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Small animal internal medicine II > Small animal gastroenterology > Flashcards

Small animal gastroenterology Flashcards

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1
Q

Name 4 paired salivary glands.

A
  • Parotis
  • Mandibular
  • Sublingual
  • Zygomaticus
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2
Q

How can you tell a submandibular salivary gland from a submand. lymph node?

A

do FNA to differentiate the two

in lymph nodes: lymphoid cells

in salivary glands: Mixed population of epithelial and stromal cells. Background may contain mucin or proteinaceous material.

If inflamed (sialadenitis), can see lymphocytes, neutrophils etc.

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3
Q

excessive saliva production is termed

A

ptyalism

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4
Q

Primary ptyalism occurs in

A

In puppies after weaning due to the enlargement of parotid gland (mouth is dry during sleeping, but dripping while excited).

Treatment: surgical

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5
Q

Secondary ptyalism occurs in (5)

A

Intoxications,
foreign bodies,
viruses (distemper, rabies, Fel resp.virus),
ulcers,
sialadenitis

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6
Q

salivary gland inflammation is termed

A

sialadenitis

Can be either uni- or bilateral. Usual mandibular glands but can occur in other salivary glands too.

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7
Q

sialadenitis can be caused by (5)

A

Idiopathic,
infectious,
traumatic,

secondary to xerostomia or dehydration,
obstruction of the ducts

Symptoms:
Gland Enlargement
Painful while opening the mouth
Hypersalivation
Dysphagia
Multiple swallows
Anorexia
Xerostomia

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8
Q

Diagnosis and tx of siladenitis.

A

FNA
Histology for confirmation

Treatment: depends on the causative agent!

Prognosis: good (obstruction !)

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9
Q

Salivary gland mucocele is

A

A mucocele is a benign, mucus-containing cystic lesion of the salivary gland.

FNA and then surgery tx

Mucoceles are benign, mucin-filled cysts.
Sialoceles are a variant of mucocele that develop from the extravasation of saliva from injured parotid parenchyma.

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10
Q

A sialocele is

A

a localized, subcutaneous cavity containing saliva. Not a cyst! lack of epithelium

FNA and then surgery tx

Mucoceles are benign, mucin-filled cysts.
Sialoceles are a variant of mucocele that develop from the extravasation of saliva from injured parotid parenchyma.

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11
Q

An oronasal fistula is

A

an abnormal connection between the oral and nasal cavities.

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12
Q

Oronasal fistulas are caused by (4)

A

Tooth root abscess
Tooth extraction
Trauma of the palate
Surgery in the oral cavity

Even congenital is possible.

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13
Q

Oronasal fistula complications. (3)

A

rhinitis
sinusitis
mucopurulent secretion

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14
Q

Tx of oronasal fistula. (3)

A

Tooth extraction
Surgery (with a „flap“ )
Antibiotics (rhinitis)

Prognosis: good

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15
Q

Stomatitis is

A

Oral mucosal inflammation/erosion/ulcer

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16
Q

Causes of stomatitis. (5)

A

Immune-mediated diseases (SLE, pemfigoid, idiopathic vasculitis)

Viruses (FeLV, FIV, Calicivirus, Fel Herpesvirus, FIP)

Candida

Immunosuppressive treatment

Uremia

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17
Q

An iatrogenic cause of gingival hyperplasia in dogs.

A

cyclosporine

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18
Q

After surgically removing feline gingival hyperplasia, does it grow back?

A

yes, it can

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19
Q

stomatitis symptoms and tx

A

Symptoms: halitosis, salivation, behavioural problems

Treatment: DEPENDING ON THE CAUSE!

Hygiene (chlorhexidine)
Pain treatment
Immunosuppressants (eosinophilic granuloma)

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20
Q

Feline eosinophilic granuloma
Symptoms:
Causes:
Diagnostics:
Tx:

A

80% eosinophilic ulcer in the upper lip (linear granuloma, patches)

Symptoms: drooling, dysphagia

Causes: bacteria, virus, immune-mediated or anaphylactic reactions

Diagnostics: blood sample for eosinophilia

Tx: immunosuppressants

50% of Feline ones recurr within 5 months

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21
Q

Describe oral tumors

A

 Frequent in dogs and cats!

 Malignant: melanoma, carcinoma, fibrosarcoma (Fel)

 Benign: papilloma (virus), epulis (odontogenous origin!, gingiva, near teeth), fibroma, lipoma

 Oral tumors tend to metastasize to lymph nodes and lungs! Take a chest x-ray.

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22
Q

Oral tumors
Symptoms: (5)
Diagnostics:
Tx:

A

Symptoms: ulcers, dysphagia, salivation, halitosis, loss of teeth

Diagnostics: histology, xrays, bloods, regional lymph nodes

Tx: surgery, chemotherapy

But its usually too late!

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23
Q

Describe esophagus anatomy
UES
LES
dog vs cat

Study These Flashcards
A

The esophagus is left of the trachea.

