Brachycephalic Airway Syndrome
Brachycephalic Airway Syndrome refers to a group of conditions that arise from the anatomical conformation of short nosed dogs and cats, known as Brachycephalic breeds. Brachycephalic breeds have intentionally been bred to shorten the length of their noses, and thus suffer from the consequential side effects of this breeding. Breeds with flattened noses have a compacted skeleton, resulting in multiple anatomical malformations to the breathing passages. Common examples of Brachycephalic dog breeds include Pugs, French Bulldogs, English Bulldogs, Pekingese and Boston Terriers. Persian cats are also a brachycephalic breed
Due to the shortening of the skeleton, the nares are compacted on their skull and consequently become narrowed. This is referred to as ‘Stenotic Nares’. This narrowing results in tortuous nasal passages, and increases the resistance of airflow through the nares. The end of the palate, known as the soft palate, can obstruct the back of the throat due to excessive length and thickness. Elongation of this soft palate can completely occlude the airway and result in complete respiratory obstruction. The last primary malformation is known as everted laryngeal saccules, protrusions of the airway mucosa that are pulled into the airway and can cause a partial obstruction. Some dogs with BAS may also have paralysis of the laryngeal cartilages, narrowing of the trachea (airway), and collapse of the larynx.
Due to a decreased ability to receive adequate airflow, brachycephalic breeds create a stronger negative airway pressure when breathing which can result in secondary respiratory and digestive problems. These include retching, vomiting and regurgitation.
All brachycephalic breeds suffer from some degree of BAS. The most common clinical history for presentation to the Emergency department of dogs with BAS is noisy breathing, particularly on inspiration, with varying levels of respiratory distress. Less commonly, dogs may present due to acute collapse following exercise or over-activity. Brachycephalic breeds may also present due to frequent retching or regurgitation.
Definitive diagnosis of BAS is performed via an upper airway examination under general anaesthesia, allowing for identification of these anatomical malformations. BAS is treated with surgical resection of the soft palate, nares and laryngeal saccules to open the airways and provide adequate flow of oxygen. Surgical correction of BAS often improves the quality of life and brachycephalic breeds, with significant improvement in breathing immediately noticeable.
What is the pancreas?
The pancreas is a gland located in front of the abdomen, lies below the stomach and directly beside the beginnings of the small intestine. Its main function is regulation of blood sugar through production of important hormones (one of which is insulin). Second function is production of enzymes that are essential for digestion of food. These enzymes are inactive in the pancreas until needed at meal times. When food is ingested theses enzymes are released into the small intestine where they become activated into potent chemicals that break down ingested food.
What is pancreatitis?
Acute pancreatitis occurs when digestive chemicals are activated inside the pancreas instead of the intestine. It causes severe inflammation and potential destruction of vital abdominal organs.
What causes pancreatitis?
Statistically, obesity and ingestion of fatty meals are the two main predisposing factors in the dog. Other suspecting causes in dogs and cats are abdominal trauma, medications and metabolic diseases. Many causes are listed as unknown or idiopathic because of the absence of any known predisposing conditions.
What are the symptoms?
Sudden onset of:
- Abdominal discomfort
- Loss of appetite
- Mental depression
Cats can show similar signs but are subtler and may only show:
- Loss of appetite
- Mental depression
- Vomiting may or may not be present
- In worst forms patients may present collapsed due to sudden drop in blood pressure and can affect on other organ systems including heart, liver, kidneys and the blood vessels.
How is it diagnosed?
Diagnosis of pancreatitis is achieved with a combination of physical examination, history, and several tests whose results increase the suspicion of pancreatitis. There is no test that can diagnose pancreatitis with 100% specificity and it is therefore easily misdiagnosed. Tests may include blood tests, imaging with radiographs, ultrasound examination and advanced imaging such as CTs or MRIs.
Ultrasound to visualise the pancreas is the most sensitive and specific and can detect up to 60-70% of the cases.
