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Dysphagia 277

Dysphagia Client Education
Sheet
VetBooks.ir Clinical Presentation Diseases and Disorders

BASIC INFORMATION
DISEASE FORMS/SUBTYPES ○ Functional: depressed consciousness,
CN deficits (V, VII, IX, XII), trigeminal
Definition Disease variants: neuritis, masticatory muscle myositis
Difficulty swallowing • Anatomic location: oral, pharyngeal, or ○ Pain: pain secondary to periodontal
esophageal dysphagia; a large number of disease, retrobulbar abscess, trauma,
Synonyms dogs may have abnormalities in more than stomatitis, or temporomandibular joint
Oral, pharyngeal, and esophageal dysphagia; one location (TMJ) disease
regurgitation • Cause: obstruction (mechanical or functional) • Pharyngeal
or pain ○ Mechanical: pharyngeal masses (neoplasia,
Epidemiology abscess, granuloma, tonsillar enlargement),
SPECIES, AGE, SEX HISTORY, CHIEF COMPLAINT FB, pharyngeal swelling, cricopharyngeal
• Dogs > cats • Varies with underlying cause and location achalasia
• Congenital abnormalities: young animals of defect ○ Functional: CN deficits (V, IX, X, XI),
(onset often at birth or weaning) • Presenting complaints may include weight cricopharyngeal asynchrony, rabies, CNS
• Acquired abnormalities: middle-aged or older loss, regurgitation, coughing, gagging, (brainstem) disease, MG, toxicity (botu-
animals halitosis, and ptyalism. lism, tetanus), polymyositis, polyneuritis
• Ravenous appetite or anorexia may be ○ Pain: pharyngitis, stomatitis
GENETICS, BREED PREDISPOSITION reported. • Esophageal (p. 873)
Depends on underlying disease process: • Clients often mistake regurgitation for
• Oral dysphagia: severe periodontal disease vomiting, warranting careful questioning. DIAGNOSIS
(anecdotally more common in small-breed
dogs), trigeminal neuritis (golden retrievers), PHYSICAL EXAM FINDINGS Diagnostic Overview
stomatitis (cats) General: Dysphagia describes any defect in the swallow
• Pharyngeal dysphagia: cricopharyngeal • Weight loss/poor body condition mechanism and is therefore nonspecific. A
achalasia (golden retrievers, cocker and • Increased respiratory effort, tachypnea, and combination of signalment, clinical course,
springer spaniels, toy breeds) cough may be appreciated with aspiration. observation during feeding, and physical exam
• Esophageal dysphagia: regurgitation (p. 873), Specific physical examination findings depend findings can help localize the lesion. Specific
hiatal hernia (brachycephalic breeds, Chinese on localization, severity, and underlying cause: testing can be tailored as appropriate.
Shar-pei) • Oral dysphagia: difficulty with mastication,
bolus formation, or prehension Differential Diagnosis
RISK FACTORS ○ Clinical observations: dropping food, • Vomiting
• Reflux (gastroesophageal and/or extraesopha- chewing on one side of the mouth, • Regurgitation (p. 873)
geal reflux) ptyalism, halitosis, signs consistent with • Expectoration
• Dietary indiscretion cranial nerve (CN) dysfunction (V, VII, • Ptyalism
• Feline immunodeficiency virus (FIV), feline IX, XII)
leukemia virus (FeLV) ○ Oral disease may be obvious (e.g., severe Initial Database
• Myasthenia gravis (MG) dental or periodontal disease, mass). • Oral/oropharyngeal examination (may
• Megaesophagus • Pharyngeal dysphagia: inability to propel require sedation [pp. 1125 and 1140])
• Periodontal disease the food bolus from the base of the tongue • CBC/serum biochemical profile/urinalysis:
• Recent anesthesia through the upper esophageal sphincter. usually nonspecific changes; inflammatory
• Neuropathy/myopathy ○ Clinical observations: exaggerated/repetitive leukogram may be seen with aspiration
• Endocrine disease: hypoadrenocortisolism, swallows, gagging, ptyalism, halitosis, pneumonia, changes consistent with endo-
hypothyroidism signs consistent with CN dysfunction crine disorders (hypoadrenocortisolism,
• Sialocele (V, IX, X, XI) hypothyroidism), increased creatine kinase
• Lymphadenopathy • Esophageal dysphagia: regurgitation (p. with diffuse myositis
• Central nervous system (CNS) disorders, 873) is the hallmark feature of esophageal • Radiographs (dental, cervical, thoracic): a
cranial nerve deficits dysphagia. minimum of three thoracic radiographic
• Rabies ○ Clinical observation: esophageal bulge, views is recommended to assess concurrent
• Toxicity: tetanus, botulism, lead, thallium regurgitation, halitosis, ptyalism, signs aspiration pneumonia. Abdominal compres-
• Dysautonomia consistent with CN X or diffuse auto- sion may be applied to evaluate for sliding
• Brachycephalic airway syndrome nomic dysfunction hiatal hernia.
CONTAGION AND ZOONOSIS Etiology and Pathophysiology Advanced or Confirmatory Testing
Rabies in animals with unknown vaccination • Dysphagia may occur secondary to pain or • Videofluoroscopic swallow study (VFSS):
history functional or mechanical defect of any of necessary for the characterization of pha-
the three swallow phases (oral, pharyngeal, ryngeal and esophageal dysfunction.
ASSOCIATED DISORDERS esophageal). • Manometry: characterization of esophageal
• Aspiration pneumonia (p. 793) • Oral dysfunction (not widely available)
• Weight loss/cachexia ○ Mechanical: oral masses (neoplasia, • ACTH stimulation test (hypoadrenocorti-
• Dehydration abscess, granuloma), foreign body (FB), solism [p. 512])
• Halitosis lymphadenopathy, sialocele, hematoma, • Thyroid function testing (hypothyroidism
• Ptyalism (p. 833) cleft palate, facial/oral trauma [p. 525])

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