11. Diseases of the oral and pharyngeal cavities in dogs and cats. Ileus. Flashcards
Physical exam( teeth, tongue, gum & salivary gland)
Dysphagia Clinical signs?
Dysphagia
CLINICAL SIGNS
Inappetence; Weight loss; Halitosis; Pawing at mouth;
Hypersalivation; Facial swelling; Oral haemorrhage; Nasal discharge;
Inability to swallow; Dropping food
Differential diagnosis of dysphagia?
DIFFERENTIAL DIAGNOSIS
§ Oral pain: Dental disease (FORL; Abscess); Oral ulcers;
Trauma; Fracture; Periodontitis; Osteomyelitis;
Retrobulbar abscess; Stomatitis; Glossitis; Gingivitis;
Pharyngitis
§ Pain when swallowing: Oesophageal disease/stricture
§ Oral mass: Neoplasia; Granuloma; Salivary gland disease;
Foreign body
§ Neuromuscular disease: Temporomandibular
myositis/joint disease; Masticatory muscle myositis;
Rabies; Tetanus; Botulism; Tick paralysis; Oral,
pharyngeal or cricopharyngeal dysfunction; Localised
myasthenia gravis; Cranial nerve abnormality
Diagnosis of dysphagia?
DIAGNOSIS
History, general & physical exam
§ Open/close mouth
§ Signs of systemic disease
§ Palpate masticatory muscle & temporomandibular joint
§ Cranial nerve function
Oral exam (if required; may require GA)
Imaging: Radiography; Endoscopy; CT; MRI
Biopsy; Histopathology
PCR; ELISA (viral diseases)
Periodontal disease?
Periodontal Disease
Inflammation of supporting structures surrounding the teeth
Affecting the gingiva, periodontal ligament or alveolar bone
Older animals > Younger animals; Small dogs > Large dogs
Predisposing factors: Non-abrasive foods; Rough tooth surface;
Malocclusion; Diabetes; Retroviral infection
Plaque formation?
PLAQUE FORMATION
Adheres to all surfaces of the tooth – Layers of bacteria, saliva & food particles. These become mineralised, forming a calculus.
Incisor Canine Premolar Molar
Cytokine release from anaerobic bacteria → Enter the tissue →
Stimulation of osteoclasts → Thinning bone within the socket.
Stages- Gingivitis ?
STAGES
Gingivitis
Reversible inflammation of marginal gum
§ Plaque in sulcus → Inflammatory response
§ Precursor to periodontitis → Treatment required
Stages - Periodontitis?
Periodontitis
Reversible inflammation of marginal gum & supra-alveolar tissue;
Loss of CT attachment & bone
Tooth loss occurs at 80% loss of tooth support
§ CSx: Halitosis; Discomfort when eating; Blood-tinged
saliva; Oronasal fistula → Nasal discharge
Maltese dog - Chronic ulcerative periodontitis syndrome
§ Tx: Plaque removal; Polish teeth; Scale under gums
Advanced Periodontitis?
Advanced Periodontitis
Heavy calculus build-up; Mostly above gum
Tooth mobility with supporting bone loss >50%
Preventing periodontitis?
Preventing periodontitis
§ Daily brushing of teeth
§ Chew toys; Bones
§ Dental diets
§ Oral rinses; Gels
Feline odontoclastic resorptive lesions(Forl)?
Feline Odontoclastic Resorptive Lesions (FORL)
Older cats > Younger Cats
Reactivation of odontoclast cells: These are stimulated to resorb tooth structure; These attack the roots, leading to cavities, gingival hyperplasia & pain
Aetiology: Unknown; Multifactorial
CLINICAL SIGNS
Reluctance to eat dry food; Pain with eating
Hyperplastic gingival tissue covers resorptive lesions on the crown
DIAGNOSIS
Visual examination & probing (may be covered by plaque & tartar)
Dental Radiology: May be indicated if there is gingivitis or
suspected retained roots
TREATMENT
Tooth extraction; Crown amputation of all affected teeth
Stomatitis?
