Respiratory - Upper Respiratory Tract Flashcards
What are the signs of respiratory distress in SA?
- Respiratory rate >50 breaths per min
- Anxious, open mouth breathing
- Orthopneic position
- standing or sitting in a certian position to make breathing easier
- Reluctance to move
- Cough, wheezes, short shallow breaths
- Pale, cyanotic mucous membranes
Define stertor
snoring-like congestion of upper respiratory tract
Define stridor
Inspiratory wheeze over larynx
Devine wheezes
- Airway sounds occurring secondary to narrowing of bronchi, may be from increased secretions or inflammation
- most commonly expiratory, can be inspiratory or continuous
Define crackles
fine popping inspiratory sounds caused by opening of alveoli/small airways found in patients with pulmonary edema, pneumonia, or hemorrhage
What are the differentials for Epistaxis (nasal bleeding)
- Local:
- Aspergillosis
- Nasal Adenocarcinoma (other cancers)
- Trauma
- Foreign Body
- Dental Disease (abscess, fistula)
- Inflammatory (allergic)
- Nasal Mite (Pneumonysoides caninum)
- Systemic:
- Thrombocytopenia
- Systemic Coagulopathy
- Hypertension
- Multiple myeloma
How are systemic causes of Epistaxis diagnosed?
- Check platelets
- look for petechiae and do CBC or blood smear
- If low, think about tick-borne and immune-mediated disease
- May need to check clotting times (PT/PTT)
- Check blood pressure
- Hypertension can be related to:
- disease (Cardiac, Cushing’s, renal)
- drugs (phenylpropanolamine)
- Hypertension can be related to:
How are local causes of Epistaxis diagnosed?
- Check the teetha dn do an oral exam
- +/- CT Scan vs Skill Radiographs
- Before scope or biopsies
- +/- Rhinoscopy
- Biopsy nasal cavity
- Measure to medial canthus of eye
- Histopathology, culture
- Nasal flush with saline
What is Aspergillosis? common signalment? signs?
- Fungal organism commonly seen in dogs
-
Aspergillus fumigatus
- ubiquitous soil saprophyte
-
Aspergillus fumigatus
- Signalment:
- young - middle aged dogs
- Dolichocephalic breeds
- Outdoor dogs
- Rare in US cats
- Signs:
- Epistaxis, sneezing, pain
- May have depigmentation of nares
- Can invade cribriform and cause neurologic disease
How is Aspergillosis diagnosed?
- Imagining: Radiograph, CT, scope
- Cytology (fast)
- Histopathology (confirms)
- Antibody test - false negatives occur
- Antigen not helpful for nasal disease (helpful for systemic aspergillosis)
- Culture? - too slow
What is the treatment for aspergillosis?
- Debulk fungal plaques
- Clotrimazole infusion OR
- topical treatment under anesthesia for about 1 hour
- Complications - laryngeal irritation/inflammation
- Only if the cribriform plate is intact
- Itraconazole:
- systemic treatment 60-70% success rate
- 5 mg/kg PO BID for 2+ months
- Other options include ketoconazole and terbinafine
Why is fluconazole not a treatment option for Aspergillosis?
aspergillosis inherent resistance
What findings are common with Nasal Adenocarcinomas? how is it diagnosed?
- Common differential for older dogs with epistaxis
- PE: Pain, asymmetry, bony changes
- Diagnostics:
- Rads vs CT
- CT can be used for radiation planning too
- Nasal biopsies for histopathology
- CT/rhinoscopy help guide - can collect biopsies blindly
- Rads vs CT
What is the treatment for Nasal Adenocarcinoma?
- Radiation therapy is treatment of choice
- Consult with oncologist for other options
What is Lymphoplasmacytic Rhinitis?
- Allergies!
- Signalment:
- young/mid-age dogs, any cats
- German shepherds, dachshunds, (possible in any breed)
- Signs: chronic serous bilateral discharge
- Can have cough from post-nasal drip
- Sometimes has a cloudy or mucoid appearance
- Etiology: often unknown, likely multifactorial
What is the pathophysiology of Lymphoplasmacytic Rhinitis?
- Allergen present in nose
- Infiltration with inflammatory cells
- Vasodilation and ⇡ permeability
- Leakage of fluid into nasal cavity
- Destruction of mucociliary clearance
- Can have secondary bacterial infections
- Present with more mucoid/purulent discharge
What is the diagnostic plan for Lymphoplasmacytic Rhinitis?
- Consider likelihood of differentials
- Dental disease, foreign body, mites, fungal, bacterial, neoplasia
- Empirical treatment trial okay
- Confirm rhinitis with histopathology, rule out differentials
- Culture to identify secondary infection (if signs are present)
What is the treatment of Lymphoplasmacytic Rhinitis?
- Avoid allergens, smoke, etc (if IDed)
- Antihistamines - not routinely helpful
- Glucocorticoids
- Systemic: prednisone/prednisolone
- goal is control, not realistic to cure completely
- Inhaled fluticasone propionate
- rare systemic side effects
- Systemic: prednisone/prednisolone
- Cyclosporine
- alone or with steroid therapy
- Desensitization (?) small studies done
- Antimicrobial Agents (secondary bacterial infections)
What are the signs and symptoms of Cryptococcosis?
- History:
- ⇣ appetite, weight loss, nasal and ocular discharge, sneezing
- PE:
- BAR, usually not febrile
- Bump on nose, ulceration, palpable bony destruction, asymmetry, pain
- Decreased nasal airflow, discharge
- May have big lymph nodes, neurologic deficits, blindness
- Fundic exam ⇢ chorioretinitis
What are the diagnostic tests for Cryptococcosis?
- Cytology of mass, ulcer, discharge
- Aspirates, are fast, easy, and may be diagnostic
- India Ink, Diff-Quik, New methylene blue
- Numerus small yeast with thick/large capsule
- Latex agglutination for Capsular Antigen
- 90-100% sensitivity and specificity on serum
- Biopsy - wedge or punch biopsy on superficial lesion
- Nasal CT Scan, biopsies inside the nose, CSF for latex agglutination are options
