esophageal diseases. esophageal disease esophageal obstruction ingestion of nondigestible object...

ESOPHAGEAL DISEASES

Esophageal Disease• Esophageal obstruction

Ingestion of nondigestible object (bones, play objects)Degree of damage depends on size, shape, time in esophagusSurgical removal is least desirable → stricture formation

– Signs• Exaggerated swallowing movements• Increased salivation restlessness• Retching• Anorexia• Hx of chewing on foreign objects

Esophageal endoscopy

Esophageal Obstruction• Dx

– Endoscopy– Radiography

• 6-mo old St Bernard• What is your diagnosis?

Esophageal Obstruction• 3 mo kitten• What is your diagnosis?

Esophageal Obstruction• 2 yr old cat• What is your diagnosis?

Esophageal Obstruction• 8 yr male cat

Interesting stuff• 7 mo old Pug

Esophageal Obstruction• Rx

– Prompt removal is important – NPO x 24 h to allow for healing– Resume feeding with soft foods

• Client info– Limit access to bones and small objects– Strings and needles are hazards for cats– Px is good if serious damage to esophagus can be prevented

Stomach Diseases• Acute Gastritis

– Commonly seen in dogs (cats to lesser degree)• Spoiled food• Change in diet• Food allergy• Infections (bacterial, viral, parasitic)• Toxins (chemicals, plants, drugs, organ failure)• Foreign objects

– Signs• Anorexia• Vomiting (maybe dehydration)• Painful abdomen• Hx of diet change, toxin ingestion, infection, parasites

Acute Gastritis• Dx

– Hx and PE– CBC, Chem Panel to assess dehydration, metabolic imbalance, organ failure

• Rx– NPO until vomiting stops

• 4-6 sips of water q1h • Fluid therapy (SQ or IV)

– Gradually start feeding• Bland food (Hill’s I/D, boiled chicken/rice)

– Antiemetics• Maropitant (Cerenia)• Metoclopramide (Reglan)

– Coating agents• Sucralfate

– H2-blockers (famotidine, ranitidine, cimetidine)– Antibiotics—often prescribed, rarely needed

Acute Gastritis• Client info

– Avoid abrupt changes in diet• Gradually mix new food in with old (1 wk)

– If pet vomit 2-3 times, NPO x 24 h; if it continues see vet– Dogs and cats do not need variety– Avoid objects that can be swallowed (treat like a baby)

Immune-Mediated Inflammatory Bowel Disease (Chronic gastritis, Enteritis, Colitis)

Seen in cats, less common in dogsAccumulation of inflammatory cells in lining of stomach, SI, LI

• Signs– Chronic vomiting, wt loss– Diarrhea, straining to defecate, mucus in stool

• Dx– Fecal to r/o parasites– CBC, Chem panel, urinalysis to r/o metabolic disorder– FeLV, FIV to r/o those diseases– Endoscopy stomach SI and colon, and biopsy for definitive

diagnosis

• Rx– What is the Rx for any Immune-mediated Disease?– Azathioprine—immunosupressant (organ transplants)– Cyclophosphamide—inhibits immune system response– Sulfasalazine—a sulfa drug with anti-inflammatory/ antibacterial

effects• Most effective against colitis

– Metronidazole– Prednisone– Hypoallergenic diet

• Free from preservative, additives• Highly digestible protein (rabbit, lamb, duck, chicken)• Homemade diets with rice base• Some commercial diets are available

Immune-Mediated Inflammatory Bowel Disease (Enteritis, Colitis)

Inflammatory Bowel Disease

– Client info• Definitive dx is through biopsy• Life-long condition (special diet, frequent medical monitoring)• Immunosupressive drugs have side-effects (PU/PD/PP, wt gain,

skin/urinary infections)• Use lowest dose that provides effect

Gastric UlcerationUsually a result of long-term NSAIDs (aspirin, ibuprofen, phenylbutazone)

• Signs– Vary from asymptomatic to vomiting

blood– Anemia, edema– Melena– Anorexia– Abdominal pain– Septicemia if perforation occurs

• Dx– X-ray using contrast medium (Ba) to show ulceration in

stomach lining (caution if perforation is suspected)– Endoscopy

Gastric Ulceration• Rx

– Fluid therapy for dehydration– NPO (as before)– Coating agents/antacids– Cimetidine—H2 antagonist (↓ HCl production)

– Omeprazole—↓ HCl production (proton-pump inhibitor)

• Client info– Do not use NSAIDs without veterinary supervision– Give NSAIDs with meal/antacids

Gastric Dilatation/VolvulusPrimarily a disease of large, deep-chested dogs (2-10 yrs)Dilation—gas filled; Volvulus—twisted along longitudinal axisFood/exercise? Etiology unknown

• Signs– Abdominal pain/distension– Weakness, collapse, depression, nausea, salivation– Increased HR, RR – may lead to arrhythmias

• Dx– PE shows dilation, poor perfusion (↑ cap refill)– X-rays show air filled stomach- “double-bubble”– ECG may show vent arrhythmia or sinus tachycardia– CBC and Chem panel necessary to assess electrolyte levels

Gastric Dilatation/Volvulus

Gastric Dilatation/Volvulus

Gastric Dilatation/Volvulus• Rx

– Goals• Decompress stomach

– Pass stomach tube– 18 gauge needle

• Stabilize patient (fluids, electrolytes,

ECG)– Rx for shock

» IV fluids» Corticosteroids

– Antibiotics • Prepare for Sx

– Sx—ASAP

Gastric Dilatation/Volvulus

Gastric Dilatation/Volvulus

– Post-Op• ECG• Blood pressure• Pain management• Monitor urine output• Antibiotics• Maintain fluids (oral, IV)

• Client info– Avoid large meals– Limit exercise after meals– Feed high-quality protein diet– Tack-down procedure not 100% preventative

Gastric Dilatation/Volvulus

Gastric NeoplasiaMost common malignant neoplasia in dogs is adenocarcinoma; in cats

lymphoma

• Signs– Wt loss– Vomiting w/ or w/o blood– Obstruction– Usually seen in older animals

• Dx– Endoscopy and biopsy for diagnosis– X-ray with Barium contrast

• Rx– Surgery is TOC (treatment of choice)

• Many tumors are too far advanced (inoperable)– Chemotherapy– Radiation less successful for gastric tumors

• Client info– Px is poor; gastric neoplasia is a fatal disease– Supportive care, control of vom, good nutrition are needed

for these animals

Gastric Neoplasia