12. Diseases of the oesophagus in dogs and cats. Regurgitation and vomitus. Flashcards
Oesophagititis?
Oesophagitis
CAUSES
§ Caustic substances § Doxycycline
§ Gastro-oesophageal reflux (GOR) § Clindamycin
§ Motility disorders § Anaesthesia
§ Megaoesophagus § Foreign body
CLINICAL SIGNS
§ Odynophagia (pain when swallowing) § Coughing
§ Regurgitation § Fever
§ Salivation § Dyspnoea
§ Food refusal
DIAGNOSIS
Clinical signs; ↑ WBC; Endoscopy; Radiography
TREATMENT
§ Omeprazole + prokinetics
§ Sucralfate suspension (acid buffer)
§ Total parenteral nutrition (TPN)
Gastro- Oesophageal reflux?
Gastro-Oesophageal Reflux (GOR)
Poor closure of the cardia → HCl; Pepsin; Trypsin; Bile; HCO3 - →Inflammation
CAUSES
§ Delayed gastric emptying
§ Upper airway obstruction
§ Hiatal hernia
§ Anaesthesia
§ Chronic vomiting
CLINICAL SIGNS
Same CSx as oesophagitis, as well as…
§ Reverse sneezing
§ Chronic bronchitis
§ Laryngitis
§ Rhinitis
§ Eructation
DIAGNOSIS
§ Clinical signs; History
§ Endoscopy (oesophagitis; hiatal hernia)
TREATMENT
§ Low-fat diet
§ H2-receptor blockers; Proton-pump inhibitors: Omeprazole
§ Prokinetics: Cisapride; Tegaserod
§ Sucralfate
Enhancement of cardia closure: Metoclopramide; Erythromycin
Oesophageal foreign body?
Oesophageal Foreign Body
CLINICAL SIGNS
§ Regurgitation
§ Salivation
§ Abdominal distension
§ Coughing; Fever; Dyspnoea
DIAGNOSIS
§ Clinical signs
§ Thoracic radiography
§ Endoscopy
§ ↑ WBC
TREATMENT
§ Endoscopic removal
§ Surgery
§ Gastric tubing
§ Euthanasia
Dysmotility/ Oesophageal Weakness?
Dysmotility/Oesophageal Weakness
Motility disorder + Food retention + Regurgitation
Types:
§ Megaoesophagus
§ Partial oesophageal dysmotility
§ Dystonia
§ Diverticulum
CAUSES
§ Idiopathic § Autoimmune disorders
§ Muscle atrophy § Post-anaesthetic condition
§ Myasthenia gravis § Oesophagitis
CLINICAL MANIFESTATION
§ Dysphagia/Regurgitation (+ bronchopneumonia)
§ Bronchitis / Bronchopneumonia → Dysmotility
CLINICAL SIGNS
§ Salivation
§ Coughing
§ Fever
§ Dyspnoea
§ Weight loss
DIAGNOSIS
Fluoroscopy; Radiography (survey; contrast)
TREATMENT
Special feeding; Percutaneous endoscopic gastrotomy (PEG)
Tx of any oesophagitis
Megaoesophagus?
MEGAOESOPHAGUS
Persistent ↓ motility of the oesophagus
Dogs > Cats
Normally idiopathic; May be caused by laryngeal paralysis; It is
important to check for aspiration pneumonia
Congenital megaoesophagus
§ Predisposed: Mini Schnauzer; Great Dane; Dalmatian;
Shar-Pei; Irish setter; Labrador
§ CSx usually develop during weaning phase
§ Ø Tx; Poor prognosis
Acquired megaoesophagus – Primary form
§ Diagnosis by exclusion
§ Large breeds > Toy breeds of dog
§ Treatment: Feeding using the Bailey chair; Sucralfate +
Bethanechol
Acquired megaoesophagus – Secondary form (causes)
§ Myasthenia gravis: Immune response against Ach
receptors; Focal/generalised (systemic weakness);
Tx: Pyridostigmine
§ Hypoadrenocorticism (Addison’s)
§ Lead poisoning
§ Oesophagitis
§ Hypothyroidism
§ Neuropathy
Spirocercosis?
