Upper respiratory diseases in dogs and cats 1+2

Question 1

History and clinical signs

Answer 1

• Discharge, sneezing, bleeding, pain, stridor, dyspnea, reverse sneezing
• virial rhinitis: watery/serous discharge
• secondary bacterial infection: purulent discharge
• Foreign body, tumor or fungal rhinitis: bloody discharge
• systemic diseases
• discharge (distemper, viral rhinotracheitis)
• epistaxis (bleeding disorders, e.g DIC)
• physical examination
• shape, nasal stridor, closing th mouth, discharge uni- or bilateral, inspection of the mouth (teeth), depigmentation

Question 2

Special diagnostic prcecure

Answer 2

• Radiography
• –> you can only see the increased radiodensity, but not differentiate the diagnosis
• need: sedation, positioning, limited value
• Rhinoscopy
• Best choice. but not for frontal sinus or bony dase disroders
• good to differentiate tumor (benign, malignant) and inflammation
• need: anesthesia, tracheal intubation, sphinxlike posture, viscualization and biopsy
• CT/MRI:
• Good for frontal sinus and body case disorders
• not good to differentiate tumor or inflammation

Question 3

Diseases of the nasal cavity and frontal sinus

Answer 3

• Congenital diseases
• Malformation of the nasal plane
• oronasal, oropharyngeal clefts
• primary ciliary dyskinesia/kartagners syndrome
• Rhinits:
• viral, bacterial, mycotic, specific, (neurogenic)
• Tumors
• nasal plane, nasal cavity, frontal sinus
• epistaxis
• trauma

Question 4

Viral rhinitis in cats

Answer 4

• Usually in unvaxinated outdoor cats.
• FHV-1, FCV 80-90% (URT)
• starts with a bilateral problem, paroxysmal sneezing, serous ocular and nasal discharge, in 5 days mucopurulent (due to secondary bacterial infection)
• immunization (LMV) severe disease but infection!
• chronic carriers: no sigsn or sneezing, mild nasal discharge, gingival ulceration

Question 5

Viral rhinitis in dogs

Answer 5

• kennel cough
• canine distemper
  
  • profuse mucopurulent nasal discharge
  • PCR
• CHV in puppies –> sytemic, life threatening disease
  
  • profuse mucopurulent nasal discharge
  • autopsy

Question 6

Bacterial rhinitis

Answer 6

• usually secondary due to
• viral infections, foreign body, tumor, distrutpion of mucosal integrity
• sometimes it can be primary (rare)
• Pasteurella, treptococcus, staphylococcus, bordetella, chlamydia
• treatment:
• antibitoics, but always find the primary disease first

Question 7

Mycotic rhinitis

Answer 7

• more common in dogs than cats
• Aspergillus spp. > Cryptococcus (except crypto. is more common in cats)
• nasal cavity and frontoal sinus
• Cause:
• opportunist, house dust, bird cages
• large number of spores, foreign bodies
  
  • e.g foxtail can cause mycotic rhinitis due to allergy in the summer, by aspirating the forign body
• can be iatrogenic due toglucocorticoid treatment
• clinical signs: nasal discharge (mucopurulent), depigmentation, pain, epistaxis
• rhinoscopy: plaques, bone resportion, atrophy of the conchae

Question 8

Sinosal aspergillosis

• treatment

Answer 8

• Topical 1% clotrimazole gel (nasal cavity/frontal sinus), 1-3 x endoscopy + oral itraconazole for 8 weeks
• be carefull not to damage the cribriform plate. if this is damaged the medication can enter the brain and lead to coma
• topical enilconazole va tubes thorugh trephine holes 10ml 10% BID for 14 days
• systemic: ketoconazole, itraconazole, or fluconazole for 8 weeks

Question 9

Specific rhinitis

Answer 9

• Polyps:
• more common in cat than dog
• uni/bilateral, nasal cavity/nasopharynx
• clinical signs: stridor, compensate with open mouth breathing -> can be lethal for cats.
  
