Wednesday, 11 June 2014

Epistaxis (nosebleeds) in dogs: Causes, Symptoms and Treatment

The term refers to the loss of epistaxis nosebleed. Typically, the epistaxis is due to a damage to the blood vessels in the nasal mucosa, but can also occur due to a greater capillary fragility or a bleeding tendency. Any breed of dog can develop epistaxis and there is no provision for what concerns the gender of the animal. Dogs with long noses (called "dolichocephalics", such as the Collie) may be more at risk for some causes of epistaxis (for example, nasal tumors).

The loss of blood may be acute (sudden) or chronic. The extent of the disease is often determined by the underlying cause of nasal bleeding. It 'important to determine if the blood loss is unilateral (one nostril) or bilateral (both nostrils) as some of the causes of epistaxis are associated with unilateral bleeding while other bilateral bleeding.



Epistaxis is usually caused by an acute (sudden) or chronic problems more insidious:

Acute epistaxis - Often occurs as a result of nasal fractures or lacerations caused by traumatic episodes. In the absence of trauma, acute epistaxis is often caused by the sudden erosion of a blood vessel problems leading to nasal due to the load of the nasal cavity or sometimes in metabolic conditions. Many times, the underlying condition is chronic or pre-existing for a long time. Tumors, foreign bodies and abscesses at the root of the tooth are often present in cases of acute epistaxis.



Intermittent or chronic recurrent epistaxis - It 's common when you form blood clots to stop bleeding. In the event that these clots have a chance to move or where new blood vessels are affected, as a result it is possible that the dog experience episodes of epistaxis. As mentioned earlier, it is important to note if the epistaxis is unilateral (one nostril) or bilateral (from both nostrils). Tumors, foreign bodies and abscesses at the root of the tooth are usually one-sided. Infections and metabolic conditions are usually bilateral. If your dog has lost weight or has been sick for a period of time before the onset of epistaxis, there may be a more serious condition. It 's rare that the volume of blood loss from his nose is dangerous to your dog's life. In any case, epistaxis is an important clinical sign that requires an evaluation by the veterinarian. Unless it is caused by trauma, epistaxis is a significant sign that tend to recur if they do not arrive at a definitive diagnosis.


Causes

The most common causes of nosebleeds include:

Trauma , such as nasal fractures caused by automobile accidents, bite wounds and lacerations nasal passages caused by sharp objects.


Foreign bodies in the nose. Epistaxis can occur when a foreign body nasal pierces a blood vessel. The inflammation associated with a foreign body may cause nasal nasal secretion streaked with blood.


Dental diseases. If dental disease is severe or in the case where a fractured tooth has a way to become infected, it is possible the development of an abscess at the root of the tooth. The roots of the teeth located in the upper jaw of the dog are very long. If the infection is spread to the base of the tooth root, it can cause swelling and extend until they affect the nasal cavity. Epistaxis occurs because the blood vessels in the nose are affected. A dog that has an abscess at the root of the tooth may show signs such as swelling of the nasal dorsum or the area below the eyes.


Nasal tumors. 'm a common cause of unilateral epistaxis in older dogs. The types of cancer are more common in dogs with adenocarcinoma , chondrosarcoma, fibrosarcoma, osteosarcoma and squamous cell carcinoma.


The parasitic infections , fungal and bacterial infections can cause nosebleeds. Only serious bacterial infections are more likely to cause nosebleeds. The bacterial infection may be due to trauma or a foreign body no longer present. The canine aspergillosis is a fungal infection that affects the nasal cavity and can lead to the onset of epistaxis. Even the nasal parasites (eg, mites canine nasal) can cause nosebleeds, but the episodes of sneezing and rubbing of the nose are the most common symptoms of nasal mite infection.



Many coagulation disorders can cause nosebleeds. The sanguinamente can also affect other body sites. Thrombocytopenia (low platelet count) is a common cause of these clotting problems. Platelets are fragments of blood cells vital to the coagulation process, the concentration of which can be reduced by many different ailments, including diseases transmitted by tick caused by a type of bacteria known as Rickettsia. The von Willebrand's disease is a deficiency of clotting factor that can affect different dog breeds (notably Doberman Pinschers) and can lead to an abnormal platelet function and prolonged bleeding after minor trauma or surgical procedures. Rodenticides that contain vitamin K antagonists are frequently the cause of generalized bleeding in the dog, since they interfere with the activation of several coagulation factors by vitamin K.




Hyperviscosity (thickening of the blood) may be due to extremely high concentrations of protein in the blood in animals suffering from certain diseases. A high protein concentration leads to a poor platelet function and to an abnormal clotting. Occasionally, nosebleeds is the first symptom of this problem. Common causes of hyperviscosity syndrome are multiple myeloma, lymphoma (cancer of the lymphoid tissue and lymphocytes) and ehrlichiosis (parasitic disease transmitted by ticks).


