Sickly Dog Flashcards
Mrs Chambers presents the family dog:
- Rocky is a 6 year old, male neutered bull mastiff
- Mrs Chambers reports that Rocky has been vomiting intermittently for the last 10 days
What additional questions would you like to ask?
- What is the vomit like? Look like?
- When does vomiting happen?
- Abdominal effort?
- Eating?
- Drinking?
- Faeces?
Create a problem list from:
- the episodes seem very passive, Rocky puts his head down and what looks like undigested food seems to “fall” out of his mouth
- there is no abdominal effort
- no bile/blood is seen in what is brought up
- Mrs Chambers thinks Rocky has lost some weight
- he has a ravenous appetite and sometimes tries to eat what he has brought up
- he passes, brown formed stools twice a day
- he drinks normally but occasionally brings up water
- Regurgitation
- food
- sometimes water?
- Weight loss
- Ravenous appetite, polyphagia?
Draw up differentials for rocky, Use DAMNITV and highlight the most common:
- the episodes seem very passive, Rocky puts his head down and what looks like undigested food seems to “fall” out of his mouth
- there is no abdominal effort
- no bile/blood is seen in what is brought up
- Mrs Chambers thinks Rocky has lost some weight
- he has a ravenous appetite and sometimes tries to eat what he has brought up
- he passes, brown formed stools twice a day
- he drinks normally but occasionally brings up water
Anomalous
- Megoesophagus secondary to CNS disease including CNS neoplasia
- hiatal hernia
- vascular ring anomaly
- extra-oesophageal compression
Metabolic
- megoesophagus secondary to:
- hypoadrenocorticism
- hypokalaemia
- hypothyroidism
Neoplastic (1ry or metastatic?)
- fibroma/fibrosarcoma
- leiomyoma/leiomyosarcoma
- papilloma/squamous cell carcinoma
- lymphoma
Nutritional
- foreign body
Inflammatory
- oesophagitis post gastric reflux
- - associated with GA
- - complication of severe vomiting/debility
- oesophageal stricture (end result of severe oesophagitis)
- megoesophagus secondary to polymyositis/polyneuritis
Immune-mediated megaoesophagus secondary to:
- Myasthenia gravis
- Systemic lupus erythematosus
Infectious – microbial, parasitic
Idiopathic
- idiopathic megoesophagus
- dysautonomia
Toxic
- megoesophagus secondary to heavy metal (lead)/OP toxicity
Traumatic
- megoesophagus post FB
- oesophagitis – e.g. stomach tube, after oesophageal FB removal
- oesophageal rupture
Vascular
- vascular ring anomaly
How can we further investigate this case:
- the episodes seem very passive, Rocky puts his head down and what looks like undigested food seems to “fall” out of his mouth
- there is no abdominal effort
- no bile/blood is seen in what is brought up
- Mrs Chambers thinks Rocky has lost some weight
- he has a ravenous appetite and sometimes tries to eat what he has brought up
- he passes, brown formed stools twice a day
- he drinks normally but occasionally brings up water
Plain lateral thoracic radiograph
What is the issue here?
Large oesophagus
What further investigations for megaoesophgus can we do?
- Hematological and biochemical analysis of blood samples may be useful to diagnose several underlying causes of acquired megaoesophagus, such as myositis with an elevated creatine kinase (CK) concentration. Further tests, such as an ACTH stimulation test or T4/ TSH levels, may also be indicated if hypoadrenocortiscm is the suspected cause. Congenital idiopathic megaoesophagus is diagnosed in young animals (often of a predisposed breed) in which all other causes have been discounted.
- Plain lateral radiographs should be enough to diagnose
- Endoscopy
- Barium contrast
What is seen on radiographs with megaoesophagus?
- A large radiolucent structure dorsal to the trachea on lateral radiographs. It should be noted that it is normal for the oesophagus to contain air if the animal is under general anaesthesia.
- The tissue between the trachea and oesophagus may be compressed producing a radio-opaque tracheal stripe sign along the dorsal surface of the trachea on a lateral radiograph. The trachea may also appear to deviate ventrally. On a dorso-ventral radiograph of the chest, the trachea may be pushed to the right by the enlarged oesophagus.
- Chronic regurgitation increases the risk of developing aspiration pneumonia. If it is present, it produces an alveolar pattern in the cranial and ventral lung lobes.
- With vascular ring anomalies, the oesophagus is usually only dilated cranial to the base of the heart.
What are the clinical signs of oesophageal disease?
- Anorexia – non specific sign but will be seen
- Dysphagia
- Pain on eating
- Gulping/exaggerated swallowing
- Salivation (ptyalism)
What are the signs of regurgitation?
- Discomfort?
- Variable time after eating
- Passive process
- Not always! Especially when it comes to cats. They can make a huge hoo ha about it. The pain of something being stuck can make them mouth open/yawm/yelp until whatever in the oesophagus comes up
- Froth/saliva (“egg white”)
- Ph neutral/alkaline
What are the clinical signs of vomiting?
- Signs of nausea
- Active process
- Abdominal retching
- Bilious fluid and/or stomach contents
- Yellow staining is a sign that the animal has actually vomited
- Use descriptive terms to help the owner e.g. yellow fluid
- Acidic ph
What is this?
Vomiting?
A wound or ulcer? You would expect it to be more coffee coloured if it had been in the stomach acid.
What is this?
Regurgitation?
E.g. tubular structures of food from the oesophagus
What are the clinical signs of aspiration pneumonia?
- Nasal discharge
- Coughing
- Tachypnoea/dyspnoea
What do you want to obtain from clinical history with oesophageal disease?
- Acute or chronic?
- Any systemic signs?
- Generalised weakness?
- Exercise intolerance?
- Laryngeal paralysis?
- Greater aspiration risk
- Any recent anaesthesia or significant vomiting
- Reflux under anaesthetic is a huge risk factor to oesophagus stricture
- Check the history!!! Understand what they have had done lately
- Are there any other clinical signs to support your differntials?
- Cyclical vomiting – can cause oesophagitis which predisposing to stricture formation
Why do you want to do both left and right lateral views in oesophageal disease?
- Aspiration pneumonia may not show up on one view but not the other!
- One lateral view – upper lung is highlighted but it may be in the recumbent lobe
What is this?
•This is a cat with barium – dilation of the oesophagus through the whole length.
What is this?
Endoscope of oesophageal stricture
Down oesophagus and reach this hole
Not the stomach entrance as only halfway down the thorax (use markers on the scope). You will not get scope through this! Tight and fibrous.
They form very quickly!
What is this?
No need for contrast agent as a clear evidence of megaoesophagus
Can see tracheal stripe sign
