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ALWAYS LOOK FOR THE POSTIVE

Learn about diseases that affect the oral cavity, esophagus, stomach, small bowel, large bowel, liver, pancreas, rectum, and anus. Explore the causes, symptoms, and treatment options for periodontal disease and oral trauma.

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ALWAYS LOOK FOR THE POSTIVE

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  1. ALWAYS LOOK FOR THE POSTIVE “When it is dark enough, you can see the stars.” -Persian proverb

  2. Diseases of Digestive SystemOral cavityEsophagusStomachSmall BowelLarge BowelLiverPancreasRectumAnus Chapter 2

  3. GI system • GI tract: mouth -> anus • Accessory structures • Teeth, tongue, salivary glands, liver pancreas, gallbladder

  4. Diseases Oral cavityEsophagusStomachSmall BowelLarge BowelLiverPancreasRectumAnus

  5. crown is covered by a thin veneer of enamel root is covered by a thin layer of cementum

  6. Periodontal Disease is plaque-induced inflammation of gums Progressive gingivitis, gingival hyperplasia, peridontitis with vertical bone destruction, and peridontitis with horizontal bone destruction The end result is loss of tooth Periodontal means “around the tooth” Etiology Food particles, bacteria, saliva, rbc and other bacterial components collect around gum line and form plaque, when this hardens it forms tartar or claculus Causes gingivits Minerals in saliva collect in plaque and harden to form calculus (tartar) which adheres to teeth 3-5 d to harden Causes bad breath Protects the bacterial environment Oral Diseases: Periodontal Disease

  7. Oral Diseases: Gingivitis Gingivitis—earliest signs of Periodontal Disease Involves only the soft tissues of the gums Reversible inflammation of gums Gingival hyperplasia (may also be breed- or drug-related) Cause—accumulation of tartar on teeth Tartar is conducive to bacterial growth Enzymes produced by bacteria damage tooth attachment and cause inflammation

  8. Without intervention, gingivitis progresses to: Periodontitis—irreversible condition: Loss of gingival root attachment (receding gums) Alveolar bone resorption Loss of teeth Oral Diseases: Periodontal Disease alveolar bone

  9. Normal Gingiva

  10. Periodontitis—irreversible condition: Alveolar bone resorption Gingivitis—reversible; earliest signs of Periodontal Disease Oral Diseases: Periodontal Disease Mild tartar more tartar (<25% loss) severe tartar (25-50) >50% bone loss Mild gingivitis more gingivitis gum receding tooth is loose No bone loss min bone loss moderate bone loss should be pulled

  11. Calculus builds up under gums Separates teeth from gums to form ‘pockets’, which encourages more bacteria to accumulate and grow Bacteria secrete toxins/enzymes that cause detachment of tooth from bony socket WBC’s invade area and release their enzymes to destroy bacteria These enzymes also cause detachment of tooth from bone Pockets get deeper and deeper Weakens bone Can cause pathologic fractures Other sequellae Bacteria enter blood stream Can cause micro-abscesses in liver, kidneys Cause endocarditis on heart valves Oral Diseases: Periodontal Disease

  12. Oral Diseases: Periodontal Disease Iatrogenic mandibular fracture resulting from excessive force extraction of a lower molar tooth

  13. Oral Diseases: Periodontal Disease Signs Halitosis Reluctance to chew hard food Pawing at mouth Oral pain; personality changes Sneezing; nasal discharge Increased salivation Facial swelling; tooth loss Dx Complete oral exam Presence of tartar (plaque) on teeth Dental radiographs Application of Peridontal Probe into Interproximal Space Sulcus. Note the Probe Reads Seven Millimeters.Visual Appearance does not Always Indicate the Degree of Bone Loss

  14. Intraoral Radiography Horizontal bone loss Standard Radiograph Unit 100 MA, 1/10 SEC, 55 KV for 25 lb. Dog Tube head set at 16” Maxillary Molars Image-Vet 70 Plus Dental Unit (AFP Imaging) Maxillary Incisors

  15. Oral Diseases: Periodontal Disease Rx Dental scaling with ultrasonic scaler Root scaling/planing (below gum line) with thin ultrasonic tip; curette Gingival curettage with curette against inner surface of gums (gingival pocket’s diseased soft tissue inner surface) Polishing to smooth the tooth surface and prevent tartar buildup Irrigation to remove diseased tissue and plaque

