Small Ani. Med- Clinical Manifestation of Respiratory Disease 1

wilsbach's version from 2015-11-30 21:37

Nasal and Paranasal Disorders

Question Answer
***No matter what is up the nose, what does the nose do? (tumor, popcorn kernel, whatever) (3 CHARACTERISTICS OF ALL NASAL DZ)MUCOSAL EDEMA, INFLAMMATION, 2* BACT INFECTIONS
most common things in a dogs noseFBs, fungus, Neoplasia, and chronic rhinitis
things you will see with nasal dischargeserous/mucopurulent/blood, epistaxis, sneezing, stertor, facial deformity, +/- systemic illness signs
*remember if any animal presents with nasal discharge, before you even go back and talk to resident, you do what?make sure they can or can't breathe through nostril- put glass slide in front of nostril, look for fog.
whats orthopneic?when they are positioned like they cant breathe (neck outstretched, etc)
short listing possible rule outs for the types of nasal discharge (serous, mucopurulent+/-blood, epistaxis) (she said she wanted us to see this again, read it over?) So, what can be up an nose and how it likes to presentSerous likes to be viral, fungal like to be mucopurulent+/-bloody, tumors like to be bloody. For epistaxis, dont forget about systemic and toxic things like rodenticide. .
do nose things like to move to the lungs?no not really, unless metastasizing cancer.
(she said shes given this to us before) chart on how to basically work up every nose case
if nasal patient is a DOG, what might you add to initial diagnostics, depending on your area?aspergillosis titer
if nasal patient is a CAT, what might you add to initial diagnostics?Cryptococcus antigen, and the viral tests (FeLV, FIV, +/- herpes and calici)
if nasal patient is BLEEDING, what might you want to add to initial diagnostics?CBC and PLATELET TEST (don't wanna get super bloody nasal bx if they have no platelets) so coag panels too (pT, PTT), maybe BMBT, and if bleeding and a dog consider tick borne dzs
what are some advanced diagnostics you can do after your initial workup (see chart thing card for initial workup) and what do you need to do if you wanna do these dxs?NEED TO BE UNDER ANESTHESIA for these. can do: Nasal Radiography/CT/MRI, Complete oral exam, Rhinoscopy (biopsy or deep nasal culture for bact or fungi), or Exploratory rhinotomy with turbinectomy
her fav way to work up noses with advanced dx is...?CT--- can tell her if it crossed cribriform plate and went into the brain
what are the two types of scopes for Rhinoscopy, where can you use each, and what kinda stuff can you do with rhinoscopy?Ridgid up to medial canthus of eye, flexible scope to get up behind soft palate and maybe partway into nasal passages. Can use for Biopsy, cytology, cultures, flushes
5 main players in feline URI?(1)** FHV-1 "feline rhinotracheitis" (2)** Feline Calicivirus (esp the nasty virulent strain) (3) bordetella bronchiseptica (one of the few bact that actually can be 1* cause of things) (4) Chlamydophila felis (C. psittaci can also affect them) (5) Mycoplasmas
So what are the main CS of a cat with URI?fever, sneezing, nasal discharge, Conjunctivitis, Ocular discharge. Usually self-limiting (can have 2* bact infections)
If you suspect herpes or calici in a cat, what specific tests can you do and where do you get the samples from?IFA and VI/PCR on conjunctival, pharyngeal or tonsillar scrapings/biopsy for FHV and FCV
why might you wanna do a bact culture with a cat nasal dz?bordetella can be a 1* pathogen, also mycoplasmas (they are weird)- careful bc there are lots of other flora and contaminants around
why do we care about ocular viruses when we are thinking about the nose?they all drain into there! ocular viruses will totally inflame nasal mucosa.
what is some of the general supportive care you can provide to a cat with nasal dz?Hydration and nutrition! (cant smell wont eat), Nebulization, Abx for 2° bacterial tract infection
if you want to give Abx for 2° bacterial tract infection in cat nasal dz, what do you usually give? What if you think it's Bordetella, Chlamydophila or Mycoplasma suspected?2* pathogens: Usually penicillin +/- clavulanic acid. IF YOU SUSPECT myoplasma/bordetella/Chlamydophila. you usually give Doxycycline BUT CAUTION IN CATS BC DOXY=RISK OF STRICTURE! esp if in pills. try to give bolus of water after or give it in syrup form
what are some things you can do to provide Ophthalmologic care for your cat with nasal dz (esp since so much of it is viral crap)oral L-lysine, if there are ULCERS, Trifluridine, idoxuridine, adenine arabinoside (I dont think she cares if we have these drugs memorized)
