Page 666 - Cote clinical veterinary advisor dogs and cats 4th

306 Epulides

Differential Diagnosis • Infectious disease testing: as indicated by Recommended Monitoring
geography for Ehrlichia, Rickettsia, Leishmania
Nasal disease: Diagnostic imaging: • Serial packed cell volume (PCV) and total
VetBooks.ir Bleeding disorder: • Thoracic radiographs: metastatic neoplasia • Monitor clinical signs
protein (TP), as needed to assess severity of
• Neoplasia, trauma, foreign body, fungal
disease, inflammatory rhinitis, others
hemorrhage
• Nasal radiographic series: open mouth and
• Thrombocytopenia, thrombocytopathia, von
frontal sinus views
Willebrand disease, or coagulation factor • CT scan: more sensitive than radiographs • Monitor underlying disorder as appropriate
defect for nasal diseases PROGNOSIS & OUTCOME
Systemic disease: Other diagnostic procedures:
• Hyperviscosity: multiple myeloma, ehrlichio- • Rhinoscopy (p. 1159), nasal flush, nasal Depends on cause
sis, erythrocytosis, leishmaniasis biopsy often indicated for suspected intra-
• Vasculitis: immune-mediated, rickettsial nasal disease, removing foreign bodies PEARLS & CONSIDERATIONS
diseases • Cytologic and histopathologic examination
• Systemic hypertension (severe) of nasal tissue Comments
• Fungal, ± bacterial culture • Remember that epistaxis may indicate a
Initial Database • Bone marrow aspiration and cytology (± core systemic bleeding disorder; use caution
CBC: biopsy) with pancytopenia with venipuncture (prefer peripheral vein
• Anemia if sufficient hemorrhage has occurred to jugular for compression) and cystocentesis.
• Thrombocytopenia: may be cause of bleeding TREATMENT • Systemic causes (e.g., bleeding disorder) can
(if severe) or associated with other disease present as acute unilateral epistaxis.
(e.g., ehrlichiosis) Treatment Overview • Rule out systemic diseases and bleeding
• Neutrophilia: infection, ± neoplasia • Stop hemorrhage disorders before focusing on nasal disease,
• Pancytopenia: bone marrow disease • Treat primary cause especially if acute onset.
Urinalysis: • Recurrent bouts of epistaxis, especially if
• Usually normal Acute General Treatment associated with mucopurulent discharge,
• Hematuria (bleeding disorder); isosthenu- For persistent, voluminous epistaxis: typically signals intranasal disease.
ria and/or proteinuria with renal failure • Cage rest ± sedation (e.g., opioids; avoid
(systemic hypertension, uremic thrombo- hypotension) Technician Tips
cytopathy) • Ice packs, pressure to muzzle • Monitor for pallor, hypotension that indicate
Serum biochemistry profile: • Topical epinephrine (1 : 100,000): 2-4 drops severe or worsening anemia and hypovolemia
• Hypoproteinemia if sufficient hemorrhage or soaked gauze intranasal tamponade • Petechiation, ecchymoses, other sites of
has occurred • Whole blood or packed red blood cell bleeding indicative of bleeding disorders
• Elevated urea with normal creatinine: (pRBC) transfusion may be needed with
gastrointestinal bleeding severe anemia (p. 1169). Client Education
• Hyperglobulinemia: ehrlichiosis, leishmani- • In refractory cases, general anesthesia to gauze Monitor for recurrence of presenting signs.
asis, multiple myeloma pack nasal passages may be necessary; carotid
• Elevated liver enzymes and total bilirubin: artery ligation for life-threatening arterial SUGGESTED READING
severe hepatic disease causing coagulopathy epistaxis Bissett SA, et al: Prevalence, clinical features, and
Blood pressure: rule out severe hypertension (p. • Although unproven, topical intranasal applica- causes of epistaxis in dogs: 176 cases (1996-2001).
1065) as contributor to epistaxis or hypotension tion or oral administration of Yunnan Baiyao, J Am Vet Med Assoc 231:1843-1850, 2007.
as result of hemorrhage a hemostatic powdered herbal mixture, AUTHOR: Shauna Blois, DVM, DVSc, DACVIM
has been reported to help reduce hemorrhage
Advanced or Confirmatory Testing from various causes. EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
Other laboratory tests:
• Coagulation profile: prolonged times with Chronic Treatment
coagulation factor defects; normal with Appropriate treatment for bleeding disorder,
thrombocytopenia and thrombopathia systemic illness, or intranasal disease
• Platelet function testing (buccal mucosal
bleeding time, von Willebrand factor Possible Complications
analysis) Anemia, collapse

Epulides Client Education
Sheet

BASIC INFORMATION • This chapter focuses on peripheral odon- Synonyms
togenic fibroma, giant cell granuloma, and • Peripheral odontogenic fibroma replaces the
Definition acanthomatous ameloblastoma, which are terms fibromatous (or fibrous) epulis and ossify-
• Epulis (plural epulides) is a nonspecific all benign tumors (i.e., do not metastasize). ing epulis. Fibromatous epulis is distinguished
clinical descriptive term referring to a local, Peripheral odontogenic fibromas and giant from ossifying epulis by containing less bone
exophytic growth on the gingiva (e.g., focal cell granulomas do not invade bone, but or dental hard tissue within the tumor’s
fibrous hyperplasia, peripheral odontogenic acanthomatous ameloblastomas are locally soft tissue. Another synonym is periodontal
fibroma, acanthomatous ameloblastoma, invasive. ligament tumor.
nonodontogenic tumors).

www.ExpertConsult.com