Diseases of Digestive System

1. Diseases of Digestive System Chapter 2

2. Oral Diseases: Periodontal Disease • Periodontal Disease is plaque-induced inflammation of gums • Progressive • Includes 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 collect around gum line and form plaque • Minerals in saliva collect in plaque and harden to form tartar (calculi) which adheres to teeth • Called gingivitis • 3-5 d to harden • Causes bad breath

3. Oral Diseases: Periodontal Disease • 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

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

5. 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

6. Oral Diseases: Gingivitis • 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

7. Oral Diseases: Gingivitis • 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) • rationale is to convert chronically inflamed ulcerated lesions into a clean surgical wound to promote healing • Polishing to remove any missed calculi • Irrigation to remove diseased tissue and plaque

8. Oral Diseases: Gingivitis • 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

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

10. 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

11. 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 • Drying agents like corn starch several times a day • Good dental hygiene will help prevent it

12. Oral Trauma • Causes (many) • Falls, fights (bites), burns, blunt trauma (HBC) • “High-rise syndrome” in cats • Fractured hard palate, mandible • 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

13. 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

14. Oral Trauma • Rx • Depends on type of trauma • Control bleeding • Provide supportive care • IV fluids • pain relief • Insure adequate airway • Repair/extract damaged teeth • 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

15. 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

16. 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 gl

17. 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

18. 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)

19. 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 salivaiton restlessness • Retching • Anorexia • Hx of chewing on foreign objects Esophageal endoscopy

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

21. Esophageal Obstruction • 3 mo kitten • What is your diagnosis?

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

23. Esophageal Obstruction • 8 yr male cat

24. Interesting stuff • 7 mo old Pug

25. 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

26. 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

27. Acute Gastritis • Dx • Hx and PE • CBC, Chem Panel to assess dehydration, metabolic imbalance, organ failure • Rx • NPO until vom stops • 4-6 sips of water q1h until watered out • Fluid therapy (SQ or IV) • Gradually start feeding after watered out • Bland food (Hill’s I/D, boiled chicken/rice) • Antiemetics • Chlorpromazine (Thorazine) • Metoclopramide • Coating agents • Kaopectate • Pepto-Bismol • Antibiotics—often prescribed, rarely needed

28. 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)

29. Immune-Mediated Inflammatory Bowel Disease (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; culture to r/o bacterial infection • CBC, Chem panel to r/o metabolic disorder • FeLV, FIV to r/o those diseases • Endoscopy and biopsy for definitive diagnosis

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

31. Gastric Ulceration Usually a result of long-term NSAIDs • Signs • Vary from asymptomatic to vom blood • Anemia, edema • Melana • Anorexia • Abdominal pain • Septicemia if perforation occurs • Dx • X-ray using contrast medium (Ba) to show ulceration in stomach lining • Endoscopy

32. 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

33. Gastric Dilation/Volvulus Primarily a disease of large, deep-chested dogs Dilation—gas filled; Volvulus—twisted along longitudinal axis • Signs • Abdominal pain/distension • Weakness, collapse, depression, nausea, salivation • Increased HR, RR • Dx • PE shows dilation, poor perfusion (↑ cap refill) • X-rays show air filled stomach • ECG may show vent arrhythmia or sinus tachycardia • CBC and Chem panel necessary to assess electrolyte levels

34. Gastric Dilation/Volvulus • Rx • Goals • Decompress stomach • Pass stomach tube • 18 gauge needle • Stabilize patient (fluids, electrolytes, ECG) • Rx for shock • IV fluids • Corticosteroids • Antibiotics • Prepare for Sx • Sx—ASAP • Post-Op • ECG • Blood pressure • Pain management • Monitor urine output • Antibiotics • Maintain fluids (oral, IV)

35. Gastric Dilation/Volvulus • Client info • Avoid large meals • Limit exercise after meals • Feed high-quality protein diet • Tack-down procedure not 100% preventative

36. Gastric Neoplasia Most common malignant neoplasia in dogs is adenocarcinoma; in cats lymphoma • Signs • Wt loss • Vom w/ or w/o blood • Obstruction • Usually seen in older animals • Dx • Endoscopy and biopsy for diagnosis • X-ray with Ba contrast

