Term 5 Week 9 DMN

What are oral causes to dysphagia

PD dz

FB

Pain (bone/inflam)

Muscle weakness

Nerve

What are pharyngeal causes to dysphagia

Pharyngeal paralysis

FB

Mass (benign vs malignant)

What are esophageal causes to dysphagia

FB

Esophagitis

Mass

What are some common masses seen in the oral cavity

Granuloma (tongue)

Sialocele/ranula (tongue)

Peripheral odontogenic fibromas (gums)
Canine peripheral ameloblastoma (gums)

What are some malignant tumors seen in the oral cavity

SCC

Melanoma

Fibrosarcoma

How can you dx oral cavity masses

FNA (Incl Lymph Nodes)

Biopsy

Thoracic Xray

CT may be indicated

How can you tx oral cavity masses

Surgical excision may help alleviate signs

Radiation therapy + Sx for malignant cases

What are some common conditions of the salivary glands

Sialocele: Damaged gland/duct (sx)

Obstructive lesions: Mass (Carcinoma etc), sialolith (sx)

Fistula

Sialadenitis: Mild, Sometimes no treatment needed

Sialadenosis: Non-painful swelling

What are causes to esophagitis

FB

Gastroesophageal reflux disease (GERD)

-Drugs (Doxycycline)

Ingestion of irritant

Spirocerca lupi

What are CS of esophagitis

Regurgitation

Extension of head & neck

Ptyalism

Repeated swallowing attempts

Pain

Depression

Anorexia

What are causes of Gastroesophageal reflux disease (GERD)

Anesthesia

Drugs: Atropine, acepromazine

Acute/Chronic vomiting

How can you dx esophagitis

Endoscopy

Esophagram (if wall defects are severe)

How can you tx esophagitis

Mild; none

Due to GERD, treat with H₂ receptor antagonists, PPI, cisapride, metoclopramide, sucralfate

Nutrition: Small frequent soft meals, low fat & fibre

Pain management

Gastrostomy tube

What can esophagitis lead to

Stricture formation as result of severe esophageal inflammation affecting the muscularis layer

What are the phases of rabies

Prodromal

Acute excitative

Paralytic

What can be causes for dysphagia

Functional abnormalities (neuro)

Anatomical abnormalities: intrinsic within GI or extrinsic compression from extra GI

What are some possible consequences of dysphagia

Malnutrition

Dehydration

Aspiration pneumonia

Poor QOL

What are the voluntary steps in swallowing

Oral preparatory

Oral

What are the involuntary steps in swallowing

Pharyngeal

Esophageal

What are some owner complains for an animal with dysphagia

Pain, messy eating/dropping food from mouth, regurgitation, halitosis, pawing at mouth

What are some infectious/inflammatory diff dx for dysphagia

Stomatitis, gingivitis, esophagitis

What are some FBs that can cause dysphagia

String, bone, hook, grass awn (migrating)

What neoplasia can cause dysphagia

SCC

What traumatic factors can cause dysphagia

Electrical burns, mandibular fractures

What are some structural/congenital causes for dysphagia

Stenosis, malformation, cricopharyngeal achalasia (CA), vascular ring anomaly

What is a metabolic cause to dysphagia

Ulcers as seen in CKD

What is a functional vascular cause to dysphagia

Lingual thrombus

What is a functional neuromuscular cause to dysphagia

Masticatory myositis

Generalized polymyositis

Botulism

Rabies

Myasthenia gravis (NMJ)

In which type of dysphagic diseases will anatomy be normal

Functional

What are some infectious causes to oral and facial lesions in cats

Feline herpes and calicivirus

Why is periodontal dz important

By 3 yrs 70% of cats and 80% of dogs will be affected

What are some viruses that can cause cheek, gum lesions in cats

FIV, FeLV

What is the role of the pharynx

Voice, swallowing, respiration

What are clinical signs of pharyngeal disorder

Repeated swallowing, food through nose, gagging

What are differential diagnoses for pharyngeal disorders

Structural: elongated soft palate

Trauma: oropharyngeal penetrating trauma (OPT)

