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CRH II > Upper Respiratory Disease: nasal passage > Flashcards

Upper Respiratory Disease: nasal passage Flashcards

1
Q

describe common clinical exam findings for nasal disease

A
  1. sneezing:
    -paroxysmal
    -intermittent
    -reverse sneeze: indicates irritation to nasopharyngeal mucosa
  2. nasal discharge:
    -symmetry
    -character
    -onset/duration
    -progression
    -inciting causes or triggers
  3. stertor
  4. other:
    -reduced appetite: esp cats
    -dysphagia
    -pawing/rubbing face
    -masses/facial distortion
    -nasal planum ulceration
    -seizures
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2
Q

describe physical exam for nasal disease

A
  1. open mouth: check for masses, etc.
  2. ocular retropulsion (gentle)
  3. checking nasal patency
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3
Q

give differentials for unilateral nasal discharge

A
  1. neoplasia
  2. tooth root abscess
  3. foreign body
  4. fungal
  5. trauma
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4
Q

give differentials for bilateral nasal discharge

A
  1. inflammatory rhinitis
  2. systemic disease:
    -hypertension
    -coagulopathy
  3. infectious:
    -secondary bacterial
    -viral
  4. highly erosive disease
    -neoplasia
    -fungal (aspergillus, crypto)
  5. severe trauma
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5
Q

describe the confusion between unilateral and bilateral nasal discharge

A
  1. unilateral disease that is very caudal could appear bilateral from discharge looping around the back of the nasal septum or refluxing up the contralateral nasal choanae
  2. unilateral discharge can BECOME bilateral if the disease process erodes through the nasal septum
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6
Q

describe serous/serosanguineous nasal discharge

A
  1. most nasal discharge starts out serous
  2. often associated with:
    -viral, allergic, or inflammatory rhinitis
    -early sign of fluid overload
  3. sanguineous usually indicates
    -disease progression
    -chronic mucosal irritation
    -mucosal erosion/destruction
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7
Q

describe mucopurulent/mucoid nasal discharge

A
  1. often indicated SECONDARY bacterial infection
    -primary nasal bacterial infections = VERY RARE
  2. chronic inflammation (increased mucus production)
  3. puppy? have DISTEMPER on the differential list!!!
  4. sometimes an early indicator of developing pneumonia
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8
Q

describe nasal discharge progression

A
  1. most start out serous
  2. often progresses to serosanguinous
    -chronic mucosal irritation and inflammation
    -mucosal erosion
  3. may become mucoid to mucopurulent
    -chronic inflammation +/- secondary bacterial infection from impaired host defenses!

not worth culturing, going to get a mixture of bacteria (duh)

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9
Q

describe hemorrhagic nasal discharge (epistaxis)

A
  1. erosive diseases:
    -neoplasia
    -fungal: aspergillosis
  2. trauma
  3. look for signs of systemic disease!
    -coagulopathy: inherited v. acquired
    -platelet disorder: thrombocytopenia (rickettsial vs. immune-mediated), thrombocytopathia
    -hypertension
    -vasculitis
    -hyperviscosity syndrome
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10
Q

describe lymphoplasmacytic rhinitis

A
  1. immune-mediated disease
  2. cause unknown, likely multifactorial
    -aberrant immune response: dysfunctional PRRs?
    -chronic exposure to allergens, irritants, infection? seasonal allergies, previous feline herpes virus
    -hypersensitivity manifestation: environmental, commensal fungi? extension of atopy, IBD?
  3. signalment:
    -usually middle-aged dogs and cats
    -dolichocephalic over-represented: dachshunds
  4. clinical signs:
    -chronic BILATERAL nasal discharge: commonly serous to mucoid
    -nasal congestion (stertor)
    - +/- open mouthed breathing
    - +/- sneezing
    -cats: reduced appetite
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11
Q

describe diagnosis of lymphoplasmacytic rhinitis

A
  1. diagnosis of exclusion!
    -rule out other diseases/triggers!
  2. definitive diagnosis:
    -CT: thickened turbinates, fluid
    -rhinoscopy: mucus, hyperemia
    -nasal biopsy + histopathology
  3. concern for secondary bacterial infection
    -significant mucopurulent nasal discharge
    -LP and neutrophilic inflammation on histopath
    -culture biopsied piece of nasal TISSUE (not discharge); should only culture one organism (if getting more than one, probs contamination)
    -CHECK THAT THE PATIENT CAN CLOT BEFORE BIOPSY!!! (check PT/PTT)
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12
Q

describe treatment of lymphoplasmacytic rhinitis

A
  1. difficult to manage
    -NOT GOING TO CURE so set client expectations
    -goal: improved clinical signs
  2. various treatment protocols:
    -antihistamines: RARELY helpful unless see eosinophilic inflammation on biopsy
    -anti-inflammatories
    -immunosuppression
    -immune modulation
    - +/- antibiotics for secondary infections
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13
Q

describe treatment protocols of lymphoplasmacytic rhinitis

A
  1. glucocorticoids
    -oral prednisone/prednisolone: anti-inflammatory dose, immunosuppression (can give either?)
    -dogs: maybe helpful
    -cats: often works well
    -if + response to oral steroids, consider
    -inhaled or topical to avoid longterm oral steroids
  2. NSAID + antibiotic:
    -dogs: doxycycline + piroxicam or meloxicam (decently good success in dogs)
    -cats: azithromycin + meloxicam
  3. immunosuppression: cyclosporine, chlorambucil, radiation therapy
  4. immunomodulation:
    -hypoallergenic diet?
    -fish oil supplementation
    -allergy shots?
    -dilute cerenia? probs more placebo effect than anything else
  5. other considerations:
    -treat secondary infections if present, ideally based on culture and sensitivity
  6. environment modification:
    -humidification
    -TRIGGER AVOIDANCE: cigarette smoke, perfumes, cleaners/air fresheners, dusty litter
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14
Q

