11) diseases of the oral and pharyngeal cavity, ileus Flashcards
history of oral cavity signs
- Dysphagia (difficulty in eating)
- Oral pain
- Interest in food but reluctance to eat
- Drooling (excessive salivation)
- Halitosis (chronic bad breath)
- Blood-tinged saliva
- Blood on: toothbrush, chew toys, food
- Facial swelling
- Nasal discharge (oronasal fistula)
physical examination of oral cavity signs
- Teeth • Dog: 3I 1C 4P 2M – 3I 1C 4P 3M • Cat: 3I 1C 3P 1M – 3I 1C 2P 1M • Check number, shape, position/occlusion, surface, colour, tartar, pain, movability, percussion sound - Tongue • Shape, size, surface (intactness, papillae), colour, consistency, movability - Gum • Colour, moisture, intactness - Salivary glands • Size, surface, colour
differential diagnosis for dysphagia
Oral pain
• Oral trauma, fractured teeth or bones
• Periodontitis, osteomyelitis
• Retrobulbar lesions
• Stomatitis, glossitis, gingivitis, pharyngitis
- Pain when swallowing
• Oesophagitis stricture
- Oral mass
• Tumour, granuloma, sialocele, foreign body
- Neuromuscular disease
• Temporomandibular myositis / joint disease
• Rabies, tetanus, botulism, tick paralysis
• Oral, pharyngeal, cricopharyngeal dysfunction
• Localized myasthenia gravis
• Cranial nerve abnormalities
periodontal disease
- The disease of the supporting structures of the tooth
• Gingiva; periodontal ligament; alveolar bone - Predisposing factors
• Non-abrasive food, rough tooth surface, malocclusion, diabetes, retroviral infections - Aetiology:
• Plaque
➢ Adheres to all surfaces of teeth – layers of bacteria, saliva, food particles → mineralized (with calcium from saliva) to form calculus
➢ Anaerobic bacteria release cytokines which leach into tissue, this stimulates osteoclasts (chronic inflammation) leading to thinning bone of socket - Stages
• Gingivitis
➢ Reversible inflammation of marginal gingival
➢ Plaque in sulcus → body reacts with WBCs → oedema / swelling / inflammation of gums
➢ Precursor to periodontitis, so must treat gingivitis
• Periodontitis
➢ Irreversible inflammation of gingiva and supra-alveolar tissue with loss of connective tissue attachment and bone (i.e. loss of periodontal support) – deep pocket
➢ Need to lose 80% support before tooth loss
➢ If not loose, scale under gums BUT need to get it all out (gingival flap)
• Advanced periodontitis
➢ Heavy calculus built up
➢ Calculus = calcified plaque; mostly above gum
➢ Tooth mobility with supporting bone loss > 50% - Prevention / Home care advice: Regular oral hygiene!
• Teeth brushing (daily) = gold standard
• Chew toys, bone substitutes
• Bones – bigger the better
• Dental diets
Feline Odontoclastic Resorptive Lesions (= FORL)
- Common in older cats
- Odontoclast cells become reactivated
• Unknown aetiology!
• Hypersensitivity causes?
• Abnormal immune reaction? - Odontoclasts attack the roots of the teeth, leading to cavities and gingival hyperplasia and pain
- Clinical signs
• Reluctance to eat dry food, pain with eating
• Hyperplastic gingival tissue covers on resorptive lesions on crown - Diagnosis
• Visual examination and probing under gums
• Can be covered by plaque, tartar
• Dental radiographs
➢ If the gingiva is inflamed or retained roots suspected - Treatment
• Tooth extraction or crown amputation of all affected teeth
• Laser therapy?