  16. Oral Diseases: Periodontal disease DOXIROBE GEL controls infection and promotes rebuilding of periodontal structures *contains Doxycycline, an antibiotic

  17. Oral Diseases: Periodontal Disease Plaque prevention gel Applied once a week

  18. Oral Diseases: Periodontal Disease Client info Good oral hygiene is necessary for all pets Brush teeth daily Routine dental cleanings performed at veterinarian’s Treat gingivitis early before irreversible lesions occur Extractions are sometimes necessary to clear up infections 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

  19. Oral Trauma Causes (many) Falls, fights (bites), burns, blunt trauma (HBC) “High-rise syndrome” in cats Fractured: hard palate, mandibular symphysis Tongue injury from biting own tongue, dog fight, eat from tin can in garbage, FB(Foreign body) Cats playing with needles, thread; strangulate tongue Electrical, chemical burns Gunshot wounds, fish hooks Bones lodged in teeth Fx mandible—cat; HBC

  20. Oral Trauma Signs History or signs of head trauma Increased salivation Inability to close mouth; due to: Pain Fracture/dislocation FB Reluctance to eat (same reasons) Presence of foreign object Dx PE of oral cavity X-ray to r/o embedded FB

  21. Oral Trauma Rx Depends on type of trauma Control bleeding Provide supportive care IV fluids pain relief Insure adequate airway Repair/extract damaged teeth, fracture Client info Like kids, if animals can get into trouble, they will Discourage chewing on electric cords Don’t leave caustic/toxic chemicals out Keep pets in fenced yard or on leash when outside Animals still eat well without entire tongue

  22. Oral Neoplasia Relatively common in cats and dogs; malignant melanoma and squamous cell carcinoma most common Signs Depend on location and size of growth More common in males Abnormal food prehension Increased salivation Tooth loss Oral pain Dx Histology of mass X-rays to r/o metastasis Biopsy of LN to r/o metastasis Squamous cell carcinoma (Upper R 3rd incisor) Bone loss around lesion Rostral maxillectomy was curative

  23. Oral Diseases: Oral Neoplasia • Benign neoplasia • Papillomas • Epulides Papillomas

  24. 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)

  25. Oral Neoplasia Rx Surgical excision Partial removal of mandible/maxilla if bone is involved Radiation therapy Chemotherapy Client info Px for malignant tumors is guarded even with aggressive therapy Benign lesions have good Px Animals (esp cats) with bone removed may need nutritional support (feeding tube)

  26. Oral Diseases http://veterinarydentistry.posterous.com/

  27. Salivary Mucocele Accumulation of excessive amounts of saliva in SQ tissue Most common lesion of salivary glands in dogs; rarely seen in cats (following trauma) 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

  28. Salivary Mucocele Dx Clinical signs Paracentesis shows thick, blood-tinged fluid Rx Aspirate fluid Surgical drainage Remove salivary gland; insert Penrose drain x 7 d Client info Cause is unknown; trauma may be involved Without removal of gland, excess fluid will continue to accumulate Some cases may resolve spontaneously Removal of mandibular salivary gland

  29. Lip-Fold Dermatitis Often seen in breed with pendulous upper lips (spaniels, setters, St. Bernard, bulldogs, bassets) Constant moisture in the folds from saliva causes bacterial growth Food, hair, moisture cause irritation, erythema, and fetid odor Signs Halitosis Collection of debris in lower lip fold Dx Clinical signs Rx Dental cleaning Clip hair Clean out folds (food) Diaper rash cream Sx is permanent Rx

  30. Lip-Fold Dermatitis Client info Keep lip folds dry (for the rest of animal’s life!!) 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

  31. Esophageal Disease Esophageal obstruction Ingestion of nondigestible object (bones, play objects) Degree of damage depends on size, shape, time in esophagus Surgical removal is least desirable → stricture formation Signs Exaggerated swallowing movements Increased salivation restlessness Retching Anorexia Hx of chewing on foreign objects Esophageal endoscopy

  32. Esophageal Obstruction Dx Endoscopy Radiography 6-mo old St Bernard What is your diagnosis?

  33. Esophageal Obstruction 3 mo kitten What is your diagnosis?

  34. Esophageal Obstruction 2 yr old cat What is your diagnosis?

  35. Esophageal Obstruction 8 yr male cat

  36. Interesting stuff 7 mo old Pug

  37. Esophageal Obstruction Rx Prompt removal is important NPO x 24 h to allow for healing Resume feeding with soft foods Client info Limit access to bones and small objects Strings and needles are hazards for cats Px is good if serious damage to esophagus can be prevented

