Nasal Disease Flashcards
What should be considered for acute-onset, persistent sneezing?
- nasal FB
- feline upper respiratory infection
less common: canine nasal mites, exposure to irritating aerosols
How does reverse sneezing affect the respiratory system?
creates a negative pleural and tracheal pressure from rapid inhalation that tears off irritant particles and accumulated mucous by aspiration from the nasopharynx to the oropharynx
(scratches the back of the throat)
What is stertor? What is the main intranasal cause?
low pitched, snoring sounds most commonly a result for pharyngeal disease
obstructions —> congenital deformities, masses, exudate, blood clots
What are the main causes of mucoid and mucopurulent discharge?
MUCOID - inflammation, excessive draining from elsewhere
MUCOPURULENT - puss + mucus = irritation, inflammation, and infection
(some serous discharge is normal)
How can respiratory disease cause epiphora? How does the presentation point toward disease?
ocular discharge can result from the blocking of the nasolacrimal duct
- BILATERAL = systemic disorders and infectious disease
- UNILATERAL = FB, polyps, tooth root abscesses
- UNILATERAL TO BILATERAL = neoplasia
What are common clinical signs associated with nasal disease?
- open-mouth breathing +/- expiratory cheek puff
- heat intolerance
- sleeping problems
- respiratory problems while eating (cannot eat without stopping to breath out of the mouth)
- halitosis without dental disease
- exophthalmos
- rubbing face on the ground
- head shaking
- facial deformities or ulcerations of nasal dorsum
- respirator difficulty on inspiration
- systemic: lethargy, inappetence, weight loss
- CNS signs rare
What actions on physical exam can aid in diagnosing nasal disease?
- auscultate for breathing sounds: stertor vs stridor
- symmetry of face and muzzle
- character of nasal discharge and laterality
- facial deformity or ulceration (Aspergillosis, neoplasia)
- patency of airflow through each nostril
- condition of teeth and gums (tooth root abscess)
- examination of roof of mouth and pharynx
- ability to retropulse eyes
- pain associated with opening or manipulating muzzle
- epiphora
- ear examination for polyps or otitis media
- percuss sinuses and nose
- pigmentation/depigmentation of nasal planum
- size and texture of submandibular LNs
- look around and feel the nose
What is the DAMNIT scheme?
a scheme used to rule out diagnoses
Degenerative, developmental (congenital)
Anomalous
Metabolic
Neoplastic, nutritional
Infectious, idiopathic, inflammatory, immune-mediate
Trauma, toxins
What are the best noninvasive tests used for diagnosing nasal disease?
- history
- physical exam
- fundoscopic examination (retina) —> tumultuous vessels from hypertension, depigmentation from infection, petechia
- thoracic radiographs
- mandibular LN cytology
- nasal swab cytology
What blood work should be done to diagnose nasal disease? If the lesion is bleeding what 5 tests can be added?
CBC + platelet count
- coagulation time
- buccal mucosal bleeding time
- tests for tick-borne disease in dogs
- arterial blood pressure
- von Willebrand factor assay in dogs
What 2 specific additional testing can be added to diagnose nasal disease in dogs?
- Aspergillus titer
- fecal flotation for migrating Capillaria or Eucoleus
What 3 specific additional testing can be added to diagnose nasal disease in cats?
- nasal swab cytology or Ag titer for Cryptococcus
- viral testing for FeLV, FIV, FHV, and FCV
- Mycoplasma felis PCR or culture
What are some invasive diagnostics for nasal disease that require sedation?
- thorough oral exam
- open mouth nasal radiography
- CT
- MRI
- rhinoscopy of external nares and nasopharynx
- dental radiographs
- biopsy/histo
- nasal mucosal brushing or flush
- deep nasal culture
Open mouth dorsoventral radiograph, dog presenting for a unilateral right-sided mucopurulent nasal discharge
unilateral, localized, increased density associated with the disappearance of the ethmoid turbinate pattern in the caudal portion of the right nasal cavity
(decreased definition caused by bone destruction and replacement with soft tissue)
- nasal adenocarcinoma confirmed by biopsy
CT, dog with nasal adenocarcinoma
soft tissue density invading the left nasal cavity with erosion of the nasal septum allowing for the invasion of the ventral portion of the left orbit through the frontal bone
How do CTs and MRIs compare?
CT: $$, best for observing bony structures and lysis or proliferation
MRI: $$$$, best for soft tissue (brain), mucous, and fluid
In what kinds of animals are cleft palates most common? What is the main cause?
purebreds and brachycephalic dogs: Boston Terriers, Pekingese, Bulldogs, Mini Schnauzers, Beagles, Cockers, Dauchshunds, Siamese cats
genetics (also nutrition, viruses, poisoning during dam’s pregnancy)
What is the most common presentation for cleft palates? What are the most common symptoms?
very young animals that are sneezing and snorting due to food and saliva passing through the nose
- runny nose after eating or before nursing
- cough and gag when drinking
- trouble eating = poor development
- trouble breathing and exercising
DEVELOP PNEUMONIA AND ARE POOR DOERS
What systemic diseases are typically on the rule out list for epistaxis?
- clotting disorders
- thrombocytopenia
- thrombocytopathy
- coagulation defects
- vasculitis (RMSF)
- hyperviscosity syndrome
- polycythemia
- systemic hypertension
What nasal diseases are typically on the rule out list for epistaxis?
