Vomiting + Regurgitation Flashcards
Give 3 forms of obstructional oesophageal disease
Mural (stricture)
Luminal (foreign bodies)
Extralumenal (mass)
Give 3 causes of oesophagitis
Trauma, reflux (anaesthesia), irritation
Give 3 motility disorders of the oesophagus
Megaeosophagus
Neuropathy
Myopathy
What are the 3 most common causes of oesophageal disease?
Oesophagitis
Oesophageal foreign body
Mega-oesophagus
Outline the clinical signs associated with regurgitation
Hypersalivation
Odynophagia
Dysphagia (pharyngeal problem more likely)
Nasal discharge
Coughing (due to 2ry aspiration pneumonia)
Give 4 anatomical oesophageal diseases
Vascular ring anomaly
Cricopharyngeal disease
Hiatal hernia
Diverticulum
Outline the differences between vomiting and regurgitation
Vomiting: abdominal effort, nausea, digested food, no swallowing pain (May be alkaline or acidic substance) MOST COMMON
Regurgitation: passive, no nausea, undigested food, possibly painful (usually alkaline)
Which questions may distinguish vomiting from regurgitation?
- abdominal effort/wretching?
- digested food being brought up?
- when in relation to eating?
- swallowing difficulties?
- pain on eating?
- do they look nauseous?
What does physical exam usually reveal for oesophageal disease?
Nothing - usually normal
Lung auscultation may reveal aspiration pnumonia
Underlying/concurent disease
Body condition may indicate how chronic the disease is
What are the most common investigations to carry out? What else may be carried out?
Diagnostic imaging -plain/contrast radiographs
Heamotology and biochemistry
Endoscopy
What are the most common differential diagnoses for megaoesophagus?
Idiopathic (dogs)
Myasthenia gravis (generalised or focal)
Thymoma
Hypoadrenocorticism
What is the prognosis of megaoesophagus? What is the treatment?
Poor
Death usually results from repeated aspiration pnumonia
Treatment aimed at minimising occourence of pnumonia eg. elevate food and water
Hold vertical after feeding
Experiment with food consistency - liquid go down better but may be aspriated, solids harder to swallow but less likely to be aspirated
Manage pnumonia
Why is aspiration pnumonia associated with megaoesophagus?
Regurgitation not associated with reflex closure of the larynx (vomiting IS)
What are the causes of oesophagitis?
- chemical injury: corrosive agents, medications (doxycycline esp in cats if gets stuck)
- gastro-oesophageal reflux: GA, hiatal hernia, persistent vomiting, feeding tubes if positioned incorrectly
- Oesophageal foreign bodies
How can oesophagitis be treated?
Dietary - small meals high protein low fat food to minimise reflux ± gastric feeding tube
Sucralfate liquid - “chemical bandage”
Inhibitors of gastric acid secretion - H2 blockers, proton pump inhibitors
What is a possible serious complication of oesophagitis?
Strictures due to serious irritation if FB remains for >24hours
Where do oesophageal FBs usually lodge?
Lodge at thoracic inlet, heart base, hiatus