Oesophageal diseases and vomiting lecture Flashcards
3 most common causes of oesophageal disease
Oesophagitis
Oesophageal FB
Mega-oesophagus
How can oesophageal diseases be categorised?
Anatomic - vascular ring anomaly, cricopharyngeal disease, hiatal hernia, diverticulum
Obstruction - mural (stricture), luminal (FB), extraluminal (mass)
Oesophagitis - trauma, reflux (anaesthesia), irritation
Motility disorders - megaoesophagus, neuropathy, myopathy
What is an oesophageal disorder?
Failure of transport and/or reflux
Clinical signs of regurgitation (6)
- hypersalivation
- odynophagia
- anorexia (uncommon)
- dysphagia
- nasal discharge
- coughing
How is vomiting different to regurgitation (4)?
Vomiting = abdominal effort, prodromal nausea, usually digested food, no swallowing pain, (alkaline or acidic)
Regurgitation = passive, no prodromal nausea, undigested food, possibly painful, no prodromal nausea
How do you diagnose oesophageal disease? (5)
PE normal usually, upper oesophageal palpation, lung auscultation, underlying concurrent disease, BCS
Which investigations are normally focused on with oesophageal disease? (3)
- Diagnostic imaging (plain then contrast radiography)
- Haematology and biochemistry - others too
- Endoscopy
Will plain radiography be able to rule out the 3 main causes of oesophagitis?
No - will show radio-opaque FB and mega-oesophagus but not oesophagitis. It WIll allow you to determine if problem is functional or structural.
What are the common causes of mega-oesophagus?
- Idiopathic (dogs)
- MG (generalised or focal)
- Thymoma
- Hypoadrenocorticism
Other, rarer causes of megaoesophagus?
- Polyneuritis
- polymyositis
- dysautonomia (cats)
- CNS disease
- botulism/tetanus
- SLE
- lead/thallium toxicity
- Hypothyroidism
How does aspiration pneumonia show up on a radiograph?
Alveolar lung pattern = the lungs fill with fluid (aspirated and inflammatory) which appears white.
What are the 3 main causes of oesophagitis?
- Chemical injury
- Gastro-oesphageal reflux
- Oesophageal FBs
Name one medication that can cause chemical injury-induced oesophagitis?
Doxycycline
What are the treatment options for oesophagitis? (3)
- Dietary (small meals, high protein, low fat, +/- fastric feeding tube)
- Sucralfate liquid (provides chemical bandage)
- Gastric acid secretion inhibitors (H2 blocker or proton pump inhibitor)
Serious treatment complication of oesophagitis?
Stricture
Where do oesophageal FB lodge? (3)
Thoracic inlet, heart base, hiatus
How is it best to remove an oesophageal FB?
- Endoscopic retrieval or push to stomach (usually this)
- Consider emergency referral
What diseases is the symptom of vomiting associated with? (5)
- GIT/abdominal,
- systemic
- neuro
- metabolic/endocrine
- toxicity
Where do most vomiting pathways converge? (2)
- Vomiting centre (brainstem)
- CRTZ (chemoR trigger zone) for blood borne substances
Primary (GIT causes of vomiting =? (4 most common; Others)
MOST COMMON =
- Dietary (acute: indiscretion, intolerance or hypersens.)
- Infection (acute: parasites)
- Inflammatory disease (chronic: gastritis, IBD, ulceration)
- Obstruction (acute: FB)
OTHERS=
- Infection (acute: parvo)
- Neoplasia (chronic)
- Obstruction (acute: neoplasia, gastric hypertrophy)
- Motility disorders/gastric volvulus (acute)
List some secondary metabolic causes of vomiting (6)
- Uraemia (i.e. CRF thus PU/PD)
- Addison’s
- Hepatic disease
- pancreatitis
- toxin ingestion (acute)
- drugs
How do you go about a workup of dogs and cats with A.) acute vomitting? B.) chronic vomiting?
A.) Radiograph for blocking FB. Otherwise treat symptomatically and fasting
B.) Bloodwork (hame/biochem to ID organ disease); Urinalysis (concentrating ability of kidney); Imaging (radiography for obstruction, ultrasound for other organ involvement); endoscopy (if no answers).
What is the commonest cause of gastric ulceration?
Iatrogenic - NSAIDs
Other causes of gastric ulceration? (5)
- Neoplasia
- Inflammation
- Systemic
- Hypotension
- Other/idiopathic
