Oral and Esophageal Diseases Flashcards
What structures make up the GI portion of the oral cavity?
Teeth, gingiva, tongue, pharyngeal region
What are clinical signs of oral disease?
- Oral discomfort/pain (head shy)
- Hesitant to eat or drops food
- Ptyalism
- Saliva stains around mouth/paws +/- blood
- Dysphagia (prehension, mastication, or swallowing)
- Halitosis
What are some physical exam findings of oral disease?
- Facial pain/swelling
- Inability to close mouth
- Masses
- Periodontal disease
- Systemic evidence of disease
Often find nothing!
What is an important aspect of an oral exam that should never be left out?
Looking under the tongue
Typically done by sweeping a finger under the tongue
What are the Ddx’s for oral lesions?
- Metabolic disease
- Neoplasia
- Infection (viral)
- Immune mediated/ inflammatory
- Trauma
- Toxin
- Foreign body
- Periodontal disease
T/F: Oral papillomatosis is a very malignant neoplasia that must be treated aggressively.
False- it’s benign and not really even a neoplasia
What small animal species are oral papillomas most commonly found in?
Dogs- transmission via grooming, playing, drooling
What do oral papilomas look like?
Cauliflower like growths on mucosal surface of lips, muzzle, and gingiva
Size varies
T/F: Oral papillomatosis is caused by a virus.
True
How do you treat oral papillomatosis?
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
What are epulides?
An odontogenic neoplasm from the periodontal ligament
Are epulides benign or malignant?
Benign- do not metastasize
What do epulides look like?
On the ginviga near the teeth particularly incisors
Firm and irregular in appearance
What kind of animals typically get epulides?
Older dogs, rare in cats
Shetland sheepdogs and old english sheepdogs over represented
What are peripheral odotogenic fibromas?
Fibromatus and ossifying epulis
Non-invasive, solitary, may be pedunculated, non-ulcerated
Surgery curative
What are acanthomatous ameloblastoma?
Invasive tumors that often cause bone destruction
How are acanthomatous ameloblastomas treated?
Large surgical resection including bone may be curative
Radiation treatment may be necessary
What is the most common malignant oral mass in dogs?
Malignant melanoma
What is the most common malignant oral mass in cats?
Squamous cell carcinoma
What are the characteristics of malignant melanomas?
67% pigmented
Metastasis not uncommon (LNs and Lungs)
What are the characteristics of squamous cell carcinomas?
Ulcerated and erosive lesions
What do fibrosarcomas look like?
Firm and smooth masses +/- nodules
Is the workup for oral neoplasms the same as for any other kind?
Yes- blood work, rads, LN assessment etc
What is the general treatment for malignant oral neoplasms?
- Surgical excision
- Radiation therapy
- Chemotherapy
What species does eosinophilic granuloma complex occur in?
Felines of any age
aka rodent ulcer
What is the suspected etiology of EGC?
Hypersensitivity reaction to fleas or other environmental irritants
What are the three EGC presentations?
Eosinophilic plaque- not on face
Eosinophilic granuloma- lip or chin swelling
Indolent ulcer- in the mouth
How is EGC diagnosed?
Impression smear and biopsy
How do you treat EGC?
- Remove irritating factor
- Steroids
- Pain management
- Tx any infection
What is the prognosis of EGC?
Good but recurrence is common
Is oral health and hygiene very very very important?
Yes
What is gingivostomatitis?
Severe chronic inflammation of gingiva and oral mucosa due to an abnormal immune response to plaque
What species is more prone to gingivostomatitis?
Cats
What underlying condition is gingivostomatitis typically associated with?
FIV
What are the clinical signs of gingivostomatitis?
Oral pain, ptyalism, halitosis, weight loss, dysphagia, head shy, inflamed reddened gums
How is gingivostomatitis diagnoses?
Systemic evaluation (including FIV/FeLV test) Oral exam + gingival biopsy
How is gingivostomatitis treated?
