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Clinical Manifestations of Gastrointestinal Disorders - Coggle Diagram
Clinical Manifestations of
Gastrointestinal Disorders
DYSPHAGIA, HALITOSIS, AND
DROOLING
halitosis
an abnormal bacterial proliferation secondary
tissue necrosis
periodontitis
tartar
oral/esophageal retention of food
accompanies dysphagia
more productive to determine the cause of the dysphagia
without dysphagia
first sure that the odor is abnormal
check
for the ingestion of odoriferous substances
feces
originating from the esophagus
Radiographs,esophagoscopy
reveal a tumor or retained
food secondary to stricture or weakness
history and
oral examination
tartar accumulation
cleaned to try to
resolve the problem
Drooling
unable or unwilling to swallow
Ptyalism/Pseudoptyalism
Excessive salivation is often due to
nausea
The environmental and vaccination history should always be assessed to determine whether rabies is a reasonable possibility
caused by nausea, oral pain, or dysphagia
Dysphagia
oral pain, masses, foreign objects, trauma, neuromuscular dysfunction
difficulty in eating
any disease causing dysphagia may have an acute onset
clinicians usually should first
consider
foreign objects or trauma
without demonstrable lesions or pain
neuromuscular disease
atrophic myositis
Finding swollen, painful temporal muscles suggests acute myositis
severe temporal-masseter muscle
atrophy plus dificulty opening the mouth
chronic temporal-masseter
myositis
Biopsy
obtain only
fibrous scar tissue
antibodies to type 2M
masticatory muscle myositis
Neurogenic
prehensile
disorders in the oral
Inability to pick up food or having food drop from the
mouth while eating
indicates a prehensile
pharyngeal
cricopharyngeal
Rabies
cranial nerve deficits (especially
deficits of cranial nerves V, VII, IX, XII)
neurologic examination
cinefluoroscopy or fluoroscopy
Localized myasthenia
important cause of pharyngeal dysphagia
ruled out with serology
oral, laryngeal, and cranial
examination
examination
most important
diagnostic step
because
producing oral pain
can be partially or completely defined at physical examination
without chemical restraint
detection of pain
anesthetized
adequate oral examination to search
anatomic abnormalities
inflammatory lesions
pain
discomfort
pain is found
whether it occurs
when the mouth is opened
retrobulbar inflammation
originates from the oral cavity
associated with extraoral structures
muscles of mastication
the clinician must
search
masses
enlarged
lymph nodes
inflamated or ulcerated areas
draining tracts
crepitus
loose teeth
excessive temporal muscle atrophy
inability to
open the mouth while the animal is under anesthesia
ocular problems
proptosis of the eye
inflammation
strabismus suggestive of retrobulbar disease
lacerations
fractures
oral pain
apparent
cannot localized
retrobulbar lesions
temporomandibular joint disease
posterior pharyngeal
lesions
should be considered
clinicopathologic evaluation
useful
especially if oral examination findings indicate systemic disease
lingual necrosis
Uremia
chronic infection secondary to
hyperadrenocorticism
biopsy
Mucosal lesions
masses, inflamed or ulcerated
areas
painful muscles of mastication
Incisional biopsy specimens
include generous
amounts of submucosal tissues
Many oral tumors
cannot be
diagnosed
superfacial biopsy specimens
normal oral oral flora cause superficial necrosis and inflammation
Clinicians
afraid to biopsy
aggressively
these lesions bleed profusely and are
hard to suture
avoid major vessels
(the palatine artery)
silver nitrate to stop hemorrhage
It is better to have difficulty stopping hemorrhage
obtaining an adequate biopsy specimen
than
have less
difficulty stopping hemorrhage
obtaining a nondiagnostic specimen
mass
do not disrupt the mucosa
especially
those on the midline and dorsal to the larynx
difficult to discern
found by digital palpation
FNA,cytologic evaluation
diagnosing masses
FNA
only find disease
do not exclude disease
not sensitive tests
Subtle masses or those dorsal to the larynx
aspirated with ultrasonographic guidance
Multiple aspirations are usually done before a wedge or punch biopsy
is performed.
difuse oral mucosal lesions
search for vesicles
pemphigus
if found, remove them intact for histopathologic and immunofluorescence studies
If vesicles are not found, then at least two or three tissue samples representing a spectrum of new and old lesions should be obtained
oral examination findings are not helpful
oral and
laryngeal radiographs
Oral
cultures
rarely helpful
normal oral flora makes
interpretation
unless there is a draining tract
or abscess.
