Page 1343 - Cote clinical veterinary advisor dogs and cats 4th

678 Nasal Discharge

inconclusive and nasal lesions persist. Using disorders are the first expression of a serious cobblestone texture. Inflammatory and
general anesthesia, nasal planum lesions medical condition. For some benign conditions, infiltrative processes cause loss of this texture
VetBooks.ir punch. The lesion should be centered in the Acute General Treatment Prevention
can be biopsied with a 3- or 4-mm biopsy
in addition to loss of pigment.
treatment may not be warranted.
specimen. If possible, multiple specimens
should be taken of primary lesions (e.g.,
on poorly pigmented animals and/or with
Infectious diseases can be cured with appropriate
pustules, papules, bullae). Crusted lesions Treatment depends on the cause of the lesions. • Prevent sun exposure, and use sunscreens
or depigmented lesions can also be useful. treatment. Other diseases may need chronic photoaggravated diseases.
• Culture: bacterial, fungal (evidence of maintenance treatment. • Discourage breeding of animals with
bacterial/fungal infection and resistance to hereditary diseases.
prior treatment) PROGNOSIS & OUTCOME
• Antinuclear antibody (ANA) test: if SLE is Technician Tips
suspected Varies, depending on the underlying disease Some nasal cutaneous disorders worsen substan-
• Endocrine or serologic testing if relevant tially with sunlight. Proper precautions (e.g.,
PEARLS & CONSIDERATIONS short walk, sunscreen) should be taken with
TREATMENT patients with this type of problem.
Comments
Treatment Overview • Skin biopsies are often needed for diagnosis SUGGESTED READING
The goal of treatment is to achieve permanent of nasal cutaneous disorders. Miller WH Jr, et al: Muller & Kirk’s Small animal
cure or control of the disease. Topical treat- • Loss of pigment on the ventral nasal planum dermatology, ed 7, St. Louis, 2013, Elsevier.
ment may be sufficient for localized and/or in areas of nasal discharge may suggest nasal
superficial skin disorders, whereas systemic aspergillosis. AUTHOR: Nadia Pagé, DMV, MSc, DACVD
EDITOR: Manon Paradis, DMV, MVSc, DACVD
therapy (ranging from simple to ongoing and • In addition to color change of the nasal
intensive) may be needed when nasal cutaneous planum, look for changes in the normal

Nasal Discharge

BASIC INFORMATION brachycephalic cats are most commonly ○ Purulent (P): yellow to brown and thick
diagnosed with sinonasal/orbital aspergil- (neutrophilic with bacteria)
Definition losis. ○ Hemorrhagic (epistaxis): frank blood
A common complaint in dogs and cats, nasal • Doliocephalic dogs predisposed to nasal ○ Combinations: mucopurulent (MP) most
discharge may be the result of intranasal or neoplasia common
extranasal (systemic) disease. Characterization • Time course
of time course (acute or chronic), location RISK FACTORS ○ Peracute/acute
(unilateral or bilateral), and character (serous, • Lack of immunization and exposure to ○ Chronic
mucoid, purulent, hemorrhagic, or mixed) is unvaccinated animals • Locations
necessary to determine the cause and treatment. • Severe periodontal disease ○ Unilateral
○ Bilateral
Synonyms CONTAGION AND ZOONOSIS ○ Unilateral progressing to bilateral
Hemorrhagic: epistaxis, nosebleed Viral respiratory tract infections are highly
contagious. HISTORY, CHIEF COMPLAINT
Epidemiology In addition to routine history questions (e.g.,
SPECIES, AGE, SEX GEOGRAPHY AND SEASONALITY systemic signs, vaccinations, travel history,
• Viral rhinitis is most common in young dogs • Dysautonomia occurs mostly in dogs in the exposure to other animals), careful question-
(e.g., canine distemper virus) and cats (e.g., Midwestern United States ing about character and duration of discharge,
feline calicivirus). • Grass awn FB more likely in some areas, laterality, progression, and response to prior
• Foreign bodies (FBs) are most common in seasons treatment can provide key clues.
young dogs and cats. Usually accompanied • Cryptococcus gattii most often recognized in • Acute onset of epistaxis: suspect coagulopathy
by peracute sneezing Australia, Pacific coastal areas of Canada and (p. 433) or less likely systemic disease (e.g.,
• Nasal tumors can occur at all ages but most the United States Ehrlichia canis, severe hypertension). Epistaxis
often ≥ 5 years. can be the first sign of nasal neoplasia, fungal
ASSOCIATED DISORDERS rhinitis, or FB.
GENETICS, BREED PREDISPOSITION Sneezing, stertor, cough, dysphonia, and pyrexia • Acute onset of M or MP discharge: if
• Primary ciliary dyskinesia can affect any (if systemic infection) pawing at face, suspect FB; if recent animal
breed, but Old English sheepdogs, English Clinical Presentation exposure or systemic illness, suspect viral
cocker spaniels, and Newfoundland dogs are infection
overrepresented. DISEASE FORMS/SUBTYPES • Chronic, minimally progressive course:
• Brachycephalic breeds have increased nasal • Systemic disease (with nasal signs) or nasal suspect structural nasal disease (e.g., stenosis,
mucosal contact points and aberrant caudal disease oronasal fistulae, chronic FB), inflammatory
turbinates that may result in reduced anti- • Discharge character disease (e.g., lymphoplasmacytic rhinitis), or
genic clearance and intranasal stenosis. ○ Serous: clear (acellular) parasitic disease (i.e., mites)
• Mesocephalic and dolichocephalic dogs are ○ Mucoid (M): clear and thick (acellular • Chronic, progressive course (especially with
at increased risk for sinonasal aspergillosis; with high protein) unilateral to bilateral progression): suspect
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