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Created page with "==Introduction== Regurgitation describes the '''passive, retrograde movement of food and water''' from the mouth or the oesophagus. It is important to differentiate regurgitatio..."
==Introduction==
Regurgitation describes the '''passive, retrograde movement of food and water''' from the mouth or the oesophagus.
It is important to differentiate regurgitation from [[Vomiting|vomiting]] as they represent very different disease aetiologies.
Regurgitation is the '''hallmark sign of oesophageal disorders'''.
Causes include:
'''Oesophageal obstruction''':
:Congenital [[Vascular Ring Anomalies|vascular ring anomaly]]
:[[Oesophageal Foreign Body|Foreign body]]
:[[Oesophageal Stricture|Stricture]]
:Neoplasia
:Extraoesophageal compression: thyroid carcinoma, pulmonary alveolar cell carcinoma
:Rare miscellaneous causes: cricopharyngeal achalasia, oesophageal diverticulum, oesophageal atresia
'''[[Oesophagitis]]''':
:gastrooesophageal reflux
:persistent vomiting
:[[Hiatal Hernia|hiatal hernia]]
:caustic agents
'''[[Megaoesophagus]]''':
:Congenital megaoesophagus: idiopathic or [[Myasthenia Gravis|myasthenia gravis]]
:acquired megaoesophagus
:neuropathy: polyradioculoneuropathy
:immune-mediated: polyneuritis, polymyositis, SLE, myasthenia gravis, [[Canine Dermatomyositis|dermatomyositis]]
:myopathy
:metabolic: [[Hypothyroidism|hypothyroidism]], [[Hypoadrenocorticism|hypoadrenocorticism]]
:[[Lead Poisoning|lead toxicity]]
:[[Canine Distemper Virus|Canine distemper]]
:Dysautonomia
'''Pharyngeal disorders''':
:[[Rabies|rabies]]
:foreign body
:other obstructions
==Clinical Signs==
{| class="wikitable collapsible"
|'''Regurgitation'''
|'''Vomiting'''
|-
|Passive event
|Abdominal effort
|-
|No prodromal nausea
|Prodromal nausea
|-
|Undigested tubular food
|Usually digested food
|-
|Possibly painful
|No swallowing pain
|-
|Usually alkaline pH
|Alkaline or acidic pH
|-
|}
There may be additional signs such as '''coughing and dyspnoea''' secondary to aspiration pneumonia.
Weakness may be present due to a '''systemic disorder''' such as myasthenia gravis, Addison's disease, polymyositis.
Animals usually have a '''ravenous appetite'''.
'''Dysphagia''' may be present if the pharynx is involved.
==Diagnosis==
Diagnosis should take into account the signalment and history.
'''Physical examination''' may involve oesophageal palpation, lung auscultation to check for aspiration pneumonia, checking for underlying or concurrent diseases.
'''Plain radiography''': may detect a radioopaque foreign body
'''Contrast radiography''': for radiolucent foreign bodies, obstructions, megaoesophagus.
'''Endoscopy''' may also be indicated to visualise the problem.
==Treatment==
'''The initiating cause should be treated''', which may involve removal of a foreign body or resection of a persistent right aortic arch.
Minimising the chances of '''aspiration pneumonia''' is important, and includes: feeding solid large pieces of food from a height.
General '''medical management''' may include: sucralfate liquid to act as a chemical bandage for the oesophagus, ranitidine and omeprazole to inhibit gastric acid secretion which may contribute to oesophagitis.
'''Complications''' following oesophageal disease include: [[Aspiration Pneumonia|aspiration pneumonia]] which should be treated aggressively, [[Oesophageal Stricture|oesophageal strictures]], continued oesophagitis, perforation, fistula, diverticulum formation, motility disorders.
The prognosis is usually '''guarded'''.
{{Learning
|flashcards = [[Feline Medicine Q&A 07]]
}}
==References==
Allenspach, K. (2009) '''Dysphagia and regurgitation in small animals''' ''RVC student notes''
Pasquini, C. (1999) '''Tschauner's guide to small animal clinics''' ''Sudz Publishing''
[[Category:To Do - Helen]]
[[Category:To Do - Review]]
Regurgitation describes the '''passive, retrograde movement of food and water''' from the mouth or the oesophagus.