Stomatitis
Inflammation of the oral mucosa
Classification:
According to lesion: According to localisation:
- Simple (catarrhalis) 6. Gingivitis
- Ulcerative 8. Periodontitis
- Ulcerative &
pseudomembranous
- Glossopalatine arch
- Ulcerative & necrotising 12. Faucitis
(caudal)
- Proliferative
Causes of stomatitis?
CAUSES
Systemic disease: Uraemia; DM
Immune-mediated disease: Systemic lupus erythematosus (SLE);
Pemphigus foliaceus; Idiopathic vasculitis
Traumatic, physical or Chemical: Foreign body; Injury; Tartar;
Acids; Heavy metal salts; Pesticides
Chronic immunosuppressive therapy
Pathogens
§ Viral: FeLV; FIV; FIP; FCV; FHV; FPV; Distemper virus
§ Bacteria: Bartonella henslae
§ Fungal: Candidiasis; Cryptococcus neoformans
Clinical signs of stomatitis?
CLINICAL SIGNS
- Anorexia 15. Local reddening
- Dysphagia 17. Erosions
- Salivation/Drooling 19. Ulcers
- Pain when eating 21. Vesicles
- Difficult opening
mouth
- Plaque
- Enlarged LNs 25. Bloody saliva
Specific types of stomatitis?
SPECIFIC TYPES OF STOMATITIS
§ Feline chronic gingivostomatitis
§ Feline eosinophilic granuloma complex (FEGC)
§ Ulcerative stomatitis
§ Canine eosinophilic granulomas (Siberian huskie)
Ulcerative stomatitis?
ULCERATIVE STOMATITIS
Predisposed: Maltese terrier; King Charles Cavalier Spaniel
Clinical signs: Dysphagia
Diagnosis: History; Physical exam; Haematology; Biochemistry;
Urinalysis; PCR; ELISA; Biopsy
Differential diagnosis: Palatine ulcers usually caused by overgrooming in cats (Feline gingivitis stomatitis); Neoplasia
Vincent-type: Acute ulcerative-necrotising stomatitis
Feline Chronic Gingivostomatitis?
FELINE CHRONIC GINGIVOSTOMATITIS
Inflammation & proliferation of the gingiva & oral mucosa
May lead to faucitis/caudal stomatitis; Relatively common
Cause: Unknown; Multifactorial; Hypersensitivity (Calicivirus)
§ Viral: FCV; FHV-1; FIV; FLV
§ Bacterial: Bartonella henslae
Diagnosis
PCR; Biopsy & histopathology: Diffuse lymphocytic infiltration in
mucosa
Clinical signs (same as stomatitis)
- Anorexia 27. Local reddening
- Dysphagia 29. Erosions
- Salivation/Drooling 31. Ulcers
- Pain when eating 33. Vesicles
- Difficult opening
mouth
- Plaque
- Enlarged LNs 37. Bloody saliva
Treatment
27
§ Dental prophylaxis
§ Extraction
§ Antibiotics: Clindamycin; Metronidazole; Amoxiclav
§ Anti-inflammatories; Pain relief
§ Cyclosporin (immunosuppressant)
Masticatory muscle myositis?
MASTICATORY MUSCLE MYOSITIS
Immune attack on the masseter muscle
Predisposed: Doberman; Rottweiler
Clinical signs
§ Acute → Inflammation: Dysphagia; Pain; Localised
swelling; Exophthalmos
§ Chronic → Fibrosis: Ø Mouth opening; Bilateral atrophy
Diagnosis: CSx; Biopsy; Histopathology; Serum 2M-antibodies
Treatment
§ Immunosuppression: Prednisolone
§ Nutrition: Naso-oesophageal tube; Gastric tube
Diseases of the tongue?
Diseases Of The Tongue
§ Glossitis: Superficial/Deep (ulcer); See stomatitis
§ Strangulation of tongue: Foreign body – Particularly root
of tongue
§ Tumour
§ Trauma
§ Congenital macroglossia (rare)
Diseases of the salivary glands?
