Nasal disease Flashcards
(48 cards)
Why do you need to be aware of disease that passes the cribriform plate?
It is very close to the brain
Clinical signs of nasal disease
Signs can be similar irrespective of cause.
Nasal discharge , sneezing, pawing/rubbing at muzzle (which can then cause corneal ulceration), facial deformity/asymmetry (more likely with neoplasia), loss of pigment on nasal planum (but can also get this after BOAS surgery - worry if acute), ulceration, epiphora (tear staining), open-mouth breathing, halitosis, starter, coughing (irritation around the larynx and pharynx can cause this), seizure (could be systemic disease with nasal signs, or could be disease that has passed the cribriform plate).
Examples of primary nasal disease
Viral rhinitis, FB, neoplasia
Examples of secondary nasal disease
dental disease causing inflammation and nasal damage, nasal-related signs e.g. bacterial rhinitis secondary to viral disease.
Nasal signs due to non-nasal disease
Systemic disease - e.g. resp disease, coagulopathy, severe hypertension. Epistaxis seen in very high bp and coagulopathies.
Disease close by - e.g. dental disease (e.g. canine apical root abscess - very close to the nasal passage), nasopharyngeal abnormalities.
Diseases that may look like nasal disease or can cause nasal signs, but aren’t primarily a nasal pathology
Systemic infectious disease (e.g. distemper causes massive nasal discharge), reverse sneezing (irritation in the upper airway that causes a soft palate wobble), dental disease, coagulopathy, severe hypertension (serous discharge often seen before epistaxis from severe hypertension), vomiting/regurg (can get up the nose, aspiration also a risk if constant).
What is reverse sneezing?
It is triggered by a nasopharyngeal irritation.
It’s a loud inspiratory noise with a laboured respiratory effort.
It’s a soft palate wobble basically.
BOAS breeds have a long soft palate therefore it is more common in these breeds.
Nothing to worry about unless it’s new / massive increase in it.
Almost always self resolving.
What are the most common causes of nasal disease?
Nasal neoplasia, inflammatory or infectious rhinitis, fungal rhinitis, structural/periodontal disease, FB, stenotic nares
Nasal disease investigations
History and CE, blood tests (coags, serology), imaging (radiographs, CT, rhinoscopy), sampling (cytology, biopsy, C&ST)
Why baseline bloods?
looking for disease and inflammatory markers
Why serology?
if looking for specific disease
Why is CT the best option?
increased detail and often easier to interpret areas like sinuses and nasopharynx as there’s no superimposition. allows distinction of soft tissue vs fluid (contrast)
Types of nasal discharge
serous, mucoid, mucopurulent, sanguinous/epistaxis, mixed
Sampling
nasal flush, nasal swab, biopsy (histopath, cytology, C&ST), C&ST
Nasal flush
vigorous irritation of nasal chambers should dislodge cells and debris which can be examined cytologically.
cuffed et tube and block at back of pharynx to prevent aspiration
Advantages of nasal flush
non-invasive, quick, occasionally helps to clear discharge and debris from nasal passages and reduce stertor, can produce tissue sample for histopath (if nasal mass is friable)
Disadvantages of nasal flush
requires GA, may not provide material suitable for exam, messy
Rhinitis and sinusitis
inflammation of the nose and/or sinuses
Clinical signs of rhinitis and sinusitis
sneezing, snuffling, nasal discharge, anorexia, other URT signs
Aetiology of rhinitis and sinusitis
usually a sequelae to viral URT infection (FHV, FCV), fungal (Cryptococcus, Aspergillus), may be seen in association with inhaled allergens, primary bacterial rhinitis rare (Chlamydophila felis, Mycoplasma spp, Bordatella bronchiseptica), mass lesion (neoplasia, FB, NP polyp), anatomical defects (cleft palate, trauma, NP stenosis), dental disease (O-N fistula, apical abscessation, periodontal disease)
Treatment of rhinitis and sinusitis
treat underlying cause and symptomatic management
Prognosis for rhinitis and sinusitis
guarded for resolution of signs
Why can rhinitis and sinusitis cause anorexia?
they lose their sense of smell
Non-destructive (inflammatory) rhinitis
increased soft tissue density conforming to the turbinates (mucopurulent exudate, haemorrhage), no evidence of a well-defined mass or bony lysis, uni or bilateral (typically bilateral when seen secondary to resp disease), linked to viral disease in cats (FCV, FHV)
