Exam 2 - Nasal Disease in Dogs & Cats Flashcards
what are some general clinical signs of nasal disease?
nasal discharge, sneezing, gagging/retching, stertor, inappetance
what can serous nasal discharge indicate?
- normal
- viral URT
- may be early in disease
what can mucopurulent nasal discharge indicate?
- inflammation
- secondary bacterial rhinitis, fungal rhinitis
-foreign body/mass/polyp/tooth root abscess
what can epistaxis indicate?
-trauma
-coagulopathy
-vasculitis
-hypertension
-trauma
-foreign body/neoplasia
-hyperviscosity syndromes
how can you characterize clinical signs of nasal disease in dogs & cats?
- type of discharge
- onset & duration
- unilateral, bilateral, or unilateral progressing to bilateral
- other - nasal foreign body patients typically rub at their face
if there is an acute onset, what may this characterize the nasal disease into?
viral infection or foreign body
if there is an chronic onset, what may this characterize the nasal disease into?
neoplasia or fungal infection
if there are unilateral nasal disease signs, how may this characterize the nasal disease?
foreign body, polyp, tooth root abscess
if there are bilateral nasal disease signs, how may this characterize the nasal disease?
allergic rhinitis & chronic rhinitis
if there are unilateral nasal disease signs that progress to bilateral, how may this characterize the nasal disease?
fungal rhinitis & neoplasia
what should be included in your physical exam in a patient with suspected nasal disease?
complete physical exam, facial symmetry, ulceration of nasal planum, exophthalmus, patency of nares, fundic exam, & oral exam
what diagnostic tests should I run if a patient presents with epistaxis?
blood pressure, CBC for platelet count, BMBT, VWF, PT, PTT, & look for local nasal disease
what systemic evaluation can be done prior to anesthesia or more invasive tests?
CBC, chemistry, urinalysis, FeLV/FIV, & tick-borne testing
when should you take thoracic radiographs of a patient with nasal disease?
if animal is:
coughing, tachypnic, & has crackles
concern of aspiration pneumonia, cryptococcus
what test is only helpful to evaluate for cryptococcus in cats?
cytology of nasal swab
T/F: a cytology run off a nasal swab can help rule out cryptococcus
false - can’t rule it out
what is this?
cryptococcus
an FNA of the submandibular lymph nodes for cytology can be helpful for evaluating for what?
neoplasia & cryptococcus
when is a nasopharyngeal exam typically done?
when looking for nasopharyngeal polyps in cats - with a spay hook & dental mirror
why not culture swabs from the nose, oral cavity, tonsils, or nasal flush samples?
contaminated by the environment
what is the preferred imaging modality for diagnosing nasal disease?
CT
what all does CT evaluate in nasal disease?
nasal cavity, sinuses, septum, hard palate, & cribiform plate
what all is rhinoscopy used for in diagnosing nasal disease?
foreign body retrieval, assessing mass lesions, fungal plaques, turbinate destruction, & guided biopsies
in nasal sampling, what is cytology used for?
looking for aspergillus
in nasal sampling, what is nasal flushing used for?
dislodging tissues & removing foreign bodies
what are the potential complications of nasal biopsies?
aspiration, bleeding, trauma to the brain, & non-diagnostic samples
how can aspiration be prevented in nasal biopsies?
ET tube in place, pharynx packed with gauze, suction & clearing back of throat afterward, & removing the ET tube partially inflated
how can bleeding be prevented in nasal biopsies?
dilute epinephrine
cold saline infusion or icepack
unilateral carotid artery ligation - very rare
what dog breeds are predisposed to aspergillus infections?
dolichocephalic dog breeds
what is the treatment of choice for aspergillus infections?
topical clotrimazole infusion
maybe give oral antifungal treatment in combo with local therapy
T/F: aspergillus fumigatus is a normal inhabitant of the nasal cavity
true
what is a nasopharyngeal polyp?
benign growth of inflammatory tissue, fibrous connective tissue, & epithelium
what causes nasopharyngeal polyps?
cause unknown - infection or congenital is suspected
where do nasopharyngeal polyps originate?
tympanic bulla, nasopharynx, & auditory tube
what animals are typically affected by nasopharyngeal polyps?
cats older than 5 years old
what are the typical clinical signs associated with nasopharyngeal polyps in cats?
stertor, upper airway obstruction
less common - mucopurulent discharge & otitis
how are nasopharyngeal polyps diagnosed?
signalment, visual exam - deep otoscopic exam & patient under anesthesia in dorsal recumbency
polyp may displace soft palate
how are nasopharyngeal polyps treated?
gentle traction through the mouth or ear
1 month course of tapering prednisone - 1-2mg/kg PO every 24 hours for 2 weeks initially
what are the potential complications of removing a nasopharyngeal polyp?
horner’s syndrome & recurrence
what are the signs of horner’s syndrome?
ptosis, miosis, enophthalmos, & elevation of the 3rd eyelid
what are the common signs of idiopathic chronic rhinitis?
bilateral mucoid or mucopurulent discharge that can be blood tinged, sneezing, mucosal inflammation, turbinate destruction, & patient is otherwise healthy
how is idiopathic chronic rhinitis diagnosed?
diagnosis of exclusion
how can signs improve in idiopathic chronic rhinitis?
humidification, intranasal saline drops, prednisone, NSAIDs not at the same time as steroids, & eliminate environmental irritants
how is idiopathic chronic rhinitis cured?
it’s not - very frustrating for owners
what is the only indication to run a cytology of a nasal swab in cats?
when looking for cryptococcus
if you think your patient may have a tooth root abscess, what diagnostics should you do?
radiograph
T/F: with a few exceptions, rhinoscopy isn’t diagnostic unless coupled with CT
true
what must be known prior to obtaining a nasal biopsy in terms of bleeding status?
clotting status
what is the caudal limit of where the biopsy instrument can go? why?
never deeper than the level of the medial canthus
avoid penetrating the cribiform plate
what is the most common complication of nasal biopsies?
hemorrhage
T/F: bacterial rhinitis occurs secondary to other nasal disorders
true
when may a deep nasal biopsy be taken for culture?
looking for aerobic, anaerobic, & fungal organisms & mycoplasma
what clinical signs & response to treatment are suggestive of bacterial rhinitis?
mucopurulent nasal discharge that resolves or becomes serous after antibiotics are started
what antibiotics may be tried empirically for treatment of bacterial rhinitis?
amoxicillin, amoxicillin-clavulanate, doxycycline, trimethoprim-sulfa, or clindamycin
how is cryptococcus treated?
oral itraconazole or fluconazole for at least 1-2 months beyond the resolution of clinical signs
pain on palpation of the face & depigmentation of the nasal planum are highly suggestive of what disease in dogs?
nasal aspergillosis
how is idiopathic chronic rhinitis characterized?
off of predominant population of inflammatory cells present
with the exception of polyps, nasal neoplasms in dogs & cats are almost always what?
malignant
