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Oroesophageal Dz

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sihirlifil's version from 2018-02-18 01:17

Anatomy of dental cavity

Question Answer
Unique features of the ruminant oral cavityNo maxillary incisors (dental pad)
Tounge & lips used to grasp
Mandible can move horizontally
Dental formula: deciduousI 0/4, PM 3/3
Dental formula: permanentI 0/4, PM 3/3, M 3/3
When do the incisors erupt?I 1 & 2: 0-2 weeks
I 3 & 4: 2-4 weeks
When do the premolars erupt?PM 1-3 usually erupted at birth
How old is this guy
2-4 weeks
Permanent tooth eruption (cattle): Incisors1: 1.5-2y
2: 2-2.5y
3: 3-3.5y
4: 3.5-4y
Permanent tooth eruption (cattle): PM2-3 years for all 3
Permanent tooth eruption (cattle): molars1: 8-12m
2: 12-18m
3: 24-30m
What are some limitations of aging by dentitionCan't really be accurate after 4yo
Excess wear/trauma on teeth
Systemic illness can affect
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Dental/Periodontal Dz

Question Answer
What kind of tooth root abscesses are most common? (in who)TR abscesses in general more common in camelids
Mandibular molars most commonly affected
Causes of tooth root abscessesEruption of permanent teeth
Feeding rough, stemmy hay
Disruption of pulp cavity
CS of tooth root abscessReulctance to eat
Abnormal chewing
Hypersalivation
On PE, what would you see with a tooth root abscess?Focal, firm swelling & purulent drainage (usually erupts into oral cavity!) & maxillary sinusitis
Radiographic signs of a tooth root abscessLysis around tooth root, lytic bone extending into surrounding areas
What's going on here?
Tooth root abscess
Treatment of tooth root abscessLong-term antibiotics
Surgical extraction
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Salivary Gland Dz

Question Answer
Causes of hypersalivation (ptyalism)Esophageal obstruction (choke)
Oral/pharyngeal injury or FB
Stomatitis
Rabies
Which mechanism is usually the reason for ptyalism?Failure to swallow saliva (rather than excess production)
When doing a PE on an animal who is hypersalivating, always remember to....WEAR GLOVES!!! rabies risk!!!
What's a sialocele? how do you treat it?Soft, fluctuant swelling & inflammation of the surrounding tissue, usually caused by trauma
Tx: surgical removal or open drainage & chemical debridement (CuSO4)
Sialoadenitis: CS? what causes it? tx?CS: gland enlargement, usually hot & painful. inflammation of the gland itself
Usually trauma or migration of grass awns
Tx: systemic antibx & anti-inflam, drain abscess if indicated
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Oral Cavity Dz

