Page 417 - Small Animal Internal Medicine, 6th Edition

PART THREE Digestive System Disorders

Michael D. Willard

VetBooks.ir CHAPTER 26

Clinical Manifestations of

Gastrointestinal Disorders

DYSPHAGIA, HALITOSIS, AND is apparent but cannot be localized, retrobulbar lesions,
DROOLING temporomandibular joint disease, and posterior pharyngeal
lesions should be considered. A concurrent clinicopatho-
Dysphagia, halitosis, and drooling often coexists in animals logic evaluation may be useful, especially if oral examina-
with oral disease. Dysphagia (i.e., difficulty in eating) usually tion findings indicate systemic disease (e.g., lingual necrosis
results from oral pain, masses, foreign objects, trauma, neu- resulting from uremia, chronic infection secondary to
romuscular dysfunction, or a combination of these (Box hyperadrenocorticism).
26.1). Halitosis typically signifies an abnormal bacterial pro- Mucosal lesions (e.g., masses, inflamed or ulcerated
liferation secondary to tissue necrosis, tartar, periodontitis, areas) and painful muscles of mastication should be biop-
or oral/esophageal retention of food (Box 26.2). Drooling sied. Masses that do not disrupt the mucosa, especially
occurs because animals are unable or unwilling to swallow those on the midline and dorsal to the larynx, can be dif-
(i.e., pseudoptyalism). Excessive salivation is often due to ficult to discern and are often best found by digital pal-
nausea; animals that are not nauseated rarely produce exces- pation. Fine-needle aspiration and cytologic evaluation
sive saliva (Box 26.3). Although any disease causing dyspha- are reasonable first steps for diagnosing masses. Remem-
gia may have an acute onset, clinicians usually should first ber that fine-needle aspirates can only find disease; they
consider foreign objects or trauma as the cause in acutely do not exclude disease (i.e., they are not sensitive tests).
dysphagic patients. The environmental and vaccination Subtle masses or those dorsal to the larynx are often best
history should always be assessed to determine whether aspirated with ultrasonographic guidance. Multiple aspi-
rabies is a reasonable possibility. rations are usually done before a wedge or punch biopsy
The next step is a thorough oral, laryngeal, and cranial is performed.
examination. This examination is often the most important Incisional biopsy specimens must include generous
diagnostic step because most problems producing oral pain amounts of submucosal tissues. Many oral tumors cannot be
can be partially or completely defined at physical exami- diagnosed with superficial biopsy specimens because normal
nation. Ideally, this is done without chemical restraint to oral flora cause superficial necrosis and inflammation
facilitate detection of pain. However, many animals must obscuring the lesion. Clinicians are often afraid to biopsy
be anesthetized for an adequate oral examination to search aggressively because these lesions bleed profusely and are
for anatomic abnormalities, inflammatory lesions, pain, and hard to suture. The clinician should avoid major vessels (e.g.,
discomfort. If pain is found, the question is whether it occurs the palatine artery) and use silver nitrate to stop hemor-
when the mouth is opened (e.g., retrobulbar inflammation), rhage. It is better to have difficulty stopping hemorrhage after
is associated with extraoral structures (e.g., muscles of masti- obtaining an adequate biopsy specimen than to have less
cation), or originates from the oral cavity. The clinician must difficulty stopping hemorrhage after obtaining a nondiag-
search for fractures, lacerations, crepitus, masses, enlarged nostic specimen. If diffuse oral mucosal lesions are noted,
lymph nodes, inflamed or ulcerated areas, draining tracts, search carefully for vesicles (e.g., pemphigus); if found,
loose teeth, excessive temporal muscle atrophy, inability to remove them intact for histopathologic and immunofluores-
open the mouth while the animal is under anesthesia, and cent studies. If vesicles are not found, then at least two or
ocular problems (e.g., proptosis of the eye, inflammation, three tissue samples representing a spectrum of new and old
or strabismus suggestive of retrobulbar disease). If oral pain lesions should be obtained.

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