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Medicine 4th stage Lec 4 Dr. Ali Rabee Diseases of the buccal cavity and associated organs Diseases of the muzzle The congenital defect of harelip may be contiguous with a cleft palate. Severe dermatitis with scab formation, development of fissures, and sloughing and gangrene of the skin of the muzzle are common lesions in cattle affected with photosensitive dermatitis, bovine malignant catarrh, bovine virus diarrhea and rinderpest. In sheep severe lesions of the muzzle are less common, but occur in bluetongue and ecthyma. Stomatitis Stomatitis is inflammation of the oral mucosa and includes glossitis (inflammation of the tongue), palatitis (lampas) (inflammation of the palate) and gingivitis (inflammation of the mucosa of the gums). Etiology Stomatitis may be caused by physical, chemical or infectious agents that's includes: Physical agents 1. Trauma while dosing orally with a balling gun. 2. Laceration of the tongue. 3. Foreign body injury. 4. Malocclusion of teeth. 5. Sharp awns or spines on plants. 1 Medicine 4th stage Lec 4 Dr. Ali Rabee 6. Eating frozen feed and drinking hot water are recorded, but seem highly improbable. 7. Ulcers of the soft palate of horses may be due to mechanical trauma. Chemical agents 1. Irritant drugs, e.g. chloral hydrate. 2. Counterirritants applied to skin, left unprotected and licked by the animal, including mercury and cantharides compounds. 3. Irritant substances administered by mistake, including acids, alkalis and phenolic compounds. 4. Manifestation of systemic poisoning, e.g. chronic mercury poisoning. 5. Lesions associated with uremia syndrome in horses. Infectious agents Cattle 1. Oral necrobacillosis associated with Fusobacterium necrophorus. 2. Ulcerative, granulomatous lesions may occur on the gums in cases of Actinomycosis. 3. Stomatitis with vesicles occurs in foot-and-mouth disease and in vesicular stomatitis. 2 Medicine 4th stage Lec 4 Dr. Ali Rabee 4. Erosive, with some secondary ulcerative, stomatitis occurs in bovine viral diarrhea (mucosal disease), bovine malignant catarrh, rinderpest. 5. Proliferative lesions occur in popular stomatitis, proliferative stomatitis. 6. Oral mucosal necrosis in bovine sweating sickness. Sheep 1. Erosive lesions in bluetongue, rinderpest and peste de petits ruminants. 2. Vesicular lesions rarely in foot and mouth disease. 3. Granulomatous lesions due to ecthyma. Horse 1. Cheilitis and gingivitis (inflammatory nodules of the lips and gums caused by plant awns). 2. Vesicular lesions in vesicular stomatitis. 3. Herpesvirus infections. 4. Lingual abscess associated with Actinobacillus spp. Clinical findings 1. There is partial or complete anorexia and slow, painful mastication. 2. Chewing movements and smacking of the lips are accompanied by salivation, either frothy and in small amounts, or profuse and 3 Medicine 4th stage Lec 4 Dr. Ali Rabee drooling if the animal does not swallow normally and the saliva may contain pus or shreds of epithelial tissue. 3. A fetid odor is present on the breath only if bacterial invasion of the lesion has occurred. 4. Enlargement of local lymph nodes may also occur if bacteria invade the lesions. 5. An increased desire for water is apparent and the animal resents manipulation and examination of the mouth. Treatment 1. Affected animals should be isolated and fed and watered from separate utensils if an infectious agent is suspected. 2. Specific treatments are described under the headings of the individual diseases. 3. Nonspecific treatment includes frequent application of a mild antiseptic collutory such as a 2% solution of copper sulfate, a 2 % suspension of borax or a 1 % suspension of a sulfonamide in glycerin. 4. Soft, appetizing food should be offered and feeding by stomach tube or intravenous alimentation may be resorted to in severe, prolonged cases. 4 4th stage Medicine Lec 4 Dr. Ali Rabee Pharyngeal obstruction Obstruction of the pharynx is accompanied by stertorous respiration, coughing and difficult swallowing. Etiology 1- Foreign bodies These include bones, corn cobs and pieces of wire. While horses are considered discriminating eaters in comparison to cattle, they will occasionally pick up pieces of metal while eating. 