Small animal gastroenterology Flashcards
Name 4 paired salivary glands.
- Parotis
- Mandibular
- Sublingual
- Zygomaticus
How can you tell a submandibular salivary gland from a submand. lymph node?
do FNA to differentiate the two
in lymph nodes: lymphoid cells
in salivary glands: Mixed population of epithelial and stromal cells. Background may contain mucin or proteinaceous material.
If inflamed (sialadenitis), can see lymphocytes, neutrophils etc.
excessive saliva production is termed
ptyalism
Primary ptyalism occurs in
In puppies after weaning due to the enlargement of parotid gland (mouth is dry during sleeping, but dripping while excited).
Treatment: surgical
Secondary ptyalism occurs in (5)
Intoxications,
foreign bodies,
viruses (distemper, rabies, Fel resp.virus),
ulcers,
sialadenitis
salivary gland inflammation is termed
sialadenitis
Can be either uni- or bilateral. Usual mandibular glands but can occur in other salivary glands too.
sialadenitis can be caused by (5)
Idiopathic,
infectious,
traumatic,
secondary to xerostomia or dehydration,
obstruction of the ducts
Symptoms:
Gland Enlargement
Painful while opening the mouth
Hypersalivation
Dysphagia
Multiple swallows
Anorexia
Xerostomia
Diagnosis and tx of siladenitis.
FNA
Histology for confirmation
Treatment: depends on the causative agent!
Prognosis: good (obstruction !)
Salivary gland mucocele is
A mucocele is a benign, mucus-containing cystic lesion of the salivary gland.
FNA and then surgery tx
Mucoceles are benign, mucin-filled cysts.
Sialoceles are a variant of mucocele that develop from the extravasation of saliva from injured parotid parenchyma.
A sialocele is
a localized, subcutaneous cavity containing saliva. Not a cyst! lack of epithelium
FNA and then surgery tx
Mucoceles are benign, mucin-filled cysts.
Sialoceles are a variant of mucocele that develop from the extravasation of saliva from injured parotid parenchyma.
An oronasal fistula is
an abnormal connection between the oral and nasal cavities.
Oronasal fistulas are caused by (4)
Tooth root abscess
Tooth extraction
Trauma of the palate
Surgery in the oral cavity
Even congenital is possible.
Oronasal fistula complications. (3)
rhinitis
sinusitis
mucopurulent secretion
Tx of oronasal fistula. (3)
Tooth extraction
Surgery (with a „flap“ )
Antibiotics (rhinitis)
Prognosis: good
Stomatitis is
Oral mucosal inflammation/erosion/ulcer
Causes of stomatitis. (5)
Immune-mediated diseases (SLE, pemfigoid, idiopathic vasculitis)
Viruses (FeLV, FIV, Calicivirus, Fel Herpesvirus, FIP)
Candida
Immunosuppressive treatment
Uremia
An iatrogenic cause of gingival hyperplasia in dogs.
cyclosporine
After surgically removing feline gingival hyperplasia, does it grow back?
yes, it can
stomatitis symptoms and tx
Symptoms: halitosis, salivation, behavioural problems
Treatment: DEPENDING ON THE CAUSE!
Hygiene (chlorhexidine)
Pain treatment
Immunosuppressants (eosinophilic granuloma)
Feline eosinophilic granuloma
Symptoms:
Causes:
Diagnostics:
Tx:
80% eosinophilic ulcer in the upper lip (linear granuloma, patches)
Symptoms: drooling, dysphagia
Causes: bacteria, virus, immune-mediated or anaphylactic reactions
Diagnostics: blood sample for eosinophilia
Tx: immunosuppressants
50% of Feline ones recurr within 5 months
Describe oral tumors
Frequent in dogs and cats!
Malignant: melanoma, carcinoma, fibrosarcoma (Fel)
Benign: papilloma (virus), epulis (odontogenous origin!, gingiva, near teeth), fibroma, lipoma
Oral tumors tend to metastasize to lymph nodes and lungs! Take a chest x-ray.
Oral tumors
Symptoms: (5)
Diagnostics:
Tx:
Symptoms: ulcers, dysphagia, salivation, halitosis, loss of teeth
Diagnostics: histology, xrays, bloods, regional lymph nodes
Tx: surgery, chemotherapy
But its usually too late!
Describe esophagus anatomy
UES
LES
dog vs cat
The esophagus is left of the trachea.
UES - upper esophageal sphincter prevents reflux from esoph. to mouth
LES – lower esophageal sphincter prevents reflux from stomach to esophagus
Vagus nerve:
Canines have striated muscle in their esophagus. Felines smooth muscle at last 1/3. This is important when thinking about prokinetics that only work on smooth muscle, they don’t work so well in dogs with esophageal disorders.
