Clinical techniques in small animal practice最新文献

Successful management of otitis externa requires recognition of changes in the anatomy and physiology of the external and middle ear, as well as the adequate tools and examinations to detect changes from normal. Otoscopy and methods for assessing the normalcy of the tympanum, collection of samples for cytologic evaluation or culture, and myringotomy are diagnostic techniques important in practice. Treatment tubes and intralesional triamcinolone injections are techniques that improve the response in some cases.

Cytology is the most common and immediately informative diagnostic tool in the practice of dermatology. It is simple to perform and requires equipment usually already present in most practices such as a microscope and slides, cotton-tipped applicators and stains. Cytology interpretation is also easily self taught. With little practice the practitioner can easily become familiar with sample interpretation from inflammatory lesions; including recognition of bacteria, yeast, dermatophyte spores and hyphae, deeper fungal elements and parasites. Additionally, the practitioner should become familiar with the variety of inflammatory cells seen with these conditions, as well as keratinocyte morphology. This article provides an overview and the initial steps on how to become a more proficient cytologist in practice.

Feline pyoderma is a disease entity more prevalent than previously described. Diagnosis is made by finding bacteria in the presence of inflammatory cells or bacterial phagocytosis on routine cytological examination. Diseases leading to secondary bacterial pyoderma include allergic and inflammatory skin diseases, parasitosis, feline chin acne, and others. Lesions of feline pyoderma are variable and include crusted and eroded papules, pustules, furuncles, eroded to ulcerated plaques with variable exudation and crusting, and linear to nodular ulcerative granulomatous lesions. Three cases of feline pyoderma responsive to antimicrobial therapy are discussed: case 1, a 10.5-year-old male neutered domestic short hair with eosinophilic lip ulcer, case 2, a 7-year-old male neutered domestic short hair with multiple cutaneous eosinophilic plaques, and case 3, an 8-month-old male neutered domestic short hair cat with Pseudomonas dermatitis, vasculitis, and panniculitis. Antibiotic selection for treatment of feline pyoderma should be based on cytological examination, and culture and sensitivity in unresponsive cases.

Feline allergen specific immunotherapy (ASIT) is considered to be a safe and effective treatment for feline atopy. ASIT is defined as the practice of administering gradually increasing quantities of an allergen extract to an allergic subject. The purpose of which is to reduce or eliminate the symptoms associated with subsequent exposures to the causative allergen. ASIT offers an effective and safe treatment option for cats. Reported success rates range for 60 to 78% in feline atopic patients. Additionally, the reported incidence of side effects in feline atopic patients undergoing ASIT is very low and mainly anecdotal.

Parasites are a common cause of dermatological disease in the dog and cat. Knowledge of different miticidal options for the common parasitic diseases is imperative when choosing the appropriate treatment for a patient. This is especially important with the recent advent of safer and more effective antiparasitic medications. Diagnostic and therapeutic methods for Cheyletiella spp., Demodex spp., Notoedres cati, Sarcoptes scabei, and Otodectes cyanotis are discussed, with emphasis on protocols for miticidal therapies, as well as safety concerns and side effects. This information will allow the practitioner to choose the safest and most efficient treatment for parasitic skin disease in their small animal patients.

Chronic nasal disease is often a challenge to diagnose. Computed tomography greatly enhances the ability to diagnose chronic nasal disease in dogs and cats. Nasal computed tomography provides detailed information regarding the extent of disease, accurate discrimination of neoplastic versus nonneoplastic diseases, and identification of areas of the nose to examine rhinoscopically and suspicious regions to target for biopsy.

Patients suffering from upper respiratory disease such as chronic nasal congestion, sneezing, nasal discharge, and epistaxis invite complete evaluation of their paired nasal cavities. Thorough assessment of these cavities employs sundry diagnostic procedures that enable the investigating clinician to characterize the internal structures of the nasal cavities. After the conscious patient undergoes a complete physical examination, a gross assessment of its external nasal structures is established and areas of physical asymmetry are noted. A working anatomic knowledge of these asymmetric foci helps to guide the next diagnostic steps. The patient is then placed under general anesthesia, during which, in list order, imaging studies, rhinoscopy, and nasal biopsy or foreign body retrieval, are performed.

Chronic nasal discharge is a common clinical sign of disease in dogs. Canine sinonasal aspergillosis is a relatively common disease in dogs. The three hallmarks of canine nasal aspergillosis are a profuse mucoid to hemorrhagic chronic nasal discharge that may alternate with periods of epistaxis, ulceration of the external nares with crusting, and pain or discomfort in the facial region. Diagnostic imaging (preferably computed tomography, CT) of the nasal cavity and paranasal sinuses is an important component of the evaluation of dogs with signs of nasal disease. Rhinoscopy is an important part of both the diagnosis and the therapy for nasal aspergillosis. Therapeutic recommendations for sinonasal aspergillosis have included surgery and the use of several systemic and topical antifungal drugs.

Surgery of the nasal cavity may be exposed primarily via a dorsal or ventral approach. Surgical treatment of lesions of the nasal cavity usually is limited to benign lesions or in combination with adjunctive therapy such as radiation therapy. Caution must be exercised with a dorsal approach to the nasal cavity to avoid complications of inadvertent penetration of the brain case. Gentle tissue handling and careful closure of the mucoperiosteum must be exercised following a ventral approach to minimize the risk of oronasal fistula formation.

Chronic rhinitis is a common and important problem in cats potentially resulting from a number of intranasal or systemic disorders. Idiopathic chronic rhinosinusitis and nasal neoplasia are the most common causes of chronic nasal disease in cats. For most cats with chronic rhinitis, diagnostic imaging, endoscopic studies, and nasal biopsy will be required to establish a diagnosis. A discussion of some of the more common causes of chronic nasal disease is presented.