The Oesophagus -regurgitation & dysphagia

Question 1

Regurgitation

Answer 1

Passive evacuation of food and/or fluid from oesophagus
Results from local mechanical events within oesophagus

Question 2

Dysphagia

Answer 2

Difficulty swallowing

Question 3

Differentiating between oropharyngeal and osophageal dysphagia

Answer 3

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

Question 4

Regurgitation versus vomiting

Answer 4

Nasusea is before vomitting not regurgitation
Retching before vomitting not regurgitation
Food partially digested in vomiting not regurgitating

Question 5

Clinical signs of Aspiration pneumonia

Answer 5

Soft cough, dyspnoea, tachypnoea, pyrexia, lung crackles, +/- nasal discharge

Question 6

Predilection site for aspiration pneumonia

Answer 6

Right middle lung lobe

Question 7

Aspiration pneumonia Treatment

Answer 7

Oxygen therapy if needed
Fluid therapy if needed
Broad spectrum antibiotics
Nebulisation
Coupage

Question 8

Oesophageal diseases can be split into 2 catergories which are…?

Answer 8

Obstructive E.g Foreign body, Neoplasia, Vascular ring anomaly
Functional E.g. Megaesophagus, Gastroesophageal reflux

Question 9

Signs of oesophageal disease

Answer 9

Regurgitation
Dysphagia
+/- Odynophagia- Painful swallowing
+/- Ptyalism- Too much saliva
+/- Ravenous or reduced appetite
+/- Weight loss
+/- Respiratory signs due to secondary aspiration pneumonia

Question 10

Type of contrast used in visualsing oesophagus

Answer 10

Barium sulphate

Question 11

Vascular ring anomaly

Answer 11

Congenital vascular anomaly
Persistant right aortic arch (most common)
Causes significant narrowing & obstruction of oesophagus

Question 12

Clinical signs of vascular ring anomaly

Answer 12

Start regurgitating when weaned
Often have weight loss & stunting

Question 13

Breeds predisposed to vascular ring anomaly

Answer 13

GSDs & Irish Setters

Question 14

Treatment to treat vascular ring anomaly

Answer 14

Surgery to transect ligamentum arteriosum

Question 15

Foreign body treatment

Answer 15

Medical emergency
Stabilise patient
General anaesthesia
Endoscopic removal – 1st choice

Question 16

What happens if you are unable to remove foreign body via endoscopic removal

Answer 16

Oesophagotomy or oesophagectomy
Oesophagotomy – incision into lumen
Oesophagectomy – removal of portion

Question 17

Strictures

Answer 17

Circular band of scar tissue
Secondary to severe oesophagitis

Question 18

Signs of strictures

Answer 18

Circular band of scar tissue
Secondary to severe oesophagitis

Question 19

Strictures diagnosis

Answer 19

Difficult to see on plain films
Contrast radiography
Number, length, location
Endoscopy

Question 20

Strictures treatment

Answer 20

Endoscopic balloon dilation
Followed by medical therapy for oesophagitis
+/- steroids to reduce recurrence

Question 21

Hiatal hernia

Answer 21

Stomach moves up chest

Question 22

Dogs predisposed to hiatal hernia

Answer 22

Shar-Pei, English/French bull dogs

Question 23

Hiatal hernia clinical signs for both congenital and acquired

Answer 23

Congenital – soon after weaning
Regurgitation, vomiting, hypersalivation, haematemesis, poor body condition, dyspnoea (AP)

Question 24

Hiatal hernia Treatment

Answer 24

Small hernia
Medical management for oesophagitis

Large hernia
Surgical management
Narrow oesophageal hiatus

Question 25

Give example of Parasitic granulomas of oesophagus

Answer 25

Spirocerca lupi- Ingestion of beetle Immature adult worms migrate to oesophageal wall & mature Adults form granulomatous nodules in oesophageal wall

Question 26

Treatment of Parasitic granulomas of oesophagus

Answer 26

Doramectin

Question 27

Breeds predisposed to Megaoesophagus

Answer 27

Irish setter, GSD, Great Danes Clinical signs usually start at weaning

Question 28

Megaoesophagus diagnosis

Answer 28

Contrast radiography Oesophagoscopy Look for secondary causes

Question 29

Suggest secondary causes of Megaoesophagus

Answer 29

Myasthenia gravis Severe oesophagitis Hypoadrenocorticism Generalised myopathy

Question 30

Myasthenia gravis (MG)

Answer 30

Chronic autoimmune disorder in which antibodies destroy the communication between nerves and muscle, resulting in weakness of the skeletal muscles

Question 31

Myasthenia gravis (MG) Diagnosis

Answer 31

Tensilon test – generalised only, non-specific Acetyl choline receptor antibody assay - acquired only

Question 32

Myasthenia gravis (MG) Treatment

Answer 32

Pyridostigmine Injectible

Question 33

Oesophagitis Treatment

Answer 33

Small, low fat, high protein meals +/- withhold food PO Sucralfate liquid Metoclopramide Gastric acid secretory inhibitors (PPI)