GI - Upper GI tract disorders

Question 1

What does dysphagia mean?

Answer 1

Difficulty swallowing

Question 2

What does odynophagia mean?

Answer 2

Painful swallowing

Question 3

What are signs of odynophagia?

Answer 3

Opening mouth
Vocalising
Bucking away from food

Question 4

What is regurgitation?

Answer 4

Passive return of food - no effort required

Question 5

Which type of dysphagia is easier to recognise/diagnose?

Answer 5

Structural dysphagia - a structural abnormality
Rather than functional dysphagia - everything looks normal but neuromuscular dysfunction

Question 6

What can cause halitosis?

Answer 6

Oropharyngeal inflammation/necrosis
Pulmonary disease
Gastric disease
Metabolic disease - ammonia

Question 7

What is ptyalism?

Answer 7

Increased saliva production

Question 8

What is pseudoptyalism?

Answer 8

Normal saliva production but cant swallow/clear from mouth - causes drooling

Question 9

What can cause ptyalism/hypersalivation?

Answer 9

Painful oral disease
Drugs
Nausea
GI acid reflux
Rabies

Question 10

What should you do if you find an oral mass?

Answer 10

Biopsy - cant tell difference between inflammatory and neoplastic lesions

Question 11

What disease causes animals to be unable to open their jaw properly?

Answer 11

Masticatory muscle myositis

Question 12

What is masticatory muscle myositis?

Answer 12

An immune mediated disease which targets muscle fibres of masticatory muscles causing extreme inflammation, atrophy and fibrosis

Question 13

How do you treat masticatory muscle myositis?

Answer 13

Immunosuppression - prednisolone
Soft food

Question 14

What is the prognosis of masticatory muscle myositis?

Answer 14

Good - especially if caught in the acute phase

Question 15

What is the name for inflammation of the salivary gland?

Answer 15

Sialadenitis - inflammation
Sialadenosis - unknown (maybe form of limbic epilepsy), non inflammatory

Question 16

What clinical signs can salivary gland disease cause?

Answer 16

Hypersalivation
Swelling and pain
Gagging
Retrobulbar effect - swelling pushes back of eyelids

Question 17

How do you treat non-inflammatory sialadenosis?

Answer 17

Phenobarbitone

Question 18

What insect can cause extreme irritation and destruction of mouth?

Answer 18

Oak processionary moth caterpillar

Question 19

What are some primary clinical signs of dysphagia?

Answer 19

Difficulty forming a bolus
Excessive jaw/head motion
Dropping food
Drooling
Gagging

Question 20

What are the secondary clinical signs of dysphagia?

Answer 20

Failure to thrive
Nasal discharge
Coughing
Halitosis

Question 21

How should you investigate focal mass lesions?

Answer 21

Anaesthetic
Radiograph jaw, head and chest
Aspirate local lymph nodes
Biopsy for histopath

Question 21

How should you investigate diffuse gingivostomatitis?

Answer 21

Do a dental and radiographs
Take oral swabs for feline herpesvirus and feline calicivirus
FIV and FeLV ELIZA

Question 22

What test can you do for masticatory muscle myositis?

Answer 22

2M antibodies

Question 23

What diagnostic tests can be used to localise dysphagia?

Answer 23

Contrast study (contraindicated due to aspiration)
Fluoroscopy swallow study
Endoscopy

Question 24

What are the names of the sphincters controlling normal oesophageal function?

Answer 24

Upper and lower oesophageal sphincter

Question 25

What nerve detects oesophageal distention and stimulates contraction?

Answer 25

Vagus nerve

Question 26

What is extreme oesophageal dysfunction called?

Answer 26

Megaoesophagus

Question 27

What disease means stomach contents reenter the oesophagus?

Answer 27

Gastro/oesophageal reflux disease (GERD)

Question 28

What causes GERD?

Answer 28

Hiatal hernia Lower oesophageal sphincter dysfunction Underlying chronic enteropathy

Question 29

What can cause lower oesophageal sphincter dysfunction?

