Nasal Diseases Flashcards
Approaching nasal disease.
Hx.
PE.
Problem list and differentials.
Diagnostic investigations.
Interventions/management.
Predispositions and signalment considerations.
Other Hx considerations.
Age.
Breed:
- brachycephalic and dolichocephalic.
- working/outdoor (FBs).
Onset of clinical signs:
- Acute v progressive.
Trauma?
Any difficulty eating/eating on one side (dental disease)?
Vomiting/regurgitation?
Nasal disease clinical signs.
Nasal discharge:
- unilateral v bilateral.
- appearance: serous, mucopurulent, haemorrhagic.
- any change over time?
Sneezing.
Reverse sneezing.
Stertor / stridor.
Systemic signs.
CNS signs.
PE.
Listen for noises.
Nasal discharges - types?
Facial deformity.
Pain.
Nasal planum depigmentation.
Crustiness etc.
Assess airflow bilaterally.
- glass slide (clouding).
Assess regional LNs.
Retropulsion of the eyeballs / exophthalmia.
Dental disease?
Ophthalmic disease?
- Inflammatory differentials for nasal disease.
- Infectious differentials for nasal disease.
- Idiopathic.
Allergic.
Irritation. - Bacterial: secondary.
Virus:
- Herpesvirus and calicivirus in cats.
- CDV.
Fungal:
- Aspergillus in dogs mainly.
- Cryptococcus in cats mainly.
Parasitic:
- Pneumonyssus caninum in dogs.
- cutebra sp.
Trauma/fracture.
FB.
Systemic causes (epistaxis):
- coagulopathy.
- hyperviscosity syndrome.
- systemic hypertension.
Dental disease and oronasal fistula.
Nasopharyngeal polyp in cats.
Nasopharyngeal stenosis.
GI reflux w/ anaesthesia.
Brachycephalic syndrome.
Ciliary dyskinesia.
- Diseases of unilateral presentation.
- Diseases of bilateral presentation.
- FB, nasal tumour (early course, older patient), aspergillus (early course, younger dogs, nasal depigmentation, dolichocephalic, epistaxis), chronic rhinitis (Dx of exclusion).
- Chronic rhinitis (idiopathic), URT viruses (vac, ocular signs, previous signs), aspergillus (advanced), nasal tumour (advanced, absent to reduced nasal air flow, CNS signs).
Presentation of chronic rhinosinusitis in cats.
Idiopathic.
Unclear role of bacterial and viral infections.
>1mth of clinical signs.
- sneezing and nasal discharge.
- increased URT noises.
- usually bilateral but can be unilateral.
- often preserved nasal airflow:
– if unilateral and no nasal airflow, then tumour and fungal rhinitis higher on the list.
Presentation of dogs w/ chronic rhinitis?
Underlying allergic, irritant, immune-mediated process?
Whippets and dachshunds predisposed.
Chronic, gradually progressive disease:
- sneezing, snorting and mucoid/mucopurulent nasal discharge.
- most commonly bilateral but can be unilateral.
- poss. airway obstruction.
- poss. post-nasal drip causing coughing.
- facial pain/deformity not expected.
Presentation of nasal FBs.
Usually compatible Hx.
Acute onset of clinical signs in a previously well patient.
Sneezing, gagging and pawing at the face.
Progression to purulent nasal discharge and foul smelling.
Sino-nasal aspergillosis presentation.
Predisposition:
- Meso/dolichocephalic dog breeds.
– Aspergills fumigatus.
- Brachycephalic cats: sino-orbital.
– Aspergillus felis.
Clinical signs:
- mucopurulent nasal discharge or epistaxis.
- unilateral or bilateral.
- sneezing, nasal pain (head-shy), nasal depigmentation.
- uncommonly: stertor, facial deformity, CNS signs.
Nasal neoplasia presentation.
Usually older patients.
Chronic history of nasal discharge (often mucopurulent to haemorrhagic).
Sneezing.
Dyspnoea.
Reduced airflow.
Stertor.
Facial distortion.
Pain.
Ocular discharge/exophthalmia.
Diagnostic investigation options for patient presenting w/ nasal disease.
Blood tests.
Swabs.
Diagnostic imaging.
Rhinoscopy.
Blood tests.
Tests for bleeding disorders:
- platelet count.
- PT/APTT.
Serology for fungal disease:
- Aspergillosis in dogs – often unhelpful.
- Cryptococcus in cats – good sensitivity and specificity.
Viral testing in cats:
- PCR for FHV/FCV for acute disease.
- ELISA FIV (Ab) / FeLV (Ag) for chronic disease.
Nasal investigations under GA.
Full oral exam:
- use bitch spay hook to lift soft palate e.g. glass blade.
- otoscope for visualisation.
- forceps.
Dental probing.
Nasal diagnostic imaging.
X-rays:
- intra-oral nasal views most helpful.
- consider dental x-ray plates.
- consider thoracic radiographs - mets.
Radiographic signs to look for:
- FBs e.g. metallic.
- Tooth root abscesses/dental disease.
- Turbinate destruction.
- Nasal bone invasion.
- Increased soft tissue opacity.
- Check sinuses – frontal sinuses.
Head CT for better details.