What is the treatment?
- The most severely affected patients will receive intravenous delivery of fluids to help restore blood pressure, hydrate the pancreas and other vital organs.
- Other drugs that may be indicated: pain relief, insulin, antibiotics, anti-vomiting and anti-ulcer medications and special drugs to restore normal gut movement
Duration of treatment:
Duration of treatment on average has been shown to be 5-7 days but more severe cases have been shown to require treatments as long as 4-5 weeks.
Prognosis to full recovery is guarded unless they are treated aggressively and early.
Recurrence is common and possible sequelae to acute pancreatitis include acute recurrent pancreatitis, exocrine pancreatic insufficiency and diabetes mellitus. Because of the special needs required for a pancreatic patient you primary care veterinarian may suggest your pet be referred to a speciality facility that is adequately staffed and equipped for providing around the clock care of the critically ill animal.
Home care and possible long-term effects:
When will my pet be able to come home?
Your pet will be discharged from hospital once vomiting has ceased, food and water trials have been performed and your pet’s general well-being has returned.
Are there dietary changes?
Dietary changes are essential for the dog but not for cats.Dogs must receive a low fat diet, best provided with prescription diets available. 3-4 small feeds throughout the day will ease the workload on the pancreas.
Can pancreatitis be prevented?
Pets do not need and cannot digest large amounts of fat. Please remember that your pet is only 10th of your weight and so food required is only a 10th of our volume. Small square of cheese is equivalent to us eating the whole block!
- Feed a good quality premium pet food
- Dot not feed table scraps
- Do not overfeed
- Spread meals out over the day.
Pyometra occurs when the uterus (female reproductive organ) becomes infected and filled with pus. This generally only occurs in middle-aged to older females that have not been desexed. When females are desexed, generally, both ovaries and the uterus are removed. Rarely, if any of the ovary is left behind in the body, a “stump” pyometra can occur in desexed females.
- Progesterone (medications) used to delay or suppress oestrus (heat)
- Oestrogens (medications) used on mismated females
- Post-insemination or post-copulation (post-mating/breeding) infection
- Dioestrus (typically 4-6 weeks after heat)
- Lethargy/quiet demeanour
- Inappetence (not eating)
- Polydipsia and polyuria (drinking and urinating more often)
Pyometra can be “open” or “closed”. When the cervix is open, purulent and bloody discharge will be seen from the vulva. When closed, no discharge is seen; instead, the abdomen may become swollen or distended from the uterus enlarging with fluid.
Pyometra can be seen on radiographs (x-rays) and is typically confirmed with an ultrasound. The normal uterus is not seen on x-rays. Both x-rays and ultrasound show evidence of an enlarged, fluid filled uterus. Blood tests may also be performed, which typically shows an increased white cell count and increase in a protein called globulins, produced with inflammation or infection; and anaemia from chronic/long-term disease.
While in the emergency hospital, overnight stabilisation will usually be performed. This often involves giving intravenous fluids for rehydration, and starting antibiotic therapy.
The best treatment is to have your patient desexed. This removes the source of infection, and prevents the condition from ever happening again. Antibiotics are also used to treat any remaining infection.
Occasionally, particularly if the patient is to be used for breeding in the future, medical treatment will be used. This typically involves a course of antibiotics, and administration of hormones including prostaglandin, which assists by contributing to expulsion of fluid in the uterus. Medical treatment is avoided, especially with closed pyometra, as it is associated with many side effects and may increase the risk of the uterus rupturing/breaking apart in the body.
Numerous studies report different recurrence rates following pyometra. This has ranged from no additional risk compared with dogs that have never had pyometra, to up to 77% within the first 27 months after treatment.
The best prevention for animals not intended to be used for breeding is desexing. Assuming this is performed properly, this will prevent the possibility of pyometra ever occurring, and additionally prevents the possibility of developing uterine or ovarian cancer, and minimises the risk of developing mammary cancers, later in life.