always look for the positive “when it is dark enough, you can see the stars.” -persian proverb
TRANSCRIPT
ALWAYS LOOK FOR THE POSITIVE
“When it is dark enough, you can see the stars.”
-Persian proverb
Diseases of Digestive SystemChapter 2
ORAL DISEASES
Oral Diseases: Periodontal Disease
Gingivitis: earliest sign of Periodontal Disease Reversible inflammation of the soft tissues of the gums Cause: accumulation of tartar on teeth
Tartar is conducive to bacterial growth Enzymes produced by bacteria damage tooth attachment
and cause inflammation Gingival hyperplasia could develop secondary to gingivits
Periodontal means “around the tooth”
Periodontal Disease is plaque-induced inflammation of gums Food particles & bacteria collect around gum line and form
plaque (tartar)
Minerals in saliva collect in plaque and harden to form calculus which adheres to teeth
3-5 days to harden Causes bad breath Protects the bacterial environment
Progressive, results in eventual tooth loss
Oral Diseases: Periodontal Disease
Periodontitis: irreversible condition resulting from untreated gingivitis Receding gums Alveolar bone resorption Loss of teeth
Oral Diseases: Periodontal Disease
alveolar bone
Periodontitis Separation of teeth from gums to form pockets
Bacteria and inflammation destroy the periodontal ligament
Pockets are abnormal if the depth exceeds:
3mm in the dog
1mm in the cat
Other consequences Bacteria enter blood stream
Can cause micro-abscesses in liver, kidneys
Cause endocarditis on heart valves
Oral Diseases: Periodontal Disease
Periodontal Pockets
Oral Diseases: Periodontal Disease
Mild tartar more tartar severe tartar >50% bone lossMild gingivitis more gingivitis gum receding tooth is looseNo bone loss min bone loss moderate bone loss should be pulled
Oral Diseases: Periodontal Disease
Iatrogenic mandibular fracture resulting from excessive force extraction of a lower molar tooth
Oral Diseases: Periodontal Disease Signs of periodontal disease
Halitosis Reluctance to chew hard food Pawing at mouth personality changes Sneezing, nasal discharge Increased salivation Facial swelling, tooth loss
Dx Complete oral exam Presence of tartar (plaque) on teeth Measurement of periodontal pockets
Oral Diseases: Periodontal DiseaseTreatment: Dental Prophylaxis
◦ Dental scaling with ultrasonic scaler With hand scaler
◦ Root planning
◦ Gingival curettage
◦ Lavage
◦ Polishing to smooth the tooth surface and prevent tartar buildup
◦ Flouride treatment
Oral Diseases: Periodontal disease
DOXIROBE GEL controls infection and promotes rebuilding of periodontal structures
*contains Doxycycline, an antibiotic
Oral Diseases: Periodontal Disease
Plaque prevention gel
Applied once a week at homeby owner
Oral Diseases: Periodontal Disease Client info
Good oral hygiene is necessary for all petsBrush teeth dailySchedule routine dental cleanings at veterinary officeTreat gingivitis early before irreversible lesions occur
Extractions are sometimes necessary to clear up infections beneath the gum line
Hard, crunchy food may promote better dental health by removing tartar before it calcifies
Once it calcifies, tartar must be removed professionally
http://www.youtube.com/watch?v=-qnbJZWycdg&feature=PlayList&p=480B67A7E8907594&playnext_from=PL&playnext=1&index=5
Oral Diseases: Trauma Many Causes:
Falls, fights, burns, blunt trauma (HBC) “High-rise syndrome” in cats
Fractured hard palate, mandible Tongue injury Cats playing with needles & thread Electrical, chemical burns Gunshot wounds, fish hooks Bones lodged in teeth
Fx mandible—cat; HBC
Oral Diseases: Trauma Signs
History or signs of head trauma Increased salivation Inability to close mouth due to:
Pain
Fracture/dislocation
Foreign body (FB)
Reluctance to eat Presence of foreign object
Dx PE of oral cavity X-ray to r/o embedded FB
Oral Diseases: Trauma Treatment
Depends on type of trauma Control bleeding Provide supportive care
IV fluidspain relief
Ensure adequate airway Repair/extract damaged teeth
Client infoDiscourage chewing on electric cordsDon’t leave caustic/toxic chemicals outKeep pets in fenced yard or on leash when outsideAnimals still eat well without entire tongue
Oral Diseases: Neoplasia Relatively common in cats and dogs - malignant
melanoma and squamous cell carcinoma most common Signs
Depend on location and size of growth Abnormal food prehension Increased salivation Tooth loss Oral pain
Dx Histology of mass X-rays to r/o metastasis Biopsy of regional lymph node to r/o metastasis
Oral Diseases: Neoplasia
Squamous cell carcinoma (Upper R 3rd incisor)
Bone loss around lesion
Rostral maxillectomy was curative
Oral Diseases: Oral Neoplasia
A gingival (buccal mucosa) melanoma involving a dog's caudal mandible
and temporomandibular joint region.
