Epistaxis and hemoptysis

Question 1

hemorrhage from the nose due to one of or a variety of etiologies

Answer 1

epistaxis

Question 2

What are the most common Ddfx for epistaxis in dogs and cats that are allowed outside.

Resident Friends Trade Trauma rePeatedly

Answer 2

Rickettsial
Fungal
TVT
Trauma
Parasitic

Question 3

What are likely extranasal (systemic) causes of epistaxis?

Answer 3

Thrombocytopenia
Thrombocytopathia
Coagulation factor deficiency
Increased capillary fragility (i.e., hypertension, hyperviscosity, hyperlipidemia, thromboembolic, neoplasia invading blood vessels)

Question 4

cause of epistaxis due to a quantitative platelet abnormality

Answer 4

thrombocytopenia

Question 5

cause of epistaxis due to a qualitative platelet defect

Answer 5

thrombocytopathia

Question 6

What are likely intranasal (localized) causes of epistaxis?

Answer 6

trauma
polyps
neoplasia
infectious (fungal, parasitic, bacterial, viral)
inflammatory (LPR, eosinophilic)
dental disease (ONF, TRA)
fb
vascular malformation

Question 7

Primary bacterial rhinitis is an uncommon cause of epistaxis. What are the usual suspects that cause bacterial rhinitis?

Answer 7

Bordetella
Pasturella
Mycoplasma spp

**agents that are ubiquitous to the respiratory tract

Question 8

What platelet count should prompt you to investigate a thrombocytopathia in the epistaxis patient?

Answer 8

> 100,000 /mcL

Question 9

What test should be performed prior to rhinoscopy for the epistaxis patient?

Answer 9

BMBT - need to r/o systemic bleeding disorder

Question 10

What type of block may be a part of your anesthetic protocol prior to rhinoscopy?

Answer 10

infraorbital bloc

(0.5 -2 mL of bupivicain or lidocaine, 5-20 min prior to rhino)

Question 11

Describe the retroflex technique to visualize the caudal nasopharynx.

Answer 11

1. endoscope inserted into mouth, unflexed, until you reach the soft palate.
2. flex tip of scope to maximal angle, positioning hte light of the scope above the soft palate.
3. pull the scope forward to visualize the choana.

https://ebooks.health.elsevier.com/9780443116155/video/chapters/9780443116155XXX89X0/1f0562af-7c21-4a8f-b4d6-24bd5967119b

Question 12

choana

Answer 12

an opening in the roof of the mouth that connects the nasal cavity to the nasopharynx; gutteral openings of the nasal cavity

Question 13

Describe how to approximate the location of the cribriform plate.

Answer 13

measure the level of the medial canthus of the eye

**prevents excessive passage of instrument into nasal cavity, which can result in penetration of the brain via the dorsal nasal meatus

Question 14

complication(s) of rhinoscopy

Answer 14

hemorrhage - fungal/ neoplasia can be associated with more marked hemorrhage d/t tissue erosion/ invasion of vasculature (rec anxyiolitic)

aspiration of blood

neurologic signs if rostral brain is damaged

Question 15

What are strategies that can be used to reduce epistaxis after rhinoscopy/ tissue sampling?

Answer 15

1. Ice packs
2. Anxiolytic medication(s)
3. intranasal infusion of oxymetazoline (vasoconstrictor) with severe hemorrhage
4. pressure

**If there is severe bleeding post-op, consier ligation or embolization of carotid artery

Question 16

T/F: Bilateral epistaxis is pathopneumonic for extranasal causes.

Answer 16

F - Ex. Intranasal tumors start unilateral and can become bilateral with disease progression.

Question 17

Ulceration and depigmentation of the nasal planum can be supportive of what Ddfx in patients with epistaxis?

Answer 17

immune-mediated disease
fungal (sinonasal aspergillosis)
neoplasia

Question 18

T/F - Melena and hematemesis can occur in patients with epistaxis, not due to extranasal causes.

Answer 18

T - this can occur when blood from the nasopharynx is swallowed.

Question 19

T/F - Hyperviscosity syndrome can be associated with epistaxis.

Answer 19

T - Hyperviscosity syndrome can cause epistaxis (nosebleeds). When blood becomes abnormally thick due severe hyperproteinemia, it can put increased pressure on the delicate blood vessels in the nasal mucosa, causing them to rupture and bleed easily; this is particularly prevalent in small, poorly supported venules within the nasal cavity, making nosebleeds a common symptom of hyperviscosity syndrome

Question 20

What is the most common cause of a primary thrombocytopathia?

Answer 20

vWD

Question 21

expectoration of blood/ blood mucus from the respiratory tract at/or below the larynx

Answer 21

hemoptysis

**fun fact: hamia = blood, ptysis = spitting

Question 22

What types of history questions essential for the patient experiencing hemoptysis?

Answer 22

cardiac/ pulmonary abnormalities = exercise intolerance, dyspnea, syncope, cough

stressful events (i.e. chewing on electric cord causing a non-cardiogenic edema)

GI hx (vs hematemesis)

trauma

cough prior to hemotpysis (indicates chronicity)

medications

toxin exposure

travel history

Question 23

Ddfx - hemoptysis

Answer 23

pulmonary

cardiovascular

systemic

Question 24

What are pulmonary causes of hemoptysis?

Answer 24

Question 25

What are cardiovascular causes of hemoptysis?

Answer 25

Question 26

What are systemic causes of hemoptysis?

Answer 26

Question 27

T/F: Platelet defects are less likely to cause hemoptysis than coagulopathies.

Answer 27

T

Question 28

What specific parasites can cause hemoptysis?

Answer 28

Paragonimus spp (North American fluke)

Eucoleus aerophilus (formerly capillaria aerophila - capillards = nematodes)

Aelurostronglyus abstrutus

Question 29

What types of fungal organisms can result in a fungal pneumonia?

Answer 29

blastomyces

histoplasma

coccidioides