Primary and secondary peristaltic waves occur in the esophagus.
Cat and dog esophagus looks different on endoscopy.
prokinetics: metoclopramide, ranitidine in higher doses
Signs of esophageal disease. (7)
Regurgitation (main one, passive process)
Dysphagia
Odynophagia (painful swallowing)
Ptyalism
Frequent swallowing
Weight loss
Secondary complications (e.g. asp.pneumonia)
Hiatal hernias can also cause regurgitation.
Vomiting vs regurgitation
Vomiting: active propulsion of food, nausea,
salivation, uses stomach muscles
Localisation:
✓ Stomach
✓ Small intestine (large intestine?)
✓ Extragastrointestinal (e.g. pyometra)
Regurgitation: passive process
How might vomiting cause regurgitation?
excessive vomiting can cause esophagitis that might then cause regurgitation after the vomiting has passed
Differences in clinical signs of dysphagia, regurgitation and vomiting.
Think water vs solids
Pain
Time from eating to reaction
Abdominal effort
Any other signs
Diagnosing esophageal disease. (5)
Blood samples don’t often show inflammatory changes like left shift or elevated CRP.
Fecal sample unhelpful for esophageal disease in europe but in south america esophagus worm, Spirocerca lupi (spirocercosis), can be found in fecals.
X-Ray:
W/o contrast media first.
W contrast media– iodine or barium?
Endoscopy is gold standard for esophageal disease.
BAL (cough!)
Name esophageal diseases. 5+
Inflammatory like esophagitis, reflux, fistula
Infections like spirocercosis parasite
Obstructive like stricture, hernia, FB, blood vessel anomalies (PRAA), intussusception
Motility disorders like megaesophagus, dysautonomy, diverticulum, myasthenia gravis
And tumors
Megaesophagus can be characterized as
segmental or diffuse.
can also be idiopathic,
congenital (primary) or
acquired (secondary)
Congenital: German shepherds!, miniature
snautzer etc. siamese!
Esophageal dilation and abnormal hypomotility.
5 most common causes of megaesophagus. (5)
- myasthenia gravis
- hypoadrenocortisism aka Addison’s
- hypothyroidism
- heavy metals
- esophagitis (anything that causes chronic esophagitis, that then causes a stricture that then causes megaesophagus in front of the stricture)
Clindamycin and doxycycline can cause esophagitis-> stricture-> ME, so need to be given with copious water or with food.
Clinical symptoms of megaesophagus. (4)
- regurgitation
- malnutrition
- asp.pneumonia
- salivation
Diagnosing megaesophagus.
- blood sample (secondary ME: ACTH stim.test, T4/TSH etc. cause both Addison’s and hypothyroidism can cause it)
- radiographs
- endoscopy
TX of megaesophagus. (7)
Tx Depends on the cause of it.
- Diet should be dry in esophagitis in order to “scratch the inflamed esophageal mucosa in order to encourage healing”.
- Feed in an upright position
- Feeding tubes if needed
- Antibiotics for secondary aspiration pneumonia
- Prokinetics can be used even though they aren’t as effective in dogs compared to cats.
- Sucralfate as a suspension (for esophagitis)
- Sildenafil 1mg/kgq 12 h in dogs (helps to open the LES)
Prognosis depends on the case and how well the owners are willing to manage it.
Describe esophageal foreign body cases.
Emergency! Needs to be removed ASAP.
Usually stuck in narrow area like cranial esophagus, heart base or LES.
Do not try to bluntly pull with forceps if you can’t see - risky! Use endoscopy to remove!
Signs of esophageal foreign body. (6)
And complications of it? (3)
Regurgitation
Salivation
Anorexia
Pain
Dysphagia
Sometimes symptoms are very minor!
Complications: Perforation, stricture, fistula
How do you diagnose an esophageal FB?
Ddx? (4)
X-Ray (w and w/o contrast media), NB incase of perforation use iodinated contrast media!
Endoscopy
DDx:
Stricture
Tumors
Hiatal hernia
Gastro-esophageal intussusception
Give sucralfate and only use PPIs if needed not just cause (omeprazole, ranitidine).
Side effects of proton pump inhibitors. (3)
tolerance
rebound effect (increased stomach acid production after sudden discontinuation of the drug)
paradoxical increased vomiting
Esophageal fistula is
an abnormal connection between esophagus and surrounding tissues/organs! rare!
Connection can be to:
Lungs
Bronchi
Trachea
Pleural cavity – rare!
Neck tissues – rare!
Aquired: FB, perforation, inflammatory cause (diverticulum)
Can be congenital too (tracheobronchial structures do not separate from GI tract e.g. Cairn terriers).
Signs of esophageal fistula and how to diagnose it.
