12. Diseases of the oesophagus in dogs and cats. Regurgitation and vomitus. Flashcards

1
Q

Oesophagititis?

A

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)

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2
Q

Gastro- Oesophageal reflux?

A

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

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3
Q

Oesophageal foreign body?

A

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

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4
Q

Dysmotility/ Oesophageal Weakness?

A

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

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5
Q

Megaoesophagus?

A

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

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6
Q

Spirocercosis?

A

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

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7
Q

Persistent right aortic arch (PRAA)

A

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

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8
Q

Difference between Regurgitation and Vomiting?

A
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9
Q

Distinguishing from vomiting and regurgitation?

A

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

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10
Q

Causes of vomiting?

A

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

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11
Q

History, Physical exam of the patient, laboratory diagnostics, radiography and US?

A

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)

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12
Q

Symptomatic treatment?

A

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

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