Nasopharyngeal polyps (kittens)

Nasopharyngeal stenosis

Functional: rabies, myasthenia gravis

Congenital: CA

What is the main clinical sign of esophageal disorder

Regurgitation

What are differential diagnoses for esophageal disorders

Obstruction: stricture, FB

Anatomical: diverticula, fistula

Inflammatory: esophagitis

Functional: megaesophagus

If the esophagus can transport food/liquid it can be a __________ problem or a ___________ problem

Structural (obstruction, anatomic anomaly)

Functional (megaesophagua, LES achalasia, dysautonomia)

If it hurts to transport food/liquid what is going on in the esophagus

Irritation, inflammation

Dx: esophagitis secondary to vomiting, esophageal ulcer, mass

What is the role of the larynx

Voice changes

What are clinical signs of laryngeal disorders

Dysphonia, gaggin, inspiratory stridor

What are differential diagnoses of laryngeal disorders

Trauma (choke chain)

Edema

Paralysis

What are examples of conditions that require emergency intervention

Conditions causing dyspnea: obstruction/compressive foreign body

Presentation in shock (hypovolemic): GI hemorrhage

Acute abdomen/non-productive retching

How can you dx esophageal stricture

Esophagram under fluoroscopy

How can you tx esophageal stricture

Balloon catheter dilation

Bougienage

Stents

Surgical resection

What is myasthenia gravis

An immune mediated paraneoplastic condition where antibodies are produced AGAINST the nicotinic Ach receptors (found at the neuro-muscular junction)

What is the gold standard dx for myasthenia gravis

Presence of serum autoantibodies vs Ach receptors

What are clinical forms of myasthenia gravis

Generalized

Focal

Acute fulminant (flaccid tetraparesis, respiratory distress)

What are clinical signs of megaesophagus

Regurg

Dysphagia

Weight loss/poor BCS/poor growth

Signs associated with aspiration pneumonia (nasal discharge, fever, coughing)

How can you dx megaesophagus

Chest rads

Barium swallow study but aspiration risk

Fluoroscopy

Test for underlying dz

What are tx/management strategies for megaesophagus

Elevated feeding surface, increased feeding frequency, change texture

Tx underlying dz, prokinetics, gastroprotectants, treat aspiration pneumonia

What are acquired and congenital causes to megaesophagus

Acquired: idiopathic (most common) large breed dogs, secondary: MG, stricture, hypothyroidism, hypoadrenocoriticism, toxin (lead)

Congenital: vascular ring anomaly, incomplete nerve development

Which breeds are predisposed to a congenital form of megaesophagus

GSD, great danes, irish setters, labs

Which forms of megaesophagus require lifelong treatment? Which can improve with age?

Lifelong tx = aquired

Can improve = congenital

Which cases of megaesophagus have a poor prognosis

Idiopathic

What is the life threatening risk with megaesophagus

Aspiration pneumonia

Which breeds are predisposed to hiatal hernias

Brachys, shar peis

What are the types of hiatal hernias

Type I: sliding/axial (most common)

Type II: rolling/para-esophageal

How can you dx hiatal hernias

Survey rads

Contrast study

What is masticatory myositis and what does it cause

Condition in dogs 1-3yr old typically goldens, labs and GSDs which causes temporal/masseter pain in opening and closign of the jaw

What can you see on bloodwork with masticatory myositis

Hyperglobulinemia

Anemia

CK (increase acutely)

(also proteinuria)

How can you dx masticatory myositis

2M titre

CT

MRI

Biopsy

How can you tx masticatory myositis

Immunosuppression

What is an esophagotomy

Incision into the esophagus lumen

What is an esophagotsomy

Creation of an opening in esophagus to place feeding tube

What is a partial esophagectomy

Partial resection of the esophagus

Why may early fibrin sealing of esophagotomy sites occur more slowly than in other areas of the GI

The esophagus lacks a serosal layer

How would you surgically approach the cervical esophagus? What are advantages and disadvantages to this?