2- Tissue swellings Cattle Retropharyngeal lymphadenopathy or abscess due to tuberculosis, actinobacillosis or bovine viral leukosis. Fibrous or mucoid polyps. Horses Retropharyngeal lymph node hyperplasia and granulomas. Retropharyngeal abscess and cellulitis. Retropharyngeal lymphadenitis caused by strangles. Pharyngeal cysts. 5 lymphoid Medicine 4th stage Lec 4 Dr. Ali Rabee Clinical findings 1. There is difficulty in swallowing and animals may be hungry enough to eat but, when they attempt to swallow, cannot do so and the food is coughed up through the mouth but drinking is usually managed successfully. 2. An obvious sign is a snoring inspiration, often loud enough to be heard some yards away, the inspiration is prolonged and accompanied by marked abdominal effort. 3. When the disease runs a long course, emaciation usually follows. 4. When there is metallic foreign bodies in the oral cavity or pharynx, the clinical findings include purulent nasal discharge, dysphagia, halitosis, changes in phonation, laceration of the tongue and stertorous breathing. Treatment 1. Removal of a foreign body may be accomplished through the mouth. 2. Treatment of actinobacillary lymphadenitis with iodides is usually successful and some reduction in size often occurs in tuberculous enlargement of the glands but complete recovery is unlikely to occur. 3. Parenteral treatment of strangles abscesses with penicillin may effect a cure. 6 Medicine 4th stage Lec 4 Dr. Ali Rabee 4. Surgical treatment has been highly successful in cases caused by medial retropharyngeal abscess. Pharyngeal paralysis Pharyngeal paralysis is manifested by inability to swallow and an absence of signs of pain and respiratory obstruction. Etiology Pharyngeal paralysis occurs sporadically, due to peripheral nerve injury, and in some encephalitides with central lesions. Peripheral nerve injury: Guttural pouch infections in horses. Trauma to the throat region. Secondary to specific diseases: Rabies and other encephalitides. Botulism. African horse sickness. A series of unexplained fatal cases in horses. Clinical finding 1. The animal is usually hungry but, on prehension of food or water, attempts at swallowing are followed by dropping of the food from the mouth, coughing and the expulsion of food or regurgitation through the nostrils. 7 Medicine 4th stage Lec 4 Dr. Ali Rabee 2. Salivation occurs constantly and swallowing cannot be stimulated by external compression of the pharynx. 3. There is rapid loss of condition and dehydration. 4. Pneumonia may follow aspiration of food material into the lungs and produces loud gurgling sounds on auscultation. 5. The animals are normal except that regurgitated boluses are dropped from the mouth, usually in the form of flattened disks of fibrous food material. 6. Affected animals m ay lose weight and complete pharyngeal paralysis is usually permanent and fatal. Treatment 1. Treatment is unlikely to have any effect. 2. The local application of heat may be attempted. 3. Feeding by nasal tube or intravenous alimentation may be tried if disappearance of the paralysis seems probable. Esophagitis Inflammation of the esophagus. Etiology 1. Primary esophagitis caused by the ingestion of chemical or physical irritants is usually accompanied by stomatitis and pharyngitis. 8 Medicine 4th stage Lec 4 Dr. Ali Rabee 2. Laceration of the mucosa by a foreign body or complications of nasogastric intubation may occur. 3. The administration of sustained release anthelmintic boluses to young calves that are not large enough for the size of the bolus used may cause esophageal injury and perforation. 4. Death of Hypoderma lineatum larvae in the sub-mucosa of the esophagus of cattle may cause acute local inflammation and subsequent gangrene. 5. Inflammation of the esophagus occurs commonly in many specific diseases, particularly those that cause stomatitis. Clinical findings 1. In the acute injury of the esophagus, there is salivation and attempts to swallow, which cause severe pain, particularly in horses. 