Oesophageal diseases and Vomiting Flashcards
Clinical signs of regurgitation
hypersalivation odynophagia (pain on eating) anorexia Dysphagia (difficulty swallowing) nasal discharge coughing
Regurgitation vs. Vomiting - Vomiting
Abdominal effort
Prodromal nausea
Usually digested food
No swallowing pain
Regurgitation vs. Vomiting - regurgitation
Passive event
No prodromal nausea
Undigested food
Possibly painful
diagnosis
signalment
history
PE - usually normal for oesophageal disease
diagnosis - investigations
Haematology & biochemistry
Other blood tests, urine analysis etc.
Diagnostic imaging - Plain radiography, Contrast radiography
Endoscopy
DDx for regurgitation - 3 most common
Oesophagitis
Oesophageal foreign body
Mega-Oesophagus
DDx for regurgitation - anatomic
Vascular ring anomaly, cricopharyngeal disease, hiatal hernia, diverticulum
DDx for regurgitation - obstruction
Mural (stricture)
Luminal (FB)
Extraluminal (mass)
DDx for regurgitation - oesophagitis - causes
trauma, reflex, irritation
DDx for regurgitation - motility disorders
Megaoesophagus, neuropathy, myopathy
mega-oesophagus - common causes
Idiopathic megaoesophagus (dogs)
Myasthenia gravis (generalised or focal)
Thymoma
Hypoadrenocorticism
aspiration pneumonia
Regurgitation is not associated with reflex closure of the
larynx
Airway is unprotected
Aspiration pneumonia is common
Potentially life-threatening
oesophageal dysfunction & laryngeal paralysis is a bad combination
oesophagitis - causes
Chemical injury - corrosive agents, medications
gastro-oesophageal reflux - General Anaesthesia, hiatal hernia, persistent vomiting, poorly positioned feeding tubes
Oesophageal foreign bodies (FBs)
oesophagitis - treatment
Dietary – small meals, high protein-low fat food to minimise reflux +/- gastric feeding tube
Sucralfate liquid – chemical bandage
Inhibitors of gastric acid secretion
oesophagitis - possible serious complication
strictures
oesophageal FB
Lodge at thoracic inlet, heart base, hiatus
Bones, fish hooks, toys, needles, sticks
Endoscopic retrieval or push to stomach
Potential for mucosal damage/perforation
Should be considered an emergency
Needs endoscopy
primary causes of vomiting
Dietary (acute) - indiscretion, intolerance, hypersensitivity
Infection (acute) - parasites, parvovirus
Inflammatory disease (chronic) - gastritis, IBD, ulceration
Neoplasia (chronic)
Obstruction (acute) - neoplasia, foreign body, gastric hypertrophy
Motility disorders/gastric volvulus (acute)
secondary causes of vomiting
Uraemia Addison’s disease (adrenocortical insufficiency) Hepatic disease Pancreatitis Toxin ingestion (acute) Drugs
regulation of acid secretion - drug types
prevents gastric ulcers
anti-histamines
anti-cholinergics
proton-pump inhibitors
sucralfate
Oesophageal and gastric ulceration
Aluminium hydroxide and sucrose octasulfate
Dissociates in acid
Sucrose octasulfate reacts with HCl and is polymerised to viscous sticky substance that binds to proteinacious exudate usually found at ulcer sites
Protective barrier
Stimulates HCO3 - mucus & prostaglandin secretion
Cimetidine/Ranitidine/Famotidine
HA (H2) receptor antagonist
inhibition of gastric acid
some gastric prokinetic activity
Used frequently to treat any sort of regurgitation/vomiting
No evidence that there is any efficacy in dogs or cats
omeprazolne
Proton pump inhibitor
Binds parietal cells, irreversibly blocking H+/K+ ATPase - inhibits the transport of H+ into the stomach
gastric hyperacidity
GI ulcers and erosions
Zollinger-Ellison syndrome (gastrinoma)
Long duration of activity – once daily dosing
Anti-Emetic Therapy
Used if vomiting is debilitating - pain, marked fluid and/or electrolyte loss
management of the underlying disease
Cause cannot be determined in all patients
Anti-emetic therapy may not always be desirable
Vomiting can be protective
metoclopramide
Para-aminobenzoic acid (PABA) derivative with central and GI effects
Antagonises D2-dopaminergic & 5-HT3 receptors in the CRTZ & peripheral cholinergic effect
Upper GI prokinetic agent
ondansetron
5-HT3-Serotonergic antagonist
expensive
Best anti-emetic for chemotherapy-induced nausea and vomiting
Also good for pancreatitis
maropitant
Neurokinin-1 receptor antagonist
Central and peripheral effects
Stops the binding of substance P
Very potent: Careful, masks underlying diseases!
licensed for use in dogs- soon also cats
useful in any kind of vomiting