Stomatitis
- Inflammation of the oral mucosa
- Classification
• According to the lesion
➢ S. simplex (catarrhalis)
➢ S. ulcerosa
➢ S. ulcerosa et pseudomembranacea
➢ S. ulcerative – necrotizing
➢ S. proliferative
• According to localization
➢ Gingivitis
➢ Periodontitis
➢ Glosso-palatine arch, glossitis
➢ Faucitis (caudal stomatisis) - Aetiology
• Systemic disease! (endocrine, metabolic diseases
➢ Uraemia
➢ Diabetes mellitus
• Immune-mediated diseases
➢ Systemic lupus erythematosus (SLE)
➢ Pemphigus foliaceus
➢ Idiopathic vasculitis
• Traumatic, physical / chemical agents
➢ Foreign bodies, injuries, tartar
➢ Chemicals: acids, heavy metal salts, pesticides
• Infectious diseases
➢ FeLV/FIV, FCV, FHV, FIP
➢ Feline panleukopenia virus
➢ Canine distemper
• Chronic immunosuppressive therapy - Clinical signs
• Anorexia and/or dysphagia
• Salivation, drooling (thick, ropey saliva)
• Severe halitosis
• Local lesions: reddening, erosions, ulcerations, vesicles, plaque
• Stomatitis categories I – IV
Chronic gingivostomatitis in cats
• Immune-mediated, possible calicivirus infection • Typically, lymphocytic-plasmocytic inflammation • Clinical signs of dysphagia ➢ Ulcerations of the gingiva, buccal mucosa, tongue, pharynx ➢ Pain! ➢ Enlarged mandibular lymph nodes • Treatment ➢ Extraction of teeth! ➢ Antibiotics o Clindamycin o Metronidazole ➢ Anti-inflammatories o Prednisolone ➢ Pain relief o Oral tramadol, buprenorphine ➢ Trial anti-viral agents (calici)
Feline eosinophilic granuloma complex
• Oral eosinophilic ulcer
➢ Upper lip: well circumscribed, symmetrical
➢ Non-pruritic, red-brown, ulcerated lesion
• Oral eosinophilic granuloma (linear), plaque (rare)
➢ On tongue (base), lips, gum, pharynx
➢ Single-multiple, discrete, firm, raised nodules (plaque) may ulcerate
• Cutaneous lesions
➢ Plaque (skin of abdomen)
➢ Linear granulomas (back of hind limbs)
• Clinical signs: dysphagia, ptyalism, oral pain
• Treatment:
➢ Removing any possible underlying cause
➢ Prednisolone oral
➢ Good ectoparasitic control
➢ Food elimination trial
diseases of the tongue
- Glossitis • Superficial • Deep, ulcer (often with stomatitis), aetiology: see stomatitis - Strangulation of the tongue • Eating swine, poultry tracheal rings • Linear foreign bodies (string etc) • Foreign bodies in the root of the tongue - Tumour - Trauma - Congenital microglossia (rare
oral neoplasia
- Dogs: malignant melanoma (gingiva, metastasis, bad prognosis) > squamous cell carcinoma > fibrosarcoma
- Cats: squamous cell carcinoma (ulcerative, sublingual or rostral)»_space;» fibrosarcoma
- Epulides
• Most common benign oral tumour
• Older large breed dogs
• Acanthomatous:
➢ Arise from the periodontal ligament, locally invasive into bone and can cause dental disruption
• Fibromatous / ossifying:
➢ Arise from dental laminar epithelium, not very invasive but cause dental disruption
➢ If keep recurring, will progress to fibrosarcoma
• Excellent prognosis
salivary gland diseases
- Sialocele (aka “salivary mucocele”)
• Enlargement associated with a salivary gland due to accumulation of saliva within the surrounding tissue
• Usually idiopathic, trauma around that region
• Large, non-painful, soft
• Treatment: surgical removal of salivary ducts / gland - Sialoadenitis
• Bilateral inflammatory enlargement that is mildly painful
• Typically, secondary to prolonged vomiting or regurgitation
• No evidence of infection
• Treatment: glucocorticoids and antibiotics - Sialoadenosis
• Bilateral non-inflammatory enlargement that is non-painful, afebrile
ileus - classification
▪ Mechanical ileus • Intraluminal • Intramural • Extramural → LUMEN IS PARTIALLY (subileus) OR COMPLETELY CLOSED ▪ Functional Ileus • Paralytic ileus • Vascular bowel disease • Spastic bowel segment → LUMEN IS OPEN, BUT PERISTALSIS STOPPED!
foreign body ileus?
▪ Solid/ cavitary object ▪ Linear FB ▪ Trichobezoar/ cat ▪ Pathophys and lab findings: • Intestinal spasm, ischemia pain • Impaired peristalsis vomiting; dysbiosis • Fluid, acid-base & electrolyte imbalance o Dehydration, hypovolemia o HypoK+, hypoCl- o Metabolic alkalosis or metab. acidosis • Impaired gut barrier integrity o Bacterial translocation o Endotoxemia; septicaemia o Perforation; o Septic peritonitis
ileus - history, clinical signs
• Young (large breeds) – more common
• Appetite Ø, depressed, vomiting (prox → more severe)
• Dehidration → shock
• Abdominal pain
• Abdominal palpation:
o Palpated FB
o Unequally wide intestines (dilated, fluid, gas filled)
o Linear FB→Bunching of intestines
o Lack of feces ‒ possible
• Chronic (subileus):
o Appetite Ø, weight loss, intermittent vomiting, chronic diarrhea
ileus - diagnosis
• Plain radiography • Contrast radiography o FB o gas + fluid o unequally wide intestines o dysmotility • Abdominal ultrasonography o gas+ fluid o unequally wide loops o pendular movement • Diagnostic laparotomy
