Acute and Chronic Nasal Disease Flashcards
what are the 3 main points that can be used to narrow down a differential list
- local vs systemic
- unilateral vs bilateral
- congenital vs acquired
what are the differential categories for nasal disease
infectious
inflammatory
neoplastic
misc - foreign body, etc
what should always be asked in a history for a nasal disease presentation
nasal discharge characterization and chronicity
how to classify nasal discharge
serous
mucoid
hemorrhage
unilateral vs bilateral
what diagnostics should be run for epistaxis
CBC
BMBT
aPTT (intrinsic pathway)
PT (extrinsic pathway)
pseudo-nasal discharge
discharge that comes from the lower airways NOT the nose
ex. regurgitation or reflux from GERD or hiatal hernias
steps of a clinical exam for nasal disease
- observation
- hands-on
- oral exam
- neurologic exam
observation part of clinical exam
- stridor, stertor
- congestion
- signs of distress
- pawing
- facial asymmetry (and discoloration)
- nasal discharge
hands on part of clinical exam
- LN palpation
- ocular retropulsion
- aural exam
- Horner’s syndrome
what to check for in an oral exam
- pain on extension
- depigmentation
- dental disease
- mass lesions
what to check for in a neuro exam
Horner’s syndrome
- miosis
- ptosis
- enophthalmos
- 3rd eyelid protrusion
acute nasal diseases
- foreign body
- feline upper respiratory tract infection
- canine infectious respiratory disease complex
foreign body - chronicity, discharge, clinical signs
acute onset
+/- hemorrhage
paroxysmal reverse sneezing
facial pain and rubbing
foreign body - diagnosis and treatment
dx: sedated nasal exam + probe
tx: remove the foreign body + NSAIDs
- flush nasal cavity
- often does NOT require antibiotics
complications: FB can migrate –> pneumo or pyothorax; sinonasal aspergillosus
FURTI - etiologies
feline herpesvirus
feline calicivirus
chlamydia
bordetella
mycoplasma
FURTI - chronicity, discharge, clinical signs
acute onset
intermittent or recurrent
sneezing
nasal discharge
ocular discharge/conjunctivitis
fever
anorexia
FHV: ocular lesions (dendritic ulcers) + facial dermatitis
FCV: oral ulcers + lameness
feline herpesvirus
establishes latency in the trigeminal nerve and recrudesces during times of stress
infection with herpes is lifelong
feline calicivirus
most cats are able to clear infection
only a few become carriers
FURTI - diagnosis and treatment
dx: RARE - only for severe systemic signs or chronic/unresolving cases
- conjunctival and nasal PCR
tx: supportive care
- nasal flushes
- nebulization
- nutritional support
- if not improved in 10 days –> doxycycline + famciclovir
CIRDC - etiologies
many
viral: rota, corona, influenza, parainfluenza, adeno, herpes, distemper, pneumovirus
bacterial: bordetella, mycoplasma, streptococcus
CIRDC - chronicity, discharge, clinical signs
acute onset
cough (bordetella)
fever
anorexia
dehydration
tracheal irritation
tachypnea
CIRDC - diagnosis and treatment
dx: RARE - only for severe systemic signs or chronic and unresolving cases
- PCR for mycoplasma + bordetella
- thoracic rads if chronic, severe, recurrent
tx: supportive care
- can give doxycycline
chronic nasal diseases
- dental disease (abscess, fistula)
- feline chronic rhinosinusitis
- canine lymphoplasmocytic rhinitis
- canine sinonasal aspergillosis
- feline fungal disease
- nasal neoplasia
dental disease (abscess, fistula) - chronicity, discharge, clinical signs
chronic
unilateral mucopurulent to hemorrhagic
difficulty eating
halitosis
asymmetry
fractured tooth
pain
ptyalism
dental disease - diagnosis and treatment
dx: oral probing, dental radiographs, head CT
tx: surgery +/- antibiotics
feline chronic rhinosinusitis signalment
any age cat
usually young to middle aged
feline chronic rhinosinusitis - chronicity, discharge, clinical signs
chronic
recurrent to waxing/waning
unilateral or bilateral
variable discharge w/ sneezing
systemically HEALTHY cat with LOCAL signs only
- congested nasal passages
- erythema
- swollen/edematous turbinates
feline chronic rhinosinusitis - diagnosis and treatment
dx: diagnosis of exclusion
- definitive dx requires BIOPSY
- infectious disease testing only beneficial for viral or fungal (PCR or fungal cultures)
tx: lifelong disease, requires ongoing treatment
- NSAIDs/steroids
- topical (inhaled) decongestants
- nasal flushes
- short term doxycycline if suspect bacterial component
predisposing factors to feline chronic rhinosinusitis
- altered airflow (anatomical)
- increased mucus
- secondary bacterial infection
canine lymphoplasmocytic rhinitis - chronicity, discharge, and clinical signs
chronic
recurrent
waxing and waning
unilateral or bilateral discharge
systemically HEALTHY dog with LOCAL signs only
canine lymphoplasmocytic rhinitis - diagnosis and treatment
dx: diagnosis of exclusion
- definitive: biopsy
tx: meloxicam followed by prednisone (after a washout period)
canine sinonasal aspergillosis etiology
aspergillus fumigatus
other aspergillus species cause disseminated aspergillosis
canine sinonasal aspergillosis - signalment
young to middle aged
RARE in brachycephalics
canine sinonasal aspergillosis - chronicity, discharge, clinical signs
chronic (months to years)
unilateral > bilateral
mucopurulent to epistaxis
sneezing w/ discharge
depigmentation of the nose
facial pain
seizures
LN enlargement
increased airflow
canine sinonasal aspergillosis - diagnosis and treatment
dx:
- CT & rhinoscopy - lytic changes to conchae
- culture: definitive diagnosis
tx: debridement + azole antifungal topical
- rhinoscopy + debride to clear out the fungal plaques from nasal passages up to sinuses
- administer clotrimazole into the sinus for 20 min contact time
requires 2-3 treatments on average
do the destroyed nasal passages reform once canine sinonasal aspergillosis is treated
no - will almost always get chronic rhinitis due to decreased nasal conchae
what are the most common feline fungal nasal diseases
cryptococcus
aspergillus
where does crypto and aspergillus affect the cat
crypto: sinonasal
aspergillus: sinonasal + sino-orbital
clinical signs - feline cryptococcus
sneezing
discharge
- bilateral mucopurulent
“roman nose”
seizures
chorioretinitis
clinical signs - feline aspergullis
erosive/ulcerative facial lesions
exophthalmos
same signs as canine sinonasal aspergillosis
diagnosis - feline cryptococcus
latex antigen test
+/- retinal exam to evaluate for chorioretinitis
diagnosis - feline aspergillus
culture
treatment - feline cryptococcus
fluconazole PO
continue oral antifungals until latex antigen test comes back negative
treatment - feline aspergillus
debridement + multimodal systemic therapy (ampho, azoles)
most common nasal tumors in dogs
squamous cell carcinoma
mesenchymal - fibrosarcoma, chondrosarcoma
most common nasal tumors in cats
lymphoma
mesenchymal - fibrosarcoma, chondrosarcoma
palliative treatments for nasal neoplasia
SCC: NSAIDs
lymphoma: prednisolone
