SAM 2 TEST 2- intro + esophagus Flashcards
dysphagia
difficulty swallowing and or chewing
ptyalism
excessive production of saliva, hypersalivation
regurigatation
passive explosion of material from pharynx or esophagus
vomiting
forceful explosion of stomach contents through the mouth
hematemesis
blood in vomitus
borborygmi
bowel sounds
diarrhea
steatorrhea
tenesmus
straining to defecate
hematochezia
frank blood in or around stool
obstipation
severe or complete (inability to pass stools) constipation
dyschezia
painful defecation
Canine Oral Papillomatosis
Papillomavirus in dogs
Transmission via saliva, grooming, playing1-2 month’s incubation Mucosal surface – pale, smooth growths at first then rough and irregular
with fronds “Cauliflower Like”
Will go away as pup’s immune system matures
EPULIDES
EPULIDES – ODONTOGENIC NEOPLASM
From periodontal ligament – seen mostly in dogs BENIGN – do not metastasize
On gingiva, near teeth, especially incisor
Firm & Irregular
+/- symptomatic
Older Dogs, rarely cats
Breed: ANY, Shetland Sheepdogs, Old English Sheepdogs
Peripheral Odontogenic Fibromaa
(Fibromatous & Ossifying Epulis)
Non invasive, solitary, +/- pedunculated, non ulcerated Surgery Curative
Acanthomatous Ameloblastoma
Invasive +/- bone destruction Often needs large resection including bone to be curative +/- RT
What is the number one oral maligant neoplasm in the dog?
Maligant melanoma - #1 in DOG 2/3 pigmented
1/3 unpigmented
Metastasis not uncommon – LNs, Lung
What is the number one malignant oral neoplasm in the cat?
Squamous cell carcinoma - #1 in Cat, #2 in Dog Ulcerated, erosive lesions
EOSINOPHILIC GRANULOMA COMPLEX
Feline – any age
‘Rodent Ulcer’
Suspect hypersensitivity reaction Fleas/other insects, environment, diet
Can occur together or separately & range in size Eosinophilic Plaque – not on face Eosinophilic Granuloma – lip or chin swelling Indolent Ulcer – ulcers of mouth
What’s the treatment for eosinophilic granuloma complex?
What about the prognosis?
Minimum data base i.e. CBC, Chemistry, UA Evaluate lesions for infection
Impression smear and biopsy
Tx can include:
Food trial
Steroid – tapering course pending response Flea control
Pain management
Treat secondary infection
Prognosis is good Recurrence is common
GINGIVOSTOMATITIS
Severe chronic inflammation of gingiva and oral mucosa FELINE > CANINE
Abnormal immune response to plaque
Starts around a tooth; extends
Can be associated with: FIV
What’s the treatment for gingivostomatitis?
Medical management with oral hygiene control
Routine periodontal treatments
Brushing
Immune mod medications such as prednisone or other immune mod meds
_* Full mouth extractions * +/- medications after_
PHARYNGEAL DISEASE
Foreign Body
Inflammation or Infection
Primary or secondary to neoplasia or foreign body Abscess
Obstruction/Compression Salivary Gland disease
Neoplasia (i.e. salivary, thyroid, tonsilar) Lymphadenopathy
Odynophagia
painful swallowing
What is one of the key things about pharyngeal disease?
Voice change
If nothing seen on oral exam OR history lead you elsewhere …
Endoscopy: Assess caudal pharynx and soft palate Fluoroscopy: Assess function
CT scan of head, pharynx, cervical region, chest
Difficulty swallowing
Upper respiratory signs Nasal discharge
Stertor = ‘snore sound’
NASOPHARYNGEAL POLYP
If you are worried about polyps, what should you do?
SEDATED EAR EXAM
Inflammatory response – possibly to viral organisms Arises from middle ear
Penetrates into nasopharunx OR
Penetrates eardrum
What is the treatment for a nasopolyp?
GENTLE TRACTION removal for Nasopharyngeal
https://www.youtube.com/watch?v=VKz7pF4IkAI
Ventral Bullae Osteotomy Excellent prognosis with removal Possible Recurrence
What is the number one salivary disease in dogs?
Sialocele - ‘salivary mucocele’ #1 salivary gland disorder in dogs
SIALOCELE
Accumulation of saliva in submucosal or subcutaneous tissues Trauma
Inflammation
Location Cervical # 1
Ranula (under tongue) Pharyngeal & Zygomatic – rare
Small to large swelling +/- resp distress Usually non-painful with chronicity Mobile, soft, flocculent
What are the swelling locations for a siocele?
Parotid: Below Ear
Mandibular: Angle of Jaw
Zygomatic: Caudal to eye+/- retrobulbar swelling
What is the dx and treatment for siocele?
Systemic Evaluation
Aspirate for cytology and culture
Straw to light brown colored Viscous, non-odiferous fluid
No bacteria +/- if drained before
CT pending involvement
Treatment Surgical removal WITH BIOPSY !
