The Oesophagus -regurgitation & dysphagia Flashcards
Regurgitation
Passive evacuation of food and/or fluid from oesophagus
Results from local mechanical events within oesophagus
Dysphagia
Difficulty swallowing
Differentiating between oropharyngeal and osophageal dysphagia
Oropharyngeal (oral, pharyngeal, cricopharyngeal)
Try & swallow repeatedly but gag, retch, struggle to drink & may eject food from mouth (immediately after eating)
Oesophageal
Usually only 1 swallowing attempt, may or may not be able to drink, may bring up food at any time after eating
Regurgitation versus vomiting
Nasusea is before vomitting not regurgitation
Retching before vomitting not regurgitation
Food partially digested in vomiting not regurgitating
Clinical signs of Aspiration pneumonia
Soft cough, dyspnoea, tachypnoea, pyrexia, lung crackles, +/- nasal discharge
Predilection site for aspiration pneumonia
Right middle lung lobe
Aspiration pneumonia Treatment
Oxygen therapy if needed
Fluid therapy if needed
Broad spectrum antibiotics
Nebulisation
Coupage
Oesophageal diseases can be split into 2 catergories which are…?
Obstructive E.g Foreign body, Neoplasia, Vascular ring anomaly
Functional E.g. Megaesophagus, Gastroesophageal reflux
Signs of oesophageal disease
Regurgitation
Dysphagia
+/- Odynophagia- Painful swallowing
+/- Ptyalism- Too much saliva
+/- Ravenous or reduced appetite
+/- Weight loss
+/- Respiratory signs due to secondary aspiration pneumonia
Type of contrast used in visualsing oesophagus
Barium sulphate
Vascular ring anomaly
Congenital vascular anomaly
Persistant right aortic arch (most common)
Causes significant narrowing & obstruction of oesophagus
Clinical signs of vascular ring anomaly
Start regurgitating when weaned
Often have weight loss & stunting
Breeds predisposed to vascular ring anomaly
GSDs & Irish Setters
Treatment to treat vascular ring anomaly
Surgery to transect ligamentum arteriosum
Foreign body treatment
Medical emergency
Stabilise patient
General anaesthesia
Endoscopic removal – 1st choice
What happens if you are unable to remove foreign body via endoscopic removal
Oesophagotomy or oesophagectomy
Oesophagotomy – incision into lumen
Oesophagectomy – removal of portion
Strictures
Circular band of scar tissue
Secondary to severe oesophagitis
Signs of strictures
Circular band of scar tissue
Secondary to severe oesophagitis
Strictures diagnosis
Difficult to see on plain films
Contrast radiography
Number, length, location
Endoscopy
Strictures treatment
Endoscopic balloon dilation
Followed by medical therapy for oesophagitis
+/- steroids to reduce recurrence
Hiatal hernia
Stomach moves up chest
Dogs predisposed to hiatal hernia
Shar-Pei, English/French bull dogs
Hiatal hernia clinical signs for both congenital and acquired
Congenital – soon after weaning
Regurgitation, vomiting, hypersalivation, haematemesis, poor body condition, dyspnoea (AP)
Hiatal hernia Treatment
Small hernia
Medical management for oesophagitis
Large hernia
Surgical management
Narrow oesophageal hiatus
Give example of Parasitic granulomas of oesophagus
Spirocerca lupi- Ingestion of beetle
Immature adult worms migrate to oesophageal wall & mature
Adults form granulomatous nodules in oesophageal wall
Treatment of Parasitic granulomas of oesophagus
Doramectin
Breeds predisposed to Megaoesophagus
Irish setter, GSD, Great Danes
Clinical signs usually start at weaning
Megaoesophagus diagnosis
Contrast radiography
Oesophagoscopy
Look for secondary causes
Suggest secondary causes of Megaoesophagus
Myasthenia gravis
Severe oesophagitis
Hypoadrenocorticism
Generalised myopathy
Myasthenia gravis (MG)
Chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in weakness of the skeletal muscles
Myasthenia gravis (MG) Diagnosis
Tensilon test – generalised only, non-specific
Acetyl choline receptor antibody assay - acquired only
Myasthenia gravis (MG) Treatment
Pyridostigmine Injectible
Oesophagitis Treatment
Small, low fat, high protein meals
+/- withhold food PO
Sucralfate liquid
Metoclopramide
Gastric acid secretory inhibitors (PPI)