SPIROCERCOSIS
Spirocercosis lupi – A widely distributed nematode; Causes parasitic
nodules in the oesophagus, aortic aneurysms & spondylitis
Clinical signs
§ Regurgitation § Coughing
§ Vomiting § Dyspnoea
§ Weight loss § Sudden death
Diagnosis: Faecal examination; Endoscopy
Treatment: Imidacloprid/Moxidectin; Surgery
Prevention : Milbemycin
Persistent right aortic arch (PRAA)
PERSISTENT RIGHT AORTIC ARCH (PRAA)
Extraluminal compression by the lig. arteriosum
Most common vascular ring anomaly in dogs; German shepherd;
Congenital disease
Clinical symptoms (shortly after weaning)
§ Regurgitation
§ Coughing
§ Dyspnoea
§ Weight loss
Diagnosis
§ Survey & contrast radiography
§ Endoscopy
Differential diagnosis: Stricture; Intraluminal obstruction
Treatment: Surgery
Difference between Regurgitation and Vomiting?
Distinguishing from vomiting and regurgitation?
DISTINGUISHING THEM IN PRACTICE
§ History & CSx
§ Physical exam: Palpation of distended cervical
oesophagus; Cervical mass; Injury; Foreign body
§ Thoracic radiography (± Barium): Obvious
megaoesophagus; Foreign body; Perforation; Pleuritis;
PTX
§ Endoscopy: Oesophagitis; Hiatal hernia; Stricture
§ Fluoroscopy: Motility disorders; Hiatal hernia; Stricture
Causes of vomiting?
CAUSES OF VOMITING
Metabolic diseases
§ Renal disease
§ Hepatobiliary disease
§ Electrolyte/Acid-base derangements
Endocrine diseases
§ Hypoadrenocorticism
§ Hyperthyroidism
§ Diabetic Ketoacidosis
Toxins/Drugs
§ Heavy metals/Ethylene glycol
§ NSAIDS; Abx; Chemotherapy agents
Dietary causes
§ Indiscretion
§ Allergy
§ Intolerance
Abdominal diseases
§ Pancreatitis
§ Peritonitis
§ Neoplasia
Gastric diseases
§ Gastritis
§ GDV; Foreign body
§ Delayed gastric emptying
§ Neoplasia
S. intestinal diseases
§ IBD; Obstruction; Parasites; Neoplasia; Infection
L. intestinal diseases
§ Constipation; Colitis
History, Physical exam of the patient, laboratory diagnostics, radiography and US?
HISTORY
Duration: Food in vomit > 8hrs after ingestion → Delayed gastric
emptying; Acute/chronic
PHYSICAL EXAM OF THE PATIENT
§ Oral exam
§ Mucosa
§ Cardiac arrhythmia
§ Abdominal palpation
§ Rectal examination
LABORATORY DIAGNOSTICS
§ Complete blood count § Anaemia
§ Neutrophilic leucocytosis § Neutropenia
§ Biochemical tests § Eosinophilia
§ Acid-base status* § Hypoproteinaemia
§ Hyperkalaemia
*Acid base-status: Hypochloraemic metabolic alkalosis;
Metabolic acidosis
RADIOGRAPHY
Survey radiographs: Foreign bodies; Distension; Displacement;
Delayed gastric emptying; Penetrating ulcers
Contrast radiographs: Foreign body; Masses; Deep ulceration;
Gastric motility disorder; Pyloric obstruction
US, ENDOSCOPY & OTHER METHODS
§ Ultrasonography: Dilated stomach with fluid; Thickening
of the gastric & intestinal wall; Abdominal organs; Ileus
§ Gastroduodenoscopy: Best for gastric diseases; Direct
visualisation; Biopsy; Histopathology
§ Other: Fluoroscopy; Scintigraphy;
Barium-impregnated polyethylene spheres (BIPS)
Symptomatic treatment?
SYMPTOMATIC TREATMENT
Antiemetics
§ Maropitant
§ Phenothiazines (also causes hypotension & sedation!)
§ Metoclopramide
§ Ondansetron
Fluid therapy
§ 0.9% saline infusion
§ K+ supplement (check serum K+ first)
Dietary
§ NPO for 24 hours; If Ø vomiting → Low fat;
Single protein source diet; Chicken & rice
Antacids
§ H2-receptor antagonists → Famotidine; Ranitidine
§ Proton pump inhibitors → Omeprazole; Pantoprazole
Protectives
§ Sucralfate: Provides a barrier to acid penetration;
Inactivates pepsin; Absorbs bile acids; Stimulates PG
synthesis
§ Misoprostol: Suspected NSAID-induced gastritis;
Contraindicated in pregnant animals
