Exam 1 Lec 4-5 Flashcards
Lecture 4
Disorders of the oral cavity, Pharynx, Esophagus
- Given PE findings, C/S of a C/F patient, construct and prioritize a differential diagnoses list and initial diagnostic plan for common oral, pharyngeal and esophageal diseases
- Gingivitis/Periodontitis
-Bacterial proliferation, plaque buildup, destruction of gingival structures, halitosis, inflammation, oral pain and tooth loss
Dx
-Visual inspection of gums
-Stage periodontal disease
Tx
-Supra and subgingival tartar should be removed
-Antibiotics as needed
- Sialocele
-Disorder of the oropharynx
-Accumulation of saliva in SQ tissues
-Salivary duct obstruction or rupture
-Swelling under the jaw or tongue, +/- pain
2-4 yo dogs, common in GSD and Miniature poodle
Dx
-Aspiration with 16-18 g needle
Tx
-Open and drain swelling, remove salivary gland
Oral Neoplasia Dogs
- Common benign tumors
-Aconthomatous ameoblastoma: peripheral odontogenic fibroma or epulis - Common malignant tumors
-Squamous cell carcinoma, malignant melanoma and fibrosarcoma - Less common: papillomatosis, plasmacytoma
-Usually young dogs
-Recover after a few months
Dx
-FNA and biopsy masses
-Follow on tagging with local LN aspirate
-Thoracic radiographs, CT of affected area
Tx
-Surgical excision +/- radiation and chemotherapy
Malignant Melanoma Dogs
Dogs
-60-70% already metastasis by diagnosis
-Do FNA regional LN
-Minimum database
-Anyzocytosis: change cell size, morphology
-Anyzokariosis: change nuclei
Cats
-Pic below
-Benign
-Cytoplasmatic pigment
Oral Neoplasia in Cats
- SCC: the most common often sublingual
- Eosinophilic granulomas
-Good prognosis
-Etiology unknown
-Alelrgies, food, fleas, may be responsible
-Possible genetic predisposition
-Oral lesion: indolent ulcers along lip margins or oral mucosa
-Necrotic, pus material, inflammation
-Concurrent cutaneous lesions possible
Dx
-Tissue biopsy needed for differentiation
Tx
-Corticosteroids (Prednisolone)
-Meticulous flea control
-Antibiotics can help and lead to resolution
Squamous hyperplasia similar to eosiniphic granulomatous
-Get biopsy for definitive diagnosis
-Esinophilic granulomas
Raised re lesions, look dramatic, respond dramatically to treatment
Swollen chin due to incessantly licking
Some cats only have oral lesions such as on the roof of the mouth
Stomatitis
Dogs
-Eosinophilic granulomas
-Raised circular, coalescence lesions, plaque-like
-FNA and biopsy
-Eosinophils
-Huskies, Artic breeds, CKCS
-Rare in dogs
Primary causes
-Systemic disease
-Renal failure
-Trauma
-Immune-mediated disease
-CUPS: chronic ulcerative periodontitis = Kissing lesions (teeth contact with mucosa)
-Upper respiratory disease
-Dental disease
Secondary causes
-Immunosuppression from FeLV, FIV
-Bartonella henselae (feline)
-Diabetes mellitus
-Hyperadrenocorticism
C/S
-Marked inflammatory response
-Very painful
-Inflamed gingiva or posterior pillars of pharynx
Dx
-Feline Lymphocytic-plasmatic stomatitis
-Biopsy to confirm
Tx
-Corticosteroids
-Immunosuppression with Cyclosporine or Chlorambucil
-Antibiotics
-Oral rinses
-End result is usually partial or full mouth tooth extraction (cats)
Dysphagia
Causes
1. Masticatory muscle myositis
2. Cricopharyngeal achalasia/dysfunction: incoordination between cricopharyngeus muscle and the swallowing reflex
-Primarily in young dogs
-Regurgitation immediately after or during swallowing
-Detrimental misdiagnosis with Pharyngeal dysphagia
Dx
-Barium swallow study with fluoroscopy
Tx
-Cricopharyngeal myotomy
-Injection of muscle with botulinum toxin
- Pharyngeal dysphagia
-Primarily acquired in older dogs
-Etiology: neuropathies, myopathies, junctionopathies (e.g., myasthenia gravis - MG), lesions of CN IX or X
-Regurgitation associated with swallowing
-Aspiration is common
Dx
-Fluoroscopy with barium swallow study
Tx
-Feed via gastrostomy tube (best referral place)
-Resolve underlying conditions such as hyperthyroidism
- Congenital Megaesophagus
-Etiology: unknown
C/S
-Young animal but may not be diagnosed until older
-Regurgitation
-+/- Weight loss
-Coughing
-Fever due to aspiration pneumonia
