Exam 1: Regurgitation

define regurgitation by chronology, appearance, behavior, abdominal contractions, associated clinical signs, and risk of aspiration pneumonia

• usually occurs immediately or soon after foof intake

• typically looks like undigested food covered with asliva

• usually without nausea

• usually absent

• dysphagia, odynophagia, hypersalivation, repeated swallowing attempts, weight loss if chronic

• high

define vomiting by chronology, appearance, behavior, abdominal contractions, associated clinical signs, and risk of aspiration pneumonia

• may occur at any time point after ingesting a meal or inn between meals

• may have many different appearances or look more/less digested. Presence of bile or digested blood indicates gastric

• often preceded by nausea

• typicall present

• nausea, lethargy, anorexia, weight loss, ect

• moderate

do all dogs with regurgitation have esophageal disease

• yes but…

• passive or silent vomiting is not associated with obvious abdominal contractions and may be misinterpreted as regurg. Occurs in association with delayed gastric emptying and abnormal gastric antral motility

describe esophageal musculature in dogs and cats

• dog- striated muscle over whole length

• cat- striated muscle in proximal 1/3, then smooth muscle

describe esophageal innervation

• afferent- cranial nerves IX and X

• brain stem centers- swallowing center, reticular formation, other nuclei

• efferent impulse- cranial nerve X

what is primary peristalsis

• triggered by swallowing

• propels bolus down to lower esophageal sphincter (LES)

• intensified by food bolus

what is secondary peristalsis

• occurs when primary does not propel the bolus all the way to LES

• triggered by esophageal distension

what are the general classes of esophageal disease

• inflammation due to caustic substances, gastro-esophageal reflex

• functional problems due to dilation and megaesophagus

• mechanical problems due to ring anomaly, foreign body, stricture, neoplasia

what are the cllinical signs of esophageal disease

• regurgitation

• dysphagia

• swallowing attempts on empty, hard swallows

• excessive salivation

• halitosis

• licking own lips, lip smacking

• odynophagia

• anorexia, hyporexia

• ravenous appetite (megaesphagus)

• weight loss

• resp signs (aspiration pneumonia)

what should be your diagnostic approach for esophageal disease presentation

• thorough exploration of history for clues

• chest radiographs to rule out esophageal foreign body, megaesophagus, aspiration pneumonia

• continued search for issue
  -lab work as needed

what are causes of esophagitis in dogs

• gastroesophageal reflex (anesthesia related, severe vomiting, other causes such as hiatal herniation)

• foreign body (mucosal damage, possible infection)

• swallowing of caustic substances

what is the incidence of GER during general anesthesia

• 51/90 dogs dogs maintained with halothane, iso, or sevo had at least 1 episode. Early inset is more commonly associated with regurgitation during anesthesia event

• morphine administration prior to anesthesia often causes vomiting and increases the risk of GER in dogs

what is your pathway if you find generalized esohageal dilation on rads

• AChR- antibody titer ± ACTH stim, thyroid, lead, ANA

• ddx focal MG, idiopathic megaesophagus

what are your ddx for esophageal dilation only cranial to the heart base or no generalized dilation on rads

• vascular ring anomaly

• luminal mass

• stricture

• esophagitis

• contrast rads, swallow study

  • esophagoscopy if needed

what is your process for radio-opaque esophageal structure

• perforation

• if no perforation, perform esophagoscopy

• ddx- stricture, luminal mass, foreign body

what is persistent right aortic arch

• dog and cat

• regurgitation typically after weaning, high risk of aspiration pneumonia

• dx with rads

• treat with surgical resection

what are your differentials for acquired secondary megaesophagus

• inflammatory
  -esophagitis
  -polymyopathy, SLE dermatomyositis
  -NMJ- myasthenia gravis (AChR antibodies)

• endocrine
  -hypoadrenocorticism (basal cortisol)
  -± hypothyroidism (T4, cTSH)

• toxic
  -lead (history)
  -organophosphates

• dysautonomia

• idiopathic (elimination)