Unit 3 - Nasal and Large Airway Disease Flashcards
Excessive mucus in the nasal cavity will cause which abnormal respiratory sound?
stertor
Disease narrowing the intrathoracic trachea could cause which kind of dyspnea?
obstructive expiratory
You are evaluating a 10 year old MN domestic shorthair cat for a chronic cough that has not responded to antibiotics. Chest radiographs show diffuse abnormalities. You recommend airway sampling next. What airway sampling options for this patient?
Endotracheal wash or bronchoalveolar wash (not necessary)
What clinical findings are consistent with nasal disease?
sneezing, nasal discharge, stertor, pawing/rubbing face, masses/facial distortion, nasal planum ulceration, seizures, mentation changes
What can cause unilateral nasal discharge?
neoplasia, tooth root abscess, foreign body, fungal, and trauma
What can cause bilateral nasal discharge?
inflammatory rhinitis, systemic disease, neoplasia, fungal, viral, or trauma
What is serous/serosanguineous nasal discharge often associated with?
viral, allergic, or inflammatory rhinitis
What does sanguineous discharge typically indicate?
the process is progressive and erosive
What does mucopurulent nasal discharge typically indicate?
a secondary bacterial infection
What can cause hemorrhagic nasal discharge?
severely erosive disease or systemic disease
What erosive disease can cause hemorrhagic nasal discharge?
neoplasia or aspergillosis
What systemic disease can cause hemorrhagic nasal discharge?
coagulopathy or hypertension
When doing a PE to determine the underlying cause of nasal discharge, what should you examine?
visual exam mouth/nose, palpate bones/muscle, ocular retropulsion, nasal patency, fundic exam, lymph node palpation, and neurologic exam
What ‘first tier’ diagnostic testing should be done for nasal discharge?
CBC, cytology, thoracic rads, coagulation profile, and blood pressure
What ‘second tier’ diagnostic testing should be done for determining the underlying cause of nasal discharge?
anesthetized oral examination, nasal CT, and rhinoscopy with biopsy
When measuring instruments for rhinoscopy, what should you measure the instrument to?
the medial canthus of the eye
What are the most common nasal diseases in dogs?
lymphoplasmacytic rhinitis, aspergillosis, and neoplasia
What are the most common nasal diseases in cats?
viral rhinitis, chronic rhinosinusitis, and nasopharyngeal polyps
What breeds typically get lymphocytic-plasmacytic rhinitis?
dolicephalics - Daschunds and Whippets
What clinical signs are associated with lymphocytic-plasmacytic rhinitis?
chronic nasal discharge, nasal congestion (stertor), and sneezing
How common is lympho-plasmacytic rhinitis?
It is approximately 1/3 of canine nasal disease referrals
How is lympho-plasmacytic rhinitis diagnosed?
It is based on diagnosis of exclusion - nasal biopsy, rule out infectious causes with culture
What is important to know about the treatment of lympho-plasmocytic rhinitis?
it is difficult to manage and you will not be able to cure it
What is the treatment of choice for lympho-plasmacytic rhinitis?
anti-inflammatories (immunomodulatory antibiotic and NDSAID), anti-histamines, and possibly itraconazole
What causes fungal rhinitis?
cryptococcus neoformans and Aspergillus fumigatus
What forms of Cryptococcus neoformans infections occur in cats?
nasal, cutaneous, and CNS
What forms of Cryptococcus neoformans infections occur in dogs?
Disseminated disease (more common) and subclinical nasal disease
How is Cryptococcus diagnosed?
organism identification (cytology, histopathology, culture) or antigen assay
How is Cryptococcus neoformans infection treated?
Fluconazole and Amphotericin B + 5-flucytosine (cats) or fluconazole
What breeds typically get Aspergillus fumigatus infections?
german shepherd and other dolicocephalic breeds
What clinical signs are associated with Aspergillus fumigatus infections?
Nasal discharge (serous to mucopurulent +/- epistaxis), nasal planum depigmentation, sneezing, nasal pain, systemic signs, rarely neurologic signs
How is nasal aspergillus diagnosed?
CT and rhinoscopy + cytology/histopath
How is nasal aspergillus treated?
topical clotrimazole (treatment of choice), topical enilconazole, +/- debulking sinus/trephination, +/- systemic azole therapy
What is the prognosis of sino-orbital aspergillosis in cats?
it is poor
What can cause feline upper respiratory disease complex?
Herpesvirus, Calicivirus, Chlamydia felis, Mycoplasma, and Bordatella bronciseptica
What percentage of URI cases are due to feline herpesvirus?
up to 38%
What percentage of URI cases are due to Calicivirus?
up to 36%
What is the difference between shedding in herpes virus and calicivirus?
Calicivirus sheds continuously and Herpes virus sheds intermittently
How is feline viral rhinitis diagnosed?
signs + bacterial/viral isolation; culture and sensitivity and PCR
How is feline viral rhinitis managed?
stress avoidance, relative isolation, long-term(L-lysine or Famciclovir)
How do you manage a feline viral rhinitis patient that is partially anorexic?
Provide smelly or warm food, clean nose, and use antibiotics as needed
How do you manage a feline viral rhinitis patient that is systemically ill?
fluid and nutritional support and antibiotics as need (doxycycline is the preferred)
What neoplasias can be seen in the nose and what is the most common?
Adenocarcinoma (most common), sarcomas, and lymphoma
Nasal neoplasias are locally invasive, what does that cause?
bone destruction and CNS signs
What is the treatment of choice for nasal neoplasia?
radiation therapy
What can cause canine infectious tracheobronchitis (kennel cough)?
Bordatella bronchiseptica, Canine Parainfluenza virus, and Canine adenovirus type-2
How do kennel cough patients present?
younger dogs, history of recent exposure, and paroxysmal, non-productive, harsh cough
How is kennel cough treated?
In most cases, it is mild and self limiting. If there is a persistent non-productive cough you an treat with antitussives +/- an anti-inflammatory. In severe or prolonged cases, antibiotics is indicated
How is kennel cough prevented?
DHPP and Bordatella vaccines
What is tracheal collapse?
progressive degeneration of cartilage rings
If tracheal collapse occurs at the cervical trachea, what phase of breathing does it happen in?
inspiration
If tracheal collapse occurs at the thoracic trachea, what phase of breathing does it happen in?
expiration
What is the signalment for tracheal collapse?
Middle age to older dogs, small/toy breed dogs, goose-honk cough, and exercise intolerance
How is tracheal collapse diagnosed?
clinical signs, physical exam, radiographs, fluoroscopy, and bronchoscopy
What is the gold standard for tracheal collapse diagnosis?
bronchoscopy
What is a grade 1 tracheal collapse?
Collapses less than 25%
What is a grade 2 tracheal collapse?
Collapses 25-50%
What is a grade 3 tracheal collapse?
Collapses 50-75%
What is a grade 4 tracheal collapse?
complete collapse
What is the management method of choice for tracheal collapse?
antitussives
What other management methods can be used for tracheal collapse?
anti-inflammatories, sedatives, weight loss, supportive, and stenting of tracheal rings
Why can bronchodilators be a bad management choice for tracheal collapse?
they would act on the bronchiolar smooth muscle and not the trachea which can decrease lower airway pressure
What is the viscious cycle of tracheal collapse?
collapse causes inflammation and cough then coughing causes tracheal inflammation, then inflammation perpetuates the cough.. And it just continue - you may need to break the cycle of inflammation to relieve the cough