**WHAT IS THE CAT NOSE FUNGUS?Cryptococcus neoformans (most common fungal infection in cats) (think yeast, southern US, pigeon droppings)
where does cryptococcus like to be, in who?CATS, NOSES (nasal cavity, sinuses, paranasal tissues, and lungs) also local invasion of skin, eyes and CNS. Can get systemic distribution via lungs *looks like SCC so check it out
How do you dx and tx cryptococcus neoformans?(cats!!) DX: Antigen test (Latex agglutination), can also monitor therapy with this. Can also do cytology. TX: Ketoconazole, itraconazole, fluconazole (flu if you think it's crossing into brain, remember flu can pass BBB), 5-flucytosine, Amphotericin B—lipid complex
where does aspergillus like to be, in who?DOGS! Young to middle aged mesaticephalic and dolichocephalic breeds esp susceptible (think GSD). Noses, (Nasal passages and frontal sinuses), can be Local or disseminated infection
clinical signs of aspergillus?(dogs!) Facial pain, nasal discharge (Mucoid to hemorrhagic, crusting) and DEPIGMENTATION (fungi are weird). also anorexia, sneezing, Neurologic or ocular manifestations (bc local spread), Masticatory muscle atrophy
only 2 things cause depigmentation of noseobscure weird random immune mediated dzs, and also fungi!!
how do you tx aspergillus?NOSE: TOPICAL clotrimazole, *NOT WITH INTRACRANIAL DZ (so not if crossed cribriform plate) +/- oral Itraconazole or fluconazole + terbinafine. Remember rotisserie dog
if aspergillus is disseminated, that is probably is a worse strain- A. terreus, deflectus, flavipes, fumigatus
how do you tx aspergillus if immunocompromised dog?poorer prog. Esp. GSD with the IgA problem. Can try some Azoles, +/- Amph B lipid complex, surgical removal of granulomas
what is that horrifying nasal parasite in dogs?Pneumonyssoides caninum
Pneumonyssoides caninum--> CS, treatment?Violent sneezing, Head shaking, pawing, Reverse sneezing, Chronic nasal discharge, Epistaxis. TX: Milbemycin oxime, Ivermectin
what are Nasopharyngeal polyps? location? clinical signs?These are benign growth which start in Eustachian tube and then can move to External/middle ear or Pharynx and nasal cavity. They look like a Pink polypoid growths. CS: Stertor, upper airway obstruction, serous/mucopurulent discharge (usu start serous and goto mucopur) and +/- neurologic signs (bc can grow into middle/inner ear-- not really aggressive enough to cross bone)
what are your options for tx for nasopharyngeal polyp?(1) Traction (pull it out) but the root is usually still in there so can regrow. (2) Bulla osteotomy +/- rhinotomy (best thing)
clinical signs of nasal tumors?Facial, palatal, dental arcade deformity, Unilateral progressing to bilateral nasal discharge (so usually start one side and move to other-- can see this on DI) (serous/ mucopurulent/ hemorrhagic)
what are the common BENIGN nasal tumors? what are the most malig ones?BENIGN: Adenomas, fibromas, papillomas, TVT’s—dogs (sx removal or chemo). MALIG: Adenocarcinoma, SCC, undifferentiated, lymphoma'
is radiation helpful for nasal tumors?Radiation responsive! Good choice of tx! MST 13 mo, 45% alive at 2 years
what is allergic rhinitis? CS? how do you Dx? Tx?Not well characterized, but usually Association with irritant (Cigarettes, new perfume or kitty litter). Usually dx Historical relationship between CS and exposure and improvement after irritant is removed from enviroment. CS for cats esp is usually SKIN AND GI signs!! Usually tx with Chlorpheniramine or cetirizine/Zertec®
who is idiopathic rhinitis more common in? When are you able to dx the prob as idiopathic rhinitis?Cats > dogs, probably some relationship with FHV/FCV going on (bc longstanding serous discharge through nose= irritation). Must rule out all other causes before dx this.
how do you tx idiopathic rhinitis?(cats!) (1) Facilitating drainage (nebulize, intermittent flushes, Judicious topical decongestants) (2) Decrease irritants in environment (3) Control 2° bacterial infections (+/- tx for mycoplasma) (4) +/- Anti-histamines, +/- corticosteroids
what is the SALVAGE PROCEDURE for idiopathic rhinitis?turbinectomy (totally end stage- she said she prolly still wouldnt do it bc it doesnt stop them from being snotty. makes more snotty. Sneeze huge goobery snot)
Canine Chronic/Lymphoplasmacytic Rhinitis--> what is this? how do you dx? what is an ADDITIONAL thing you can do for dogs?Same as cat chronic rhinitis dx and tx options ((1) Facilitating drainage (nebulize, intermittent flushes, Judicious topical decongestants) (2) Decrease irritants in environment (3) Control 2° bacterial infections ((+/- tx for mycoplasma) (4) +/- Anti-histamines, +/- corticosteroids)) with the additional tx option of piroxicam which some dogs respond well to.