describe fungal rhinitis- cryptococcus neoformans

A
  1. worldwide distribution; found in pigeon poop
  2. cats:
    -nasal (granuloma)
    -cutaneous
    -systemic
  3. dogs: rare
    -CNS
    -disseminated
  4. clinical signs:
    -roman nose
    -mucopurulent +/- hemorrhagic nasal discharge
    -sneezing
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15
Q

describe cyrptococcus diagnosis and treatment

A
  1. cytology of nasal discharge
    -yeast with THICK non-staining capsule
  2. serum latex agglutination (SLA) titer
    -detects capsule ANTIGEN
  3. treatment:
    - +/- surgical debulking
    -oral anti-fungal therapy:
    –intra- or fluconazole
    –if severe disease or CNS involvement, amphotericin B
    -treatment time up to 6 months, monitor SLA titer (ideally treat until negative)
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16
Q

describe aspergillus fumigatus

A
  1. sino-nasal disease of dogs
    -often unilateral mucoid discharge, but can be hemorrhagic, epistaxis
    - +/- planum depigmentation
  2. german shepherds!!! rottweilers!
  3. cats: sino-orbital disease
17
Q

describe aspergllosis diagnosis

A
  1. nasal CT:
    -loss of nasal turbinates
    -fluid/debris in nose, sinuses
    - +/- bone destruction
    –orbital bones, palate, frontal sinus, cribriform (invading CNS)
    –bc immune response to aspergillosis is highly destructive and erosive
  2. rhinoscopy:
    -visualize plaque: white, grey, necrotic, can look metallic
    -cytology +/- fungal culture
18
Q

describe aspergillosis treatment

A
  1. if isolated to nasal passages
    -plaque debulking followed by
    -topical 1% clotrimazole: 1 tx = 80-85% success, 2 tx = >90% success
    -keep treating until negative culture
  2. if infiltrated beyond nose into CNS
    -topical clotrimazole cream: CAUTION with liquid formulations

-oral antifungals:
–itraconazole + terbinafine, unlikely to successfully clear alone

19
Q

describe feline upper respiratory disease complex

A
  1. viral:
    -feline herpesvirus-1
    -feline calcivirus
  2. bacterial:
    -mycoplasma species
    -bordetella bronchiseptica
    -chlamydia felis
  3. primary infections: most commonly VIRAL (>80% of cases)
    -co-infections common: increase disease severity, most are opportunistic
  4. secondary infections: most commonly bacterial; not present in every case
    -strep, staph, pasteruella, E. coli
  5. often causes:
    -mucopurulent discharge
    -systemic signs/illness: patient feels bad, fever, tachypnea, etc.
20
Q

describe pathogen generalities of feline upper respiratory complex

A
  1. pathogen shedding:
    -oro-nasal and oral secretions
  2. transmission:
    -close/direct contact: mutual grooming, overcrowding
    -fomites: bowls, cages, toys, YOU
    - +/- aerosolization: over 4 feet
  3. high morbidity, low mortality
21
Q

describe general clinical signs of URTI

A
  1. oculo-nasal discharge: serous to mucopurulent
  2. squinting
  3. sneezing
  4. stertor: nasal congestion
  5. +/- systemic illness
  6. +/- lower airway signs
  7. +/- death (kittens or older cats)
  8. facial deformity
  9. congested meow
22
Q

describe feline herpesvirus-1 (FHV-1)

A
  1. feline viral rhinotracheitis (FVR)
  2. large enveloped dsDNA alphaherpesvirus
    -strain variation minimal
    -similar to virus of dogs and seals
    -fragile outside host so easily disinfected
  3. most cats are exposed during their lifetime (get rest of slide)
  4. most cats are exposed during their lifetime but exposure DOES NOT EQUAL INFECTION
  5. can cause URTI, dendritic ulcer (harry potter lightning bolt in eye), and ulcerative, eosinophilic dermatitis
23
Q

describe feline calcivirus

A
  1. small, unenveloped ssRNA
  2. survives outside host for prolonged periods
    - at leasy 30 days, resists routine disinfection
  3. following infection:
    -shed continuously for 1-2 months and less than 10% become chronic carriers and shed for life
  4. causes URTI +/- ulcerations
    -tongue, lips, nasal planum
    -lameness reported
  5. virulent, systemic FCV
    -unique, uncommon FCV strain
    -highly pathogenic
    -high mortality (over 50%)
24
Q

describe chlamydia felis

A
  1. obligate intracellular bacteria
    -primitive class of bacteria, resembles gram (-)
    -lack essential metabolic pathways
  2. most common in young cats
    -2-12 months of age
  3. includes only conjunctivitis
    -acute, chronic, or recurrent disease
    - +/- chemosis, blepharospasm
25
Q

describe other pathogenic causes of feline URTI

A
  1. bordetella bronchiseptica
    - gram negative aerobic coccobacillus
  2. mycoplasma species
    -fastidious organism (lacks cell wall)
  3. most commonly part of a co-infection
    -opportunistic
    -lower resp signs&raquo_space;> URTI
    -rarely causes cough in cats
26
Q

describe URTI diagnosis

A
  1. history of known exposure
  2. clinical signs and exam:
    -remember unique associations
    -lightning bolt corneal ulcer: herpes
    -coughing dog at home: bordetella
    -conjuntivitis only: chlamydia
    -URTI + multi-systemic illness: FCV
  3. +/- organism ID
    -PCR
    -oronasal +/- conjunctival swabs

CRH II (26 decks)

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