pippin: a case of sialadenosis
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Pippin:a case of sialadenosis
Accession #: 154963Katie 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• May 9 & 12 – rDVM,
clinical signs persist, repeat rads, blood work, endoscopy
Pippin
• May 20 – Still vomitting/reguritating multiple times a day, losing weight.
• rDVM performs barium study.
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
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.
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
Sialadenosis
• Rare: ~40 sporadic cases reported in literature. One case series by Boydell et 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.
Sialadenosis –Phenobarbital responsive pharyngeal dysfunction
• Gilor et 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.
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.