The signs to watch out for

  • Sneezing accompanied by the emission of large amounts of blood
  • Nasal swelling
  • Severe dental disease
  • Fractured tooth
  • Black tarry stools (caused by the ingestion of blood)
  • Bad smell from the mouth or nose
  • Noisy breathing
  • Loss of appetite
 Diagnosis
Many times the diagnosis can be made based on history and a physical examination accurate, especially in the case in which the cause is trauma. If the diagnosis can not be established, are recommended some basic laboratory tests, including:

  • Complete blood count to identify anemia, inflammation, infection, or low platelet count, which can contribute to epistaxis.
  • Biochemical profile of serum to assess the overall health of the dog and functionality of vital organs. The biochemical profile rarely the primary cause of epistaxis identifies a problem, although they are measured total protein (hyperviscosity syndrome). It 'still a useful examination to rule out any secondary diseases, concomitant problems and to minimize anesthetic risk.
  • Urinalysis to evaluate kidney function, check for the presence of infection and to identify the possible presence of proteinuria (protein in urine), which may be associated with some cases of epistaxis.
  • Serological tests for infectious diseases , especially fungal diseases ( histoplasmosis , blastomycosis, aspergillosis) and tick-borne diseases (such as ehrlichiosis can cause a decrease in platelet count and an increase in the level of plasma proteins).
  • Tests of blood coagulation , including platelet count, von Willebrand factor (to verify the presence of von Willebrand disease, an inherited coagulation relatively common in dogs) and other tests of blood clotting (eg, prothrombin time , partial thromboplastin time, activated clotting time). The coagulation tests are indicated to rule out any abnormalities of coagulation. These abnormalities may be inherited, caused by toxins or metabolic conditions.
  • Oronasal examination under anesthesia for evaluation of dental diseases, obvious nasal masses or foreign bodies. This procedure is often combined with other procedures requiring general anesthesia (for example, X-rays and nasal biopsies).
  • The nasal radiographs and dental anesthesia is required and may show an abscess at the root of a tooth or an area of bone destruction caused by a tumor.

  • The nasal biopsies can be performed using X-rays as a guide. These are generally considered "blind biopsies", since the mass is not displayed during the biopsy procedure. Usually, a probe is inserted into the long and thin with a sharp end through the nostrils in a zone approximated. Biopsies can be taken at the point where you suspect an injury.

Your veterinarian may recommend performing more specialized tests to diagnose the primary problem. These tests may only be available at specialized facilities and include:

  • The computed tomography (CT) and magnetic resonance imaging (MRI) imaging techniques are very useful in case of nasal masses and to evaluate the extent of bone involvement. Knowing the exact location of the mass is useful to perform a biopsy of the mass in order to draw an accurate diagnostic test.
  • The rhinoscopy is the procedure that involves the use of a small flexible instrument equipped with optical fibers to inspect the nasal structures. Such an instrument is inserted through the nostrils and advanced. By means of this procedure it is possible to identify tumors, foreign bodies and the specific area affected by the bleeding. Foreign bodies can be removed and you can make the removal of a biopsy specimen.
  • If you are not come to the formulation of a diagnosis, it is possible to resort to exploratory surgery . Practiced an incision along the back of the dog's nose that allows the inspection of the nasal cavity. Through exploratory surgery can remove foreign bodies or masses and draw a biopsy sample.

Treatment

Your veterinarian may recommend one or more of the tests mentioned above. In the meantime, you may need to treat the symptoms, especially if the problem is severe. The following treatments nonspecific (symptomatic) may be applicable to some dogs, but not all, who have epistaxis. These treatments can reduce the severity of symptoms and bring relief to the dog. However, nonspecific therapy is not a substitute definitive treatment of the underlying disease responsible for the condition of the dog .

Stress should be always reduced to a minimum. Stress, excitement and wheezing may dislodge clots and the onset of further bleeding. Stress can also increase blood pressure, which could in turn encourage further bleeding. If the dog is in good health, the use of sedatives and drugs that lower blood pressure, such as acepromazine, can be helpful.


Cold compresses and direct pressure on the nose promote the constriction of blood vessels and help to reduce the blood supply and encourage the formation of blood clots.
Occasionally, it may be necessary to use general anesthesia to stop bleeding, especially if the dog is not very cooperative. Epinephrine causes a strong constriction of blood vessels and can be instilled into the nose by means of an appropriate syringe. If necessary, you can apply a piece of gauze in the nose to produce a more direct pressure on the bleeding site, and thus promote a more rapid coagulation.


In the case of traumatic injury, hemorrhage usually stops spontaneously or by means of supportive therapy. The nasal tumors can be surgically removed, treated with chemotherapy or radiotherapy. Fungal infections often respond to intranasal or oral antifungal agents. Abscesses at the root of the tooth to improve following the removal of the tooth and the administration of antibiotics. Many coagulation disorders are largely treatable once identified the primary problem. In order to establish a specific therapy is necessary that the specific cause is identified.



In case the bleeding does not stop, or if it escalates interests other sites, we recommend you consult your veterinarian immediately.

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