DDx Dysphagia Flashcards
What are the four phases of Dysphagia?
- Abnormal Oral phases = abnormal prehension, mastication, lubrication, and transportation of food from tongue to pharynx
- Abnormal Pharyngeal phase= food bolus doesn’t propel from oropharynx, though hypopharynx, and to proximal esophagus.
- Cricopharyngeal dysphagia is abnormal transportation of bolus through proximal esophageal sphincter. This is due t inadequate or complete lack of opening/relaxation (cricopharyngeal achalasia) of upper esophageal sphincter or from abnormal riming of its opening/relaxation (cricopharyngeal asynchrony)
- Esophageal dysphagea is difficuly in passing bolus down the esophageal body
WHat are the clinical signs of oral, pharyngeal, and oesophageal dysphagia?
- Oral dysphagia = Difficulty prehending or masticating food, and unable to transport to base of tongue
- Pharyngeal dysphagia = gagging or retching, repeated attempts to swallow, excessive head movements, and dropping food from mouth.
- esophageal dysphagia = regurgitation
- Note coughing can occur with any form of dysphagia
What are common signlaments of dysphagia?
- Cricopharyngeal achlasia is congenital and likely observed in juvenile dogs at weaning
- Heritable trait for oropharyngeal dysphagia in Golden retrievers
- Foreign body most likely in young-midle aged pets
- Geriatric pets are most likely going to have systemic disease
- Cats less likely to have dysphagia but it is usually secondary to oral tumour, ulcer, or stomatitis
What are the obstructive lesion differentials causing dysphagia?
Cause of dysphagia
Diagnosis
Survey radiographs of head, neck, thorax, CBC< biochem (CK+electrolytes), urinalysis
Obstructive lesions (mechanical or anatomic)
Foreign body
Oral and laryngeal exam under anaesthesia to identify obstructions
Endoscopy+/- fluoroscopy may be required
Neoplasia
Inflammatory (absess, polyp, granuloma)
lymphadedonopathy
Sialocele
Lingual frenulum disorder
Cleft palate
TMJ disorder
Trauma (fracture, luxation)
Cricopharyngeal achalasia/asynchrony
Absent gag reflex
What are the pain differentials causing dysphagia?
Pain
Periodontal (tooth fracture/abscess, periodontitis)
Oral and laryngeal exam under anaesthesia to identify inflammatory processes
what are the neuromuscular differentials causing dysphagia?
Neuromuscular disorders
Inflammatory myopathy (masticatory myositis, polymyositis)
Neurological exam +/- exam under anaesthesia to identify laryngeal paralysis
Polyradiculitis
Botulism
Tick paralysis
TMJ disease
Myasthenia gravis
Acetylcholine receptor antibody titer
What endocrine disorder can cause dysphagia?
Hypothyroidism
Thyroid testing
What treatment options are available for dysphagia?
- Accurate diagnosis is required
- If untreatable change food consistency (liquid, solid), meal frequency (smaller, more frequent), and feed positions (upright) could be attempted.
- If adequate calories not provided then place a feeding tube.
- Treat complications such as aspiration pneumonia
What is the definition of regurgitation?
= Passive expulsion of food or fluid from esophagus due to mechanical, obstructive disease or functional (motility) abnormalities.
What are the clinical signs of regurgitation?
- May notice pets head lowers and produces maerial or find fluid or food without hearing the pet.
- Can be immediately or hours after feeding, and can vary from digested or undigested food, mucous or clear, frothy liquid.
- Bilous material is not associated with regurgitation. Odynophagia and ptyalisms may be present
- Systemic signs – weight loss, polyphagia, weakenss, and other neurologic abnormalities.
- Aspiration pneumonia may be present
What are the common signalments of regurgitation?
- Megaesophagus
- Congenital megaesophagus: Labrador retrievers, newfoundlands, Chinese Shar-peis
- +/- acquired: Great Dane, German Shepherd and Irish setter
- Clinical and non-clinical motility disorder that may improve ore resolve with maturation in Shar-Peis, Bouviers des Flandres and terrier breeds
- Spirocercosis may cause esophageal dysphagia
- Recent anaesthetic epidosed (e.g. spay/neuter, dentistry) and oral medication (doxycycline, clindamycin) are common cause of esophageal structure
- Anaesthesia can cause megaesophagus from esophageal muscle atony secondary to gastroesophageal reflux- induced esophagitis.
- Idiopathic laryngeal paralysis associated with esophageal dysfunction
What are the esophageal disorfer differentials causing regurgitation? And their associated diagnostic tests?
Esophageal Disorders
Megaesophagus (primary/secondary)
Plan cervical and thoracic radiographs:
Esophageal dilation
Focal with stricture or vascular ring anomaly, generalised with megaoesophagus
Foreign body, mass
Radiopaque structures
Thymoma
Widening of mediastinum
Esophagitis
If plain radiographs non diagnostic then esophagram, endoscopic exam, or videofluorscopic exam
What are the alimentary disorders that can cause regurgitation?
Pyloric outlflow obstruction
Hiatal hernia
Gastric dilatation volvulus
What neurological disoders can result in regurgitation?
CNS (brainstem lesion, neoplastic, trauma)
Peripheral neuropathy (lead, thallium, polyradiculitis, polyneuritis)
Dysautonomia
What neuromuscualr disorders can reslt in regurgitation?
Botulism
Tetanus
Distemper
Acetylcholinsterase toxicity
Myasthenia gravis
