Surgical Diseases of The Oesophagus

Question 1

Name 4 common FB in oesophagus in dogs (5)

Answer 1

• Bones
• Rawhide
• Toys and balls
• Fish hooks
• Clothing

Question 2

Name 3 common FBs in the oesophagus of cats (4)

Answer 2

• Needles
• String
• Toys
• Hair

Question 3

Are oesophageal FB more common in cats or dogs?

Answer 3

More common in dog – they scavenge more and will often swallow quickly

Question 4

What are the clinical signs of an oesophageal FB (7)

Answer 4

Retching

Regurgitation (food & water)

Because of a FB; you may delay investigation = bad

Vomiting (?) (can owner differentiate regurgitation from vomiting?)

Ptyalism

Anorexia

Restlessness

Cervical pain

Question 5

How can you investigate an oesophageal FB? (3)

Answer 5

• Based on a high index of suspicion from clinical history
  
  • Often the O will have witness this and will know they have eaten
  • Sometimes the O even feeds it e.g. bone
• Plain radiography (in most instances)
• Endoscopy

Question 6

Where is common for an oesophageal FB? (2)

Answer 6

Base of the heart and at the diaphragm

Question 7

What is going on here?

Answer 7

Down the oesophagus but cant get through the lower sphincter – stuck here

Question 8

Find the FB…. Why did it get so stuck?

Answer 8

The tennis ball…

It is furry so sticks nicely

Question 9

What is the FB here?

Answer 9

Fish hook

Question 10

What is different with a fish hook being a FB compared to others?

Question 11

If you suspect a fish hook, what is different about the radiography?

Answer 11

Include neck and stomach in plain radiography as well as oesophagus

Question 12

What is the worst type of fish hook to get stuck?

Answer 12

Treble hook and barbed

Question 13

What would you suspect here?

Answer 13

Rawhide – radiolucent

Will depend on the history

Question 14

This is a cat, what may you suspect?

Answer 14

Fur balls. Although normally go further to stomach or bowel

= radiolucent

Question 15

What is this? It is radiolucent, why can you see it?

Answer 15

Kebab stick – radiolucent

Contrast which has coated the outside so you can see

Worry about a perforation in oesophagus. Aspirate into lungs or mediastinal space

Use water soluble which is designed to swallow

Question 16

What is this?

Answer 16

Potato FB

Question 17

How can we approach the treatment of an oesophageal FB?

Answer 17

• Fish hook- can be left to the morning
• But yes they are emergencies especially those producing pressure on the wall
• Remove ASAP to minimise the complications
• Bone most common= can be removed orally via a scope or can push into the stomach which is okay as body will natural break it down in24-48hours
• If you not have the facilities you should refer
• In most instances, an emergency requiring immediate removal
• Most can be removed endoscopically using grasping forceps
• Refer to a centre that has the appropriate equipment and expertise
• Approximately 10% cannot be removed orally and are pushed into the stomach; bony FBs will then be digested with no requirement for a gastrotomy

Question 18

What is this? How is it used?

Answer 18

OFB - rigid endoscope
Means you can remove FB in 5-10mins
Air in it and light. Put forceps down it to grasp the FB
Human colonoscope fits great esp terrier
Bigger dog – may need a longer make your ow

Question 19

What is this, what do we do?

Answer 19

Bone FB

How gross they are or the smell depends on the time and meat

Would need to remove the gunge before you get to this

Grasp if not too stuck can be removed

Question 20

What is this? What do we do?

Answer 20

Fish hook

Often have bait on too and is gross

Barbed – have to have a sharp push which will tear but need to

Question 21

What are these and when do we use?

Answer 21

OFB - grasping forceps
Big chunky ends to them
Need to balance to be hard enough but not too hard
Can remove 85%-90% orally
10%- into stomach. Only gastrotomy if cant dissolve
5%- open surgery

Question 22

What is this? What do we need to warn the O of? What can we do?

Answer 22

OFB - post removal endoscopy
May stricture at the site as sore – warn O
But not too common
Protectants and antacids can be given too- minimise reflux and protect

Question 23

What do we give whilst the animal is recovering from an OFB? (3)

Answer 23

• Medical therapy to reduce likelihood of stricture formation
  
  • H2 antagonist
  • Proton-pump inhibitor
  • sucralfate
• Analgesics
• Feed soft food – gradually introduce normal

Question 24

What does this show? Why is it not used much?

What can we do to help?

Answer 24

Open surgery – oesophagotomy
Don’t ideally want to do this – does not heal as well
Put in PEG tube at the same time. Can feed the animal and bypass the oesophagus so doesnt distend and breakdown
Oesophagus as no serosal surface – which is in the bowel and allows it to seal

Question 25

How much do you love Tred?

Answer 25

So so much

Words cannot say