ALWAYS LOOK FOR THE POSITIVE

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ALWAYS LOOK FOR THE POSITIVE

• When it is dark enough, you can see the stars.
• -Persian proverb

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Diseases of Digestive System

• Chapter 2

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ORAL DISEASES
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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

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Oral Diseases Periodontal Disease

• 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

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Oral Diseases Periodontal Disease

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

alveolar bone
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Oral Diseases Periodontal Disease

• 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

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Periodontal Pockets
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Oral Diseases Periodontal Disease
Mild tartar more tartar severe
tartar gt50 bone loss Mild gingivitis
more gingivitis gum receding tooth is
loose No bone loss min bone loss moderate
bone loss should be pulled
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Oral Diseases Periodontal Disease
Iatrogenic mandibular fracture resulting from
excessive force extraction of a lower molar tooth
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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

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Oral Diseases Periodontal Disease

• Treatment 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

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Oral Diseases Periodontal disease
DOXIROBE GEL controls infection and promotes
rebuilding of periodontal structures
contains Doxycycline, an antibiotic
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Oral Diseases Periodontal Disease
Plaque prevention gel
Applied once a week at home by owner
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Oral Diseases Periodontal Disease

• Client info
• Good oral hygiene is necessary for all pets
• Brush teeth daily
• Schedule routine dental cleanings at veterinary
  office
• Treat 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

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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 mandiblecat HBC
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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

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Oral Diseases Trauma

• Treatment
• Depends on type of trauma
• Control bleeding
• Provide supportive care
• IV fluids
• pain relief
• Ensure adequate airway
• Repair/extract damaged teeth
• Client info
• Discourage chewing on electric cords
• Dont leave caustic/toxic chemicals out
• Keep pets in fenced yard or on leash when outside
• Animals still eat well without entire tongue

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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

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Oral Diseases Neoplasia
Squamous cell carcinoma (Upper R 3rd
incisor) Bone loss around lesion Rostr
al maxillectomy was curative
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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)
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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)

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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

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Salivary Mucocele

• Dx
• 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
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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

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Lip-Fold Dermatitis

• Treatment
• 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

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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 Youre
  going to get off first or Im going to DIE. Its
  really that simple.
• -Will Smith

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ESOPHAGEAL DISEASES
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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

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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

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Esophageal Diseases Gastroesophageal Reflux
Diagnosis Endoscopy and/or fluoroscopy
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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

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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

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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
• Signs
• Exaggerated swallowing movements
• Increased salivation restlessness
• Retching
• Anorexia
• Hx of chewing on foreign objects

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Esophageal Diseases Obstruction
Esophageal endoscopy
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Esophageal Obstruction

• Diagnosis
• Endoscopy
• Radiography

6 month old St. Bernard
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Esophageal Obstruction
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Esophageal Obstruction

• 8 yr male cat

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Esophageal Obstruction

• 7 mo old Pug