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SAM 2 > Oral and Esophageal Diseases > Flashcards

Oral and Esophageal Diseases Flashcards

1
Q

What structures make up the GI portion of the oral cavity?

A

Teeth, gingiva, tongue, pharyngeal region

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2
Q

What are clinical signs of oral disease?

A
  • Oral discomfort/pain (head shy)
  • Hesitant to eat or drops food
  • Ptyalism
  • Saliva stains around mouth/paws +/- blood
  • Dysphagia (prehension, mastication, or swallowing)
  • Halitosis
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3
Q

What are some physical exam findings of oral disease?

A
  • Facial pain/swelling
  • Inability to close mouth
  • Masses
  • Periodontal disease
  • Systemic evidence of disease

Often find nothing!

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4
Q

What is an important aspect of an oral exam that should never be left out?

A

Looking under the tongue

Typically done by sweeping a finger under the tongue

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5
Q

What are the Ddx’s for oral lesions?

A
  • Metabolic disease
  • Neoplasia
  • Infection (viral)
  • Immune mediated/ inflammatory
  • Trauma
  • Toxin
  • Foreign body
  • Periodontal disease
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6
Q

T/F: Oral papillomatosis is a very malignant neoplasia that must be treated aggressively.

A

False- it’s benign and not really even a neoplasia

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7
Q

What small animal species are oral papillomas most commonly found in?

A

Dogs- transmission via grooming, playing, drooling

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8
Q

What do oral papilomas look like?

A

Cauliflower like growths on mucosal surface of lips, muzzle, and gingiva

Size varies

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9
Q

T/F: Oral papillomatosis is caused by a virus.

A

True

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10
Q

How do you treat oral papillomatosis?

A

Benign neglect

Typically persist for 1-5mo and will go away as the immune system matures

You can resect them if they are interfering with normal functions but it’s not necessary

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11
Q

What are epulides?

A

An odontogenic neoplasm from the periodontal ligament

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12
Q

Are epulides benign or malignant?

A

Benign- do not metastasize

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13
Q

What do epulides look like?

A

On the ginviga near the teeth particularly incisors

Firm and irregular in appearance

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14
Q

What kind of animals typically get epulides?

A

Older dogs, rare in cats

Shetland sheepdogs and old english sheepdogs over represented

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15
Q

What are peripheral odotogenic fibromas?

A

Fibromatus and ossifying epulis
Non-invasive, solitary, may be pedunculated, non-ulcerated
Surgery curative

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16
Q

What are acanthomatous ameloblastoma?

A

Invasive tumors that often cause bone destruction

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17
Q

How are acanthomatous ameloblastomas treated?

A

Large surgical resection including bone may be curative

Radiation treatment may be necessary

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18
Q

What is the most common malignant oral mass in dogs?

A

Malignant melanoma

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19
Q

What is the most common malignant oral mass in cats?

A

Squamous cell carcinoma

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20
Q

What are the characteristics of malignant melanomas?

A

67% pigmented

Metastasis not uncommon (LNs and Lungs)

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21
Q

What are the characteristics of squamous cell carcinomas?

A

Ulcerated and erosive lesions

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22
Q

What do fibrosarcomas look like?

A

Firm and smooth masses +/- nodules

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23
Q

Is the workup for oral neoplasms the same as for any other kind?

A

Yes- blood work, rads, LN assessment etc

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24
Q

What is the general treatment for malignant oral neoplasms?

A
  • Surgical excision
  • Radiation therapy
  • Chemotherapy
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25
Q

What species does eosinophilic granuloma complex occur in?

A

Felines of any age

aka rodent ulcer

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26
Q

What is the suspected etiology of EGC?

A

Hypersensitivity reaction to fleas or other environmental irritants

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27
Q

What are the three EGC presentations?

A

Eosinophilic plaque- not on face
Eosinophilic granuloma- lip or chin swelling
Indolent ulcer- in the mouth

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28
Q

How is EGC diagnosed?

A

Impression smear and biopsy

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29
Q

How do you treat EGC?

A
  • Remove irritating factor
  • Steroids
  • Pain management
  • Tx any infection
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30
Q

What is the prognosis of EGC?

A

Good but recurrence is common

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31
Q

Is oral health and hygiene very very very important?

A

Yes

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32
Q

What is gingivostomatitis?

A

Severe chronic inflammation of gingiva and oral mucosa due to an abnormal immune response to plaque

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33
Q

What species is more prone to gingivostomatitis?

A

Cats

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34
Q

What underlying condition is gingivostomatitis typically associated with?

A

FIV

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35
Q

What are the clinical signs of gingivostomatitis?

A

Oral pain, ptyalism, halitosis, weight loss, dysphagia, head shy, inflamed reddened gums

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36
Q

How is gingivostomatitis diagnoses?

