Regurgitation

Question 1

Vomiting vs Regurgitation (7)

Answer 1

Vomiting vs Regurgitation

• prodromal nausea: yes: no
• retching: yes: no
• distension of cervical oesophagus: no: ±
• time relative to eating: anytime:anytime
• food: ±: ±
• bile: ±: no
• pH: acidic/alkali: alkali

Question 2

Oesophageal disease causes (5)

Answer 2

• acquired megaoesophagous
• vascular ring anomaly
• FB
• reflux oesophagitis
• myaestenia gravis

Question 3

Oesophageal disease CS

Answer 3

• regurgitation
• dysphagia
• pytalism
• ravenous appetite
• weight loss
• dyspnoea (caused by aspiration pneumonia)

Question 4

Diagnostic imaging

• Facts (2)
• plain (2)
• contrast (5)

Answer 4

• do whole of neck and chest to see it all
• GA/narcotics with ET tube paralysis oesophagus (use ACP to see megaoesophagous!)

Plain:

• don’t normally see oesophagus
• look for FB, paralysis, abnormalities

Contrast:

• barium
• drink
• with food: slows passage ans shows strictures
• DON’T use if suspect a rupture –> it is inert in alimentary tract but irritable in cavities
• if inspired, can condense in LN, give 2 weeks of ABs

Question 5

Oesophascopy

• method (4)
• normal (3)

Answer 5

• GA
• use flexible tube
• direct visualisation so very reliable but sample collection is difficult
• diagnostic and therapeutic

Normal:

• longitudinal folds (annular rings in the cat)
• pale pink
• closed cardia

Question 6

Anatomy (4)

Answer 6

• in mediastinum
• fixed ends: larynx and cardia
• 2 sphicters: cricopharynx and cardia
• layers: mucosa, submucosa, muscularis, neovascular

Question 7

Oesophagotomy (3)

Answer 7

• rarely done
• only for stricture
• complication is sticture

Question 8

Megaoesophagous types (4)

Answer 8

can be primary or secondary

secondary:

• myaestaenia gravis
• hypoadrenocorticoism
• generalised myopathy
• generalised neuropathy
• toxins

can be congenital (advise return to breeder) or acquired

Question 9

Idiopathic megaoesophagous

• Dx
• Tx

Answer 9

Dx: by exclusion/radiography - tracheal strip ( air causes accentuation of tracheal and oesophagous wall together

Tx:

• feed from a height
• small frequent meals

Question 10

Megaoesophagous: myaesthenia gravis

• types
• pathogenesis
• DX (2)
• adverse SE
• other

Answer 10

• congenital or acquired
• acquired due to antibody production against acetyl choline receptors at the motor end plates –> autoimmune!

Dx:

• tensiolon test (endrophoniym
• assay for acetyl choline receptor antibody

adverse muscurinic side effects:

• hypersalivation
• involuntary mictuition
• bradycardia
• arrhythmias
• hypotension
• weakness (collapse after exercise

may also have a thyoma

Question 11

Vascular ring anomalies

• cause
• Dx
• Tx

Answer 11

• congenital, embryological development (persistent right aortic arch, double aortic arch, persistent right ligamentum, right subclavian artery)

Dx: Megaoesophagous restricted to being cranial to the heart

Tx: ligate ligamentum and dissect surrounding CT until oesophagus buldges

Question 12

FB

Answer 12

• distal oesophagous
• Dx by multiple x rays
• remove by endoscopy
• PO: H2 blockers, PPI, sucaralfate, analgesics (not NSAIDs), food and water

Question 13

Strictures

• cause
• Tx

Answer 13

• congenital or acquired
• secondary to gastroesophageal reflux (chronic vomiting) –> oesophageal inflammation

Tx: balloon catheter and dilation

Question 14

Hiatal Hernia

Answer 14

• sliding or paraoesophageal

CS:

• reflux oesophagitus
• regurgitation
• body condition

Tx:

• medical: sucralfate, metaclopramide (increases tone of sphincter), H2 blockers,
• suture oesophagus to hiatus –> narrows it