Ddx:
Tx:
Prognosis:
Signs: When congenital, signs occur during the weaning period. When aquired, signs occur later.
Frequently - respiratory signs!
Diagnose with x-ray +/- contrast (pay attention to lung patterns) + endoscopy.
Ddx: pneumonia (lobular), asp. pneumonia, bacterial pneumonia, foreign body
Tx: Surgery (removal of lobe that fistula is into)
Post-op AB treatment
Prognosis: w/o complications good
Blood vessel anomaly to cause esophageal disease.
PRAA (persistent right aortic arch) 95% cases,
signs begin in weaning period.
Breed predisposition: GSD, Irish setter
Symptoms: Regurgitation, Weight loss
DDx: Stricture
Diagnose with:
XRay (w contrast media) – in PRAA there is a dilatation cranially from the heart base!
Endoscopy: distinguish from the stricture! (artery pulsation)
Tx and prognosis of PRAA.
SURGERY REQUIRED
- post-op hypomotility complication
- medicaments do not work on striated muscles
- prokinetics (cisapride) has some effect on
smooth muscles
Prognosis:
Early correction! (otherwise persistent dilatation, irreversible nerve degeneration)
Post-op symptoms may stay!
Esophagitis can be acute or chronic.
Causes of it include: (7)
- chemicals
- foreign body
- reflux
- irradiation
- megaesophagus
- tumors
- anesthesia !
Esophagitis affecting factors-cycle: (4)
- GE reflux causes esophagitis
- Esophagitis decreases motility
- Gastric acid increased in distal part of esophagus but there is hypomotility which can cause,
- Focal inflammation which decreases LES competence further, increasing GE reflux
Vicious cycle.
Clinical signs of esophagitis. (5)
- regurgitation! (from initial vomiting)
- salivation
- extended neck is typical
- avoiding food
- cough
Diagnose esophagitis with (3)
Ddx? (6)
- Blood samples
- X-Ray if you’re skilled at interpretation (contrast media can stick to inflamed mucosa in a zip-zag pattern but its subtle)
- endoscopy (biopsy!) is gold standard!
ddx: FB, stricture, hernia, ME, diverticulum, vessel anomaly
Tx of esophagitis. (5)
- Feeding with kibble to encourage mucosal turnover.
- Sucralfate (Antepsin)
- Omeprazole/esomeprazole?
- Prokinetics
- Antibiotics only in cases of aspiration pneumonia.
Esophageal stricture can be either
fibrotic, or due to compression by a mass.
Symptoms: only liquid diet tolerated by animal
Diagnose with xray and endoscopy
Ddx: esophagitis, blood vessel anomalies, tumors
Tx of esophageal stricture. (7)
Feeding tubes
Diet
Fluid therapy
Dilatation (needs to repeated several times and even then it may not work!)
Sucralfate
Omeprazole ?
Prednisolone to prevent fibrosis formation.
Prognosis: guarded- good. Complication: perforation
Describe esophageal diverticulum.
Rare (brachys are typical)
Congenital (as a fetus, the mucosa herniates into the muscularis) vs aqcuired
DDx: hiatal hernia, gastric-esophageal intussusception
Treatment: SURGERY!
Prognosis: cautious (persistent hypomotility!)
Describe hiatal hernia.
Various subtypes
Can be intermittent („sliding“, easy to miss)
Usually congenital (Shar-pei, brachys)
Treatment: surgical + associated esophagitis
GI tumors location classification (4)
A – extramural
B, C – intramural uni- and bilateral essentially
D - luminal
Paraneoplastic syndromes of GI tumors. (11)
Cachexia (lymphoma) vs anorexia
Protein-losing enteropathies
Gastro-intestinal ulcers (adenocarcinoma)
Hypercalcemia
Hypoglycemia (insulinoma)
Anemia
Leucocytosis – neutrophilia
Thrombocytopenia
Fever
Hypertrophic osteopathy
Alopecia (feline pancreatic carcinoma)
Hypertrophic osteopathy is a classic PNS for what type of cancer?
esophageal neoplasia
What 3 chemotherapies may cause sensitivity reaciton in dogs with MDR1 mutation?
vincristine
vinblastine
doxorubicin
Describe esophageal tumors.
Are rare! < 0.5%
In Dogs: carcinoma (mostly), leiomyosarcoma, fibrosarcoma, osteosarcoma, melanoma, leiomyoma, polyps
In Cats: carcinoma (mostly), lymphoma, leiomyosarcoma, firbrosarcoma, osteosarcoma
NB Most GI tract tumors are in fact malignant.
Signs of esophageal tumor. (8)
Mechanical obstruction
REGURGITATION - aspiration
Halitosis
Salivation
Fever
Anorexia, weight loss
Pain during swallowing
Hypertrophic osteopathy