A 
Systemic evaluation (including FIV/FeLV test)
Oral exam + gingival biopsy
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37
Q

How is gingivostomatitis treated?

A

Medical management with oral hygiene control

Prednisolone if it does not respond and full mouth extractions in extreme cases

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38
Q

What are some clinical signs of pharyngeal disease?

A
  • Odynophagia (painful swallowing)
  • Dysphagia
  • Retching, gagging, coughing
  • Ptylasia
  • Head shy (painful)
  • Dyspnea
  • Vocal changes
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39
Q

What are some pharyngeal conditions?

A
  • Foreign body
  • Inflammation or infections
  • Obstruction/compression
  • Masses
  • Neuromuscular disease
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40
Q

What are some physical exam findings of pharyngeal disease?

A
  • Swelling in cervical region
  • Pain
  • Pyrexia
  • Enlarged tonsils/LNs
  • Ptyalism
  • Upper respiratory signs depending on obstruction
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41
Q

What are some advanced imaging options for assessment of pharyngeal diseases?

A

Endosopy- assess caudal pharynx and soft palate
Fluoroscopy- assess function
- CT scan

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42
Q

What are some infections associated with tonsilar disease?

A

Feline herpes and calicivirus

Canine distemper

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43
Q

What are some neoplasms associated with tonsilar disease?

A

SCC, fibrosarcoma, melanoma

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44
Q

T/F: Primary inflammatory disease is very rare in the tonsils.

A

True

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45
Q

What are the findings in an animal with nasopharyngeal polyps?

A

Difficulty swallowing
Upper respiratory signs
Stertor

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46
Q

Where do polyps arise form?

A

Due to an inflammatory response to something (maybe virus?)

From middle ear to penetrate into nasopharynx or eardrum

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47
Q

How do you treat nasopharyngeal polyps?

A

Pharyngeal may be removed with gentle traction

Ear drum- ventral bullae osteotomoy

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48
Q

What is the prognosis of nasophyngeal polyps with surgery?

A

Excellent with resection

Recurrence possible

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49
Q

What is the number 1 salivary gland disorder in dogs?

A

Sialocele- salivary gland mucocele

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50
Q

What is a sialocele?

A

Accumulation of saliva in submucosal or subcutaneous tissues of a salivary gland due to trauma or infection

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51
Q

What are the most common locations for a sialocele to occur?

A

Cervical is most common
Ranula- check under tongue
Pharyngeal and zygomatic are rare

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52
Q

What are the findings of a sialocele?

A

Small to large swelling that may cause respiratory distress
Usually non-painful if chronic
Mobile, soft, flocculant

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53
Q

Where are the parotid, mandibular, and zygomatic glands locatted?

A

Parotid- below ear
Mandibular- angle of the jaw
Zygomatic- caudal to eye (may effect retropulsion of the eye)

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54
Q

How are sialoceles diagnosed?

A

Aspiration of straw to light brown viscous fluid with no bacteria

55
Q

How do you treat a sialocele

A

Take it out!

Prognosis is excellent

56
Q

What is sialadenitis

A

Inflammation of the salivary gland due to trauma or systemic infection

57
Q

T/F: Secondary infections are uncommon with sialadenitis.

A

False- needs more aggressive therapy

58
Q

What are the findings in an animal with sialadenitis?

A

Painful with head carried down
Ptyalism
Fever/lethargy

Mild cases without any infection will self-resolve

59
Q

What is sialoadenosis?

A

Non-infections/neoplastic non-specific inflammation of a salivary gland

60
Q

What is the suspected etiology of sialoadenosis?

A

Neurogenic

61
Q

What are the clinical signs of sialoadenosis?

A

Retching, gulping, gagging, ptyalism, vomiting, anorexia, and pain

62
Q

What is the treatment for sialoadenosis?

A

Phenobarbitol

63
Q

What is the most common complications of pharyngeal trauma?

A

Foreign material lodged in wounds and secondary infections (draining tracts and abscesses)

64
Q

What are clinical signs of pharyngeal trauma?

A

Bloody saliva

Acute- dysphagia and oral pain
Chronic- anorexia, pyrexia, retrobular swelling

May have hx of playing with sticks or trauma

65
Q

How is pharyngeal trauma diagnosed?

A

Radiographs to assess for foreign material/air
Oral exam
Endoscopy
CT if indicated

66
Q

How do we treat pharyngeal trauma?

A

Remove foreign material and surgical repair of tissues if indicated

Antibiotics

67
Q

What is the prognosis of pharyngeal trauma dependent upon?

A

Extent of damage to airway and esophagus

Failed tx may be due to retained foreign bodies or inappropriate therapy

68
Q

What are the three phases of swallowing?

A

Oral- prehend food and form bolus
Pharyngeal- propel bolus along pharynx and opening of UES
Esophageal- bolus moves along esophagus into stomach

69
Q

What are some pathologies that can lead to trouble swallowing?