  38. Go through differences in small bowel vs. large bowel diarrhea

  39. Mucosa -> muscularis -> serosa

  40. Stomach Diseases Acute Gastritis Commonly seen in dogs (cats to lesser degree) Spoiled food Change in diet Food allergy Infections (bacterial, viral, parasitic) Toxins (chemicals, plants, drugs, organ failure) Foreign objects Signs Anorexia Vomiting (maybe dehydration) Painful abdomen Hx of diet change, toxin ingestion, infection, parasites Figure 23 Typical appearance of reflux gastritis with a radial pattern of erosions on the antral folds.

  41. Acute Gastritis Dx Hx and PE CBC, Chem Panel to assess dehydration, metabolic imbalance, organ failure Rx NPO until vomiting stops 4-6 sips of water q1h Fluid therapy (SQ or IV) Gradually start feeding Bland food (Hill’s I/D, boiled chicken/rice) Antiemetics Maropitant (Cerenia) Metoclopramide (Reglan) Coating agents Sucralfate H2-blockers (famotidine, ranitidine, cimetidine) Proton pump inhibotor: Omeprazole Antibiotics—often prescribed, rarely needed

  42. Acute Gastritis Client info Avoid abrupt changes in diet Gradually mix new food in with old (1 wk) If pet vomit 2-3 times, NPO x 24 h; if it continues see vet Dogs and cats do not need variety Avoid objects that can be swallowed (treat like a baby)

  43. Immune-Mediated Inflammatory Bowel Disease (Chronic gastritis, Enteritis, Colitis) Seen in cats, less common in dogs Accumulation of inflammatory cells in lining of stomach, SI, LI Signs Chronic vomiting, wt loss Diarrhea, straining to defecate, mucus in stool Dx Fecal to r/o parasites CBC, Chem panel, urinalysis to r/o metabolic disorder FeLV, FIV to r/o those diseases Endoscopy stomach SI and colon, and biopsy for definitive diagnosis

  44. Rx What is the Rx for any Immune-mediated Disease? Azathioprine—immunosupressant (organ transplants) Cyclophosphamide—inhibits immune system response Sulfasalazine—a sulfa drug with anti-inflammatory/ antibacterial effects Most effective against colitis Metronidazole Prednisone Hypoallergenic diet Free from preservative, additives Highly digestible protein (rabbit, lamb, duck, chicken) Homemade diets with rice base Some commercial diets are available Immune-Mediated Inflammatory Bowel Disease (Enteritis, Colitis)

  45. Inflammatory Bowel Disease • Client info • Definitive dx is through biopsy • Life-long condition (special diet, frequent medical monitoring) • Immunosupressive drugs have side-effects (PU/PD/PP, wt gain, skin/urinary infections) • Use lowest dose that provides effect

  46. Gastric Ulceration Usually a result of long-term NSAIDs (aspirin, ibuprofen, phenylbutazone) Signs Vary from asymptomatic to vomiting blood Anemia, edema Melena Anorexia Abdominal pain Septicemia if perforation occurs Dx X-ray using contrast medium (Ba) to show ulceration in stomach lining (caution if perforation is suspected) Endoscopy

  47. Gastric Ulceration Rx Fluid therapy for dehydration NPO (as before) Coating agents/antacids Cimetidine—H2 antagonist (↓ HCl production) Omeprazole—↓ HCl production (proton-pump inhibitor) Client info Do not use NSAIDs without veterinary supervision Give NSAIDs with meal/antacids

  48. Gastric Dilatation/Volvulus Primarily a disease of large, deep-chested dogs (2-10 yrs) Dilation—gas filled; Volvulus—twisted along longitudinal axis Food/exercise? Anatomic predisposition, ileus, trauma, primary gastric motility disorders, vomiting, and stress Signs Abdominal pain/distension Weakness, collapse, depression, nausea, salivation Increased HR, RR – may lead to arrhythmias Dx PE shows dilation, poor perfusion (↑ cap refill) X-rays show air filled stomach- “double-bubble” ECG may show vent arrhythmia or sinus tachycardia CBC and Chem panel necessary to assess electrolyte levels

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