37. Gastric Neoplasia • Rx • Surgery is TOC • Many tumors are too far advanced (inoperable) • Chemotherapy • Radiation less successful for gastric tumors • Client info • Px is poor; gastric neoplasia is a fatal disease • Supportive care, control of vom, good nutrition are needed for these animals

38. Diseases of SI Often involves impairment of absorptive surface of SI (what is that?) • Acute Diarrhea—one of the most commonly seen types of diarrhea • Causes—(often accompanies acute gastritis) • Diet change • Stressful situations • Drug therapy • Signs (Duh?) • Acute onset • ± vomiting • Normal appearance otherwise • Dx • Fecal to r/o parasites • CBC (dehydration), Chem panel to r/o metabolic diseases

39. Acute Diarrhea • Rx • Fluids for dehydration, electrolyte imbalance (SQ, IV, PO) • NPO x 24 h; water OK if no vomiting • Intestinal absorbants/coating agents (Kaopectate, PeptoBismol) • Loperamide—opiod receptor inhibitor that slows gut motility • Antibiotics (?) • Bland diet after 24 h • Hills I/D • Boiled chicken/rice

40. Parasite Diarrhea • Signs • Diarrhea • Wt loss • Poor hair coat • Listlessness • Dx • Fecal exam • Tx • Anthelmintics for parasites • Antiprotozoal medication for Giardia, Coccidia

41. Giardia

42. Parvovirus Seen mainly in young, unvaccinated puppies • Signs • Diarrhea, usually with blood • Vomiting • Febrile • Anorexia, depression • Dx—ELISA (enzyme-linked immunosorbent assay) test • Rx • IV fluids • Antidiarrheal therapy • Antibiotics (Gram neg) • Keep warm

43. Parvovirus (coyote)

44. Parvovirus • Client info • Sick animals will infect other unprotected animals • Parvo can be fatal • Vaccinate for protection

45. Diseases of LI Function is to reabsorb water, electrolytes; store feces • Inflammatory Bowel Disease (IBD) • Signs • Diarrhea with wt loss • ↑ frequency of defecations, ↓ volume • Tenesmus • ↑ mucus • Dx • Fecal to r/o parasites • Chem panel to r/o metabolic causes • Biopsy of LI wall • ↑ lymphocytes and plasma cells

46. Inflammatory Bowel Disease • Rx • Sulfasalazine—a sulfa drug with anti-inflammatory effects • Most effective against colitis • Prednisone • Mesalamine—a metabolite of Sulfasalazine in LI (actions unknown) • Hypoallergenic diet • Hill’s d/d, c/d, i/d • Homemade diets • Client info • Treatment is often prolonged • Goal of Rx is to control symptoms, not cure disease • Animals with IBD need to be taken outside frequently for BM’s

47. Intussusception Cause usually unknown; can result from parasites, FB, infection, neoplasia • Signs • Vom/diarrhea with or without blood • Anorexia, depression • Dx • Palpation of sausage-like mass in cranial abdomen • Rx • Surgical reduction/resection of necrotic bowel • Restore fluid/electrolyte balance • Restrict solid food x 24 h after Sx; then bland diet x 10-24 d • Client info • Recurrence is infrequent • Px depends on amt of bowel removed • Puppies should be treated for parasites to prevent intussusception

48. Intussuception

49. Megacolon Uncommon in dogs, more common in cats Associated with Obstipation • Signs • Straining to defecate • Must be distinguished from straining to urinate in male cats • vomiting • Weakness, dehydration, anorexia • Small, hard feces or liquid feces • With or without blood, mucus

50. Megacolon • Dx • Palpation of distended colon filled with hard, dry feces • Radiographs show colon full of feces • Rectal palpation assures adequate pelvic opening • Rx • Warm water enema • Animals can become hypothermic • Manual removal under anesthesia • Mucosal surface is delicate • Client info • Encourage water intake • Salt food • Always provide adequate supply • High-fiber diet