12) diseases of oesophagus regurgitation vs vomitus Flashcards

1
Q

regurgitation general

A
Expulsion of material from the mouth,
pharynx or oesophagus
• Spontaneous
• Passive backflow
• Undigested food, no bile
• Eating the regurgitated content (no nausea)
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2
Q

regurgitation mechanism

A
• Altered motility
• Obstruction of flow
o External compression
o Internal obstruction
• inflammation
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3
Q

vomitus general

A

Expulsion of material from the stomach and / or intestines
• Active muscle contractions, retching
• Undigested or digested food, gastric chyme, bile
• Nausea

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4
Q

vomitus mechanism

A
  • Activation of peripheral receptors within the gastrointestinal tract
  • Activation of central vomit centre by CNS disease e.g. Motion sickness, neoplasia etc
  • Vestibular disease
  • Activation of chemoreceptor trigger zone by chemicals / toxins, e.g. uraemia, diabetic ketoacidosis
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5
Q

Distinguishing regurgitation from vomiting

A
  • History
    • Nausea, retching, eating the content, bile, stretching or flexing the neck during swallowing, aspiration of water / liquid and coughing
  • Physical examination
    • Palpation of distended cervical oesophagus, cervical mass, injury or foreign body
  • Thoracic radiography
    • Obvious megaoesophagus, foreign body, perforation and pleuritis or PTX
  • Endoscopy: oesophagitis, hiatal hernia, stricture
  • Fluoroscopy: motility disorders, hiatal hernia, stricture
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6
Q

oesophagus - history and clinical signs

A
  • Regurgitation
  • Dysphagia
  • Odynophagia (painful swallowing)
  • Salivation
  • Changes in appetite
    • ↑ motility disorder
    • ↓ inflammatory disorder
  • Aspiration pneumonia
    • Coughing, fever, dyspnoea, pulmonary crackles
  • Cachexia, weight loss
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7
Q

diagnostic evaluation of esophagus

A
  • Physical evaluation
    • Expanded oesophagus, pneumonia, neurological deficits (mydriasis), salivary gland, foreign body, mediastinal tumour
  • Laboratory examination
    • WBC (pneumonia, perforation, pleuritis)
    • Na+/K+ (hypoadrenocorticism → megaoesophagus)
    • CK, AST (polymyositis → megaoesophagus)
    • Acetylcoline receptor antibody (25% of acquired megaoesophagus: myasthenia gravis!)
    • Coprology (spirocercosis)
  • Radiography
    • Foreign body, PRAA, megaoesophagus
  • Endoscopy, fluoroscopy
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8
Q

oesophageal diseases - oesophagitis

A
  • Causes
    • GOR, anaesthesia, persistent vomiting, foreign body, doxycycline (cats), motility disorder, megaoesophagus, caustic substances
  • Symptoms
    • Odynophagia, regurgitation, salivation, food refusal, coughing, fever, dyspnoea
  • Diagnosis
    • Clinical signs
    • WBC ↑
    • Endoscopy
    • Radiography?
  • Treatment
    • Omeprazole + prokinetics (see GOR treatment)
    • Sucralfate suspension
    • Total parenteral nutrition / enteral nutrition (in severe cases)
    • Aspiration pneumonia: antibiotics
  • Prognosis usually good
    • Untreated: stricture, megaoesophagus (cause or consequence?)
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9
Q

gastro-esophageal reflux

A
  • Poor closure of cardia → HCl, pepsin, trypsin, bile, HCO3- → inflammation; frequent problem!
  • Aetiology
    • Delayed gastric emptying
    • Upper airway obstruction
    • Hiatal hernia
    • Anaesthesia
    • Chronic vomiting
  • Symptoms
    • Same as for oesophagitis
    • Reverse sneezing
    • Chronic bronchitis, laryngitis, rhinitis
    • Eructation
  • Diagnosis
    • Symptoms + history
    • Endoscopy! (oesophagitis, hiatal hernia)
  • Treatment
    • Low fat diet, avoiding late night feeding
    • H2-receptor blockers/proton-pump inhibitors
    • Prokinetics: cisapride, tegaserod (serotonin-4-receptor agonists)
    • Sucralfate
    • Enhance cardia closure
    ➢ Metoclopramide
    ➢ Erythromycin
    ➢ GABA “B” type agonist: baclofen
    • Brachycephaly syndrome → surgery
  • Prognosis usually good
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10
Q

