SA Med, MT, I
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What is most common etiology for sialocele (salivary mucocele)? Are they painful?
- most are traumatic (may be idiopathic)
- non-painful swelling
What is recommended treatment for sialocele?
- open mass/drain
- remove affected salivary gland for excellent prognosis
Sialadenosis is uncommon but what what gland is most commonly affected when given this diagnosis? Is it painful?
- submandibular gland
- non-painful swelling of salivary gland
what would you expect to find with barium swallow using fluoroscopy in patient with sialadenosis? What about histopath?
- study should be *normal* (pharynx and esophagus have normal function)
- histo would be normal (no inflammation, etc)
How is sialadenosis treated?
- sometimes responsive to *phenobarbital *
- (form of limbic epilepsy??)
is oral neoplasia more common in dog or cat? In this species that is more often affected, is it likely malignant or benign?
dogs - malignant
what are some common benign oral tumors in dogs?
- oral papillomas
- eosinophilic granulomas
Although benign, which form of epulis is most aggressive and locally invasive?
which oral tumor quickly mets to the lungs?
- *remember to take thoracic rads
In the cat, what presenting signs are common for neoplasia, eosinophilic granulomas, and stomatitis? So how do you definitively diagnose?
- bleeding from oral cavity
- possibly dysphagia/dyspnea
- *deep biopsy*
what is the most common oral tumor in cat?
squamous cell carcinoma
what oral lesions may be related to hypersensitivity reactions?
feline eosinophilic granuloma (may have concurrent cutaneous lesions)
what additional tests should be run with MDB when considering feline oral lesions?
FeLV and FIV
how is feline eosinophilic granuloma treated? what is concern with long term tx with these meds?
- immunosuppresive doses of steroids; cyclosporin; or chlorambucil if refractory
- -long term steroid use inhibits insulin --> diabetes melitis
- (better prognosis in young, lesions may regress in 3-5mo)
what is inflammation of mucous lining of mouth structures? what viruses are associated with this condition in cats?
- calicivirus, FVR
- immunosuppression from FeLV/FIV
What form of stomatitis can be associated with feline odontoclastic resorptive lesions (FORLs)?
feline lymphocytic-plasmacytic stomatitis
T/F: there is no reliant, consistent therapy for Feline Lympho-Plasmocytic stomatitis?
- try dentals + Abs + pain meds, then extractions but sometimes even full mouth extraction doesn't cure
what is difference between primary and secondary cleft palate? which is more serious and requires surgery?
- 1: cleft lip (cosmetic only)
- 2: cleft soft/hard palate (can die from aspiration pneumonia)
what is diagnostic test for MMM? what muscles are most commonly affected?
- antibodies (IgG) for type 2M myofibers
- temporalis and masseter muscles
compare acute v. chronic presentation of MMM: pain, swelling/atrophy, ability to open mouth. which is more commonly presented to clinic?
- acute: PAINFUL!, swollen, exophthalmos, can't open mouth
- chronic: not painful, mm. atrophy, can't open mouth, more common to present
You suspect the patient has MMM based on clinical signs and MDB reveals elevated CK and AST. What do you do next?
- send serum for check for antibodies to type 2M fibers
- (only histopath if this comes back negative but you still highly suspect it is MMM)
What two drugs can be given concurrently to start treating MMM?
*prednisolone* for rapid response and *azathioprine* which takes weeks to become effective but can then take over to allow earlier weaning of pred
Cricopharyngeal achalasia v. pharyngeal dysfunction: which is problem with swallowing reflex (back of pharynx) and which is inability to even form bolus or propel to back of mouth? What major clinical sign do both disorders have in common?
- CA: problem w/swallow reflex
- PD: inability to form bolus and send to back
- both present w/regurgitation
cricopharyngeal achalasia v. pharyngeal dysfunction: which is in older v. younger patients? which is likely to be acquired?
- CA: young (very rarely acquired)
- PD: older; acquired
is it appropriate to do cricopharyngeal myotomy as treatment for achalasia or pharyngeal dysfunction?
- tx of choice for CA
- contraindicated in PD (no good tx exists for PD)
What is common clinical presentation for megaesophagus and what is most common complication?
- CS: regurgitation (esp. puppies at weaning)
- complication: aspiration pneumonia
What is definitive tx for megaesophagus? What are some options for palliative care?
- there is NONE; non-curable disease --> death/euth from aspiration pneumonia w/in 1yr
- supportive tx includes Abs, famotadine/sucralfate, cisapride; small frequent meals upright
T/F: some cases of megaesophagus will spontaneously improve in time.
true; but not common
what is the most common etiology of megaesophagus? what is another leading cause (24%)?
- idiopathic in 74% of cases
- myasthenia gravis in 25%
Once megaesophagus has been confirmed, what are some tests you can do to rule out the etiology?
- *Ach receptor antibody titer* (MG-do this test if you can only afford 1 of these)
- T4/TSH/free T4 (hypothyroidism-rare)
- ACTH stimulation (hypoadrenocorticism-rare)
What is tx for MG?
- Acetylcholine esterase inhibitors like
- pyridostigmine PO/longer acting
- neostigmine injectable/shorter acting
Esophagitis is often a presumptive diagnosis made after ruling out what other conditions that present w/similar signs (regurg/anorexia)?
megaesophagus, mass, foreign body
what is treatment for esophagitis?
- decrease gastric acidity (omeprazole = gold standard)
- prevent gastroesophageal reflux (metaclopramide/cisapride)
- Abs for anaerobes (amoxiclllin, clindamycin)
Are hiatal hernias more commonly congenital or acquired? In what breed?
- congenital with increased incidence in shar pei
- (acquired can be from trauma or resp. distress like laryngeal paralysis)
With hiatal hernia, is patient vomiting or regurgitating?
- can do both (and some are asymptomatic)
- +/- hypersalivation
how do you treat hiatal hernias?
- same as esophagitis so:
- decrease acidity (omeprazole)
- prevent reflux (metoclopramide)
- protectant (sucralfate)
what are the most common presentations associated with dysautonomia (idiopathic loss of autonomic nervous function)?
What is the most commonly recognized vascular ring anomaly? what is the most common clinical sign?
- persistent right aortic arch in dogs
- (congenital defect where embryonic aortic arch persists and traps esophagus)
how do you *definitively* diagnose vascular ring anomaly? how old are these patients usually?
- contrast esophagram (dilation of esophagus cranial to heart usually)
- at weaning or 2-6months of age
what are the most common locations for esophageal obstruction?
- thoracic inlet
- base of heart
- immediately cranial to diaphragm
how do you diagnose esophageal foreign body?
- thoracic rads
- (contrast rarely needed)
even once foreign body is removed from esophagus, what problem can still occur?
strictures always possible!
what are common reasons for esophageal stricture?
- foreign body
- reflux (esp. anesthesia)
- meds like doxy in cats
where in the esophagus are leiomyomas/leiomyosarcomas often found?
lower esophageal sphincter
what is most common esoph. neoplasia in cats?
squamous cell carcinoma
what is dramatic clinical feature of esoph. neoplasia?
- lots of DROOLING
- (often asymptommatic as well)
Surgery is rarely curative for esoph. neoplasia, except with regard to which neoplasia?
- leiomyomas in lower esoph. sphincter
- (with other forms, resection is usu. just palliative)
Most common cause of megaesophagus?
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