  • cats may extend their neck and pand and being very anxious
• rhinoscopy, biopsy, surgery
  
  • Recurrence of the polyp is very unusual if bulla osteotomy
  • prognisis is excellent! Horners syndrome usually resolves within a month
• Foreign bodies:
• sudden sneezing (initially), pain
• rhinoscopy
• Allergic rhinitis
• serous discharge, sneezing

Question 10

Tumors of the nasal cavity

Answer 10

• Any age, but usually older dogs/cats over 5 years
• clinical signs:
• similar to rhinitis
• epistaxsis +/-
• unilateral bloody nasal discharge
• radiography, rhinoscopy + biopsy, CT, MRI
• Cause:
• cats usually lymphoma
• dogs: squamous cell carcinoma, adenocarcinoma, sarcoma
• Treatment:
• CT, MRI, radiation therpy, chemotherapy, surgery
  euthanasia: bleeding, dyspnea, stop eating

Question 11

Pharynx

• history and diagnosis

Answer 11

Oro-/naso-/laryngopharynx

• history:
• dysphagia, couging, gagging, regurgitation, salivation
• physical examination: sedation +/-, intubation
• diagnosis:
• pharyngoscopy, retrograde rhinoscopy, video fluroscopy, CT (middle ear), UL (masses)

Question 12

Diseases of the pharynx

Answer 12

• foreign body: common in dogs
• sudden salivation after eating bones
• pain, dysphagia, dyspnea
• retropharyngeal abscess:
• migrating foreign body,
• salivation, fever, dysphagia, diagnsis dofficult, painfull neck
• WBC increases
• nasopharyngeal polyps: same as above
• nasopharyngeal stenosis:
• young cats
• rare, open-mouth breathing
• endoscopy, surgery, ballon dilatation

Question 13

Soft palate abnormalities

Answer 13

• Elongated soft palate:
• brachycephalic dogs, stertorous breathing, exercise intolerance, collapse, gagging
• Cleft palate
• neonate patients
• milk in the nares, aspiration
• surgery
• can lead to nasal discharge and chronic rhinitis
• soft palate hypoplasia
• brachycephalic dogs, chronic rhinitis, gagging, reverse sneezing
• can lead to nasal dicharge and chronic rhinitis

Question 14

Larynx

• history and diagnostic procedures

Answer 14

• changes in vocalisation, stridor (air turbulence thorugh the narrowed laryngeal opening)
• always rule out rabies!
• coughing, gagging
• systemic disease?, nauropathy, myopathy, secondary complications like aspiration
• palpation (pain, fremitus), auscultation (stridor), excersising the patient
• laryngoscopy
• x-ray

Question 15

Diseases of the larynx

Answer 15

• laryngitis/obstructuve inflamatory disease
• laryngeal paralysis
• laryngeal collapse /brachycephalic airway syndrome
• neoplasia

Question 16

Laryngitis

Answer 16

• rarely a disease alone
• dommon infectious agents:
• Dog: CAV-2, CPIV, Bordetella bronchiceptica (kennel cough)
• Cat: FHV-1, FCV
• loud cough, fever +/-, pneumonia +/-, lethargy +/-
• antibiotics: Doxycycline, amoxcicillin+clavulonic acid
• Antitussives: butorphanol, hydrocodone (but! pneumonia)
• other causes (non-infectious):
• local irritation (endotracheal tube, foreign body, hot food, insect bites)
• Treatment:
• glucocorticosteroids + NSAIDs
• tracheostomy

Question 17

Obstructive laryngitis

Answer 17

• rare, dogs and cats
• histopathology is imperative to distinguish between neoplasia and obstructube inflammatory disaease
• severe respiratoy distress, dysphonia, stridor, dyspnea
• glucocorticoids, tracheostomy, tube placement
• biopsy can kill the animal (bleeding?)

Question 18

Laryngeal paralysis

Answer 18

• arythenoid cartilage fails to abduct during inspiration! Recurrent laryngeal nerve
• Usually happens in old, large breed dogs, idiopathic:
• congenital: Bouvier des flandres, siberian husky, bull terrier
• acquired: idiopathic, trauma, systemic neuromuscular disease
  
  • labrador retrivers, saint bernards, irish setters
• stridor, excersive intolerance, voice change, couching, respiratory distress, hyperthermia
• inspection, paradoxic movement (laryngoscopy), complete neurologic examination, X-ray(aspiration, metastatic dis.)