Oesophageal foreign body

A
- Symptoms
• Regurgitation
• Salivation
• Distended abdomen
• Coughing, fever, dyspnoea
- Diagnosis
• Symptoms
• WBC ↑
• Thoracic radiography (survey and contrast) or
• Endoscopy
- Treatment
• Endoscopic removal
➢ Informing the owner (risk of procedure: perforation, PTX, surgery)
➢ Prepared operation room
➢ Anaesthesiologic preparedness
• Unsuccessful attempt (30 – 70%)
➢ Surgery
➢ Gastric tubing
➢ Euthanasia
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11
Q

oesophageal motility disorders

A
  • Dysmotility / oesophageal weakness
    • Motility disorder + food retention + regurgitation
    • Aetiology: idiopathic, muscle atrophy, myasthenia gravis, autoimmune disorders, post-anaesthetic condition (reversible), oesophagitis
    • Types
    ➢ Megaoesophagus
    o Severe dysmotility + oesophageal expansion
    ➢ Partial oesophageal dysmotility
    ➢ Dysautonomia
    ➢ Diverticulum
    • Clinical manifestation
    ➢ Dysphagia / regurgitation
    ➢ Dysphagia / regurgitation + bronchopneumonia
    ➢ Bronchitis / bronchopneumonia → dysmotility
    • Symptoms
    ➢ Regurgitation, salivation, coughing, fever, dyspnoea, weight loss
    • Diagnosis
    ➢ Fluoroscopy
    ➢ Radiography (survey, contrast
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12
Q

Megaoesophagus

A
  • Common in dogs, rare in cats
  • Persistent reduced motility of the oesophagus
  • Laryngeal paralysis can lead to megaoesophagus
  • Must assess for aspiration pneumonia
  • Congenital (cause is unknown)
    • Miniature Schnauzers, Great Danes, Dalmatians, Shar-Pei, Irish Setter, Labrador Retriever
    • Clinical signs usually develop when weaning onto solid food
    • No treatment
    • Poor prognosis
  • Acquired (adult onset)
    • Primary
    ➢ Idiopathic
    ➢ Diagnosis of exclusion (i.e. causes of secondary)
    ➢ Typically, large breed dogs
    ➢ Treatment
    o Special feeding
    ▪ “Bailey chair” – keeping the patient vertical while feeding
    o Bethanechol + Sucralfate
    • Secondary
    ➢ Myasthenia gravis (20% of cases)
    o Immune response against acetylcholine receptors
    o +/- can be focal or generalized (systemic weakness)
    o Treatment: pyridostigmine
    ➢ Other
    o Hypoadrenocorticism (prednisolone), lead poisoning (Ca-EDTA), oesophagitis, hypothyroidism (levothyroxine), systemic lupus erythematosus (prednisolone), polymyositis/polymyopathy (see SLE)
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13
Q

Spirocercosis

A
- Spirocercosis lupi
• Widely distributed nematode, causing parasitic nodules in the oesophagus, aortic aneurysms, spondylitis
- Symptoms
• Regurgitation, vomiting, weight loss, coughing, dyspnoea, rarely sudden death
- Diagnosis
• Faecal examination
• Endoscopy
- Treatment
• Doramectin
➢ Off-label
➢ MDR1 gene mutation!
• Imidacloprid/moxidectin
• Surgery
- Prevention
• Parasitic prevention with milbemycin
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14
Q

Persistent right aortic arch

A
  • Congenital disease
  • Extraluminal compression by the ligamentum arteriosum
  • Symptoms
    • Shortly after the animal eats solid food for the first time
    • Regurgitation, coughing, dyspnoea, weight loss
    • Rarely minor signs, patients are several years old
  • Diagnosis
    • Survey and contrast radiography
    ➢ Ventral and leftward tracheal deviation, cranial oesophageal dilatation
    • Endoscopy
  • Treatment
    • Surgery
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