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Surgery of the Upper Airways, Thyroid, Larynx and Trachea > BOAS: Pathophysiology and Recognition > Flashcards

BOAS: Pathophysiology and Recognition Flashcards

1
Q

Define brachycephalic.

A

Shortened skull length to width (width > 80% of length) results in both nasal cavity and pharyngeal compression

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2
Q

With the skull index definition, what breeds are brachycephalic? (13)

A

Pug,
French Bulldog,
English Bulldog,
Boston Terrier,
Cavalier King Charles Spaniel,
Pekingese,
Japanese Chin,
Dogue de Bordeaux,
Shih-tzu,
Boxer,
Pomeranian,
Griffon,
Lhasa Apso.

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3
Q

Unfortunately, breeding for a particular phenotype (the wide head and flat muzzle) has resulted in accompanying diseases (7)

A

upper airway obstruction,
skin folds = pyoderma, shallow orbits with protruding globes = corneal ulceration and globe prolapse,
dental overcrowding
malocclusion
hemi vertebrae

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4
Q

Risk factors for BOAS (6)

A

Breed

Age

Nostril status

Body condition score

Gender (breed specific)

Conformation-breed specific

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5
Q

BOAS is a progressive disease and dogs usually present with BOAS at what age

A

between 1 and 4 years

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6
Q

How does the neck relate to BOAS?

A

Neck girth is another risk factor for BOAS

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7
Q

BOAS; what sex in pugs are more likely?

A

Female

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8
Q

BOAS; what sex in bulldogs are more likely?

A

Male

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9
Q

Other than nostrils, what external conformational factors in pugs effect BOAS? (2)

A

wider head
wider set eyes

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10
Q

Other than nostrils, what external conformational factors in English bulldog effect BOAS? (2)

A

width of head
thick neck

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11
Q

Other than nostrils, what external conformational factors in French bulldog effect BOAS? (2)

A

short neck length
shorted muzzle.

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12
Q

The turbinates are bony structures covered by mucous membranes, these membranes serve to ? (2)

A

warm and humidify the air before it moves to the lung

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13
Q

After turbinates where does air pass before going through the back of the mouth, and into the larynx to enter the trachea?

A

The air then passes over the soft palate,

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14
Q

When the dog is excited or exercising, nasal breathing will switch to open-mouth breathing. Why?

A

Increase the efficiency of inspiration and reduce heat by panting.

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15
Q

Brachycephalic dogs have a shortened skull and muzzle, the hypothesis is that?

A

is due to premature closing of the sutures at the base of the skull.

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16
Q

What causes restricted air flow in BOAS?

A

Increased soft tissue in the pharynx and nasal cavity

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17
Q

The lesion sites that are linked to BOAS include (7)

A

stenotic nares,
thickened + long soft palate,
hypoplastic trachea,
compressed nasopharynx
bronchial collapse,
hyperplastic tongue
excessive turbinate crowding in the nasal cavity

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18
Q

BOAS lesions can cause secondary areas of collapse and inflammation, such as (3)

A

laryngeal collapse,
laryngeal ventricle eversion
tonsillar hypertrophy.

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19
Q

Increased thoracic pressures in BOAS may result in:
(6)

A

pulmonary hypertension
cor pulmonale
reflux
Hiatal hernia
Aspiration pneumonia

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20
Q

Nasal Grading System; when to assess nostril mobility?

A

After exercise

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21
Q

Nasal Grading System; define grade 0

A

Clear space dorsally between lateral nasal wing and philtrum, usually mobile.

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22
Q

Nasal Grading System; define grade 1

A

Mild stenosis - clear but small gap between nasal wing and philtrum, usually mobile.

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23
Q

Nasal Grading System; define grade 2

A

Nasal wing touches philtrum dorsally, often immobile.

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24
Q

Nasal Grading System; define grade 3

A

No hole in nostril - dorsally or ventrally, immobile.

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25
Q

Grade 2-3 nasal grading, increases BOAS risk by how much?

A

4x

26
Q

What is the effect of an elongated soft palate on breathing ability?

A

trap the epiglottis of the larynx making it difficult to switch from nasal breathing to open mouth breathing.

27
Q

if the dog struggles to breathe, how can this further impede airflow?

A

Soft palate and surrounding tissues can become quite swollen and oedematous

28
Q

3 stages of laryngeal collapse

A

1 Everted laryngeal ventricles

2 Deviation of the cuneiform cartilage medially

3 Medial collapse of the cuneiform and corniculate cartilage of the arytenoid obstructing the airway

29
Q

Which is the most common stage of laryngeal collapse, seen in 50% of cases?

A

Everted laryngeal ventricles

30
Q

Where do Laryngeal ventricles (or saccules) sit?