Diseases Of The Salivary Glands
SIALOCELE
Enlargement associated with a salivary gland due to accumulation of
saliva within the surrounding tissue
Large; Non-painful; Soft; Ranula under the tongue
Cause: Idiopathic; Trauma
Clinical signs: Dysphagia; Gagging
Treatment: Surgical removal of gland/ducts
SIALOADENTIS
Inflammatory response with Ø evidence of infection
Mildly painful, bilateral enlargement of glands; Typically secondary
to prolonged vomiting/regurgitation
Clinical signs: Dysphagia; Gagging; Fever
Treatment: Glucocorticoids; Antibiotics
SIALOADENOSIS
Bilateral, large, non-inflammatory enlargement; Non-painful
Clinical signs: Retching; Gulping; Ptyalism
Diagnosis: FNA (but not characteristic)
Oral neoplasia?
Oral Neoplasia
Dog: Malignant melanoma > Squam. cell carcinoma > Fibrosarcoma
Cat: Squam. Cell carcinoma > Fibrosarcoma
MALIGNANT MELANOMA
Older medium sized dogs; Rare in cats
Metastasis is common: Submandibular LNs & lung
Bad prognosis
Treatment: Surgery; Intralesional chemotherapy; Radiotherapy
SQUAMOUS CELL CARCINOMA
Cats > Dogs
Ulcerative & locally invasive into the surrounding bone; Sublingual
or rostral
Highly metastatic if located in the caudal mouth
Treatment: Removal of nose; Chemotherapy; Maxillary/Mandibular
removal – Removal not well tolerated in cats
FIBROSARCOMA
Older large breed dogs; Retrievers
Originate from gingiva or palate; Locally invasive
Treatment: Excision; Radiotherapy
EPULIS?
EPULIS
Most common benign oral tumour
Older large breed dogs
Acanthomatous epulis
§ Arise from the periodontal ligament; Invades bone
§ Treatment: Surgical removal → Extend to bone margins
Fibromatous epulis
§ Arise from dental laminar epithelium; Not very invasive
§ May progress to fibrosarcoma
§ Treatment: Surgical removal → Ø Bone margins
Papillomatosis
Ileus?
Ileus
Disruption of the normal propulsive GI motor activity → Blockage of nutrient delivery
Predisposed: Young dogs > Old dogs; Large breeds > Small breeds
Classification
Mechanical ileus Functional ileus
- Intraluminal 39. Paralytic
- Intramural 41. Vascular bowel
disease
- Extramural 43. Spastic bowel
segment
FOREIGN BODY ILEUS
Cause: Solid/cavitary object; Linear foreign body; Trichobezoar
Pathophysiology
§ Intestinal spasm & ischaemia → Pain
§ Impaired peristalsis → Vomiting; Dysbiosis
§ Fluid, acid-base & electrolyte imbalance → Dehydration;
Hypovolaemia; Hypokalaemia; Hypochloraemia; Met.
acidosis/alkalosis
§ Impaired gut barrier integrity → Bacterial translocation;
Endotoxemia; Septicaemia; Perforation; Septic peritonitis
HISTORY & CLINICAL SIGNS
§ Ø Appetite; Depressed; Vomiting
§ “Praying position” of the dog (see Fig 11.2)
§ Dehydration → Shock
§ Abdominal pain
May also
be seen in cases of GDV, gastric dilation & pancreatitis.
Abdominal palpation: Foreign body; Wide intestines; Bunching of
intestines (in linear foreign body cases); Ø Faeces
Chronic (subileus): Ø Appetite; Weight loss; Intermittent vomiting;
Chronic diarrhoea
DIAGNOSIS
§ Plain radiography
§ Contrast radiography: Foreign body; Gas; Fluid; Wide
intestines; Dysmotility
§ Abdominal ultrasonography: Gas; Fluid; Wide intestinal
loops; Pendular movement
§ Exploratory laparotomy
