Small Ani. Med 2- Oral Dzs

wilsbach's version from 2016-02-25 13:25


Question Answer
what is a typical clinical presentation of a sm ani with oral issues? Most cats: incidental finding during PE. chewing on one side, Inappetence / Anorexia, Smelly odor from mouth, dyspahgia.
oral inflammation can be from what 4 main probs?Gingivitis, Stomatitis, FORL (feline odontoclastic resorptive lesions ) Pharyngitis/Laryngitis
Ulcera from immune mediated diseases can cause oral problems-- 4 examples?SLE, bullous pemohigous disease, idiopathic vasculitis, toxic epidermal necrosis
what are the 2 benign neoplasia of the mouth?papilloma, epulis (3 types of epulis)
what are the 3 malig oral tumors CATS get? DOGS? CATS=SCC + Fibrosarcoma.... DOGS= MM + SCC
whats the weird cat oral dzfeline eosinophilic granuloma complex
how can the immune system relate to gingivitis/stomatitis?Immunosupressive disease or chronic immunosuppressive therapy can CAUSE gingivitis (prolly bact in there not being kept in check)
what are the viruses which might lead to gingivitis/stomatitis?*FeLV, FIV, Calici, Herpes, Corona (FIP), feline syncytium-forming virus
(read over) list of stuff that can cause gingivitis/stomatitis (that isnt immunosuppressive/virus stuff) dental disease, FORL, Canine distemper, Candida albicans, SLE, bullous (pemphigous disease), idiopathic vasculitis, toxic epidermal necrosis
gingivitis vs stomatitis?ging= inflammation of gums. Stoma= inflammation of all the mucous membranes of the mouth

cats/ Immune mediated dzs

Question Answer
Feline Chronic Gingivitis Stomatitis FCGS is aka?Feline lymphoplasmacytic Gingivitis Stomatitis Complex
why does Feline Chronic Gingivitis Stomatitis FCGS happen? what is the common age to see this with? Idiopathic, Maybe immunological overreaction. there are TWO AGES at which it is common to see this: (1) around 1 y old (2) average 7 years old** this is the more common time.
how do you treat Feline Chronic Gingivitis Stomatitis FCGS?Professional dental cleaning, teeth extractions full mouth, abx, +/- Immunosuppressive therapy, Laser
feline odontoclastic resorptive lesions (FORL) what age is this common to see in? how common is this dz?common (20-75%) cats > 4 y
what causes FORLs? (feline odontoclastic resorptive lesions) explain the pathophys. What is the tx? NOT bacterial but true cause unknown. odontoclasts (migrated from bone marrow/spleen) remain active on tooth root ->‘eat’ surface. TX: tooth extraction
Feline eosinophilic granuloma complex (aka Eosinophilic ulcer, plaque, linear granuloma) where does this occur in the mouth most commonly? what are the main clinical signs?** 80% maxillary lips. You will see Ptyalism, difficulties eating, inappetence.
Feline eosinophilic granuloma complex--> what will bloodwork look like? how do you dx? how do you tx? CBC: eosinophilia. Diagnosis: biopsy . Treatment: corticosteroids, triamcinolon (50% recurrence within ½ year)
what are the 5 immune mediated dzs which can cause oral ulcers?SLE (systemic lupus erythematosus), Bullous pemphigoid, Pemphigus vulgaris, idiopathic vasculitis, toxic epidermal necrosis
Loss of self-tolerance leading to immune mediated oral diseases might be triggered by infection by things like... trigger from infections (borrelia, ehlichia, anaplasma,babesia, hepatozoon)
how do you dx immune mediated causes of oral dz? Biopsy
systemic lupus erythematosus: what are the clinical signs/presentation of this dz? dx?Systemic signs (polyarthritis, fever, glomerulonephritis, cytopenias...). DX with BX
Bullous pemphigoid/ Pemphigus vulgaris affect the mouth where? how do you dx these?on gums / tongue / lip. DX: Coombs, cytology, Biopsy f histopathology, (Immunofluorescence – direct/indirect)

