Oral & Esophageal Dz Flashcards
1
Q
What’s the fancy doctor word for hypersalivation?
A
Ptyalism
2
Q
What is the name of the little bump in the mouth that communicates with the vomeronasal organ and is part of olfactory senses in both the dog and cat?
A
Incisive papilla. NOT a tumor!!
3
Q
T/F The molar salivary gland is found in cats.
A
True. It isn’t a tumor!! It’s just salivary tissue.
4
Q
What are some of the clinical signs of oral cavity or esophageal disease?
A
oral discomfort (head shy), hesitant to eat or drops food, ptyalism and saliva stains around mouth, on paws +/-
5
Q
How are benign oral masses aka Canine Oral Papillomatosis transmitted?
A
Transmission via saliva, grooming, playing with 1-2 months incubation
6
Q
What veggie do benign oral masses resemble?!
A
Cauliflower. Mucosal surface- pale, smooth growths at first then rough and irregular with fronds. “Fronds.”
7
Q
Which of the following is FALSE with regards to Canine Oral Papillomatosis?
Will go away as dog’s immune system matures
The growths spontaneously resolve after about 1-5 months
Some growths will persist
Shrivel and turn grey with regression
Commonly affects older dogs
A
Commonly affects older dogs.
It commonly affects YOUNGER dogs!
8
Q
Where do Epulides aka odontogenic neoplasm originate from?
A
from periodontal ligament; mostly seen in dogs
9
Q
Do Epulides metastasize?
A
No! They are benign and do not metastasize
10
Q
Where can we expect to see Epulides?
A
Can expect to see Epulides on gingiva, near the teeth- in particular the incisor and they’re firm and irregular
11
Q
Are Epulides more commonly seen in dogs or cats?
A
Dogs! Especially older dogs and can be found in any breed
12
Q
What are some notable features about fibromatous & ossifying epulis?
A
They’re noninvasive, solitary, +/- pedunculated, non ulcerative and sx is curative
13
Q
Are acanthomatous ameloblastoma invasive?
A
yup! They are invasive +/- bone destruction. Often needs large resection including bone to be curative. +/- radiation therapy
14
Q
What is the #1 malignant neoplasia in DOGS?
A
The #1 is malignant melanoma: 2/3 pigmented and 1/3 unpigmented. Frequently metastasizes to LNs and lungs
15
Q
What is the #1 malignant neoplasia in CATS?
A
SCC- #1 in Cats and #2 in Dogs
Ulcerative, erosive lesions
16
Q
How will fibrosarcomas appear?
A
Firm and smooth +/- nodules
17
Q
What diagnostic testing do you perform for regional LN assessment?
A
cytology
18
Q
What diagnostic testing do you perform when staging the lungs?
A
x rays or CT; CT best
19
Q
Eosinophilic Granuloma Complex (EGC) is also known as what?
A
Rodent Ulcer!
20
Q
What is the suspected underlying cause of EGC?
A
Suspected hypersensitivity rxn. Fleas/other insects/ environment/ diet
21
Q
EGCs can occur together or separately & range in size. Where can you find eosinophilic plaques, eosinophilic granuloma and indolent ulcers?
A
Eosinophilic plaque: not on face
Eosinophilic granuloma: lip or chin swelling
Indolent ulcer: ulcers of mouth
22
Q
What are the 5 ways we can tx EGCs?
A
- food trial
- steroid: tapering course pending response (warning: Dexamethosone shot is not advised bc it’s a long acting steroid)
- flea control
- pain management
- tx secondary infection
23
Q
T/F Once ECGs are treated, you will never have to worry about them again.
A
False! Prognosis is super good but recurrence is common.
24
Q
What is the condition associated with an abnormal immune response to plaque on the teeth?
A
Gingivostomatitis: severe chronic inflammation of gingiva and oral mucosa
25
Are we more likely to see gingivostomatitis in dogs or cats?
CATS!