Ventral mid-line cervical

Advantage: accessible superficial

Disadvantage: exposure to carotid sheath, jug, recurrent laryngeal nerve

How would you surgically approach the thoracic esophagus/heart base? What are advantages and disadvantages to this?

Right lateral thoracotomy

Advantages: access to area where most FB lodge

Disadvantages: modified anesthesia due to risk of respiratory compromise, pain

How would you surgically approach the thoracic esophagus cranial or caudal to the heart? What are advantages and disadvantages to this?

Left cranial or caudal thoracotomy

Disadvantage: risk of pneumothorax

How would you surgically approach the abdominal esophagus? What are advantages and disadvantages to this?

Ventral midline celiotomy

Advantages: can also access stomach if needed

Disadvantages: difficult to exposure thoracic esophagus

How would you approach the oral cavity to the esophagus? What are advantages and disadvantages to this?

Endoscopy

Advantages: can view, collect samples, retrieve FBs, less invasive vs sx, can push fb into stomach

Disadvantages: may be unsuccessful in FB retrieval, cannot get full thickness sample

Which CN are involved in mastication

CN 5, 7, 9, 12

What are the forms of rabies

Furious and paralytic

Which category exposures require human rabies vaccination

II- nibbling of uncovered skin, minor scratches or abrasions without bleeding

III- single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal lick, exposure due to direct contact with bats

What are some reflexes to check for when you are doing a PE of the oral cavity

Swallow and guard reflex

What is the term for decreased salivation and what can cause it

Xerostomia caused by blocked salivary gland, dehydration, fever, age, systemic illness

What are common places for esophageal obstruction

Thoracic inlet

Base of heart

At the level of the diaphragm

What are the 2 types of contrast agents and their uses

Iodinated- if there is perforation

Barium- not to be used in perforation

What is ABCD

Airway

Breathing

Circulation

Disability

What can non-productive retching in dogs be a sign of

GDV

What drug specifically in cats can cause esophagitis

Doxycycline

What are examples of H2 receptor antagonists

Famotidine (Pepcid)

Ranitidine (Zantac)

What is a PPI

Omeprazole

Is cisapride or metoclopramide more potent

Cisapride is a more potent GI pro-kinetic compared to metoclopramide

What can high fat meals cause

Can encourage regurgitation

If ballon catheter dilation or bougienage fail in the tx of esophageal stricture what are you last attempt treatments

Stents and surgical resection

Why do cat with MG not develop ME

No striated muscle in the caudal esophagus

What are treatment options for hiatal hernias

Gastropexy or pexy of the esophagus

Describe the equine esophagus

2-4 feet long

Upper 2/3 striated and lower 1/3 smooth muscle

Strong cardiac sphincter

What is the most common clinical sign for esophageal disease in horses

Ptyalism

What are differential dx for ptyalism in horses

Dysphagia: prehension (CN VII), mastication (CN V, VII, XII), swallowing (CN IX, X) pharyngeal and esophageal

FB in oral cavity (rare)

Poor dentition

What causes guttural pouch inflammation

Bacterial empyema (strep equi- strangles), fungal mycosis, tympany

Why is fungal infection of the guttural pouch the most dangerous

Can erode arteries can cause life-threatening nosebleeds

How can you tx infection of the guttural pouch

Flushing and abx ± sx

What are presenting signs for cleft palate in foals (extremely rare)

Milk reflux from nostrils

Rattle in trachea on auscultation

Aspiration pneumonia: coughing, abnormal lung sounds, tachypnea, tachycardia, pyrexia

Don’t grow well

What are differential dx for esophageal dz

Esophageal obstruction (choke)

Esophagitis (reflux associated)

Esophageal perforation/stricture/diverticula

Motility disorders of the esophagus (megaesophagus)

Congenital disorders (rare)

Neoplasia (rare)

What is esophageal obstruction called in horses

Choke

What are clinical signs of choke

Frothy nasal discharge

Feed from nostrils and mouth

Ptyalism

Gagging/retching

Coughing

How do you diagnostically evaluate choke in horses

Sedation to get the head lower than the point of the shoulder (xylazine also has analgesic effect)

Endoscopy if available

Passage of NG tube

US