A

In the larynx, between the vestibular and vocal folds

31
Q

Laryngeal ventricle lies medial to the A) cartilage and lateral to the B) (2)

A

A) thyroid
B) vocal and vestibular folds

32
Q

CARE - remember that static images on endoscopy, radiography or CT may be affected by (4)

A

endotracheal tube,
phase of respiration,
head position
degree of mouth opening

33
Q

BOAS primary lesions (6)

A
  • Stenotic nares
  • Elongated/thickened soft palates
  • Macroglossia
  • Reduction in the nasopharyngeal area
  • An obstructed nasal cavity
  • Tracheal hypoplasia
34
Q

BOAS secondary factors (5)

A
  • Laryngeal Collapse (8-53%)
  • Tonsillar hypertrophy
  • Hiatal hernia
  • Oesophagitis
  • Pulmonary hypertension
35
Q

The upper airway obstruction may manifest as (7)

A

respiratory noise,
dyspnoea,
exercise intolerance,
heat sensitivity,
sleep disorders,
cyanosis,
collapse

36
Q

BOAS GI signs? (4)

A

Regurg
V+
Oesophagitits
Reflux

37
Q

Which of the following is not important when assessing nostrils?

Any skin flaring behind the nostril

The ventral space

The dorsal space

A

The ventral space

38
Q

Some dogs, particularly what breed, that appear to have reasonable respiratory function until stressed or exercised when they then show marked dyspnoea. Clinical signs are exacerbated by heat and exercise.

A

Pugs

39
Q

Respiratory functional grading; how long do we exercise?

A

3 mins

40
Q

Respiratory functional grading; what is noted? (4)

A

refusals,
airway noise,
effort,
extreme respiratory signs pre- and post-exercise

41
Q

Define Respiratory functional grading; Grade 0

A

Not present

42
Q

Define Respiratory functional grading; Grade 1

A

Mild (only audible with a stethoscope)

43
Q

Define Respiratory functional grading; Grade 2

A

Moderate (intermittent and heard without a stethoscope)

44
Q

Define Respiratory functional grading; Grade 3

A

Severe (easily audible without a stethoscope and constant)

45
Q

What is Respiratory functional grading assessing?

A

Airway noise

46
Q

Any dog that is severely affected at rest should not be exercised! What grade are they?

A

3

47
Q

Respiratory functional grading; where do we auscultate these patients?

A

directly over the larynx, with the stethoscope held gently against the side of the larynx

48
Q

What 2 sounds are we listening for with Respiratory functional grading and what do they mean?

A
  • stertor- the soft palate vibrating (too long or because the nasal cavity is obstructed.
  • stridor; larynx is collapsing due to high pressures when breathing in
49
Q

Laryngeal collapse is more common in which BOAS breed?

A

Pug

50
Q

Stertor is best described as a low-pitched noise most likely originating from the:

A

nasopharynx

51
Q

Which Respiratory functional grading is “clinically unaffected”

A

0 and 1

52
Q

Which Respiratory functional grading is “clinically affected”

A

2 and 3

53
Q

what Respiratory functional grading are surgical candidates?

A

3

54
Q

What does a grade 2 Respiratory functional grading mean in terms of surgery?

A

likely surgical candidates but if obese, weight loss could be initiated prior to surgery.

55
Q

What else can we use the grading system for in addition to our objective respiratory function test?

A

Monitoring

56
Q

The Respiratory Functional Grading Scheme (RFG Scheme) was launched by?

A

Kennel Club/University of Cambridge i

57
Q

Other than using RFG. Other signs of nasal obstruction (3)

A
  • flaring of the skin just behind the nasal planum,
  • lack of nasal wing mobility
  • excessive panting on the edge of obstruction .
58
Q

How does whole body barometric plethysmography (WBBP) happen?

A

dogs are placed in a sealed chamber with biased airflow moving across it.

59
Q

What parameters are measured with whole body barometric plethysmography (WBBP)(7)

A

breathing frequency;
total inspiratory volume,
insp time and peak flow;
total expiratory volume,
Exp time and peak flow;
lags between breath cycles (if any)
minute respiration volume.

60
Q

How many dogs dont give a usable result with whole body barometric plethysmography (WBBP)?
Why (3)

A

10 - 20%

  • Pant, bark, move
61
Q

Why is BOAS index important?

A

bjective measurement with which to evaluate risk factors for BOAS and the effectiveness of our surgical treatments, looking at the whole upper airway rather than individual sections.

62
Q

What BOAS index “should be” bred?

A

0, 1, 2

Surgery of the Upper Airways, Thyroid, Larynx and Trachea (10 decks)

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