ESOPHAGEAL DISEASES

Esophageal Disease Esophageal obstruction Ingestion of nondigestible object (bones, play objects) Degree of damage depends on size, shape, time in esophagus Surgical 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 dogs Accumulation 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 Ulceration Usually 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—H 2 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/Volvulus Primarily a disease of large, deep-chested dogs (2-10 yrs) Dilation—gas filled; Volvulus—twisted along longitudinal axis Food/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

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

– 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 Neoplasia Most 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