26
Can be associated with FIV, SEVERE oral pain, ptyalism +/- blood, halitosis, weight loss (bc hungry but hurts to eat), dysphagia and head shy are all clinical signs associated with what?
Gingivostomatitis!
27
All of the following are diagnostic methods for Gingivostomatitis but which one is needed to confirm the diagnosis?
MDB (CBC, Chem, UA)
FELV/FIV assessment
Oral exam
Gingival biopsy
Gingival biopsy! Often at time of dental cleaning and is needed to confirm dx
28
What is the tx protocol for Gingivostomatitis?
medical management w oral hygiene control: routine periodontal treatments, brushing, immune modification medications such as prednisone or other immune modification meds
full mouth extractions +/- medications after
29
T/F Pharyngeal dz includes problems associated with the tonsils and salivary glands.
True!
30
Pharyngeal dz includes masses (nasopharyngeal polyp-malignant) and dysfxn i.e. neuromuscular dz). What are the clinical signs associated with pharyngeal dz?
```
odynophagia- painful swallowing
dysphagia
retching, gagging, coughing
ptyalism-frequently blood stained
head shy-pain
dyspnea
****voice change!- meow or bark!!*** This is the BIG change!
```
31
With regards to the physical exam for pharyngeal dz, it's important to check for swelling in the cervical area, enlarged LNs and tonsils, ptyalism, upper respiratory signs, pyrexia but what else should we do ?
Watch your patient eat and drink! Are they not drinking because it's painful or are they not drinking because they can't swallow etc
32
When doing radiographs with a patient with suspected pharyngeal dz, what are we looking for?
assess cervical neck and chest for compressions or obstructive lesions; also look for foreign body
33
What is done when a sedated oral exam is given to an animal with suspected pharyngeal dz?
- culture and biopsy of tissue if abnormal
- removal of polyp if present
- FNA and cytology of lesions
34
If nothing is seen on oral exam or history and we're assessing for pharyngeal dz then what other procedures can we perform?
endoscopy: assess caudal pharynx and soft palate
fluoroscopy: assess fxn
CT scan of head, neck, pharynx, cervical region, chest
35
What infectious organisms are frequently seen with tonsilar dz?
- associated w URI organisms -especially viral
- Feline Herpes, Calicivirus
- Canine Distemper
36
What neoplasms are frequently seen with tonsilar dz?
SCC, fibrosarcoma, melanoma
37
Difficulty swallowing, upper respiratory signs and nasal discharge, stertor "snoring sound" are all clinical signs associated with what?
Nasopharyngeal polyp
38
All of the following describe what?
Inflammatory response- possibly from viral organisms, arises from middle ear and penetrates into nasopharynx OR penetrates eardrum.
Polyps!
39
How do we tx polyps?
Gentle traction removal for nasopharyngeal polyps!
Ventral bullae osteotomy
Excellent prognosis with removal !
Possible recurrence
40
What is the #1 salivary gland disorder in dogs?
Sialocele 'salivary mucocele'
41
Accumulation of saliva in submucosal or subcutaneous tissue caused by trauma or inflammation is the definition of:
Sialocele
42
What is the #1 location for Sialoceles?
cervical = #1
ranula (under tongue)
pharyngeal & zygomatic= rare
43
What are the clinical signs associated with sialoceles?
small to large swelling +/- respiratory distress, usually NON-painful with chronicity, mobile, soft, flocculent
44
What are the common swelling locations found with sialoceles?
parotid: below ear
mandibular: angle of jaw
zygomatic caudal to eye +/- retrobulbar swelling
45
What is the diagnosis and management of sialoceles?
```
aspirate for cytology and culture!
-straw to light brown colored
-viscous, NON-odiferous fluid
-no bacteria +/- if drained before
CT pending involvement
-
```
46
T/F sialoceles clear up on their own.
False! We treat by doing surgical removal WITH BIOPSY!!
| Excellent prognosis!
47
Inflammation of the salivary gland due to trauma or systemic infection is the definition of what?