Answer 29

Breed disposition - brachys Local oesophagitis - acid reflux perpetual cycle

Question 30

Why can a hiatal hernia cause GERD?

Answer 30

Stomach able to move between thorax and abdomen - affects oesophagus

Question 31

What can cause/exacerbate oesophagitis?

Answer 31

Anaesthetic - sphincter relaxes Chronic GERD Post oesophageal trauma - hot food, foreign body, stricture After vomiting

Question 32

What can be caused after oesophageal healing?

Answer 32

Stricture

Question 33

What can cause megaoesophagus proximal to the heart base?

Answer 33

Vascular ring anomalies - aorta develops on the wrong side so ligamentum arteriosum tethers oesophagus to heart base

Question 34

how should you take radiographs to assess oesophageal function?

Answer 34

Conscious - drugs cause muscles to relax so can look like megaoesophagus

Question 35

What are the two main diffuse megaoesophagus differentials?

Answer 35

Myasthenia gravis Diffuse oesophagitis

Question 36

What can cause focal megaoesophagus?

Answer 36

Obstruction Vacular ring anomaly foreign body Stricture

Question 37

What pattern can occur on contrast radiography of the oesophagus in cats?

Answer 37

Herring bone pattern - normal

Question 38

What can contrast radiography of the oesophagus cause?

Answer 38

Aspiration pneumonia - so is contraindicated

Question 39

When should you not do endoscopy of the oesophagus?

Answer 39

Megaoesophagus - requires an anaesthetic which is bad for them

Question 40

When should you do endoscopy of the oesophagus?

Answer 40

To retrieve a foreign body To evaluate for hiatal hernia To evaluate for or dilate a stricture

Question 41

How do you dilate a stricture?

Answer 41

Balloon catheter into the middle and then dilate using increasing sizes of balloons

Question 42

What breed of dog is predisposed to craniomandibular osteopathy?

Answer 42

West highland white terrier

Question 43

What clinical signs does craniomandibular osteopathy cause?

Answer 43

Pain/difficulty opening jaw, limited range of motion in jaw

Question 44

What is the treatment for craniomandibular osteopathy?

Answer 44

There is none for the bone remodelling Supportive management Spontaneously resolves at 1 year old usually

Question 45

What are the 3 types of myasthenia gravis?

Answer 45

Generalised - exercise intolerance +/- megaeosophagus Focal - just megaoesophagus Fulminant - acute onset, resp muscle failure and death

Question 46

What test do you do for myasthenia gravis?

Answer 46

AChR antibody blood test

Question 47

What is cricopharyngeal achalasia?

Answer 47

Congenital neuromuscular disorder of the cricopharyngeal muscles (upper oesophageal sphincter) Causes failure to coordinate normal passage of food through the pharynx

Question 48

What are the signs of cricopharyngeal achalasia?

Answer 48

Dysphagia since a puppy Repetitive failed swallowing attempts

Question 49

What is the treatment for myasthenia gravis?

Answer 49

Anticholinesterase drugs - pyridostigmine

Question 50

What is the management for GERD?

Answer 50

Lower oesophageal sphincter drugs Weight management Acid blockers Diet modification - low fat

Question 51

What is the management for megaoesophagus?

Answer 51

Positional feeding NOT lower oesophageal drugs

Question 52

What drug is an acid blocker?

Answer 52

Omeprazole - proton pump inhibitor

Question 53

What drug is a lower oesophageal drug?

Answer 53

Cisapride

Question 54

How is oesophagitis managed?

Answer 54

Acid blockers - omeprazole Coating agent - sucralfate Lower oesophageal sphincter drug - cisapride drug that facilitates gastric emptying - metaclopramide Analgesia (NOT NSAIDs) - paracetamol

Question 55

How should you administer sucralfate? Why?

Answer 55

1 hour before feeding At different time to acid blockers - stops them being absorbed as coats lining