UES - upper esophageal sphincter prevents reflux from esoph. to mouth

LES – lower esophageal sphincter prevents reflux from stomach to esophagus

Vagus nerve:
Canines have striated muscle in their esophagus. Felines smooth muscle at last 1/3. This is important when thinking about prokinetics that only work on smooth muscle, they don’t work so well in dogs with esophageal disorders.

Primary and secondary peristaltic waves occur in the esophagus.

Cat and dog esophagus looks different on endoscopy.

prokinetics: metoclopramide, ranitidine in higher doses

24
Q

Signs of esophageal disease. (7)

Study These Flashcards
A

Regurgitation (main one, passive process)

Dysphagia
Odynophagia (painful swallowing)

Ptyalism
Frequent swallowing

Weight loss
 Secondary complications (e.g. asp.pneumonia)

Hiatal hernias can also cause regurgitation.

25
Vomiting vs regurgitation
Vomiting: active propulsion of food, nausea, salivation, uses stomach muscles Localisation: ✓ Stomach ✓ Small intestine (large intestine?) ✓ Extragastrointestinal (e.g. pyometra)  Regurgitation: passive process
26
How might vomiting cause regurgitation?
excessive vomiting can cause esophagitis that might then cause regurgitation after the vomiting has passed
27
Differences in clinical signs of dysphagia, regurgitation and vomiting. Think water vs solids Pain Time from eating to reaction Abdominal effort Any other signs
28
Diagnosing esophageal disease. (5)
Blood samples don't often show inflammatory changes like left shift or elevated CRP. Fecal sample unhelpful for esophageal disease in europe but in south america esophagus worm, Spirocerca lupi (spirocercosis), can be found in fecals. X-Ray: W/o contrast media first. W contrast media– iodine or barium? Endoscopy is gold standard for esophageal disease. BAL (cough!)
29
Name esophageal diseases. 5+
Inflammatory like esophagitis, reflux, fistula Infections like spirocercosis parasite Obstructive like stricture, hernia, FB, blood vessel anomalies (PRAA), intussusception Motility disorders like megaesophagus, dysautonomy, diverticulum, myasthenia gravis And tumors
30
Megaesophagus can be characterized as
segmental or diffuse. can also be idiopathic, congenital (primary) or acquired (secondary) Congenital: German shepherds!, miniature snautzer etc. siamese! ## Footnote Esophageal dilation and abnormal hypomotility.
31
5 most common causes of megaesophagus. (5)
- myasthenia gravis - hypoadrenocortisism aka Addison's - hypothyroidism - heavy metals - esophagitis (anything that causes chronic esophagitis, that then causes a stricture that then causes megaesophagus in front of the stricture) ## Footnote Clindamycin and doxycycline can cause esophagitis-> stricture-> ME, so need to be given with copious water or with food.
32
Clinical symptoms of megaesophagus. (4)
- regurgitation - malnutrition - asp.pneumonia - salivation
33
Diagnosing megaesophagus.
- blood sample (secondary ME: ACTH stim.test, T4/TSH etc. cause both Addison's and hypothyroidism can cause it) - radiographs - endoscopy
34
TX of megaesophagus. (7)
Tx Depends on the cause of it. - Diet should be dry in esophagitis in order to "scratch the inflamed esophageal mucosa in order to encourage healing". - Feed in an upright position - Feeding tubes if needed - Antibiotics for secondary aspiration pneumonia - Prokinetics can be used even though they aren't as effective in dogs compared to cats. - Sucralfate as a suspension (for esophagitis) - Sildenafil 1mg/kgq 12 h in dogs (helps to open the LES) ## Footnote Prognosis depends on the case and how well the owners are willing to manage it.
35
Describe esophageal foreign body cases.
Emergency! Needs to be removed ASAP. Usually stuck in narrow area like cranial esophagus, heart base or LES. Do not try to bluntly pull with forceps if you can't see - risky! Use endoscopy to remove!
36
Signs of esophageal foreign body. (6) ## Footnote And complications of it? (3)
Regurgitation Salivation Anorexia Pain Dysphagia Sometimes symptoms are very minor! ## Footnote Complications: Perforation, stricture, fistula
37
How do you diagnose an esophageal FB? ## Footnote Ddx? (4)
X-Ray (w and w/o contrast media), NB incase of perforation use iodinated contrast media! Endoscopy DDx: Stricture Tumors Hiatal hernia Gastro-esophageal intussusception ## Footnote Give sucralfate and only use PPIs if needed not just cause (omeprazole, ranitidine).
38
Side effects of proton pump inhibitors. (3)
tolerance rebound effect (increased stomach acid production after sudden discontinuation of the drug) paradoxical increased vomiting
39
Esophageal fistula is
