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Pippin: a case of sialadenosis

Pippin: a case of sialadenosis. Accession #: 154963 Katie Phillips. Pippin. Pippin – 9 yr old intact male terrier. May 8 - Acute onset vomiting and regurgitating 6-10 times a day. Emergency clinic work up was unremarkable

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Pippin: a case of sialadenosis

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  1. Pippin:a case of sialadenosis Accession #: 154963 Katie Phillips

  2. Pippin • Pippin – 9 yr old intact male terrier. • May 8 - Acute onset vomiting and regurgitating 6-10 times a day. • Emergency clinic work up was unremarkable • May 9 & 12 – rDVM, clinical signs persist, repeat rads, blood work, endoscopy

  3. Pippin • May 20 – Still vomitting/reguritating multiple times a day, losing weight. • rDVM performs barium study.

  4. More history • Pippin presented to NCSU 5/27 emergency service continued vomiting & nausea • Complete medicine work up 5/31 • Small vol. fluid in caudal esophagus • Splenic nodules - aspirated

  5. Pippin • 7/14 – Continues to vomit/regurge multiple times per day. Losing weight, but hungry. Hypersalivating- foaming at mouth and nose. • Physical exam: BCS 2/9, intermittently acts painful on palpation of laryngeal region, firm mandibular salivary glands, lip smacking, reluctant to open mouth. • Esophagram: Decreased oropharyngeal sensation causing delayed pharyngeal contraction, nasoesophageal reflux and aspiration. Suspect pain with mastication.

  6. Phenobarbital trial • Gave Pippin one dose of 1 mg/kg Phenobarbital – within hours he was markedly improved –less depressed, nauseated, readily opens mouth and ate quickly. • Diagnosis - Sialadenosis

  7. Sialadenosis • Rare: ~40 sporadic cases reported in literature. One case series by Boydellet al. • Typical presentation is excessive salivation, lip smacking, enlarged salivary glands, vomiting & regurgitating. • Rule out other causes. Diagnosis is based on pharyngeal dysfunction, salivary gland enlargement with normal cytology/histology and response to Phenobarbital.

  8. Sialadenosis –Phenobarbital responsive pharyngeal dysfunction • Giloret al. – described esophagram of a case as accumulation of food in pharynx before pharyngeal contraction is initiated, followed by normal esophageal transit. Followed by repeated swallowing.

  9. Sialadenosis • Pathophysiology is unknown. Presumptively focal seizures in limbic system. • Why respond so fast to phenobarb? • These patients show dramatic response within hours and are back to normal within days. Many dogs will relapse if phenobarbital is stopped, and continue with low doses rest of life.

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