Excellent prognosis
SIALADENITIS
Inflammation of the salivary gland Trauma
Systemic infection
Secondary infection not uncommon – needs more aggressive
therapy
Painful, carrying head down
Ptyalism
Fever, lethargy
Mild cases without infection self-resolved
PHARYNGEAL TRAUMA
Penetrating stick OR other cause wound Secondary Infection
Remaining splinters or
piece of foreign material
Draining tracts, abscess, swelling
Bloody saliva
ACUTE: Dysphagia & oral pain +/- resp signs
CHRONIC: Anorexia, pyrexia,
retrobulbar swelling
History of playing with sticks, active or no known cause
pharygeneal trauma treatment and prognosis
Removal of foreign material Treatment for secondary infection Surgical repair of injured tissues
PROGNOSIS:
Best if airway or esophagus not injured & ACUTE cases Recurrence occurs if no FB found, esp. difficult with inflammation
Failed treatment with retained or migrating FBs, too short duraiton of antibiotics, permanent damage to oral or pharyngeal structures
Oral Swallowing phase
Oral (CN 5, 7, 12)
Prehend food and form bolus which moves to end of tongue
Pharyngeal- swallowing phase
Pharyngeal (CN 9, 11)
Propel bolus along pharynx
Closure of the larynx by epiglottis & inhibition of breathing UES sphincter opens (cricopharyngeal muscle)
Esophageal- swallowing phases
Esophageal (CN 9, 10, SNS) Bolus moves along into stomach
what are the clinical signs for oral swallowing phase issues?
ORAL: Dropping food and water; difficult to pick up
What are the CS for pharyngeal swallowing phase issues?
PHARYNGEAL: Retch, cough, gag, food expelled rapidly after attempting to swallow, repeated attempts to swallow
What are the CS for esophageal phase issues?
ESOPHAGEAL: Retch, gag, expel food quickly after eating or some time later
CRICOPHARYNGEAL ACHALASIA/DYSPHAGIA
Rare
Genetic disorder in dog
Breeds: Cocker and Springer Spaniels
Acquired in adults associated with NM disorders
CxS: repeat attempt to swallow, followed by gag and regurgitation
Cricopharyngeal muscle
- Involved in swallowing reflex
- Inability to relax muscle leads to inability to swallow food or liquid
- Prevents propulsion of food bolus from caudal pharynx into esophagus
What are treatment options for cricopharyngeal dysphagia?
SURGERY: Cricopharyngeal Myotomy or
Cricopharyngeal & Thyropharyngeal Myectomy
65 % success rate
Failure = lack of improvement, worsening, aspiration pneumonia
Pets with NM disorders – treat underlying disease Treat aspiration pneumonia
Esophagus in dog vs cat
Striated muscle entire length – DOG
Distal smooth muscle – CAT
ESOPHAGITIS
Inflammation of the esophageal mucosa – can affect motility
Secondary to medications, foreign bodies, caustic toxins, gastrointestinal reflux from GA or GI dz
RADS: Unremarkable or transient dilation Endoscopy: Erythemic +/- edematous mucosa
how do we treat esophagitis?
TREATMENT
Pain management
Buprenorphine, Tramadol, Fentanyl patch
Sucralfate/Carafate
250 – 1 gram PO as slurry Q 6-8 hours
Antacid PPI
Omeprazole 0.7=1.0 mg/kg PO BID
Monitor for strictures
Look for underlying disease (i.e. GERD)
treatment/managment of FB
GOAL
Remove per OS with FB retrieval
RISK
Perforationeffusion, pyothorax, surgery
Stricture
Fistulae or Diverticulae
No H2 blockers if pushed into stomach
+/- Sucralfate
+/- Pain management Feed small frequent meals
Monitor for stricture and esophagitis signs
ESOPHAGEAL DIVERTICULAE
Small lesions do not cause overt clinical signs
Larger lesions associated with impactions, esophagitis, rarely rupture and pyothorax
Diagnosis with radiographs with contrast or fluoroscopy with contrast
Secondary to trauma or congenital Tx: Surgery
What is the most common type of megaesophagus?
Idiopathic aquired
Congenital megaesphagus
CONGENITAL
Abnormal NM innervation
< 6 months old
Breeds: SharPei, Fox Terrier, German Sheperd, Labs, Danes, Irish Setter, Mini Schnauzer, Newfie Siamese cats
May improve with time No genetic test
VASCULAR RING ANOMALY
1 = Persistent right aortic arch
Development abnormality
3rd, 4th, or 6th aortic arch and others
Abnormal vessel entraps the thoracic esophagus
DOG > CAT
Breeds: Boston, Irish Setter, German Shepard, Persian, Siamese
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 evaluation
Cystgranulomasarcoma with mets Not always, more in Hounds
Can be incidental finding at necropsy
WHERE
Southern US; tropical and subtropical regions (Greece, India, Japan, SA, Israel)
What is the treatment for spiraceri lupi?
TREATMENT
Keep dogs from eating things
Monthly preventatives in edemic regions (moxidectin/imidacloprod in Europe)
Often too advanced to treat
Meds:
Doramectin (0.4 mg/kg, SQ) every 2 weeks for 6 weeks then monthly until granuloma resolves
Ivermectin (0.6 mg/kg, SQ, two doses 2 wk apart) combined with prednisolone (0.5 mg/kg, PO, bid for 2 wk and then tapered)
HIATAL HERNIA
Movement of abdominal contents through esophageal hiatus in diaphragm
Congenital Acquired
TYPE 1: Sliding – intermittent displacement of LES and gastric fundus into thorax TYPE 2: Gastric fundus displacement only
BREEDS: Shar Pei, Bull Dogs – English & French