-Rule out obstructions such as vascular ring anomaly
Dx
-Radiographic findings
-Esophageal dilation associated with obstruction
Tx
-Feeding and dietary management
-Gastrostomy tube
-Aspiration pneumonia is the leading cause of death
- Acquired megaesophagus
-Etiology: neuropathy, myopathy, junctionopathy (e.g., MG), esophagitis (cats)
-GSD, Golden Retrievers, Irish Setters, increased risk
C/S
-Regurgitation
+/- Weight loss
Dx
-Radiographic findings of esophageal dilation unassociated with obstruction
-Screen for underlying cause
Tx
-Treat underlying cause
-MG tx: Pyridostigmine
-Addison’s disease
-hypothyroidism
-Treat gastroesophageal reflux with CISAPRIDE and OMEPRAZOLW PPI
-Treat esophagitis PPIs, most effective + liquid sulcralfate
-Feeding dietary management “Bailey Chair”
-Gastrostomy tube-if severe aspiration
Esophagitis
GERD: gastroesophageal reflux disease
-Etiology: Caused by GERD, persistent vomiting of acid stomach contents, esophageal foreign bodies, pancreatitis, caustic agents (pills that lodge in the esophagus, cats in particular)
-Anesthesia associated reflux
-Regurgitation is common; pseudoptyalism, anorexia
Dx
-History of vomiting
-Regurgitation is suggestive
-Recent anesthetic event
-Esophagoscopy
+/- Biopsy for definitive diagnosis
Tx
-Lavage
+/- Bicarbonate (make sure it does not go into trachea when placing tube)
-Injectable H2 blocker (cam be used for chronic treatment)
-Proton Pump inhibitors (decreases gastric acidity)
-Motility modification to control reflux METOCLOPRAMIDE, CISPRIDE
-Sucralfate to coat ulcerated esophageal mucosa
-Gastrostomy feeding tube for severe cases
Always follow pill administration in cats with 2-5mls of water or canned food
Miscellaneous Esophagus
- Hiatal Hernia
-Part of the stomach herniates into the thoracic cavity
-May allow GER
-Consistent narrowing is concern for stenosis - Dysautonia
-Loss of autonomic nervous system function resulting in variable signs of megaesophagus, distended urinary bladder, dry mucous membranes, mydriasis, distended alimentary canal - Esophageal Obstruction
-Occurs in dogs and cats
-Congenital - young animals affected
PRAA persistent right fourth aortic arch
-Causes a stricture with esophageal dilation and dysfunction (regurgitation)
Dx PRAA
-Radiographs may not tell you much, but used to rule out foreign body
-Contrast esophageal
-Endoscopy
-Barium contrast
Tx
-Surgical resection of PRAA
-Dissection of ligamentous arteriosus
-Dietary management, post-op too if necessary
- Esophageal Obstruction Foreign Bodies
-Dogs more commonly affected
-Regurgitation of food and water or only food
-Acute dyspnea possible
-Pneumothorax and pleural effusion from esophageal perforation possible
Dx
-Radiographs
-+/- barium contrast
-Esophagoscopy is diagnostic
Tx
-Careful removal of FB with endoscope or surgical approach
-Post removal management similar to esophagitis
- Given diagnostic plan results for an affected C/F patient, establish a presumptive diagnosis
for common oral, pharyngeal and esophageal diseases
- Develop a comprehensive treatment plan for a C/F patient affected by common esophageal, oral, or pharyngeal disease
- Identify characteristic radiographic patterns in the C/F patient with esophageal disease, with emphasis on megaesophagus and esophageal foreign bodies
Esophageal Obstruction
- Esophageal Cicatrix (scar)
-Deep inflammation of esophagus secondary to many causes resulting in scar formation and stricture
-Regurgitation is primary sign; anorexia due to pain
Dx
-Barium contrast esophagram
-Esophagoscopy is definitive diagnosis but may miss it in large breed dogs
Tx
-Balloon dilation or bougienage, followed by antibiotics and/or corticosteroids
-Surgical resection/anastomosis NOT recommended
- Esophageal Neoplasia
-Primary sarcomas associated with Spirocerca Lupi
-Primary carcinomas
-Leimyoma/leimyosarcoma at lower esophageal sphincter in older dogs
Cats
-Squamous cell carcinomas most common
Dx
-Thoracic radiographs
+/- contrast
-Esophagoscopy best
Tx
-Surgical excision is difficult and may be only palliative with the exception of leimyomas
-Photodynamic therapy
