Treatments Of Nasal Disease

Question 1

How can you treat nasal aspergillosis?

Answer 1

Iatramazole - oral antifungal - expensive for 3-6m
Topical antifungal - administered during flush
Non-surgical flush
1h surgical flush and trephining
10-14 days of flushing via catheters

Question 2

How should you treat nasal tumours?

Answer 2

Palliative
Antibiotics for secondary infection
NSAIDS and pain management

RT
Chemo - feline nasal lymphoma

Question 3

How can you treat non-infectious inflammatory rhinitis?

Answer 3

Chronic serous/ mucopurulent nasal discharge
With no other illness
Though to be associated with food allergy

Remove allergen - hypoallergenic diet
Antibiotic - amoxicillin
Mucolytics - Bromhexine, bisolvon
Prednisolone

Question 4

How can you treat a nasal foreign body?

Answer 4

Acute onset sneezing and facial irritation - progressing to mucopurulent discharge

Nasal flush
Rhinoscopic removal - look around the back of the soft palate
Rhinotomy

Question 5

How should yo treat a nasal polyp in a cat?

Answer 5

Surgical removal

Good prognosis

Question 6

What are the components of BOAS?

Answer 6

Overlong soft palate
Stenotic nares
Tracheal hypoplasia
Laryngeal hypoplasia

Ever sign of the laryngeal saccules
Tracheal collapse
Tonisillar enlargement
Laryngeal collapse

(also prone to regurgitation, oesophagitis and hiatal hernia)

Question 7

How should you treat a boas attack?

Hyperthermia, tachypnoea, collapse, cyanosis?

Answer 7

Oxygen 
Keep cool
ACP + Butorphanol sedation
Dexamethasone IV 
Anaesthetise and intubate

Question 8

How can you diagnose boas?

Answer 8

Breed
Examine airways under ga - stenotic nares, everted laryngeal saccules, overlong soft palate
Radiography
Lateral view of the pharynx - little air in pharynx, soft palate overlying pharynx, overlong soft palate
Lateral thorax - hypoplastic trachea
Endoscopy

Question 9

What component of BOAS is commonly seen in the CKCS?

Answer 9

Eosinophillic stomatitis and tonsillitis

Middle aged, present with stertor and stridor

Question 10

How can you treat boas?

Answer 10

Surgery in early life
Shorten soft palate
Remove everted laryngeal saccules
Nasoplasty
Tonsillectomy 
Permanent tracheostomy if hypoplastic trachea

Question 11

What is the presentation of laryngeal paralysis in the dog and how can you treat it?

Answer 11

Idiopathic - Labrador
Congenital - Dalmatian
CP - bilateral paralysis - syncope, cyanosis, exercise intolerance

Dx- exam under v light GA, radiographs to rule out retropharyngeal lymphadenopathy, thymoma and bloods to rule out hypothyroidism / Cushings

Tx: laryngeal tie back or permanent tracheostomy

Question 12

How can you temporarily relieve upper airways obstruction?

Answer 12

Tracheotomy

• incision into the trachea
• a tracheotomy tube can be used in the short term

Question 13

What is it called when there is a permanent stoma made in the trachea?

Answer 13

Tracheostomy

• permanent stoma made in the trachea
• indicated in URT airway obstruction that can’t be resolved

Question 14

How can you treat / manage tracheal stenosis?

Answer 14

Weight loss
Exercise on a harness 
Treat lower airway disease
- antibiotics, NSAIDs, bronchodilators, cough suppressants
Intra-luminal or extra-luminal stenting

Question 15

What commonly causes tracheal tears and how can you treat them?

Answer 15

Cervical tears - bite, choke chain, et tube cuff
Thoracic tears - avulsion in cats

Treatment - allow to heal if small or surgical repair

Question 16

How can you treat tracheal stenosis?

Answer 16

Tracheal resection

- no more than 5-6 rings

Question 17

When is a lung lobectomy indicated?

Answer 17

Lung lobe torsion
Lung abscessation / solitary neoplasia / bullae
Severe lung trauma
Bronchoesophageal fistula

Question 18

List common common injuries to the thorax.

Answer 18

Pneumothorax 
Lung contusions
Rib fractures
Haemothorax
Pneumomediastinum 
Diaphragmatic rupture 
Airway obstruction 
Shock

Question 19

What can you do to help you diagnose pathology in the thorax?

Answer 19

Thorax radiography

Therapeutic and diagnostic thoracocentesis

Question 20

What can you do to manage a recurrent pleural effusion / pneumothorax?

Answer 20

Tube thoracostomy

Question 21

How should you treat a rib fracture?

Answer 21

Suspect pulmonary contusions

Analgesia, rest and oxygen supplementation
If very displaced it requires internal fixation - high risk of pulmonary contusion

Question 22

What is a flail chest and how should it be treated?

Answer 22

Complete fracture of the rib in two places, so that the rib moves independently to the rest of the thorax

• paradoxical movement compromises ventilation
• surgical stabilisation required

Question 23

How does diaphragmatic hernia present and how must it be treated?

Answer 23

Acute - traumatic
Chronic - hiatal hernia or PPDH

Diagnosis - respiratory compromise, GI signs and abdominal content in thorax on radiograph

Tx- surgical repair