Medical management with oral hygiene control
Prednisolone if it does not respond and full mouth extractions in extreme cases
What are some clinical signs of pharyngeal disease?
- Odynophagia (painful swallowing)
- Dysphagia
- Retching, gagging, coughing
- Ptylasia
- Head shy (painful)
- Dyspnea
- Vocal changes
What are some pharyngeal conditions?
- Foreign body
- Inflammation or infections
- Obstruction/compression
- Masses
- Neuromuscular disease
What are some physical exam findings of pharyngeal disease?
- Swelling in cervical region
- Pain
- Pyrexia
- Enlarged tonsils/LNs
- Ptyalism
- Upper respiratory signs depending on obstruction
What are some advanced imaging options for assessment of pharyngeal diseases?
Endosopy- assess caudal pharynx and soft palate
Fluoroscopy- assess function
- CT scan
What are some infections associated with tonsilar disease?
Feline herpes and calicivirus
Canine distemper
What are some neoplasms associated with tonsilar disease?
SCC, fibrosarcoma, melanoma
T/F: Primary inflammatory disease is very rare in the tonsils.
True
What are the findings in an animal with nasopharyngeal polyps?
Difficulty swallowing
Upper respiratory signs
Stertor
Where do polyps arise form?
Due to an inflammatory response to something (maybe virus?)
From middle ear to penetrate into nasopharynx or eardrum
How do you treat nasopharyngeal polyps?
Pharyngeal may be removed with gentle traction
Ear drum- ventral bullae osteotomoy
What is the prognosis of nasophyngeal polyps with surgery?
Excellent with resection
Recurrence possible
What is the number 1 salivary gland disorder in dogs?
Sialocele- salivary gland mucocele
What is a sialocele?
Accumulation of saliva in submucosal or subcutaneous tissues of a salivary gland due to trauma or infection
What are the most common locations for a sialocele to occur?
Cervical is most common
Ranula- check under tongue
Pharyngeal and zygomatic are rare
What are the findings of a sialocele?
Small to large swelling that may cause respiratory distress
Usually non-painful if chronic
Mobile, soft, flocculant
Where are the parotid, mandibular, and zygomatic glands locatted?
Parotid- below ear
Mandibular- angle of the jaw
Zygomatic- caudal to eye (may effect retropulsion of the eye)
How are sialoceles diagnosed?
Aspiration of straw to light brown viscous fluid with no bacteria
How do you treat a sialocele
Take it out!
Prognosis is excellent
What is sialadenitis
Inflammation of the salivary gland due to trauma or systemic infection
T/F: Secondary infections are uncommon with sialadenitis.
False- needs more aggressive therapy
What are the findings in an animal with sialadenitis?
Painful with head carried down
Ptyalism
Fever/lethargy
Mild cases without any infection will self-resolve
What is sialoadenosis?
Non-infections/neoplastic non-specific inflammation of a salivary gland
What is the suspected etiology of sialoadenosis?
Neurogenic
What are the clinical signs of sialoadenosis?
Retching, gulping, gagging, ptyalism, vomiting, anorexia, and pain
What is the treatment for sialoadenosis?
Phenobarbitol
What is the most common complications of pharyngeal trauma?
Foreign material lodged in wounds and secondary infections (draining tracts and abscesses)
What are clinical signs of pharyngeal trauma?
Bloody saliva
Acute- dysphagia and oral pain
Chronic- anorexia, pyrexia, retrobular swelling
May have hx of playing with sticks or trauma
How is pharyngeal trauma diagnosed?
Radiographs to assess for foreign material/air
Oral exam
Endoscopy
CT if indicated
How do we treat pharyngeal trauma?
Remove foreign material and surgical repair of tissues if indicated
Antibiotics
What is the prognosis of pharyngeal trauma dependent upon?
Extent of damage to airway and esophagus
Failed tx may be due to retained foreign bodies or inappropriate therapy
What are the three phases of swallowing?
Oral- prehend food and form bolus
Pharyngeal- propel bolus along pharynx and opening of UES
Esophageal- bolus moves along esophagus into stomach
What are some pathologies that can lead to trouble swallowing?