Question 19

Management of laryngeal paralysis

Answer 19

• obstruction –> marked negative pressure
• –> mucosal and pulmonary edema
• –> hyperthermia, inflammation
• Supplemental oxygen:
• enodtracheal tube, mask, tracheal catheter/tube
• propofol 4-7 mg/kg IV
• sedation:
• anxiolytic tranquillizer; Acepromazine (0.02-0.05 mg/kg IV, IM, SC)
• hyperthermia: cool IV fluid, wet towels
• edema and inflammation: glucocorticoids, furosemide
• examnation and treatment of the underlying disorder
• srugical repair of the are to open airway
• partial laryngectomy, arytenoid alteralisation, removal of the vocal folds)
• aspiration pneumonitis is a common consequence

Question 20

Laryngeal collapse/brachycephalic airway syndrome

Answer 20

• secondary to congenital airway malformations in brachycephalic dogs
  
  • stenotic nares, elongated soft palate, hypoplastic trachea, laryngeal saccular edema and eversion
• chronic increased negative pressure during inspiration (as compensatory mechanism) –> laryngeal cartilages will weaken and collapse (stage I-III)
• medially displaced cuneiform and corniculate processes
• sedation, oxygen, cooling, glucocoticoids, furosemide
• surgical treatment of congenital malformations before laryngeal surgery

Question 21

Laryngeal neoplasia

Answer 21

• subacute or chronic. similar symptoms as laryngeal paralysis
• rare:
  
  • cts: squamous cell carcinoma, lymphoma but polyps and obstructive laryngitis
  • dogs: malignant epithelial tumours and rhabdomyoma
• dysphagia, stridor, respiratory distress, gagging, coughing
• laryngoscopy and biopsy, metastasis=
• surgery (partial laryngectomy, permanent tracheostomy)
• Chondrolipoma: biopsy is possible but never do it! serious consequences.

Question 22

Trachea

• stenotic disease

Answer 22

• Collapse (acquired), Hypoplasia (congenital) –> increased airway resistance –> hypoventilation –> respiratory acidosis; chronic obstruction –> pulmonary hypertension, cor pulmonale

Question 23

Trachea

• hisotry and physical examination

Answer 23

• Couging:
  
  • noisy inspiratory sounds, wheezing expiratory sounds /goose honk” cough
• Palpation of the neck:
  
  • emphysema, collapse, mass (thyroid gland, haematoma, abscess)
  • cough can be elicited (laryngeal, tracheal irritation)
• Auscultation:
  
  • over larynx, trachea, lungs (sounds are usually most intesne near their site of origin)

Question 24

Trachea

• diagnostic tests

Answer 24

• Radiography: LL and VD/DV
  
  • collapse: dynamic disease. X-ray not good, endoscopy best choice.
  • Hypoplasia: X-ray good. No trachea/thoracic inlet > 0.2, 0.16, 0.12
  • mediastinal mass, PTX, pneumomediastinum
• Tracheobronchoscopy: mucosa, culture, cytology, biopsy, foreign body removal
• blood tests: rarely sefull, systemic or allergic disease
• Coproscopy: lungworm infection

Question 25

Diseases of the trachea

Answer 25

• tracheitis
• tracheal collapse
• tracheal hypoplasia
• parasites
• trauma, obstructive masses
• foreign body

Question 26

Non-infectious tracheitis

Answer 26

• causes:
• prolonged barking, collapsing trachea, chornic cardiac disease, allergic lower airway disease
• tests:
• firm palpation of the thoracic inlet –> typical tracheal cough; tonsilitis, cardiac murmor +/-, lung sounds +/-,
• treatment:
• antitussives (codeine, butorphanol, dextromethorphan)
• bronchodilating drigs: thophyline/aminophyline, terbutaline
• prednisolone, nebulization (6 times daily)
• underlying disease

