always look for the positive “when it is dark enough, you can see the stars.” -persian proverb

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


Periodontitis: irreversible condition resulting from untreated gingivitis Receding gums Alveolar bone resorption Loss of teeth


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


Periodontal Pockets


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


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


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


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


Diagnosis: Endoscopy and/or fluoroscopy


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


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

dharkins

bone on Rtooth brush on L

Esophageal Diseases: Obstruction

Esophageal endoscopy

Esophageal Obstruction Diagnosis

Endoscopy Radiography

6 month old St. Bernard

dharkins

13 in serrated kniifeSx after 4 d

Esophageal Obstruction

Esophageal Obstruction 8 yr male cat

dharkins

wire candle lighter

Esophageal Obstruction

7 mo old Pug

dharkins

2 carat diamond ring

always look for the positive “when it is dark enough, you can see the stars.” -persian proverb

Documents