an abnormal connection between esophagus and surrounding tissues/organs! rare! Connection can be to:  Lungs  Bronchi  Trachea  Pleural cavity – rare!  Neck tissues – rare! | Aquired: FB, perforation, inflammatory cause (diverticulum) ## Footnote Can be congenital too (tracheobronchial structures do not separate from GI tract e.g. Cairn terriers).
40
Signs of esophageal fistula and how to diagnose it. Ddx: Tx: Prognosis:
Signs: When congenital, signs occur during the weaning period. When aquired, signs occur later. Frequently - respiratory signs! Diagnose with x-ray +/- contrast (pay attention to lung patterns) + endoscopy. Ddx: pneumonia (lobular), asp. pneumonia, bacterial pneumonia, foreign body Tx: Surgery (removal of lobe that fistula is into) Post-op AB treatment Prognosis: w/o complications good
41
Blood vessel anomaly to cause esophageal disease.
PRAA (persistent right aortic arch) 95% cases, signs begin in weaning period. Breed predisposition: GSD, Irish setter Symptoms: Regurgitation, Weight loss DDx: Stricture Diagnose with: XRay (w contrast media) – in PRAA there is a dilatation cranially from the heart base! Endoscopy: distinguish from the stricture! (artery pulsation)
42
Tx and prognosis of PRAA.
SURGERY REQUIRED - post-op hypomotility complication - medicaments do not work on striated muscles - prokinetics (cisapride) has some effect on smooth muscles Prognosis: Early correction! (otherwise persistent dilatation, irreversible nerve degeneration) Post-op symptoms may stay!
43
Esophagitis can be acute or chronic. Causes of it include: (7)
- chemicals - foreign body - reflux - irradiation - megaesophagus - tumors - anesthesia !
44
Esophagitis affecting factors-cycle: (4)
- GE reflux causes esophagitis - Esophagitis decreases motility - Gastric acid increased in distal part of esophagus but there is hypomotility which can cause, - Focal inflammation which decreases LES competence further, increasing GE reflux Vicious cycle.
45
Clinical signs of esophagitis. (5)
- regurgitation! (from initial vomiting) - salivation - extended neck is typical - avoiding food - cough
46
Diagnose esophagitis with (3) ## Footnote Ddx? (6)
- Blood samples - X-Ray if you're skilled at interpretation (contrast media can stick to inflamed mucosa in a zip-zag pattern but its subtle) - endoscopy (biopsy!) is gold standard! ## Footnote ddx: FB, stricture, hernia, ME, diverticulum, vessel anomaly
47
Tx of esophagitis. (5)
- Feeding with kibble to encourage mucosal turnover. - Sucralfate (Antepsin) - Omeprazole/esomeprazole? - Prokinetics - Antibiotics only in cases of aspiration pneumonia.
48
Esophageal stricture can be either
fibrotic, or due to compression by a mass. Symptoms: only liquid diet tolerated by animal | Diagnose with xray and endoscopy ## Footnote Ddx: esophagitis, blood vessel anomalies, tumors
49
Tx of esophageal stricture. (7)
Feeding tubes Diet Fluid therapy Dilatation (needs to repeated several times and even then it may not work!) Sucralfate Omeprazole ? Prednisolone to prevent fibrosis formation. ## Footnote Prognosis: guarded- good. Complication: perforation
50
Describe esophageal diverticulum.
Rare (brachys are typical) Congenital (as a fetus, the mucosa herniates into the muscularis) vs aqcuired DDx: hiatal hernia, gastric-esophageal intussusception Treatment: SURGERY! ## Footnote Prognosis: cautious (persistent hypomotility!)
51
Describe hiatal hernia.
 Various subtypes  Can be intermittent („sliding“, easy to miss)  Usually congenital (Shar-pei, brachys)  Treatment: surgical + associated esophagitis
52
GI tumors location classification (4)
A – extramural B, C – intramural uni- and bilateral essentially D - luminal
53
Paraneoplastic syndromes of GI tumors. (11)
 Cachexia (lymphoma) vs anorexia  Protein-losing enteropathies  Gastro-intestinal ulcers (adenocarcinoma)  Hypercalcemia  Hypoglycemia (insulinoma)  Anemia  Leucocytosis – neutrophilia  Thrombocytopenia  Fever  Hypertrophic osteopathy  Alopecia (feline pancreatic carcinoma)
54
Hypertrophic osteopathy is a classic PNS for what type of cancer?
esophageal neoplasia
55
What 3 chemotherapies may cause sensitivity reaciton in dogs with MDR1 mutation?
vincristine vinblastine doxorubicin
56
Describe esophageal tumors.
 Are rare! < 0.5%  In Dogs: carcinoma (mostly), leiomyosarcoma, fibrosarcoma, osteosarcoma, melanoma, leiomyoma, polyps  In Cats: carcinoma (mostly), lymphoma, leiomyosarcoma, firbrosarcoma, osteosarcoma ## Footnote NB Most GI tract tumors are in fact malignant.
57
Signs of esophageal tumor. (8)
 Mechanical obstruction  REGURGITATION - aspiration  Halitosis  Salivation  Fever  Anorexia, weight loss  Pain during swallowing  Hypertrophic osteopathy

Small animal internal medicine II (25 decks)

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