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)
What are clinical signs for dysfunction of the oral phase of swallowing?
Dropping food and water
What are the clinical signs for dysfunction of the pharyngeal phase of swallowing?
Retching, cough, gagging, rapid regurgitation, repeated attempts to swallow
What are the clinical signs for dysfunction of the esophageal phase of swallowing?
Retching, gagging, rapid or delayed regurgitation
What are the physical exam findings of a patient with swallowing dysfunction?
Neurological assessment- gag reflex
Watch patient drink/eat
Assess pulmonary function
Assess muscle mass on head
Why is it important to assess the lungs in patients with swallowing issues?
High risk of aspiration pneumonia
What test can be done to assess for myasthenia gravis?
Acetylcholinesterase antibody titers
How do you treat swallowing disorders?
Disease specific
Change food/water consistency, elevate dishes, feeding tubes, no neck leads
Must monitor for pneumonia
What is cricopharyngeal achalasia/dysphagia?
A rare neuromuscular disorder in cocker and springer spaniels
Can be genetic or acquired
What are the clinical signs of cricopharyngeal achalasia/dysphagia
Repeated attempts to swallow followed by gagging and regurgitation
What muscle is affected by cricopharyngeal achalasia/dysphagia?
Cricopharyngeal muscle
Involved in swallowing reflex (relaxing)
Achalasia is an inability to relax the muscle and leads to inability to swallow food or liquid
Is surgery a viable option for cricopharyngeal achalasia/dysphagia?
Helps in 65% of cases
Cricopharyngeal myotomy or cracopharyngeal and thyropharyngeal myectomy
What are some signs of failure of surgery for cricopharyngeal achalasia/dysphagia?
Lack of improvement, worsening CS, aspiration pneumonia
What are some general characteristics of the esophagus?
- Transports ingesta from oral cavity to stomach
- Acts through peristalsis with lubrications from mucus secretions
What kind of muscle is found in the esophagus?
Dog- striated muscle through entire length
Cat- striated muscle proximal and smooth muscle distal
What are the clinical signs associated with esophageal disease?
Regurgitation, dysphagia, ptyalism, hard swallowing, weight loss/ravenous appetite, cough or gag
What radiograph views should be taken to evaluate esophageal pathology?
Full neck and thorax +/- contrast
What test can be done to evaluate peristalsis in the esophagus?
Fluoroscopy
Also for swallowing ability
What are the two regions of the esophagus that should be evaluated for compressive lesions?
Intrathoracic and cervical
What is the risk of using barium mixed with water to evaluate the esophagus?
Aspiration
Not a big deal but will look crazy on rads
What is the protocol for aspirating?
Antibiotics and monitoring for clearing
Most will recover uneventfully
What is endoscopy good for when evaluating the esophagus?
Visual inspection for abnormal tissues, strictures, trauma, etc
Can biopsy or balloon
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.
False- it is normal to see the heart beating
What pathology is visible in endoscopy of the esophagus?
Abnormal movement Obstruction Inflammation Mass lesion Infection
What is esophagitis?
Inflammation of the esophageal mucosa
Can esophagitis lead to motility issues?
Yes
What can cause esophagitis?
Medications, foreign bodies, caustic substances, gastric reflux, GI disease
Is esophagitis visible on normal rads?
No- may have some mild transient dilation
What will you see on endoscopy of an animal with esophagitis?
Erythemic edematous mucosa
How do you treat esophagitis?
Pain management
Surcralfate/carafate
Antacid (omeprazole)
Treat any underlying disease and monitor for strictures
What species are esophageal foreign bodies more common in?
Dogs
Duh….
What are the clinical signs of an esophageal foreign body?
Acute retching, gagging, coughing
Mucoid regurgitation
Ptyalism
May be inappetent
What is a good diagnostic test to confirm an esophageal foreign body?
Radiographs +/- contrast
What is the goal of treating an esophageal foreign body?
Removal- either per os or via the stomach
What are the complications of an esophageal foreign body?
