Leib Regurgitation Flashcards
What is regurgitation?
return of esophageal contents; it is the hallmark of esophageal disease
How long does it take for food to get from mouth to stomach?
3-5 seconds
Vomiting vs. regurgitation?
abdominal contractions in vomiting only
Common side effect of regurgitation?
food does not get to stomach, failure to grow and thrive
odynophagia
pain associated with swallowing. often unable to detect this.
Best way to determine regurgitation?
abdominal contractions as describe by the owner or directly observed
Regurg. and very hungry?
Megaesophagus and Vascular Ring Anomaly. Food can’t get to stomach so they are hungry. BUT if they get aspiration pneumonia they will lose their appetite.
Signs of aspiration pneumonia
cough, fever, inc. RR, difficulty breathing and possibly mucopurulent nasal discharge
Animal comes in with regurg. so what kind of history should you try to rule out?
- Foreign Body Ingestion
- Hot/Cuastic substance ingestion
- General Anesthesia (esophagitis)
- Neuromuscular defects (Myasthenia Gravis)
- Affected littermates (Vascular Ring Anomaly)
PE Findings of animals with regurg
Weight loss and poor hair coat
Fever (aspiration), Crackles
Dehydrated
Cervical palpation may reveal pain
Esophageal bulge (rare, close mouth and compress chest and can palpate filled and dilated esophagus
Neuromusc. weakness (myasthenia Gravis local or gen)
Lab work of Regurg Patient
Increased PCV/TP because dehydrated
Decreased TP if Chronic due to malnutrition
Leukocytosis w/ Left Shift because of Asp. Pneumonia
Ach-receptor antibody titer to rule out Myasthenia Gravis
Spirocerca lupi ova on fecal as they are esophageal parasites (south africa)
Some other diseases cause specific laboratory changes
TP levels can change drastically if a dog or cat does not eat for 1 day? True or False?
FALSE! Cats and dogs can lose up to 25% BW without a change in TP
Is Regurgitation a reflex?
NO. It is just stuck there and if you Squeeze the chest hard enough, it will move it back up OR if they keep eating, it will fill up and the contents will eventually spill back out.
How often does regurgitation occur?
99% of the time it will be VOMITING but you MUST be able to identify regurgitation
Questions to ask an owner to determine if regurg. vs. vomit.
Do they have abdominal contractions?
Does it happen when they get excited?
How many phases of swallowing are there and what are they?
- Oropharyngeal - Dysphagia associated
- Esophageal - Regurgitation associated
- Gastroesophageal - Regurgitation associated
Dysphagia
problems in the Oral Cavity and the Pharynx, anything that affects holding food
Is megaesophagus a problem of dogs or cats?
DOGS mostly and rarely in cats.
What is megaesophagus?
Dilatation of esophagus and Peristalsis is reduced or absent
When do you notice megaesophagus?
WEANING since they only have liquid diet before then
Acquired ME
Idiopathic OR 2˚ to neuromuscular disease of which Myasthenia Gravis is the most common
What is the most common neuromuscular disease that causes 2˚ ME?
Myasthenia Gravis
ME Prognosis?
Poor for Acquired idiopathic
Better for Acquired 2˚ since you can aim at treating underlying disease.
How do you DX ME?
Survey Radiographs with Barium Contrast
Demonstrate dilated esophagus and lack of motility
How do you TX ME?
Gruel consistency food. TX Aspiration Pneumonia
Idiopathic - elevated feeding
Acquired 2˚ - treat underlying pathology
What is the tracheal stripe?
silhouetting of esophageal wall and trachea
What might rads show you if there is ME?
Dilated Esophagus
Tracheal Stripe
Aspiration
What’s most common cause of regurgitation?
Foreign body and megaesophagus
Where do foreign bodies get stuck?
Thoracic inlet
Base of heart
Diaphragmatic Hiatus
Most common foreign bodies
Bones, rawhides! and fish hooks, greenies, hairballs
Why is an obstructive FB an emergency?
Peristalsis continually situates it deeper, increasing possibility of perforation and they just get more and more difficult to remove
How do you DX a FB?
Survey Rads with Barium contrast esophogram
How do you TX a FB?
Endoscopic removal is the best. If you can’t pull it out you can push it in, even if you don’t have an endoscope.
Don’t forget to treat for Esophagitis as well.
Consider putting a PEG Tube if extensive esophageal damage. (most do well and don’t need this)
Why is esophagitis so under diagnosed in vetmed?
The most common complaint is discomfort from people and our patients can’t tell us that. ALSO Barium swallows are very difficult to DX esophagitis. You need pretty severe ulceration of the mucosa for barium to stick to it.
What’s the most common reason for esophagitis?
General Anesthesia. Then
How common is gastric reflux during general anesthesia?
80% of animals reflux!
What pills/medications can cause esophagitis in cats?
Clindamycin and Doxycycline
How do you treat esophagitis?
REST IT -> NPO if possible Use Metaclopramide - keeps acid in stomach and increases tone in GES; increases gastric motility and moves food and acid toward small bowel. H2 blockers and PPIs. Sucralfate to coat ulcerated areas. Analgesics for the PAIN. NO NSAIDS
How do you DX esophagitis?
Endoscope
What is extraluminal obstruction most often caused by?
Mediastinal Mass or Hilar mass due to Lymphoma. Systemic mycotic disease (blasto and histo)
Why does a stricture occur?
Intra-luminal obstruction that creates scar tissue and as it contracts it narrows the esophageal lumen. Anything that causes esophagitis can cause stricture if it’s deep enough.
What’s the most common cause of stricture?
Sequella to esophagitis from reflux of acid during General Anesthesia. Strictures are rare though.
How do you DX Stricture?
Barium contrast or endoscopy.
How do you TX Stricture?
Endoscopic balloon dilation. Repeated dilations are required. Here at VTH 2-3 times most common but can require up to 5.
Rest the esophagos –> NPO and put in a PEG Tube.
TX the ESOPHAGITIS Aggressively.
Anti-inflammatory Pred to reduce fibrous formation.
Most common esophageal neoplasia?
SCC dogs and cats, Smooth muscle less common (leiomyoma)
Is esophageal cancer common?
no
How do you DX Esophageal neoplasia?
Barium contrast then endoscopy and biopsy.
How do you TX Esophageal neoplasia?
Surgical removal. SCC difficult to remove but Leiomyoma you can remove.
Barely and response to radiation and NO response to or chemo.
What is PX for Esophageal neoplasia?
Most commonly SCC is DX and euthanasia. Leiomyoma is good PX with surgical resection.
How do you treat regurg?
Underlying problem first.
Manage aspiration pneumonia. Parenteral Abx. FLUID THERAPY.
Treat esophagitis.
What is chlorpromazine?
Pheonthiazine - anti-emetic. Unless esophagitis is due to chronic vomiting, this is not indicated to treat esophagitis.