REGURGITATION
FROM VOMITING
Regurgitation
expulsion of material
mouth, pharynx, or esophagus
pH of 7 or greater without
evidence of bilirubin
vomiting
expulsion of material from
the stomach and/or intestines
pH is 5 or less
expectoration
expulsion
of material from the respiratory tract
associated with
coughing
dogs that cough and gag excessively
stimulate themselves to vomit
history taking is important
Animals that regurgitate and vomit
may cough
to aspiration
esophageal weakness
cervical esophagus balloon in and out during respiration
clinician cannot distinguish
between two
urine dipstick
determine pH
bilirubin in freshly “vomited” material
Finding bilirubin means the material is duodenal in origin
thoracic radiographs ± a barium-contrast esophagram
esophageal lesions
hiatal hernia, partial stricture, segmental
motility defects
missed
careful radiographic used
Endoscopy
detect esophageal lesions missed by
imaging
REGURGITATION
Some animals
dysphagia
neuromuscular disorders
difficulty swallowing liquids than solid foods,
probably because it is easier to aspirate liquids
Oropharyngeal
dysphagic animals
cough
swallowing
water
History or
observing the pet eating
allow the clinician to detect
dysphagia
(e.g., undue stretching or flexing of the neck during swallowing, repeated efforts at swallowing, food falling from the mouth during swallowing).
regurgitating animal
dysphagic
oral, pharyngeal,
and cricopharyngeal dysfunctions must be considered
the latter two clinically mimic each other
Fluoroscopic evaluation
of swallowing a barium meal
differentiate
pharyngeal from cricopharyngeal dysfunction
they
are not accurately differentiated
inappropriate therapy may
cause morbidity or mortality
esophageal regurgitation
obstruction and muscular weakness
thoracic radiographs
Barium-contrast esophagrams
liquid barium sulfate can miss partial strictures
mixing barium with canned food or kibble typically reveals these lesions
Fluoroscopy
partial loss
of peristalsis
segmental aperistalsis
gastroesophageal reflux
sliding hiatal hernias
the lower esophageal
sphincter
fluoroscopically observed
detect frequency and severity of gastroesophageal
reflux
normal animals may show occasional reflux
If regurgitation is confirmed
localized
to the oropharynx or esophagus
animal seems to be regurgitating
contrast-enhanced
radiographs fail to reveal esophageal dysfunction
the
assessment of regurgitation is wrong
there is occult esophageal
disease requiring esophagoscopy for diagnosis
esophagitis, gastroesophageal reflux
Esophageal obstruction
foreign
objects
vascular anomalies
cicatrix
tumors
Achalasia
the lower esophageal sphincter
sometimes be responsible
Obstruction
acquired
congenital
extraesophageal
vascular ring anomalies
intraluminal acquired
foreign objects
cicatrix secondary
to esophagitis
intramural
extraesophageal
Endoscopy
diagnostic
therapeutic
thoracotomy
seldom needed
management of cicatrix or intraluminal foreign objects
Esophageal weakness
congenital
idiopathic
and further
diagnostics are unfruitful
acquired
underlying neuromuscular problem
infrequently diagnosed
finding one may lead to a permanent cure
opposed to
supportive therapy
VOMITING
HEMATOCHEZIA
ABDOMINAL PAIN
TENESMUS
ABDOMINAL EFFUSION
HEMATEMESIS
FECAL INCONTINENCE
CONSTIPATION
ANOREXIA/HYPOREXIA
MELENA
WEIGHT LOSS
ACUTE ABDOMEN
DIARRHEA
ABDOMINAL DISTENTION OR
ENLARGEMENT