Diseases of the Oral Cavity and Esophagus Flashcards
Physical exam of the oral cavity, how is it conducted?
With sedation or without sedation
Exam of oral cavity without sedation
Limited
Inspection with tongue pulled out
Ext palpation through cheeks
Use mouth gag if horse is very alert
Exam of oral cavity with sedation
Recommended to use oral rinse
Clinical signs of oral diseases
Inappetance
Pain chewing, swallowing
Swollen face
Salivation, discharge from mouth
Halitosis
Weight loss
Quidding (dropping food)
Nasal discharge
Fistulas
Riding issues (bit)
Head-shaking
Bruxism (generally not a sign)
Dysphagia
Types of dysphagia
Prepharyngeal
Pharyngeal
Postpharyngeal
Prepharyngeal dysphagia
Quidding
Reluctance to chew
Pharyngeal/postpharyngeal (esophageal) dysphagia
Cough
Nasal discharge- saliva or food
Gagging
Neck extension
Types of dysphagia based on aetiology
Painful
Muscular
Obstructive
Neurologic
Diagnosis of dysphagia
Phys exam- oral cavity and neuro
Endoscopy-pharynx, esophagus, guttural pouch
Radio: plain for the skull and larynx
Contrast radio for the esophagus
US: intermandibular and retropharyngeal areas and esophagus
Management of dysphagia
Treat the cause
No hay
Slurries from complete pelleted feeds: if severe may need nasogastric or esophagstomy
Severe salivation: NaCl or Kcl supplementation
Short-term parenteral feeding
Causes of stomatitis and glossitis
FB: barley/grass awns or metals
Phenylbutazone ID (ulcer)
Vesicular stomatitis
Actinobacillosis (lignieresii)
Diseases of the salivary glands
Parotid swelling in grazing horses: from the fungal toxin slaframine
Primary, secondary and infectious sialoadenitis
Cause of primary sialoadenitis
This type is unusual!
Pain
Fever
Anorexia
Cause of secondary sialodenitis
More common!
Trauma
Cause of infectious sialodenitis
Corynebacterium pseudotuberculosis
Other bact
How to diagnose diseases of the salivary glands
Phys exam
US
Aspiration- cytology and culture
Treatment of diseased salivary glands
Palliative
NSAIDs
AB’s
Congenital esophageal diseases
Esophageal duplication cysts
PRAA (persistent right aortic arch)
Idiopathic megaesophagus
Stenosis
Acquired esophageal diseases
Obstruction- most common
FB
Compression
Gastroesophageal reflux disease
Stricture
Diverticulum- can be congenital or acquired
Trauma, perforation
Megaesophagus
Granulation tissue
Neoplasm
Types of esophageal obstruction
Intraluminal: FB e,g feed
Extramural/intramural: abscess, granuloma, tumour, abscess, cyst
Functional disorders: exhaustion, dehydration, primary megaesophagus, neuropathy
Predilection sites for esophageal obstruction
Cervical part
Thoracic inlet
Base of heart
Cardia of stomach
Clinical signs of esophageal obstruction
Food (hay/straw) impaction is the most common!
Dysphagia
Anxious
Extended neck
Coughing, gagging
Bilat frothy nasal discharge- may contain saliva, water, feed
Salivation
Odynophagia (painful swallowing)
Distension in the jugular furrow
Clinical signs of a complicated esophageal obstruction
Signs of asp pneumonia
Rupture:
- Cervical region: cellulitis, systemic inflamm
- Thoracic region: pleuritis
Diagnosis of esophageal obstruction
Nasogastric tubing
Endoscopy
US- especially for complications in the cervical region
Radio: plain or contrast
Treatment of esophageal obstruction
Buscopan
ACP
Oxytocin
Sedate with xylazine and butorphanol
Nasogastric tubing
Lavage while the head is lowered or under GA:
- surgical table should be tilted, carefully inflate the intratracheal tube
Esophagostomy (rare)
AB’s parenterally- Flunixin, Meglumine
After treatment repeat endoscopy
Oesophagitis
Often ulcerative
Reflux:
- regurgitates gastric fluid
- motility disorders
- decreased tone of cardia
- obstruction of gastric outflow
Other causes:
- trauma
- mural abscess
- chemical- cantharidin
Clinical signs of esophagitis
nonspecific!!
Signs mimic obstruction or gastric ulceration
Diagnosis of esophagitis
ENDOscopy
Hyperaemia
edema
erosions and ulcers
Esophagitis treatment
- Control of gastric acidity
- Correct the delayed gastric outflow- but must rule out phys obstruction first
- Diet
How to control gastric acidity?
Omeprazole
Ranitidine
Sucralfate
How to correc the delayed gastric outflow
Metoclopromide
Bethanecol
Appropriate diet for esophagitis
Frequent feeding of small, soaked food
May have to fast for days if very severe
Parenteral feeding
