Please enable JavaScript.
Coggle requires JavaScript to display documents.
호흡기내과 (Nasal Dz (Reverse sneeze (usually no problem, inspiration against a…
호흡기내과
Nasal Dz
C/S : discharge(type), epistaxis, sneezing, stertor, epiphora, rubbing and pawing, changes in shape, changes in color, open mouth breathing, seizures or other CNS manifestations
Diagnostic Methods : r/o systemic dz, oral exam, radiographs, CT, rhinoscopy(after CT), lavage, biopsy, culture(deep tissue), Ab titers, rhinotomy, etc.
Historical findings : 언제 시작되었고, 어떤 변화가 있었고, discharge의 성상은 어떻고, 한쪽 콧구멍에서 비롯된 건지 아니면 양쪽 콧구멍에서 비롯되었는지
Physical findings : character of discharge(serous, mucoid, purulent, mucopurulent, bloody), pigmentation of nasal planum, condition of the mouth, painful on manipulation, percussion, symmetrical, airflow
Location
Unilaterl : dental dz, foreign body
Bilateral : viral infection, systemic dz
Unilateral → Bilateral : fungal dz, neoplastic dz
Discharge
Serous : rare disorder, healthy animal(stress), viral infection, nasal mites(rare if use heartworm prevention)
Mucopurulent : the most common disorder, viral infection(CD), fungal infection(+/-blood), oral dz, FB(+/-blood), neoplasia(+/-blood), nasopharyngeal polyp, lymphocytic-plasmacytic, allergic, bacterial infection, systemic dz
Epistaxis : systemic dz(hemostasis, hypertension, E.canis), trauma, acute FB(bloody → MP), neoplasia(MP±B), fungal infection(MP±B)
Sneezing : viral infection(특히 고양이), parasitic infection, FB(grass awns, etc.), irritants
Reverse sneeze
usually no problem
inspiration against a closed glottis
paroxysms of noise and effort
When it's over, it's over.
often conformational
rarely, associated w/ pharyngeal/laryngeal dz or nasal mites
Oral dz : very common cause of nasal discharge eg. tooth root abscess, oronasal fistulae
Foreign bodies
not common
mucopurulent if chronic
Stable signs
Dogs - front nose(smelling)
Cats - back(chewing & playing)
blood very rare
visualize(rhinoscope), lavage
Nasopharyngeal polyps
개보다는 어린 고양이에서 흔함.
귓병과 같이 있기도
C/S : stertor, airway obstruction, discharge, head tilt, nystagmus, Horner's syndrome
Nasal neoplasia
very common cause of chronic discharge in dogs
especially likely if bloody discharge or facial deformity
mucopurulent or bloody
older dogs and cats
대부분 악성, adenocarcinoma가 흔함.
C/S : diminished air flow, deformity, epiphora, lymphadenopathy
Fungal rhinitis
frequently painful, erosive, and deforming → 종양과 감별진단
Cryptococcus neoformans(cats)
Aspergillus fumigatus(dogs) : nasal depigmentation or discomfort, destruction of turbinates, fungal plaque
Bacterial rhinitis - 원발성 질병으로는 매우 드무나, 합병증으로는 매우 흔함.
Allergic & Lymphocytic-Plasmacytic rhinitis : may be seasonal allergy(rare)
Diagnostic Modalities
Diagnostic imaging
basic to respiratory medicine
Radiographic changes : pattern(alveolar, bronchiolar, interstitial, vascular), intensity, location, incidentals
US : not that useful ← 음파가 공기 중에서 잘 이동x
CT ← 폐 관찰에 제일 좋음.
Cytology/Histopathologic evaluation : alligators/catheters, FNA(fine needle aspirate), TTW(transtracheal wash), BAL(bronchoalveolar lavage), brush sample, thoracoscopy, thoracotomy
Microbiological cultures : wash/lavage, brush/swab, biopsy
Pulmonary function tests
Capnography
-scopy : rhinoscopy, laryngoscopy, bronchoscopy ← 아직까지는 제한적
Assessing oxygenation : membrane color, arterial blood gas(PaO2), pulse oximetry(SPO2)
Lung or Heart?
can be very hard to tell, and they often go together.
Special tests : Rads, echo, pro-BNP, etc.
Routine MDB & Ancillary diagnostics : non-specific, but often useful
Feline Upper Respiratory Disease Complex(FURDC)
mixed or single infection : Calicivirus(FCV), Herpes virus(FHV-1), Bordetella bronchiseptica, Mycoplasma spp., Chlamydophilia felis, opportunists
kittens, unvaccinated, exposure, stress, chronic
sneezing, nasal discharge, anorexia, fever, ocular discharge
symptomatic tx
Associated signs provide clues.
FCV : oral ulcers, lameness
FHV : dendritic corneal ulcers, salivation
B.bronchiseptica : cough
Mycoplasam : lameness
C.felis : severe conjunctivitis
Feline Chronic Rhinosinusitis
chronic sniffles. idiopathic nasal dz
*Aspergillosis 치료 : topical이 더 효과적. clotrimazole
*Virulent systemic calicivirus : mutated typical calicivirus. 전염성 강함. 증상은 fever, edema, alopecia, ulceration, death(50%). more severe in adults.