

• Ischiadic tuber: 14th ICS

• Tuber coxae: 16th ICS

• Endoscopy• Resting endoscopy• Dynamic endoscopy

• Treadmill• Telemetric (overground)

• Ultrasonography

• Radiography

• CT

• Thoracocentesis

• Thoracoscopy

• Lung function tests

• Nasal and pharyngeal

swabs

• Tracheal wash

• Bronchoalveolar lavage

• Arterial blood gas

analysis

25

26

14

Respiratory endoscopy

Respiratory endoscopy

27

28

15

Recurrent laryngeal neuropathy

Dynamic endoscopy

29

30

16

Severe RAO

Thoracic ultrasonography

Reverberation artefact

31

32

17


Comet tail artefact


Pleural effusion

33

34

18

Thoracic radiography

Thoracic radiography

Normal and concave diaphragm, increasedinterstitial pattern

35

36

19

Tracheal wash

Sample is suitable for bacterial and fungal culture and cytology

Bronchoalveolar lavage (BAL)

Sample is suitable for cytology

37

38

20

BAL fluid samples

BAL fluid cytology

Tóth B.

39

40

21

Thoracocentesis

Exudate, pleuritis

Blood, haemothorax

Thoracoscopy

41

42

22

Pulmonary function tests

• Transpleural pressure change

• Pneumotachograph, flow measurement

• Resistance

• Dynamic compliance

• Arterial blood gas analysis

http://www.otszonline.huL. Couetil

43

Examination of the respiratory tract in horses...• Origin • Nose, paranasal sinus, pharynx, guttural pouch, trachea, lung, stomach Examinationof thenose • Expired air • Intensity

Documents