Sialadenitis
48
Secondary infection not uncommon (needs more aggressive therapy), painful so carrying head down, ptyalism, fever, lethargy, mild cases without infection are self resolved are all clinical signs associated with what?
Sialadenitis
49
T/F Pharyngeal problems are frequently caused by trauma.
True!
Penetrating stick OR other cause wound which results in secondary infection
-remaining splinters or piece of foreign material cause further problems
-draining tracts
50
Blood saliva; acute: dysphagia and oral pain +/- upper respiratory distres; chronic: anorexia, pyrexia, retrobulbar swelling, history of playing w sticks are all part of the clinical signs/history associated with what?
Pharyngeal trauma
51
How do we diagnose pharyngeal trauma?
Rads (+/- ID foreign material and assess emphysema- free gas); oral exam; endoscopy; explore all draining tracts; CT
52
What situation gives us the best prognosis for pharyngeal trauma?
if airway or esophagus is not injured and if it was an ACUTE case
53
Doing what results in failed treatment of pharyngeal trauma?
Retained or migrating FB, too short duration of antibiotics, permanent damage to oral or pharyngeal structures
54
Regarding the swallowing phases, what CN are responsible for oral?
CN 5, 7 and 12: prehend food and form bolus which moves to end of tongue
55
Regarding the swallowing phases, what CN are responsible for pharyngeal?
CN 9 and 11: propel bolus along pharynx; closure of the larynx by epiglottis and inhibition of breathing; UES sphincter opens (cricopharyngeal m)
56
Regarding the swallowing phases, what CN are responsible for esophageal?
CN 9 and 10 AND SNS: bolus moves along into stomach
57
The following pathologies are associated with what?
congenital: Cricopharyngeal achalasia; Esophageal dysmotility (can outgrow)
Neuromuscular dz: Myasthenia gravis
Nervous system: brainstem lesion
Myopathy/Myositis
Paraneoplastic or neoplastic
Infectious: uncommon but consider viral such as Distemper and rabies
Spirocerca lupi
Dysphagia
58
Why is it important to attempt to localize clinical signs in dysphagia?
Because a lot of the clinical signs can overlap such as ptyalism
59
The following clinical signs are associated with what?
Oral: dropping food and water; difficult to pick up: this is why it's important to watch patient eat and drink!!
Pharyngeal: retch, cough, gag, food expelled rapidly after attempting to swallow, repeated attempts to swallow
Esophageal: retch, gag, expel food quickly after eating or some time later
Dysphagia
60
What are some key features to look out for when assessing for dysphagia ?
Physical exam:
- neurologic assessment: assess GAG reflex
- watch patient eat and drink
- assess pulmonary status (aspiration pneumonia)
- thin muscling of head (if associated w muscle wasting from MMM)
- systemic manifestation of malnutrition
61
How do we diagnose dysphagia?
Basically the same as everything else: systemic eval (CBC, Chem, UA), rads, fluoroscopy, *Acetylcholinesterase antibody titer*, endoscopy of esophagus, MRI for brain stem
62
What are some tx methods for dysphagia?
Disease specific!
Food and water consistency: slurry vs meatball vs solid food; *elevate dishes!*, feeding tubes, monitor for pneumonia, *no neck leads! use harnesses!*
63
Cricopharyngeal Achalasia/Dysphagia is a rare genetic disorder in dogs. What species does it affect the most?
Cocker and Springer Spaniels
64
How is Cricopharyngeal Dysphagia acquired?
Acquired in adults associated with NM disorders
65
Repeated attempting to swallow, followed by gag and regurgitation are clinical signs for what?
Cricopharyngeal Dysphagia
66
The dysfxn of what muscle that is involved in the swallowing reflex leads to the following:
- inability to relax muscle leads to inability to swallow food or liquid
- prevents propulsion of food bolus from caudal pharynx into esophagus
Cricopharyngeal muscle
67
What imaging should be done for Cricopharyngeal Dysphagia?
fluoroscopy to evaluate: contrast (Barium!); Barium and food and see retention of barium in posterior pharynx
Rads: assess for aspiration pneumonia
68
Is surgery indicated for Cricopharyngeal Dysphagia?
