Dysphagia/Regurgitation Flashcards
Can animal prehend food?
Evaluate….
oral cavity, teeth, tongue, facial muscles
Can animal masticate?
evaluate muscles of mastication, TMJ
Can animal swallow?
evaluate pharyngeal/oesophageal function
3 broad processes causing dysphagia
- oral pain
- oral obstruction
- motility disorder (neuromusc. dz) involved in mastication/swallowing
4 DDx for neck pain
D: feline orofacial pain syndrome (FOPS) esp. Burmese, cervical disc dz A M N I: inflam CNS disease (meningitis) T: cervical fxs/trauma V
4 ddx for oral obstruction
D: A: oropharyngeal polyps, sialocoele M: N: oral neoplasia I: cryptococcal granuloma T: oral FB (bones commonly) V
4 malignant oral neoplasias
- SCC
- Fibrosarcoma
- Melanoma
- Lymphosarcoma
DDx neuromuscular diseases (re. dysphagia)
D: myasthenia gravis (focal), trigem neuropathy (CN V) A: cricopharyngeal achalasia M N I: tetanus, rabies, masticatory myositis T V
Dx of masticatory muscle myositis
serum antibody (2M fibres), CK elevation + muscle biopsy
Tx of masticatory. myositis + Px
prednisolone at immunosupressive doses Px guarded (irreversible once trismus has developed)
CS of trigeminal neuropathy
marked muscle loss (neurogenic atrophy) w/ slack jaw (hangs open)
Dx of trigem. neuropathy
a diagnosis of exclusion
Tx and Px of trigem neuropathy
nil - most resolve w/ time – prognosis usu. good
When would a fluoroscopic swallowing study be useful?
i. Motility disorders that cause dysphagia may have no detectable physical examination findings (eg. Focal myasthenia gravis)
ii. If a lesion cannot be IDed on physical/oropharyngeal exam
4 oesophageal disorders causing regurgitation
- oesophageal dysmotility
- external compression
- internal obstruction
- intramural lesions
DDx (7) causes of secondary megaoesophagus
D: myasthenia gravis A M: hypoA N: neoplastic neuromyopathy I: polymyositis T: toxins, snake envenomation, tick paralysis (Ixodes holocyclus) V
Tx of primary megaoesophagus
Incurable but patients can be managed
- aspiration pneumonia - broad spec. antimicrobials IV + IVFT
- no meds for megaO
- nutritional managment
How to manage nutrition in megaO
- Gastrotomy tube in initial management (severe)
- High calorie diet
- Small + freq. meals
- Feed from elevated platform
- O experiment w/ consistency (liquid vs. soft)
When is contrast fluoroscopy contraindicated?
when megaO found on plain rads
3 tx approaches to oesophageal FB
- endoscopic removal
- surgical: oesophagotomy via thoracotomy
- blind gentle pressure to push FB into stomach (vs. euthanasia)
4 ddx for oesphagitis
- chronic V+
- Anaesthesia
- FBs
- Meds: doxycycline in cats, clindamycin
3 meds to tx oesophagitis
- Reduce risk of reflux acidity: PPI (omeprazole), cisapride
- Promote healing of ulceration (sucralfate)
- Pain management - opioids
what is one complication of oesophagitis?
oesophageal strictures