Perforation
Stricture
Fistua or diverticula
What are esophageal strictures typically secondary to?
Trauma, neoplasia, foreign body, anesthesia
What are esophageal diverticulae associated with?
Impaction or esophagitis
Secondary to trauma or congenital
T/F: Esophageal diverticulae very commonly rupture and cause pyothorax.
False- very rarely
How do you diagnose esophageal diverticulae?
Radiogaphs + contrast or fluoroscopy
How do you treat esophageal diverticulae?
Surgery
Can leave if not clinical
What are the different categorization of esophageal dysmotility?
Focal vs Diffuse
Mild vs Severe
Transient (congenital) vs acquired
What is megaesophagus?
Severe generalized dilation of the esophagus with severely decreased or absent peristalsis
What is congenital megaesophagus caused by?
Abnormal neuromuscular innervation
What breeds are predisposed to congenital megaesophagus?
Sharpei, fox terrier, german sheperd, labs, danes, irish setter, mini schnauzer, newfie
Siamese cats
Signs will present
T/F: Animals effected with congenital megaesophagus will likely always have major issues and quality of life is an issue.
False- they may improve over time especially with proper management.
What are the causes of acquired megaesophagus?
Idiopathic
Brain stem lesion or NM disease (MG)
Possible endocrine (hypothyroid or addisons)
Lead toxicity
How do you diagnose megaesophagus?
Plain rads
What are additional diagnostics you should pursue in cases of megaesophagus
Systemic evaluation Endocrine testing Acetylcholine receptor Ab MRI of head CT of chest Fluoroscopy Lead blood levels- if hx indicates
What is the prognosis of megaesophagus?
Fair to good with proper/tolerated interventions
Guarded to poor with myasthenia gravis crisis or severe aspiration pneumonia
What are some nutritional support strategies for animals with megaesophagus?
Elevated food bowls
Variable food consistency
Food thickening agents
Feeding tubes
What is the most common vascular ring anomaly in small animals?
Persistent right aortic arch
What breeds are predisposed to PRAA?
Bostons, irish setter, german shepard, persian, siamese
What are the clinical signs of PRAA associated megaesophagus?
Regurgitation
Unthriftiness (poor hair coat, lean body condition)
Aspiration pneumonia
How does PRAA associated megaesophagus differ from diffuse megaesophagus in radiographs?
PRAA will present with a “strictured” appearance where the esophagus is trapped in the anomaly
T/F: CT is necessary for definitive diagnosis of PRAA.
False- but is is useful for surgical planning
Is surgery curative for PRAA?
Prognosis is good but may not totally resolve regurgitation
What is Spirocerca lupi?
A parasite that lives in the esophageal/gastric wall causing mass lesions and sarcomas
What are the clinical signs of Spirocerca lupi infections?
Dysphagia, regurgitation, aortic aneurysms, ptyalism, malnutrition, hypertrophic osteopathy and neoplasia
May be incidental finding at necropsy
How is Spirocerca lupi diagnosed?
Fecal flotation
Radiographs, CT
Endoscopy
Necropsy
T/F: Spirocerca lupi infections are often too advanced to treat once they present.
True- euthanasia most often outcome
If you are able to treat it, what drugs are used for Spirocerca lupi infections?
Doramectin and Ivermectin with prednisolone for 2-6wks
What are hiatal hernias?
Movement of the abdominal contents through the esophageal hiatus in the diaphragm
What are the two types of hiatal hernias?
Congenital or Acquired
Type 1- Sliding (intermittent displacement of LES and fundus)
Type 2- Fundic displacement only
What breeds are over represented in hiatal hernias?
Sharpei, english and french bulldogs
How do you diagnose and treat hiatal hernias?
Radiographs + contrast (repeated if necessary
Treatment- only if clinical- surger
What are the neoplasms seen in the esophagus and how do you treat?
SCC, leiomyosarcoma, sarcoma, mets
Surgical removal +/- chemo and RT
Very poor prognosis
