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.