Pharyngitis, Laryngitis, Tumor workup, salivary glands

Question Answer
(list to read) things you should be doing for our workup of pharyngitis, laryngitis, tumors.CBC, chemistry, met check (thoracic radiographs, reg lnn), Anesthesia, Oral examination, fine needle aspiration, biopsy (excisional/diagnostic), radiographs mandible / maxilla, CT/MRT
what are the lymphnodes of the head and neck, and which are most common to get metastasis in?***mandibularLN gets 50% of the metastasis. Then the parotid LN and the Medial retropharyngeal ln together make up the other 50%.
Canine oral papillomatosis--> what causes this? how do you tx?viral cause (papovirus), regression after 6-8 weeks (some need surgery)
what are the three kind of epulis? describe them.fibrous/fibromatous, ossifying, and acanthomatous. Fibrous and ossifying are penduculated and are not ulcerating, not invasive. The acanthomatous type causes bone destruction, locally invasive, BUT no metastases
what are Periodontal epulides? Odontogenic neoplasia-- contain dental structures. AKA Acanthomatous epulis, adamantinoma, acanthomatous ameloblastoma, peripheral ameloblastoma
Malignant Neoplasia Dog--> what are the top 3 oral malig tumors in a LARGE breed dog? SMALL breed dog?SMALL: (1) Tonsillar Squamous cell carcinoma (2) Malignant Melanoma (3) Fibrosarcoma at old age (8y) (4. Extramedullary plasmacytomas (< 5% canine oral tumors) ) LARGE: (1) Malignant Melanoma (2) Nontonsillar Squamous cell carcinoma (3) Fibrosarcoma at young age (4-5y)
what is the most common oral tumor in dogs? (what is the prevalence in cats?)MELANOMA (uncommon in cats)
how can melanoma vary, and where does it like to met to?2/3 melanotic (more in heavily pigmented dogs), 1/3 amelanotic. Mets to lymphnodes & lung (remember: most common oral tumor of dogs)
Squamous cell carcinoma-- where does this like to be in the mouth?most in gums or tonsils
what makes a SCC in the mouth a worse prog? better prog?WORSE prog if: Large & caudal. BETTER prog if Dog <6y & mesial (medial) 2nd premolar (so young dog and not far back)
how does location affect metastatic tendencies of oral SCC?rostral= lower metastatic rate!! caudal tongue + tonsil= high metastatic rate
how do you tx oral SCC?surgery= treatment & diagnosis (radiation/chemo)
3 main problems you get in salivary gland? Mucocele, Inflammation, Neoplasia (uncommon)
who is mucocele most common in?DOGS
how common is neoplasia in the salivary glands? WHO gets the more? and WHERE?uncommon, but cats>dogs... most in mandibular gland, locally invasive, mets to lung & lnn
what is a salivary mucocele?Saliva in subcutaneous tissue (trauma?)--> Tissue reaction (most sublingual)
who is most prone to a salivary mucocele, and what age? what are the CSs and what is tx?2-4 y old dogs, German shepherd, Miniature Poodle most affected. you will see Blood tinged saliva and Abnormal eating/swallowing. Therapy: surgery


Question Answer
Clinical Signs of Dysphagia?Abnormal Swallowing, Halitosis, Ptyalism, Gagging and ***multiple swallowing attempts, Drinking abnormal, Abnormal prehension, Weight loss, Painful mouth, Coughing, Hematemesis
dysphagia can stem from what 3 anatomical areas?pharmynx, palate, esophagus
The main two problems in the pharynx and eso that lead to dysphagia are..inflammation and obstruction
3 odd ball probs of the pharynx which might cause dypahgia?neuromuscular (MMM, MG), cricopharyngeal dysphagia
aka what is the major ddx for Larynx/pharynx FB? how can you differentiate them?Laryngotracheitis! (kennel cough) palp trachea-- see if you can elicit
4 Neuromuscular diseases which can lead to dysphagia?(1) Masticatory muscle myositis (2) Oropharyngeal dysphagia ((can be oral phase, pharyngeal phase, cricopharyngeal phase) (3) Cricopharyngeal dysphagia (4) Tetanus/botulism/rabies
which CNs can cause dysphagia if they are dysfunctional? V, VII,IX, X, XII paresis or paralysis -> do neuro exam! (trigeminal, facial, glossopharyngeal, vagus, hypoglossal)
what is Masticatory Muscle Myositis? WHO gets this most and at what age?Autoimmune myositis of type II M myofibers in masticatory muscles. Happens in Young adult dogs. Large-breeds & German Shepherd predisposed
what is the presentation of Masticatory Muscle Myositis like? (acute? chronic?)Sudden swelling of masticatory muscles. Acute: Painful opening of jaw (‘can’t open the mouth to drink or eat anything…’)... Chronic: severe muscle atrophy limited jaw mobility
dx's for Masticatory Muscle Myositis....what will neuro exam be like? what will be abnormal with labwork?NEURO= NORMAL. BLOODWORK= elevated CK (acute)
how do you dx Masticatory Muscle Myositis? ab against type II M myofibers in serum or muscle biopsy (note: (can become neg in steroid treatment & end stage))
pic of normal swallow/mvts
cricopharyngeal dysphagia aka cricopharyngeal achalasia-- what is happening here? Failure of upper esophageal sphincter (UES) to relax.. Asynchrony UES(upper eso sphincter) / Pharynx
At what age do you see cricopharyngeal dysphagia aka cricopharyngeal achalasia? what are the clinical signs? Signs immediately with weaning!! (very young! 6½-7 weeks, they should be fully weaned and eating dry food). You will see a inc swallowing frequency, retching, smaller than litter mates, signs of Aspiration pneumonia
how do you dx and tx cricopharyngeal dysphagia/achalasia?Diagnosis: Fluoroscopy. Therapy: myotomy (surgery/laser)
what is Myastenia gravis? how does it happen? types?Failure of transmission of signal to muscle fibre. It can be acquired (more common) or congenital issue...there is a generalized or focal presentation
what is happening in the acquired form of Myastenia gravis? Congenital form? (which is more common?)ACQUIRED is the most common... it happens bc of a immune-mediated Ab reaction against Ach receptor. In CONGENITAL form, It can be due to low Ach receptors
which cause of dysphagia can be caused by a thymoma's paraneoplastic syndrome? which breeds at risk? MYASTHENIA GRAVIS
Myesthenia gravis can be a paraneoplastic syndrome to which tumor? Which breeds are particularly at risk for this?Akita, German Shorthaired
which breeds are more at risk for myasthenia gravis?Pointer, Chihuahua, German Shepherd Dog, Newfoundland, Terriers, Abyssinians
how can you dx MG? Ach rec AB, Tensilon test (anticholinesterase drug edrophonium)
what is a common complication of MG? megaesophagus -> asp. pneumonia
how do we treat MG? long-acting anti-AChE Pyridostigmine
why might MG need thoracic rads?megaesophagus, metastases, thymoma