Page 249 - Clinical Manual of Small Animal Endosurgery

Upper Respiratory Tract 237

Clinical examination and anamnesis

As is often the case, a careful history-taking can help clue the clinician
in to the necessity and applicability of endoscopy as part of the diagnostic
and therapeutic management of the patient. Understanding the patient’s
work or recreation history (hunting or herding dogs), home environment
(if owners are tobacco smokers) and travel history are very helpful pieces
of information. Querying the owner as to the onset and duration of
clinical signs, nature of any discharge (colour, character, odour, unilateral
versus bilateral) and observation of sneezing, coughing, head shaking
and seasonality of clinical signs are all very helpful clues as to the type
of disease process.
Examination of the conscious patient in the consultation room will of
course focus on the head and respiratory status. The clinician will under-
take careful observation of respiratory effort and listening for stertorous
or stridorous airflow. Symmetry of the head and face is important. Note
should be taken of the nature of any oculonasal discharge; the colour,
character, odour and whether it is uni- or bilateral.
Using a paediatric stethoscope, auscultation of the rhinarium with
percussion can identify regions of fluid or tissue density. Auscultation of
the ventral pharynx and trachea is also important with obvious attention
being given to the heart and lungs. Airflow across each nostril should be
evaluated. This can be done by blocking one nostril (if the patient is
compliant) at a time and sensing airflow with one’s hand or cheek. Alter-
natively, one can use a glass slide to appreciate condensation as an
indicator of airflow. With experience, the clinician can learn to appreciate
subtleties of turbulence from one side to the other.
If the conscious patient is compliant, an oral exam should be done.
Attention should be given to the presence of severe dental disease, oro-
nasal fistulae with notation of abnormalities related to the hard and soft
palates, and pharyngeal lesions.

Diagnostic work-up prior to endoscopy

As epistaxis is a common presenting sign for nasal disease, a complete
blood count with accurate platelet count is imperative. Buccal mucosal
bleeding times and toenail bleeding times can also give a crude measure
of platelet function. Coagulation times, including prothrombin time and
partial thromboplastin time are also important. Blood pressure measure-
ment should also be performed, as hypertension can be associated with
epistaxis. Cats should also be evaluated for hyperthyroidism as a poten-
tial cause for hypertension.
Bacterial culture and sensitivity can be performed preoperatively on
nasal exudates if samples can be reliably obtained. Serology for fungal
disease, in particular aspergillosis, can also be performed prior to