It is important to differentiate regurgitation from [[Vomiting|vomiting]] as they represent very different disease aetiologies.
Regurgitation is the '''hallmark sign of oesophageal disorders'''.
Causes include:
'''Oesophageal obstruction''':
:Congenital [[Vascular Ring Anomalies|vascular ring anomaly]]
:[[Oesophageal Foreign Body|Foreign body]]
:[[Oesophageal Stricture|Stricture]]
:Neoplasia
:Extraoesophageal compression: thyroid carcinoma, pulmonary alveolar cell carcinoma
:Rare miscellaneous causes: cricopharyngeal achalasia, oesophageal diverticulum, oesophageal atresia
'''[[Oesophagitis]]''':
:gastrooesophageal reflux
:persistent vomiting
:[[Hiatal Hernia|hiatal hernia]]
:caustic agents
'''[[Megaoesophagus]]''':
:Congenital megaoesophagus: idiopathic or [[Myasthenia Gravis|myasthenia gravis]]
:acquired megaoesophagus
:neuropathy: polyradioculoneuropathy
:immune-mediated: polyneuritis, polymyositis, SLE, myasthenia gravis, [[Canine Dermatomyositis|dermatomyositis]]
:myopathy
:metabolic: [[Hypothyroidism|hypothyroidism]], [[Hypoadrenocorticism|hypoadrenocorticism]]
:[[Lead Poisoning|lead toxicity]]
:[[Canine Distemper Virus|Canine distemper]]
:Dysautonomia
'''Pharyngeal disorders''':
:[[Rabies|rabies]]
:foreign body
:other obstructions
==Clinical Signs==
{| class="wikitable collapsible"
|'''Regurgitation'''
|'''Vomiting'''
|-
|Passive event
|Abdominal effort
|-
|No prodromal nausea
|Prodromal nausea
|-
|Undigested tubular food
|Usually digested food
|-
|Possibly painful
|No swallowing pain
|-
|Usually alkaline pH
|Alkaline or acidic pH
|-
|}
There may be additional signs such as '''coughing and dyspnoea''' secondary to aspiration pneumonia.
Weakness may be present due to a '''systemic disorder''' such as myasthenia gravis, Addison's disease, polymyositis.
Animals usually have a '''ravenous appetite'''.
'''Dysphagia''' may be present if the pharynx is involved.
==Diagnosis==
Diagnosis should take into account the signalment and history.
'''Physical examination''' may involve oesophageal palpation, lung auscultation to check for aspiration pneumonia, checking for underlying or concurrent diseases.
'''Plain radiography''': may detect a radioopaque foreign body
'''Contrast radiography''': for radiolucent foreign bodies, obstructions, megaoesophagus.
'''Endoscopy''' may also be indicated to visualise the problem.
==Treatment==
'''The initiating cause should be treated''', which may involve removal of a foreign body or resection of a persistent right aortic arch.
Minimising the chances of '''aspiration pneumonia''' is important, and includes: feeding solid large pieces of food from a height.
General '''medical management''' may include: sucralfate liquid to act as a chemical bandage for the oesophagus, ranitidine and omeprazole to inhibit gastric acid secretion which may contribute to oesophagitis.
'''Complications''' following oesophageal disease include: [[Aspiration Pneumonia|aspiration pneumonia]] which should be treated aggressively, [[Oesophageal Stricture|oesophageal strictures]], continued oesophagitis, perforation, fistula, diverticulum formation, motility disorders.
The prognosis is usually '''guarded'''.
{{Learning
|flashcards = [[Feline Medicine Q&A 07]]
}}
==References==
Allenspach, K. (2009) '''Dysphagia and regurgitation in small animals''' ''RVC student notes''
Pasquini, C. (1999) '''Tschauner's guide to small animal clinics''' ''Sudz Publishing''
[[Category:To Do - Helen]]
[[Category:To Do - Review]]