Above: An invasive feline oral squamous cell carcinoma (courtesy of Jon Slattery)
Oral Diseases: Neoplasia Treatment
Surgical excision Partial removal of mandible/maxilla if bone is involved Radiation therapy Chemotherapy
Client info Prognosis for malignant tumors is guarded to poor even
with aggressive therapy Benign lesions have good Prognosis Animals (esp.cats) with bone removed may need
nutritional support (feeding tube)
Oral Diseases: Salivary Mucocele Accumulation of excessive amounts of saliva in SQ
tissue Most common lesion of salivary glands in dogs;
rarely seen in cats Cause is unknown (tight collar, choke chain?)
Signs Slowly enlarging, nonpainful, fluid-filled
swelling on neck or under tongue Reluctance to eat Difficult swallowing Blood-tinged saliva Respiratory distress
Salivary MucoceleDx
◦ Clinical signs◦ Paracentesis shows thick, blood-tinged fluid
Treatment◦ Aspirate fluid◦ Surgical drainage◦ Remove salivary gland; insert Penrose drain
x 7 d
Client info◦ Without removal of gland, excess fluid will
continue to accumulate◦ Some cases may resolve spontaneously
Removal of mandibular salivary gland
Lip-Fold Dermatitis Often seen in breed with pendulous upper lips Constant moisture in the folds from saliva causes bacterial growth Food, hair, moisture cause irritation, erythema, and fetid odor
Signs/Diagnosis Halitosis Collection of debris in lower lip fold
Lip-Fold DermatitisTreatment
◦ Dental cleaning◦ Clip hair◦ Clean out folds ◦ Diaper rash cream applied topically◦ Surgery is permanent treatment
Client info◦ Keep lip folds dry ◦ Flush/clean lip folds
with 2.5% benzoyl peroxide shampoo chlorhexidine malaseb pledgets (chlorhexidine + miconazole)
◦ Drying agents like corn starch several times a day◦ Good dental hygiene will help prevent it
WHAT SETS YOU APART?“I am not afraid to die on a treadmill. I will not be
outworked. If we get on a treadmill together, one of two things will happen; You’re going to get off first or I’m going
to DIE. It’s really that simple.”-Will Smith
ESOPHAGEAL DISEASES
Esophageal Diseases: Gastroesophageal Reflux
Esophagitis is an inflammation of the esophageal wall caused by Mucosal irritants Gastroesophageal reflux- the most common cause of esophagitis
Reflux of gastric contents into the esophagus leads to inflammation and abnormal function of the lower esophageal sphincter
Esophageal Diseases: Gastroesophageal Reflux
Clinical Signs◦ Anorexia
◦ Dysphagia
◦ Excessive salivation
◦ Regurgitation
Severity of clinical signs depends on:◦ The type of material ingested
◦ The length of contact with the mucosal surface
◦ The integrity of the esophageal mucosal barrier
Esophageal Diseases: Gastroesophageal Reflux
Diagnosis: Endoscopy and/or fluoroscopy
Esophageal Diseases: Gastroesophageal Reflux
Treatment of Irritating Substances◦ Do not induce vomiting
◦ Administer activated charcoal
◦ Prevent further ingestion
◦ mucosal protectants - sucralfate
Treatment for Gastroesophageal reflux◦ Dietary changes –high protein, low fat
◦ mucosal protectants – sucralfate, H2 blockers
◦ Anti-emetics - Metoclopramide
Esophageal Diseases: Gastroesophageal Reflux
Client Info Prevent access to irritating substances Avoid excessively hot food Always follow oral medications with water to prevent the tablet or
capsule from sticking to the esophagus causing irritation
Esophageal Disease: Obstruction Esophageal obstruction
Ingestion of nondigestible objects Degree of damage depends on size, shape, time in esophagus Surgical removal is least desirable → stricture formation
SignsExaggerated swallowing movements Increased salivation restlessnessRetchingAnorexiaHx of chewing on foreign objects
Esophageal Diseases: Obstruction
Esophageal endoscopy
Esophageal Obstruction Diagnosis
Endoscopy Radiography
6 month old St. Bernard
Esophageal Obstruction
Esophageal Obstruction 8 yr male cat
Esophageal Obstruction
7 mo old Pug