- acute trauma
- acute FB
- neoplasia
- fungal infection
What is the classic presentation of tooth root abscesses? How can this cause nasal disease?
sore under eye
tooth roots have connections in the nasal passage
How do oronasal fistulas cause nasal disease?
food, mucus, and debris will enter the nasal passage through the mouth
(must be surgically fixed)
What are the major signs in a history of nasal foreign bodies?
- sudden onset of acute sneezing fits
- gagging or reverse sneezing
- pawing at nose
- serous, mucopurulent, or bloody discharge from nose depending on severity and time the FB has been there
- no other pets in house sneezing
What is the most common cause of feline upper respiratory disease complex? What are 2 examples?
90% viral —> FHV1, FCV
What are 3 bacterial causes of feline upper respiratory disease complex?
- Chlamydophila felis
- Mycoplasma
- Bordetella
(more commonly secondary bacterial infection from immunosuppression)
What cats more likely acquire feline upper respiratory disease complex? How?
young kittens —> stressed and immunocompromised
spreads through close contact with actively infected cats, carrier cats, and fomites (ocular, nasal, pharyngeal secretions)
What are 2 key symptoms are seen with feline herpesvirus infection? What symptoms are also seen?
- corneal ulceration - dendritic ulcers, superficial ulcers
- dermatitis and ulcerations on nose and face
- acute rhinitis, conjunctivitis, or fever
- abortion or neonatal death
- inappetence
- progression to mucopurulent discharge with secondary bacterial infections
How can conjunctivitis from FHV be differentiated from C. felis?
conjunctival ulcers will also be present
FHV, deep corneal ulcer:
What immune reaction is typically seen in the eyes with feline herpesvirus infections?
stromal keratitis —> reaction in the cornea to virlal particles
- gray-white stomal infiltration
What is the incubation period of feline herpesvirus? When will signs typically resolve? What status do nonclinical patients typically have?
2-6 days; sick quickly after exposure
1-3 weeks —> chronic rhinitis can develop later in life
become carriers, where the virus lays latent in the trigeminal nerve ganglia and can shed following stress
Why is it important to do other diagnostics other than PCR for FHV infections?
a positive PCR and also be from recent intranasal vaccines or a carrier state
What is the most common treatment of FHV infections (feline viral rhinotracheitis)? What antiviral works?
SUPPORTIVE - humidify air, topical decongestants (saline), systemic antibiotics for secondary infection, topical antibiotics or antivirals in the eyes, PROPER NUTRITION to maintain potassium, BG, and hydration
oral Famcylovir
What are the 4 most common sequelae of FHV infection?
- chronic rhinitis and sinusitis common in short-nosed breeds where turbinate damage predisphoses to secondary bacterial infections
- chronic conjunctivitis
- fibrosis of lacrimal ducts leads to epiphora
- carrier status with shedding when stressed
How does the vaccine for FHV help?
helps prevent disease symptoms and decreases severity, but will not prevent carrier status
What is the most characteristic sign of feline calicivirus infection? What else is seen?
oral ulceration on the tongue, mouth, skin, or eyes from popped vesicles, which causes cats to drool
classical URI signs: sneezing, serous nasal discharge
What is a major sign of bacterial rhinitis? Why must diagnosis be done carefully?
mucopurulent or purulent nasal discharge
PCRs may come up positive, but most of the bacteria they screen for are part of the normal flora
What is Chlamydohila felis? What is a hallmark symptom? What else is seen?
obligate intracellular G- coccobacillus that cannot survive outside of the feline nasal passage
conjunctivitis with chemosis with or without URI symptoms
- chronic conjunctivitis (most often unilateral)
- mild rhinitis, bronchitis, and bronchiolitis
- infection of genitourinary membranes without clinical signs
How is Chlamydophila felis infection diagnosed?
- conjunctival smear shows intracytoplasmic inclusions*
- culture on special media
- PCR conjunctiva, nasal, or oropharyngeal areas
What is the most common clinical sign associated with nasal Aspergillosis? What else is seen?
nasal ulceration and depigmentation
- nasal pain
- facial distortion
- normal nasal air flow
- turbinate destruction
- sneezing
- mucopurulent +/- hemorrhagic nasal d/c
- systemically healthy
How are radiographs and CTs/MRIs used to diagnose nasal Aspergillosis?
RADIOGRAPHS: can help localize lesions, but can’t distinguish between neoplasia and fungal rhinitis
CT/MRI: more helpful to observe turbinate lysis
How is rhinoscopy used to diagnose nasal Aspergillosis? Cytology/biopsy?
can observe turbinate destruction and white, green, or black plaques
may see hyphae, most accurate on scope swab over direct smear
How is nasal Aspergillosis treated? What risk does it pose?
infuse 1% Clotrimazole or 2% Enilconazole into nasal cavity over 1 hour
aspiration pneumonia or neuro signs if the cribriform plate is involved
What is the most common nasal symptom of Cryptococcus infection in cats? What else is seen?
deformity of the nose
- chronic nasal discharge (serous, mucopurulent, bloody)
- stertor and inspiratory dyspnea
- sneezing, snuffling
- CNS: blindness, seizures
Other than the nasal cavity, what are 3 other systemic signs of Cryptococcus infection in cats?
- EYES - uveitis chorioretinitis
- SKIN AND SQ TISSUE - non-pruritic, non-painful alopecia
- LN - submandibular lymphadenopathy
