pathology of the respiratory system 1: introduction...
TRANSCRIPT
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Pathology of the Respiratory System 1: Introduction, Pathology of the Nasal Passages
Shannon Martinson, Feb 2016
http://people.upei.ca/smartinson/ VPM 222 Systemic Pathology
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INTRODUCTION
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Conducting
Transitional
Exchange
INTRODUCTION: STRUCTURE AND FUNCTION
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Respiratory Tract FunctionsPhonation Temperature
regulationBlood Pressure
Olfaction Acid-base Detoxification
Enzymes Hormones InflammatoryMediators
INTRODUCTION: STRUCTURE AND FUNCTION
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INTRODUCTION: NORMAL FLORA
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Tracheal Air
INTRODUCTION: NORMAL FLORA
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INTRODUCTION: DEFENCE MECHANISMS
Air filtration
Mucociliary clearance
Phagocytosis
Immunity
Detoxification
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Particle Deposition in the Respiratory Tract (Filtration)
10-2 microns
> 10 microns
2 µm
INTRODUCTION: DEFENCE MECHANISMS
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> 10 microns
INTRODUCTION: DEFENCE MECHANISMS
Particle Deposition in the Respiratory Tract (Filtration)
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10-2 µm
INTRODUCTION: DEFENCE MECHANISMS
Mucociliary Clearance
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~ 100 cilia/cell
~ 1,000 strokes/minute
10-2 µm
INTRODUCTION: DEFENCE MECHANISMS
Mucociliary Clearance
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www.merckvetmanual.com
~ 100 cilia/cell
~ 1,000 strokes/minute
10-2 µm
INTRODUCTION: DEFENCE MECHANISMS
Mucociliary Clearance
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10-2 µm
> 10 µm
2 microns
Pulmonary Alveolar Macrophage (PAMs)
INTRODUCTION: DEFENCE MECHANISMS
Pulmonary Phagocytosis
How good are these defence mechanism?
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0
20
40
60
80
100
120
140
0 2 4 8 12 24
% b
ac
teri
a i
n l
un
g
Hours post aerosol
Bacterial Clearance after Aerosol
Normal
Virus
Viruses
Stress
Dehydration
Lung edema
Uremia
Ammonia
Immunodeficiency
Impairment of defencemechanisms?
INTRODUCTION: DEFENCE MECHANISMS
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THE CONDUCTING SYSTEM
www.merckvetmanual.com
• Nasal passages• Sinuses • Guttural pouches • Larynx• Trachea • Bronchi
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Squamous (+)
Ciliated (+++)
Olfactory (++)
NASAL CAVITY – NORMAL GROSS AND MICROSCOPIC ANATOMY
HistologyAnatomy
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DISORDERS OF THE CONDUCTING SYSTEM
Circulatory Disturbances
Rhinitis
Sinusitis
Sinus / Nasal tumours
Guttural Pouch Diseases
Laryngitis
Tracheobronchitis
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Congestion / Hyperemia
NASAL CONGESTION / HYPEREMIA
The submucosa is well-vascularized: congestion and hyperemia are common
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NASAL HEMORRHAGE
• Coughing blood from the lungs or airways Hemoptysis
• Bleeding from the noseEpistaxis
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NASAL HEMORRHAGE
Courtesy of Dr. J Lofstedt
• Coughing blood from the lungs or airways Hemoptysis
• Bleeding from the noseEpistaxis
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NASAL HEMORRHAGE
• Coughing blood from the lungs or airways Hemoptysis
• Bleeding from the noseEpistaxis
Epistaxis in all species:
• Trauma
• Foreign body
• Nasal neoplasia
• Pulmonary hemorrhage (aneurysm)
Horses
• Exercise induced pulmonary hemorrhage
• Guttural pouch mycosis
• Ethmoidal hematoma
• Nasal Cyst
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• Pedunculated mass• Ethmoidal concha• Looks like a tumor• Unilateral epistaxis• Surgical excision
NASAL HEMORRHAGE
Equine Ethmoidal Hematoma
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NASAL INJURY AND REPAIR
• Degeneration
• Loss of attachment
• Necrosis
• Exfoliation
• Ciliated epithelium
• ~250 cilia/cell
• Highly vascularized
• Abundant glands
• Repair
• Pre-ciliated cells
• Mitosis
• Cell differentiation
• Healed epithelium
• Normal function
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Clinical signs:
• Nasal discharge
• Unilateral or bilateral
Classification according to exudate:
• Serous
• Catarrhal (Mucus)
• Suppurative (Purulent)
• Fibrinous
• Granulomatous
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
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Mucopurulent rhinitis
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
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Purulent
Fibrinous
Granulomatous
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
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Infectious Bovine
Rhinotracheitis (IBR)Parainfluenza
Equine Viral
Rhinopneumonitis
(EVR)
Feline Rhinotracheitis Canine Distemper Inclusion Body Rhinitis
(Cytomegalovirus)
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Viral Rhinitis in Domestic Animals
• Very common, but often mild and self-limiting• Unless complicated with a bacterial infection
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INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Species specific examples of rhinitis in domestic animals
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• Etiology: Bovine herpesvirus-1 (BoHV-1)• Affects cattle• Transient fever, rhinitis and tracheitis• Lesions: Hyperemia, nasal /tracheal
mucosal necrosis• Viral testing: PCR, FAT, isolation
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Infectious Bovine Rhinotracheitis (IBR)
With secondary bacterial infections: • Fibrinous /
fibrinosupurative rhinitis and tracheitis may occur
Bronchopneumonia is an important sequela
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• Etiology: Streptococcus equi ssp equi• Streptococcus equi
• Affects horses• High morbidity / Low mortality• Lesions:
• Suppurative rhinitis• Lymphadenitis• Visceral spread (Bastard Strangles)
• Laboratory tests: Bacterial culture
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Strangles
• Purpura Hemorrhagica• Immune-mediated vasculitis • Can occur after infection
with or vaccination for Streptococcus equi
Courtesy of Dr Jeanne Löfstedt
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• Etiology: Controversial• P multocida / B bronchiseptica
• Affects pigs
• Lesions:
• Facial deformities
• Atrophic conchae (turbinates)
• Growth rates?