Question Answer
Actinobacillosis akaWooden tongue
Actinomycosis akaLumpy jaw
Actinobacillosis: agent? how does it infect?Actinobacillus ligniersii: G- bact, normal inhabitant of oral cavity
Dmg to oral mucosa allows baceria to penetrate soft tissue
Actinobacillosis: CSDecreased appetite
Weight loss
Hypersalivation
Dysphagia
Dyspnea (can really enlarge!!)
Actinobacillosis: causes ___ inflammationGranulomatous
NOT LIMITED TO TONGUE~ all soft tissues or oropharynx
Top differential when seeing this tongue on necropsy?
Actinobacillosis
How do you dx wooden tongue?Clin path: Hyperfibrinogenemia, neutrophilia (usually blood results not helpful)
FNA/biopsy & culture of lesion
Histopathology
How does FNA/biopsy & culture of an Actinobacillus lesion help ddx from other infectionsNo odor to pus and sulfur granules
What does actiniobacillosis look like on histopath?Granulomations abscess
Tx of wooden tongueSodium iodide (20%) 70mg/kg IV, repeat every 3-5 days as needed
Oxytetracycline
Supportive care (can animal eat & drink?)
Prognosis of wooden tongueGood if only the tongue involved
When treating wooden tongue, what do you have to monitor for?Signs if iodine toxicosis: large flaky dandruff of topline, tearing of eyes, coughing, inappetence, diarrhea
Use caution if treating ___ cattle with sodium iodidePregnant! can cause problems with the offspring's thyroid
Actinomyces: agent? how does it infect?Actinomyces bovis: G+ anaerobic filamentous bacterium, normal inhabitant of the oral cavity (like woody tongue)
Adamage to oral mucosa allows bacteria to penetrate into soft tissue AND BONE!!
CS of lumpy jawPeriosteal new bone & fibrosis, most commonly mandible (horizontal ramus). Hard and immovable
Draining tract often develops
Top ddx
Lumpy jaw
Signs of ACUTE lumpy jawHypersalivation, difficulty eating
Signs of CHRONIC lumpy jawWeight loss, hard swelling, distortion of bone, severe osteomyelitis
Which disease closely resembles lumpy jaw?
Tooth root abscess
Dx of lumpy jaw(Clin path: Hyperfibrinogenemia, neutrophilia)
Core biopsy: sulfur granules
Radiographs: Central radiolucency (osteomyelitis), periosteal new bone & fibrous tissue
Tx of lumpy jawPenicillin
Sodium iodide (20%) 70mg/kg IV, 2 doses 3-7 days apart
Flush draining tracts with PVI
Prognosis of lumpy jaw?Good with early lesions
Bony dmg is permanent!
DDX wooden tongue vs lumpy jaw (chart)
Pharyngeal trauma: caused by?Almost always iatrogenic! Balling gun, long dose syringe, speculum, deworming gun, rigid stomach tube/calf esoph feeder
Occasional FB consumption (baling wire, sticks, etc)
CS of pharyngeal traumaAnorexia
Ptyalism
Extension of head & neck
Stertor, dysphagia
Bloat
Aspiration pneumonia
Dx of pharyngeal traumaManual exam, visual exam, endoscopy
What's going on in this rad?
Pharyngeal trauma! radiolucency where there shouldnt be one
What's going on in this rad?
Pharyngeal FB
Tx of pharyngeal traumaSupportive care
Systemic broad-spec antibx
NSAIDs
Remove FB, drain abscess
Prognosis of pharyngeal traumaGood if intervention EARLY & AGGRESSIVE
(Exception: calves with severe arytenoid chondritis)
Ascertain inciting cause: Ca gels extremely irritating
Prepare for sequelae: aspiration pneumonia, may be unable to eat
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Esophageal Dz

Question Answer
*What is an important consequence of esophageal obstruction?BLOAT! Blocks regurg
Causes of esophageal obstructionRapid eating (incomplete mastication, not moistened by saliva, pelleted feeds)
Inappropriate feed (apples, potatoes, corn cobs, etc)
Poor dentition
Locations of esophageal obstructionPharynx
Thoracic inlet
Heart base, cardia
CS of PARTIAL esophageal obstructionAgitation
Hypersalivation
Retching
Extension of head & neck
Feed & saliva from nose
CS of COMPLETE obstructionRumen tympany = Life-threatening
Esophageal obstruction findingsDehydration
Metabolic acidosis (loss of bicarb)
Stress leukogram
Dx of esophageal obstructionPass orogastric tube GENTLY (figure out where the obstruction is). Being able to enter the rumen tells you that the obstruction is cleared
Endoscopy confirms dx if unsure
Tx of PARTIAL esophageal obstructionAllow animal to relax! sedation of necessary (Acepromazine, Xylazine (0.05mg/kg IM))
Gentle orogastric intubation
Feeding instruction?
NSAIDs
Antibx for aspiration pneumonia (** spectrum)
Tx of COMPLETE esophageal obstructionRelieve gas pressure in the rumen
Trochar/cannula can be inserted percutaneously into the rumen
Prognosis of esoph obstructionGenerally good, especially if uncomplicated
Major complications of esoph obstructionMural necrosis
Esophageal stricture
Esophageal perforation
Prevention of esoph obstructionMay be just isolated event
If recurs, consider: oral exam, dental eval, feeding alone without competition, feeding soaked food
Esophageal dilatation: why does it happen? CS?Usually 2ry to pharyngeal trauma (vagal irritation)
Hiatal hernia
Signs are similar to choke!
Prognosis of esoph dilationGood following trauma :) ...but poor with hiatal hernia :(
Megaesophagus: more common in who? (rare in cattle)
Possible causes of megaesophGenetic
Vagal neuritis (from pneumonia etc)
Ring anomalies (can put them in CT scan!)
CS of megaesophagusWeight loss, regurg, hypersalivation
MAJOR thing to consider with megaesoph?Aspiration pneumonia often occurs 2ry to regurg
Dx of megaesophagusEndoscopy: look for fluid pooling in esophagus
Radiography (contrast studies helpful)
Whats going on?
Megaesophagus
Tx of megaesophagusMed can be attempted: Metoclopramide, sucralfate (rarely successful)
Can try elevated feeding... but already long necks so.... lol
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