888. REGURGITATION. Megaesophagus in the older dog - treatment

Regurgitation is the presenting sign. Mistaken for "vomiting" which is a projectile action.

D/D for regurgitation
1. Esophageal obstruction. Vascular ring anomaly, stricture, foreign body, neoplasia (spirocerca lupi).
2. Motility disorders. Megaoesophagus - congential
- acquired --- primary (idiopathic)
--- secondary
Dysautonomia
3. Inflammatory. Esophagitis (secondary to protracted vomiting), caustic irriation. Hiatal hernia. Gastro-esophageal reflux.
4. Others. Diverticula, Broncho-esophageal fistula.
5. Idiopathic.


DIAGNOSIS
1. History - Other clinical signs, young or older breed, large breed
2. Physical exam - incl full neurological exam, thorough thoracic auscultation (aspsiration pneumonia, caudal lobes on X-ray).

THORACIC X-RAY. Needs 3 views. 2 lateral + V/D. Look for aspiration pneumonia, cranial mediastinal mass, air in esophagus (one lateral without sedation as drugs can cause air in esophagus).

Contrast studies. Liquid barium using plain X-rays, evidence of strictures, vascular ring anomaly (puppies).

Food and barium dynamic studies (fluoroscopy) to assess motility of esophagus.

Other investigations to identify underlying problems.

TREATMENT depends on causes

Distemper, autonomic drugs, toxicity (lead, thallium, anti-cholilnesterase), esophigitis, systemic lupus erythematosus, hypoadrenocorticisum, thyoma, myasthenia gravis (focal, most common cause, auto-antibodies produced againt Ach receptors), polymyositis.

1. Vertical feeding - Feed from a height. Bailey's chair. 1 hour upright feeding.
2. Bethanechol or cisapride for myasthenia gravis.

CASE STUDY
Use of barium meal showed esophagus enlarged in two areas, convincing the owner of the diagnosis. Plain X-ray not so clear in showing megaesophagus.
2. Dietary - canned food, meat balls. No dry food.
3. If myasthenia gravis, require anit-cholinesterase drugs and immune suppression.
bethanechol or cisapride.

 

 

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 20 JUN 2025

HIATAL HERNIA of a case in Myanmar dog.
Sign: Regurgitation.

7-month-old terrier regurgitates every time after eating and drinking.
Bright, alert and responsive.
Normal appetite. No fever.

History: Chicken bones given to the dog the day before regurgitation.

X-ray --- rib bone fragments seen at caudal oesophagus or hiatal hernia.

Treatment:
Laparotomy. Incise cranial aspect of stomach. Take out bones with forceps.

mass is pork rib bone.

 

POST-op

Dog is back to normal.

Good appetite. No regurgitation.

Regurgitation is the presenting sign. Mistaken for "vomiting" which is a projectile action.
 

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 A hiatal hernia occurs when part of the stomach or esophagus protrudes through the esophageal hiatus into the chest cavity. 

 

 

How X-rays help:

• Identifying abnormal positioning:

  X-rays can reveal the stomach or esophagus displaced into the chest cavity, which is a key indicator of a hiatal hernia. 
• Contrast studies:

  Specialized radiographic dye studies, like contrast esophagography, can provide more detailed images, especially for differentiating between different types of hiatal hernias. 
• Dynamic assessment:

  Fluoroscopy, which involves moving X-rays, allows veterinarians to observe the swallowing process and stomach movement in real-time, further aiding in diagnosis, according to NDSR. 
• Distinguishing from other conditions:

  X-rays help rule out other potential causes of similar symptoms, such as megaesophagus, esophageal diverticula, or masses. 

Important Considerations:

• Not always definitive:

  A normal x-ray doesn't always exclude the possibility of a hiatal hernia, as the stomach may not be in the abnormal position at the time of imaging, says NDSR. 
• Other imaging may be needed:

  Sometimes, CT scans or endoscopy may be necessary for a more comprehensive evaluation, particularly for complex or persistent cases. 
• Treatment:

  Treatment options, which may include medical management or surgery, are determined based on the type and severity of the hernia and the dog's overall condition.