A

Congenital- cricopharyngeal achalasia, esophageal dysmotility
Neuromuscular- myasthenia gravis
Nervous- brainstem lesion
Myopathis or myositis
Paraneoplasic or neoplastic process
Infectious- very uncommon but can happen (viral usually)

70
Q

What are clinical signs for dysfunction of the oral phase of swallowing?

A

Dropping food and water

71
Q

What are the clinical signs for dysfunction of the pharyngeal phase of swallowing?

A

Retching, cough, gagging, rapid regurgitation, repeated attempts to swallow

72
Q

What are the clinical signs for dysfunction of the esophageal phase of swallowing?

A

Retching, gagging, rapid or delayed regurgitation

73
Q

What are the physical exam findings of a patient with swallowing dysfunction?

A

Neurological assessment- gag reflex
Watch patient drink/eat
Assess pulmonary function
Assess muscle mass on head

74
Q

Why is it important to assess the lungs in patients with swallowing issues?

A

High risk of aspiration pneumonia

75
Q

What test can be done to assess for myasthenia gravis?

A

Acetylcholinesterase antibody titers

76
Q

How do you treat swallowing disorders?

A

Disease specific

Change food/water consistency, elevate dishes, feeding tubes, no neck leads

Must monitor for pneumonia

77
Q

What is cricopharyngeal achalasia/dysphagia?

A

A rare neuromuscular disorder in cocker and springer spaniels

Can be genetic or acquired

78
Q

What are the clinical signs of cricopharyngeal achalasia/dysphagia

A

Repeated attempts to swallow followed by gagging and regurgitation

79
Q

What muscle is affected by cricopharyngeal achalasia/dysphagia?

A

Cricopharyngeal muscle

Involved in swallowing reflex (relaxing)

Achalasia is an inability to relax the muscle and leads to inability to swallow food or liquid

80
Q

Is surgery a viable option for cricopharyngeal achalasia/dysphagia?

A

Helps in 65% of cases

Cricopharyngeal myotomy or cracopharyngeal and thyropharyngeal myectomy

81
Q

What are some signs of failure of surgery for cricopharyngeal achalasia/dysphagia?

A

Lack of improvement, worsening CS, aspiration pneumonia

82
Q

What are some general characteristics of the esophagus?

A
  • Transports ingesta from oral cavity to stomach

- Acts through peristalsis with lubrications from mucus secretions

83
Q

What kind of muscle is found in the esophagus?

A

Dog- striated muscle through entire length

Cat- striated muscle proximal and smooth muscle distal

84
Q

What are the clinical signs associated with esophageal disease?

A

Regurgitation, dysphagia, ptyalism, hard swallowing, weight loss/ravenous appetite, cough or gag

85
Q

What radiograph views should be taken to evaluate esophageal pathology?

A

Full neck and thorax +/- contrast

86
Q

What test can be done to evaluate peristalsis in the esophagus?

A

Fluoroscopy

Also for swallowing ability

87
Q

What are the two regions of the esophagus that should be evaluated for compressive lesions?

A

Intrathoracic and cervical

88
Q

What is the risk of using barium mixed with water to evaluate the esophagus?

A

Aspiration

Not a big deal but will look crazy on rads

89
Q

What is the protocol for aspirating?

A

Antibiotics and monitoring for clearing

Most will recover uneventfully

90
Q

What is endoscopy good for when evaluating the esophagus?

A

Visual inspection for abnormal tissues, strictures, trauma, etc

Can biopsy or balloon

91
Q

T/F: You are unable to see the heart beating on endoscopy of the normal esophagus so if you CAN see it there’s a problem.

A

False- it is normal to see the heart beating

92
Q

What pathology is visible in endoscopy of the esophagus?

A 
Abnormal movement
Obstruction
Inflammation
Mass lesion
Infection
93
Q

What is esophagitis?

A

Inflammation of the esophageal mucosa

94
Q

Can esophagitis lead to motility issues?

A

Yes

95
Q

What can cause esophagitis?

A

Medications, foreign bodies, caustic substances, gastric reflux, GI disease

96
Q

Is esophagitis visible on normal rads?

A

No- may have some mild transient dilation

97
Q

What will you see on endoscopy of an animal with esophagitis?

A

Erythemic edematous mucosa

98
Q

How do you treat esophagitis?

A

Pain management
Surcralfate/carafate
Antacid (omeprazole)

Treat any underlying disease and monitor for strictures

99
Q

What species are esophageal foreign bodies more common in?

A

Dogs

Duh….

100
Q

What are the clinical signs of an esophageal foreign body?

A

Acute retching, gagging, coughing
Mucoid regurgitation
Ptyalism
May be inappetent

101
Q

What is a good diagnostic test to confirm an esophageal foreign body?