Yes! Sx is Cricopharyngeal Myotomy or Cricopharyngeal and Thyropharyngeal Myectomy
65% success rate
failure= lack of improvement, worsening or aspiration pneumonia
Pets w underlying NM disorders: treat underlying dz
69
Which of the following is false with regards to the physiology of the esophagus
Esophagus transports food and liquid from oral cavity to the stomach
Coordinated contraction of muscular lining- peristalsis
Mucoid secretions
Striated muscle for the entire length in dogs and cats
Striated muscle for the entire length is ONLY in DOGS
Distal smooth muscle in CATS
70
Along with regurgitation, dysphagia, ptyalism, hard swallowing, cough/gag and respiratory signs associated with aspiration pneumonia, there's one clinical sign that can be a big tip off because it isn't found in a lot of the other diseases we've discussed before. What is it?
Weight loss +/- ravenous appetite!!
71
What are we looking for when we perform radiographs for esophageal dz?
Rads: of NECK and THORAX +/- contrast
- distended gas filled esophagus vs. nothing there
- evaluation for pneumonia
- evaluation for INTRATHORACIC OR CERVICAL compressive lesions
- FB
72
What contrast mediums do we use when performing radiographs on esophageal dz?
1. Barium mixed w water or food +/- syringe but perform w care!! aspiration!
2. Iohexol
73
How should we treat an animal with esophageal dz that starts to aspirate?
cover w antibiotics, monitor and most do well
74
What are we checking for when performing fluoroscopy on esophageal dz?
- evaluate peristalsis and swallowing
| - no to minimal sedation
75
What is our protocol when performing endoscopy +/- biopsy on esophageal dz?
- general anesthesia
- flexible scope
- unless very abnormal tissue- no biopsy
- balloon stricture if seen
- biopsy if max
- FB removal
76
What are some key things we will note when performing an esophageal endoscopy?
- easily pass upper esophageal sphincter
- closed cardia at distal end
- can see heart beating intrathoracic -freaky
77
Esophagitis can happen after what?!
After anesthesia!
78
Inflammation of the esophageal mucosa- can affect motility is the definition of ?
Esophagitis
79
Along with medications, esophagitis can develop secondary to what?
FB's, caustic toxins, GI reflux from GA or GI dz
80
Which can tell us more when looking for esophagitis: Rads or Endoscopy?
Endoscopy! Rads are unremarkable or transient dilation; whereas, endoscopy shows erythemic +/-edematous mucosa
81
What is the tx protocol for Esophagitis?
Pain management: Buprenorphine, Tramadol, Fentanyl patch
Sucralfate/Carafate: 250 -1 g PO as slurry Q 6-8 hrs
Antacid --> PPI
Omeprazole 0.7= 1.0 mg/kg PO BID
Monitor for strictures
82
Esophageal FB's are more commonly see in the dog or cat?
Dog. Obvi.
83
The following clinical signs are associated with what?
| Acute retching, gagging, coughing, *mucoid regurgitation*, ptyalism, +/- inappetence
Esophogeal FB
84
T/F When looking for an esophageal FB, make sure you do GA prior to QATS (PCV/ TS; BG; AZO).
False! Other way around . . . at least do QATS prior to GA.
Alsoooo, thoracic rads can be tricky
85
What is our goal for esophageal FB?
remove per OS
86
What are the risks associated with esophageal FB?
perforation --> effusion, pyothorax, sx
stricture
fistulae or diverticulae
87
What drugs should we NOT use if esophageal FB get pushed into the stomach?
```
NO H2 blockers!
+/- Sucralfate
+/- pain management
feed small frequent meals
monitor for stricture and esophagitis signs
```
88
How do we treat esophageal strictures?
Balloon dilatation- may need repetitive procedures
89
The following are associated with what?