• Predispose to pneumonia?
• Diagnosis:
• Cross section snout at the 1-2nd
premolars
• Check for the size of meatuses
• Septal deviation
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Atrophic Rhinitis
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INFLAMMATION OF THE NASAL CAVITY = RHINITIS
• Etiology: Controversial• P multocida / B bronchiseptica
• Affects pigs
• Lesions:
• Facial deformities
• Atrophic conchae (turbinates)
• Growth rates?
• Predispose to pneumonia?
• Diagnosis:
• Cross section snout at the 1-2nd
premolars
• Check for the size of meatuses
• Septal deviation
Atrophic Rhinitis
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INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Atrophic Rhinitis
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INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Atrophic Rhinitis
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Multifactorial
• Viral:
• Canine distemper virus
• Canine Adenovirus-2
• Canine Parainfluenza virus-1
• Canine herpesvirus 1
• Secondary bacterial infections:
• Bordetella bronchiseptica
• Escherichia coli
• Streptococcus spp
• Staphylococcus spp
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Rhinitis in dogs
Courtesy of Dr Darcy Shaw
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INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Other causes of rhinitis in dogs:
• Canine influenza virus
• Fungal agents:
• Aspergillus spp
• Cryptococcus
Courtesy of Dr Darcy Shaw
Rhinitis in dogs
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• Etiology:
• Felid herpesvirus 1 ( FeHV1)
• Transient rhinitis, sinusitis, conjunctivitis in
kittens
• Can cause keratitis and corneal ulcers
• May predispose to bacterial infection and
pneumonia
• Bordetella bronchiseptica
• Pasteurella multocida
• Streptococcus spp
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Feline Viral Rhinotracheitis
• Feline calicivirus
• Causes similar disease / lesions
• Accompanied by oral ulceration
• Chlamydophila felis
• Causes similar disease / lesions
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• Etiology:
• Cryptococcus neoformans
• Cryptococcus gatti
• Fungus is acquired from environment
• Lesions: Granulomatous rhinitis /nasal
dermatitis +/- pneumonia
• Humans are also susceptible!
INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Cryptococcosis
Image: Dr Richard Malik
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INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Common Sequelae of Infectious Rhinitis
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INFLAMMATION OF THE NASAL CAVITY = RHINITIS
Common Sequelae of Infectious Rhinitis
Sinusitis Pharyngitis
Guttural pouch
infection Meningitis
Otitis Lymphadenitis
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• Similar types of injury and inflammatory response to nasal cavity
• POOR DRAINAGE
INFLAMMATION OF THE SINUSES = SINUSITIS
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• Exudate tends to accumulate
• Sinus Empyema (Pus)*• Sinus Mucocele (Mucus)*
INFLAMMATION OF THE SINUSES = SINUSITIS
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• Low incidence in domestic animals
• Most common in dogs and cats
• Epithelial >> mesenchymal, or round cell in
origin
• Benign << Malignant
• Invasive and occasionally metastatic
TUMORS OF THE NASAL CAVITY AND SINUSES
Nasal carcinoma Multilobular tumour of bone
Lymphoma
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• Clinical Signs:
• Persistent nasal discharge
• Epistaxis
• Airflow obstruction
• Facial deformity (+ / -)
• Exophthalmia (+ / -)
• Neurological signs
• Diagnosis:
• Radiographs / CT / MRI
• Rhinoscopy
• Nasal biopsy
TUMORS OF THE NASAL CAVITY AND SINUSES
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Canine Nasal Carcinoma
TUMORS OF THE NASAL CAVITY AND SINUSES
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TUMORS OF THE NASAL CAVITY AND SINUSES
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TUMORS OF THE NASAL CAVITY AND SINUSES
Enzootic nasal carcinoma(Enzootic ethmoidal carcinoma)
• Etiology: Retrovirus (Enzootic nasal tumour virus: ENTV)• Affects small ruminants • Incidence in some areas is high• Clinical signs: Respiratory distress, epistaxis, nasal discharge, weight loss
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Retrovirus
TUMORS OF THE NASAL CAVITY AND SINUSES
Enzootic nasal carcinoma(Enzootic ethmoidal carcinoma)
![Page 49: Pathology of the Respiratory System 1: Introduction ...people.upei.ca/smartinson/RESP-Lecture-1-2016_SAM_final.pdf · • Suppurative rhinitis • Lymphadenitis • Visceral spread](https://reader034.vdocuments.us/reader034/viewer/2022042208/5eab7ef9d95fc76eef266b73/html5/thumbnails/49.jpg)
TUMORS OF THE NASAL CAVITY AND SINUSES
Tumour-like conditions: • Nasal / Nasopharyngeal polyps• Pedunculated masses in the
nasal passage, auditory canal, sinuses or pharynx• Cats • Horses • Other spp less commonly
![Page 50: Pathology of the Respiratory System 1: Introduction ...people.upei.ca/smartinson/RESP-Lecture-1-2016_SAM_final.pdf · • Suppurative rhinitis • Lymphadenitis • Visceral spread](https://reader034.vdocuments.us/reader034/viewer/2022042208/5eab7ef9d95fc76eef266b73/html5/thumbnails/50.jpg)
Questions?
A huge thanks to Dr López for providing me with the materials for these lectures!