A

Radiographs +/- contrast

102
Q

What is the goal of treating an esophageal foreign body?

A

Removal- either per os or via the stomach

103
Q

What are the complications of an esophageal foreign body?

A

Perforation
Stricture
Fistua or diverticula

104
Q

What are esophageal strictures typically secondary to?

A

Trauma, neoplasia, foreign body, anesthesia

105
Q

What are esophageal diverticulae associated with?

A

Impaction or esophagitis

Secondary to trauma or congenital

106
Q

T/F: Esophageal diverticulae very commonly rupture and cause pyothorax.

A

False- very rarely

107
Q

How do you diagnose esophageal diverticulae?

A

Radiogaphs + contrast or fluoroscopy

108
Q

How do you treat esophageal diverticulae?

A

Surgery

Can leave if not clinical

109
Q

What are the different categorization of esophageal dysmotility?

A

Focal vs Diffuse
Mild vs Severe
Transient (congenital) vs acquired

110
Q

What is megaesophagus?

A

Severe generalized dilation of the esophagus with severely decreased or absent peristalsis

111
Q

What is congenital megaesophagus caused by?

A

Abnormal neuromuscular innervation

112
Q

What breeds are predisposed to congenital megaesophagus?

A

Sharpei, fox terrier, german sheperd, labs, danes, irish setter, mini schnauzer, newfie

Siamese cats

Signs will present

113
Q

T/F: Animals effected with congenital megaesophagus will likely always have major issues and quality of life is an issue.

A

False- they may improve over time especially with proper management.

114
Q

What are the causes of acquired megaesophagus?

A

Idiopathic
Brain stem lesion or NM disease (MG)
Possible endocrine (hypothyroid or addisons)
Lead toxicity

115
Q

How do you diagnose megaesophagus?

A

Plain rads

116
Q

What are additional diagnostics you should pursue in cases of megaesophagus

A 
Systemic evaluation
Endocrine testing
Acetylcholine receptor Ab
MRI of head
CT of chest
Fluoroscopy
Lead blood levels- if hx indicates
117
Q

What is the prognosis of megaesophagus?

A

Fair to good with proper/tolerated interventions

Guarded to poor with myasthenia gravis crisis or severe aspiration pneumonia

118
Q

What are some nutritional support strategies for animals with megaesophagus?

A

Elevated food bowls
Variable food consistency
Food thickening agents
Feeding tubes

119
Q

What is the most common vascular ring anomaly in small animals?

A

Persistent right aortic arch

120
Q

What breeds are predisposed to PRAA?

A

Bostons, irish setter, german shepard, persian, siamese

121
Q

What are the clinical signs of PRAA associated megaesophagus?

A

Regurgitation
Unthriftiness (poor hair coat, lean body condition)
Aspiration pneumonia

122
Q

How does PRAA associated megaesophagus differ from diffuse megaesophagus in radiographs?

A

PRAA will present with a “strictured” appearance where the esophagus is trapped in the anomaly

123
Q

T/F: CT is necessary for definitive diagnosis of PRAA.

A

False- but is is useful for surgical planning

124
Q

Is surgery curative for PRAA?

A

Prognosis is good but may not totally resolve regurgitation

125
Q

What is Spirocerca lupi?

A

A parasite that lives in the esophageal/gastric wall causing mass lesions and sarcomas

126
Q

What are the clinical signs of Spirocerca lupi infections?

A

Dysphagia, regurgitation, aortic aneurysms, ptyalism, malnutrition, hypertrophic osteopathy and neoplasia

May be incidental finding at necropsy

127
Q

How is Spirocerca lupi diagnosed?

A

Fecal flotation
Radiographs, CT
Endoscopy
Necropsy

128
Q

T/F: Spirocerca lupi infections are often too advanced to treat once they present.

A

True- euthanasia most often outcome

129
Q

If you are able to treat it, what drugs are used for Spirocerca lupi infections?

A

Doramectin and Ivermectin with prednisolone for 2-6wks

130
Q

What are hiatal hernias?

A

Movement of the abdominal contents through the esophageal hiatus in the diaphragm

131
Q

What are the two types of hiatal hernias?

A

Congenital or Acquired

Type 1- Sliding (intermittent displacement of LES and fundus)
Type 2- Fundic displacement only

132
Q

What breeds are over represented in hiatal hernias?

A

Sharpei, english and french bulldogs

133
Q

How do you diagnose and treat hiatal hernias?

A

Radiographs + contrast (repeated if necessary

Treatment- only if clinical- surger

134
Q

What are the neoplasms seen in the esophagus and how do you treat?

A

SCC, leiomyosarcoma, sarcoma, mets

Surgical removal +/- chemo and RT

Very poor prognosis

SAM 2 (21 decks)

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