Laryngeal and Pharyngeal Diseases

Question Answer
what are the main CS of Laryngeal Diseases?(1) Respiratory distress and Stridor*+/- change in vocalization....usually due to progressive airway obstruction (often acute presentation) (2) +/- systemic signs (if there was Aspiration pneumonia)
when a laryngeal case walks in the door, what is the first most important thing you should do?KEEP THEM CALM! Exercise, excitement, temperature exacerbate distress....the more they struggle, the more neg pressure is exerted, as well as more inflammation and edema--> inc inspirational effort needed (consider dynamic vs static obstruction where effort might play a big role)
laryngeal vs pharyngeal. Which one has stertor versus which has stridor?LARGYNGEAL= IN NECK= STRIDOR (I stride across your neck muwahha). PHARyNGEAL= IN NOSES SORTA= STERTOR
clinical signs of Pharyngeal Disease?Stertor, Reverse sneezing, Gagging, Retching (not actually vomiting but sounds like it) Dysphagia, Airway obstruction (Usually later in disease process)
*what is the major Laryngeal Diseases in Dogs and Cats?Laryngeal paralysis!!! (Also: Laryngeal neoplasia, Obstructive laryngitis, Laryngeal collapse, Web formation, Trauma, FB, Extraluminal mass, Acute Laryngitis)
what are the major Pharyngeal Diseases in Dogs and Cats?Brachycephalic airway syndrome*, Elongated soft palate*, Nasopharyngeal polyp* Lymphoma* in cats ((Also: Foreign body, neoplasia, Abscess, Granuloma, Extraluminal mass~
what are things imaging is useful for seeing?Radio-dense foreign bodies, masses, soft palate abnormalities
what stuff can you see on a lateral rad for larynx/pharynx (structures)Larynx, caudal nasopharynx, cranial trachea
If you are going to be planning your laryngeal sx, what imaging do you wanna use?CT-- anything in the neck area that needs to be cut- there are super important things: carotid, jugular, esophagus, trachea....want CTS FOR SX PLANNING
what cautions should you take with anesthesia and pharynx/ larynx sx?Constant monitoring during recovery! Repair may be necessary at this time
what drug might you need to eval dynamic fxn if animal is under anesthesia?doxapram
Laryngeal Paralysis--> pic of normal vs paralysis vs after tx
chart of possible causes of laryngeal paralysis
**genetic predispositions for idiopathic laryngeal paralysis? (3) bouvier des flandres, Huskies (congenital) and OLDER labs
how do you dx laryngeal paralysis? Tx? (management vs sx)DX: laryngoscopy--> observe abnormal arytenoid movement. TX: if systemic problem, fix that. MANAGEMENT if no idopathic resp distress. Can you glucocorticoids (short and tapering) along with rest and anxiolytics. If there IS idiopathic resp distress, do sx correction.
how effective is sx to correct laryngeal paralysis? what are the complications?90% survival >1yr, MST >5yr. Usually don't make it if aspiration pneumonia. Complications: 14% perioperative mortality, Aspiration pneumonia, Polyneuropathy/ myopathies will progress (do mm or nn bx)
**what are the 3 major and two extra possible problems assocaited with brachycephalic airway syndrome?? Stenotic nares, Elongated soft palate, Everted laryngeal saccules, +/- hypoplastic trachea (esp bulldog), +/- end stage laryngeal collapse
Why is it best to tx brachy syndrome EARLY, even before CS show?more and more squeezing of cartilages from neg pressure... then start to get weaker and weaker...can avoid this with fast action
tx brachy syndrome by inc airflow... how?SX repair- nares, soft palate, saccules (also weight management is a must)
what do you do to tx brachy syndrome when presenting as an emergency?Rest, anxiolytics, glucocorticoids
brachy syndrome--> (she mentioned in class) what affects flow of air the most?THE DIAMETER OF THE TUBE!! (r^4 power)
Laryngeal Collapse--> what are the ER/salvage procedures?Tracheostomy
can you do a tie-back for laryngeal collapse?NO- not just arrytnoids not working, it's the whole thing collapsing down
end stage brachy syndrome might result in...laryngeal collapse :(
Laryngeal Neoplasia--> are 1* or 2* tumors more common? what are the more common tumors? examples?Primary tumors uncommon (SCC, adenocarcinomas, Undifferentiated, lymphoma, melanoma, MCT), Local tumors more common- They distort and compress the airway. Usually Thyroid carcinomas

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