Dysphagia/Regurgitation

Question 1

Can animal prehend food?

Evaluate….

Answer 1

oral cavity, teeth, tongue, facial muscles

Question 2

Can animal masticate?

Answer 2

evaluate muscles of mastication, TMJ

Question 3

Can animal swallow?

Answer 3

evaluate pharyngeal/oesophageal function

Question 4

3 broad processes causing dysphagia

Answer 4

• oral pain
• oral obstruction
• motility disorder (neuromusc. dz) involved in mastication/swallowing

Question 5

4 DDx for neck pain

Answer 5

D: feline orofacial pain syndrome (FOPS) esp. Burmese, cervical disc dz
A
M
N
I: inflam CNS disease (meningitis)
T: cervical fxs/trauma
V

Question 6

4 ddx for oral obstruction

Answer 6

D:
A: oropharyngeal polyps, sialocoele
M:
N: oral neoplasia
I: cryptococcal granuloma
T: oral FB (bones commonly)
V

Question 7

4 malignant oral neoplasias

Answer 7

1. SCC
2. Fibrosarcoma
3. Melanoma
4. Lymphosarcoma

Question 8

DDx neuromuscular diseases (re. dysphagia)

Answer 8

D: myasthenia gravis (focal), trigem neuropathy (CN V)
A: cricopharyngeal achalasia
M
N
I: tetanus, rabies, masticatory myositis
T
V

Question 9

Dx of masticatory muscle myositis

Answer 9

serum antibody (2M fibres), CK elevation + muscle biopsy

Question 10

Tx of masticatory. myositis + Px

Answer 10

prednisolone at immunosupressive doses
Px guarded (irreversible once trismus has developed)

Question 11

CS of trigeminal neuropathy

Answer 11

marked muscle loss (neurogenic atrophy) w/ slack jaw (hangs open)

Question 12

Dx of trigem. neuropathy

Answer 12

a diagnosis of exclusion

Question 13

Tx and Px of trigem neuropathy

Answer 13

nil - most resolve w/ time – prognosis usu. good

Question 14

When would a fluoroscopic swallowing study be useful?

Answer 14

i. Motility disorders that cause dysphagia may have no detectable physical examination findings (eg. Focal myasthenia gravis)
ii. If a lesion cannot be IDed on physical/oropharyngeal exam

Question 15

4 oesophageal disorders causing regurgitation

Answer 15

1. oesophageal dysmotility
2. external compression
3. internal obstruction
4. intramural lesions

Question 16

DDx (7) causes of secondary megaoesophagus

Answer 16

D: myasthenia gravis
A
M: hypoA
N: neoplastic neuromyopathy
I: polymyositis
T: toxins, snake envenomation, tick paralysis (Ixodes holocyclus) 
V

Question 17

Tx of primary megaoesophagus

Answer 17

Incurable but patients can be managed

• aspiration pneumonia - broad spec. antimicrobials IV + IVFT
• no meds for megaO
• nutritional managment

Question 18

How to manage nutrition in megaO

Answer 18

1. Gastrotomy tube in initial management (severe)
2. High calorie diet
3. Small + freq. meals
4. Feed from elevated platform
5. O experiment w/ consistency (liquid vs. soft)

Question 19

When is contrast fluoroscopy contraindicated?

Answer 19

when megaO found on plain rads

Question 20

3 tx approaches to oesophageal FB

Answer 20

1. endoscopic removal
2. surgical: oesophagotomy via thoracotomy
3. blind gentle pressure to push FB into stomach (vs. euthanasia)

Question 21

4 ddx for oesphagitis

Answer 21

1. chronic V+
2. Anaesthesia
3. FBs
4. Meds: doxycycline in cats, clindamycin

Question 22

3 meds to tx oesophagitis

Answer 22

1. Reduce risk of reflux acidity: PPI (omeprazole), cisapride
2. Promote healing of ulceration (sucralfate)
3. Pain management - opioids

Question 23

what is one complication of oesophagitis?

Answer 23

oesophageal strictures