- small lesions that do not cause overt clinical signs
- larger lesions associated with impactions, esophagitis, rarely rupture and pyothorax
- dx w rads w contrast or fluoroscopy w contrast
- second to trauma or congenital
- tx: sx
Esophageal Diverticulae
90
The following describes what condition:
- dilation of esophagus (okay, my bad, sorta gives it away)
- severely decreased or absent peristalsis of esophagus
- severe, generalization dilation
Megaesophagus!
91
Congenital megaesophagus is d/t abnormal NM innervation and affects what breeds and what ages the most?
92
T/F Congenital megaesophagus can improve w time.
True
93
What are some ways that an animal can acquire megaesophagus?
Idiopathic
Primary CNS- brainstem lesion OR NM dz (MG)
Possible endocrine (Hypothyroid, Addison's)
Lead toxicity
94
How do we tx esophageal dilatation?
treat underlying dz
nutritional support
decrease risk of aspiration pneumonia and treat
feeding tubes
95
What is the prognosis for esophageal dilatation?
Fair to good when tolerated interventions and feeding tubes. Bailey chairs!
Guarded to poor: fulminant MG crisis
-Severe aspiration pneumonia
96
Vascular ring anomaly is a developmental anomaly. The abnormal vessel entraps the thoracic esophagus. What is the most common one?
#1 = persistent right aortic arch
DOGS> CATS
Breeds: Boston and Irish Setter, GS, Persian, Siamese
97
The following clinical signs are associated with what?
Regurgitation, *unthriftiness: poor hair coat and cody condition*
Vascular ring anomaly
98
How do we diagnose vascular ring anomaly?
Rads +/- contrast, fluoroscopy, CT helpful for sx planning
99
How do we tx vascular ring anomaly?
Surgery- the sooner the better!
100
Where can we expect to find Spirocerca lupi?
Cystic nodules (larva) in esophageal wall - also gastric wall and aorta.
Fistula to lumen allows eggs to pass into alimentary tract
NO fistula= no eggs= cannot detect in fecal eval!!
Cyst --> granuloma --> sarcoma with mets
- not always, more in Hounds
- can be incidental finding at necropsy
101
Where is S. lupi prevalent?
Southern US; tropical and subtropical regions (Greece, India, Japan, SA, Israel)
102
The following clinical signs are associated with what?
Dysphagia, Regurg, *aortic aneurysms (fatal bleeds), ptyalism, *malnutrition*, *hypertropic osteopathy (exostosis btwn thoracic vertebrae associated w neoplasia)*
S. lupi
103
How do we diagnose S. lupi?
```
fecal float
rads: dense masses in esophagus
CT
endoscopy
necropsy
```
104
How do we tx S. lupi?
- keep dogs from eating things
- monthly preventatives in endemic regions (moxidectin/imidacloprod in Europe)
- often too advanced to tx :(
Meds:
Doramectin every 2 wks for 6 wks then monthly until granuloma resolves
Ivermectin 2 doses 2 wks apart combined w prednisOLONE
105
Movement of abdominal contents through esophageal hiatus in diaphragm is the definition of what?
Hiatal hernia
106
Sliding -intermittent displacement of LES and gastric fundus into thorax describes type I or type II hiatal hernia
type I hiatal hernia
107
Gastric fundus displacement only describes type I or type II of hiatal hernia
type II hiatal hernia
108
What breeds are predisposed to hiatal hernias?
SharPei, Bull dogs- english & french
109
How do we dx and tx hiatal hernias?
rads +/- contrast +/- fluoroscopy
repeat if not seen at first!!
tx: esophagitis; sx- need sx for these guys!
110
Is it common or rare to find neoplasia in the esophagus.
Rare to find neoplasia in esophagus.
111
What cancers would we see in the esophagus?
SCC, leiomycosarcoma, sarcoma
Mets from thyroid cancer, mammary cancer, and lymphoma
112
Is RT (radiation therapy) suggested for esophageal cancer?
No, d/t associated organ damage. Sx removal +/- chemo
Palliative care
Poor prognosis