Question 27

Infectious tracheobronchitis / canine infectious respiratory disease complex (CIRDC) / Kennel cough

Answer 27

• causes:
• CAcV-2, CPIV, CaHV-1, CRCoV, Bordetella bronchiseptica
• others: reov., mycoplasma spp., distemper
• History:
• highly contagious!
• pensions for dogs, hospital, kennel
• clinical signs:
• dry, hacking, paroxusmal cough in generally healthy dogs
• treatment:
• antitussives
• antibiotics (BAL?, systemic illness; cephalosporins, amox-clav., doxycycline)
• bronchodilators

Question 28

Collapsing trachea/tracheal collpase

• predisposition, etiology,

Answer 28

• middle-aged to aged toy and miniature breeds
• chiahuahua, yorshire terrier, toy poodles, shih tzu, lhasa apso, pomeranian
• Acquired > congenital
• DV > LL
• Cervical > intrathoracic
  
  • inhalation: thoracic dilation. No cervical opening (collapse)
  • Exhalation: thoracic part collapses. Normal cervical part.
  • –> X-rays can not diagnose. endoscopy is best
• Etiology:
• deficiency in the organic matrix (failure of chondrogenesis, degeneration) –> tracheal and bronchomalatia –> stretching of the dorsal membrane, collapsing trachea (stage I-IV)
• associated problems: chronic couching (chronic airway or pulmonary parenchyma disease, chronic cardiac disease, obesity, mediastinal fat, mass.)

Question 29

Collapsing trachea/tracheal collpase

• history and clinical signs

Answer 29

• long history of coughing, from mild, intermittent to paroxysmal “goose-honk” cough, elicited by palpation, eting, drinking, excitement, cyanosis +/-, auscultation (inspiratory noises)
• chronic, progressive, irreversible
• diagnosis: Radiography (respiratory phase), Bronchoscopy (stage I-IV)

Question 30

Collapsing trachea/tracheal collpase

• treatment

Answer 30

• Respiratory emergency patient
• sedation, oxygen therapy, glucocorticoids, furosemide, intubation?, cooling
• NEVER performe tracheostomy
• Medical managment:
• Antitussives: butorphanol, hydrocodone
• prednisolone (in trachea edema, tracheitis)
• bronchodilators?
• nebulization, weight reduction, underlying disease!
• Surgical managment:
• Intraluminal stents: failure to function well, migration.
• Extraluminal prostheses: laryngeal paralysis!
• Plication: not usefull

Question 31

Tracheal hypoplasia

• predisposition, symptoms

Answer 31

• congenital problem diagnosed in young dogs (2 days to 12 years)
• Bulldogs, boston terrier
• Dyspnea, productive coughing, fever if bronchopneumonia + brachycephalic airway syndrome
• Auscultation, sensitive trachea, radiography (Øtrachea/thoracic inlet < 0,2 doliocephalic; <0.16 brachycephalic, 0.12 bulldogs), leukocytosis

Question 32

Tracheal hypoplasia

• prognosis, treatment

Answer 32

• Prognosis:
• degree of hypoplasia, concurrent upper respiratory disease, congenital cardiac disorder
• Hypoplasia alone is not a life threatening problem, no surgery can fix it. you can only do something with upper airway stenosis.
• Treatment:
• brachycephalic airway syndrome (nose, elongated soft palate, laryngeal collapse)
• bronchopneumonia
• prevention:
• advisable to discourage the breeding og these animals

Question 33

Tracheal parasites

Answer 33

• rare, but worldwide disease, kennel-related problem
• Oslerus osleri (filaroides osleri) = lungworm
• chronic dyspnea, coughing (dry), inspiratory wheezing sounds
• worms at the carina (bronchoscopy, feces) 1-5mm nodules
• fenbendazole 50mg/kg/day for 7-14 days

Question 34

Other diseases of the trachea

Answer 34

• trauma (emphysema, PTX, pneumomediastinum)
• obstructive tracheal masses:
• intraluminal lesion: neoplasia, foreign body
• extraluminal compression
• segmental trachea stenosis: congenital/aquired