2. In some cases, attempts at swallowing are followed by regurgitation and coughing, pain, retching activities and vigorous contractions of the cervical and abdominal muscles. 3. Marked drooling of saliva, grinding of the teeth, coughing and profuse nasal discharge are common. 4. Regurgitation may occur and the regurgitus contains mucus and some fresh blood. 9 Medicine 4th stage Lec 4 Dr. Ali Rabee 5. If perforation has occurred, there is local pain and swelling and often crepitus. Treatment 1. Feed should be withheld for 2-3 days and fluid and electrolyte therapy may be necessary for several days. 2. Parenteral antimicrobials are indicated, especially if laceration or perforation has occurred. 3. Reintroduction to feed should be monitored carefully and all feed should be moistened to avoid the possible accumulation of dry feed in the esophagus, which may not be fully functional. Esophageal obstruction Esophageal obstruction may be acute or chronic. Etiology Obstruction may be intra-luminal by swallowed material or extraluminal due to pressure on the esophagus by surrounding organs or tissues. Esophageal paralysis may also result in obstruction. Intraluminal obstructions 1. Solid obstructions, especially in cattle, by turnips, potatoes, peaches, apples, oranges, etc. 2. The most common type of esophageal obstruction in horses is simple obstruction due to impaction of ingesta. 10 Medicine 4th stage Lec 4 Dr. Ali Rabee 3. Foreign bodies in horses include pieces of wood, antimicrobial boluses and fragments of nasogastric tubes. 4. A trichobezoar caused esophageal obstruction in a cow; it may have been regurgitated rather than ingested because of the lack of teeth marks on the trichobezoar. Extra-luminal obstructions 1. Tuberculous or neoplastic lymph nodes in the mediastinum or at the base of lung. 2. Cervical or mediastinal abscess 3. Persistent right aortic arch. 4. Thymoma. Clinical findings Acute obstruction or choke Cattle 1. The obstruction is usually in the cervical esophagus just above the larynx or at the thoracic inlet. Obstructions may also occur at the base of the heart or the cardia. 2. The animal suddenly stops eating and shows anxiety and restlessness. There are forceful attempts to swallow and regurgitate, salivation, coughing movements. 11 and continuous chewing Medicine 4th stage Lec 4 Dr. Ali Rabee 3. If obstruction is complete, bloating occurs rapidly and adds to the animal's discomfort, ruminal movements are continuous and forceful and there may be a systolic murmur audible on auscultation of the heart. 4. There is inability to swallow, salivation and continued bloat. Horse 1. In the horse with esophageal obstruction due to feed, the obstruction may occur at any level of the esophagus from the upper cervical region all the way to the thoracic portion. 2. The ingestion of large quantities of grain or pelleted feed can cause obstruction over a long portion of the esophagus. 3. The clinical findings vary with the location, nature, extent and duration of the obstruction. Typically the major clinical finding is dysphagia with nasal reflux of saliva, feed and water. 4. Affected horses will usually not attempt further eating but will drink and attempt to swallow water. 5. Horses with acute esophageal obstruction are commonly difficult to handle because they are panicky and make forceful attempts to swallow or retch. 6. In some horses it may be difficult to pass a nasogastric tube because they resist the procedure, passage of a nasogastric tube is 12 Medicine 4th stage Lec 4 Dr. Ali Rabee necessary to make the diagnosis and to assess the level of the obstruction. 7. Persistent obstruction may occur in the horse and death may occur in either species from subsequent aspiration pneumonia or, when the obstruction persists, from dehydration. Treatment 1. Conservative approach. 2. Sedation. Acepromazine 0.05 mg/kg BW intravenously. Xylazine 0.5-1.0 mg/kg BW intravenously. Detomidine 0.01-0.02 mg/kg BW intravenously. Romifidine 0.04-0.12 mg/kg intravenously. 3. Pass a stomach tube and allow object to move into stomach, endoscope or by Manual removal through oral cavity in cattle or by Surgical removal of foreign bodies. 13