Diseases of oesophagus Flashcards
Symptoms of oesophageal diseases
- regurgitation
- dysphagia (difficulty swallowing)
- odynophagia (painful swallowing)
- salivation/drooling
- appetite: increased in motility disorder, decreased in inflam disorders
- aspirational pneumonia
- weight loss, cachexia
How to differentiate vomiting and regurgitation
- VOMITING: nausea, retching (active muscle contraction
- REGURGITATION: passive backflow, there is no sign of nausea -> higher chance of eating content
Eosophageal diseases. Diagnostics
- physical evaluation is limited (expanded oesophagus, pneumonia, neurological deficit, foreign body)
- lab examination: not very specific
- radiography: foreign body, megaoesophagus, PRAA
- endoscopy: excellent for morphological diseases, function (peristaltic movement) can’t be evaluated
What parameters of lab exam and when can be helpful in oesophageal diseases?
- WBC
- Na+/K+, cortisol (hypoadrenocorticim —> megaoesophagus)
- CK, AST (polymyositis -> megaoesophagus)
- acetylcholine receptor antibody (25% of acquired megaoesophagus: myasthenia gravis!)
- coprology (sprirocercosis)
Is endoscopy good choice for diagnosis all oesophageal diseases?
Endoscopy is very good for morphological diseases. It’s done under general anaesthesia -> no peristaltic movement -> function of oesophagus can’t be evaluated -> fluoroscopy
List of oesophageal diseases
- Oesophagitis/oesophageal stricture
- Gastro-oesophageal reflux disease (GOR)
- Motility disorder/megaoesophagus
- Oesophageal foreign body
- Spirocercosis (only in dogs)
- Hiatal hernia
- Vascular ring anomalies (e.g. PRAA)
- Neoplasia
Crycopharyngeus muscle dysfunction …
Congenital or acquired neuromuscular disorder
Quite rear
Types: achalasia …
Symptoms: …
Diagnosis: fluoroscopy
Therapy: crycopharyngeus muscle myotom
Oesophagitis. General info, aetiology
- inflammation of oesophageal mucosa
- very often; painful
- mainly caused by gastric acid or foreign body
- can be due to anaesthesia (opened cardiac —> gastric acid backflow); persistent vomiting; drugs (irritation): doxycycline (fe!), clindamycin; motility disorder, megaoesophagus (due to indigested food inside of oesophagus)
Oesophagitis. Symptoms, diagnosis
- painful
- salivation, food refusal, regurgitation, coughing, fever, dyspnea
- d:endoscopy, symptoms, WBC incr
Oesophagitis. Treatment
- without treatment —> stricture, can be life-threatening
- low fat GI diet
- PPIs
- prokinetics (metaclopromide): to “close” cardi
- total parenteral nutrition/entreral nutrition (PEG-tube in severe cases) - to avoid perforation of oesophagus in case of severe lesions
- asp. pneumonia: AB
Prognosis: usually good
Oesophageal stricture
- narrowing of oesophageal lumen (by scar tissue) -> regurgitation
- aetiology: not-treated chronic severe oesophagitis
- can’t be treated with drugs
- treatment: repeated endoscopic balloon dilatation/surgery + drug therapy: treatment of oesophagitis + prednisolone (will decrease scar tissue formation)
Prognosis: usually good
Gastro-oesophageal reflux (GOR). Aetiology. Symptoms. Treatment.
- poor closure of cardia —> HCl, pepsin, trypsin, bile, HCO3 —> inflammation
- common
- aetiology: delayed gastric emptying, upper airway obstruction (brachycephalic syndrome), hiatal hernia, anesthesia, chronic vomiting
- symptoms: repeated swallowing, neck stretching, gastric chyme gagging
- d: symptoms + history + endoscopy
- DD: oesophagitis, hiatal hernia, stricture
- treatment: underlaying background (!), low-fat diet, PPI, H2-blockers, sucralfate, prokinetics (cisaprid, tegaserod), metaclopride
- prognosis: usually good
Oesophageal foreign body
- can be easily missed because owner will complain about vomiting
- often because of bones
- symptoms: regurgitation, drooling
- d: radiography (plain, contrast) + endoscopy
- treatment: first trying to remove with endoscope, if not successful: surgery, if can’t be afforded: pushing down with gastric tube (BUT IN THIS CASE CHANCE OF PERFORATION OF OESOPHAGUS IS HIGH!)
- after removal of foreign body -> treatment of oesophagitis (rule out perforation with iodine contrast radiography)
Oesophageal motility disorders
- spectrum of diseases (from partial to while distension of oesophagus: megaoesophagus)
- congenital or acquired disease
- majority of acquired cases are idiopathic
- in mild cases, main clin sign is coughing due to partial aspiration
- clinical signs: various: chronic coughing/regurgitation/dysphagia/bronchopneumonia
- d: fluoroscopy (mild cases), radiography (severe cases)
Megaoesophagus. Aetiology
Congenital: mini schanuzers, Great Danes, dalmatians, shar-pei, Irish setters, Labrador retriever
Acquired:
- majority of cases are idiopathic: treatment will be symptomatic: special feeding (Bailey chair + small portions); increasing motility with drugs (berhanecol, sildenafil)
- myasthenia gravis (pyridostigmine)
- hypoadrenocorticism (prednisolone)
- lead poisoning (Ca-EDTA)
- oesophagitis
- hypothyroidism (levothyroxine)
- SLE (prendnisolone)
- polymyositis
PEG-tube placement
Percutaneous endoscopic gastrostomy
Feeding tube directly to stomach
Spirocercosis
- Spirocerca lupi -only in dogs!
- parasitic nodules in the canine oesophagus (granulomas), can look like neoplasms
- partial obstruction, irritation, inflammation of oesophagus -> regurgitation, coughing
- aortic aneurysms -> sudden death in case of rupture (rarely)
- d: coprology
- treatment: doramectin/ivermectin (carefully with MDR-1); surgery
- prevention: Imidacloprid/moxidectin
PRAA
- persistent right aortic arch: extraluminal compression by the ligamentum arteriosum
- congenital disease
- symptoms: regurgitation, coughing
- d: plain and contrast radiography
- treatment: surgery
