Page 421 - Small Animal Internal Medicine, 6th Edition

CHAPTER 26 Clinical Manifestations of Gastrointestinal Disorders 393

of the lower esophageal sphincter may sometimes be respon- disease causes esophageal disease in people but has not been
sible (Box 26.4). Obstruction should be characterized as reported to cause esophageal weakness in dogs. Lower
VetBooks.ir congenital or acquired and as intraluminal, intramural, or esophageal achalasia-like syndrome has been identified in
dogs with congenital and acquired weakness. The prevalence
extraesophageal. Congenital obstructions are usually extra-
esophageal vascular ring anomalies. Acquired intraluminal
low. Fluoroscopic examination is necessary for diagnosis.
obstructions are usually foreign objects or cicatrix secondary of this syndrome is currently uncertain, but assumed to be
to esophagitis. The clinician should always determine Esophagoscopy may detect esophagitis or small lesions
whether animals with esophageal foreign objects (especially (e.g., partial strictures) that contrast-enhanced esopha-
small foreign objects that would have been expected to have grams do not reveal. If esophagitis is found, the clini-
passed) have a partial esophageal stricture that predisposed cian should look carefully for a cause (e.g., hiatal hernia,
them to obstruction. Endoscopy may be both diagnostic and gastric outflow obstruction). After entering the stomach,
therapeutic in these animals; thoracotomy is seldom needed the endoscopist must retroflex the tip of the endoscope and
for management of cicatrix or intraluminal foreign objects. examine the gastric side of the lower esophageal sphinc-
Esophageal weakness may be congenital or acquired. ter for leiomyomas or malformation (e.g., hiatal hernia).
Congenital weakness is typically idiopathic, and further Gastroduodenoscopy is performed concurrently to look for
diagnostics are unfruitful. Acquired esophageal weakness gastric and duodenal reasons for gastroesophageal reflux
usually results from an underlying neuromuscular problem. or vomiting.
Although an underlying cause is infrequently diagnosed,
finding one may lead to a permanent cure as opposed to
supportive therapy of the symptoms. A complete blood
count (CBC), serum biochemistry profile, determination of BOX 26.5
serum antibody titers to acetylcholine receptors, resting
serum cortisol (see Chapter 50), serum creatine kinase, and/ Causes of Esophageal Weakness
or fecal examination for Spirocerca lupi ova are performed to
look for causes of acquired esophageal weakness (Box 26.5). Congenital Causes
One may also consider searching for lead intoxication Idiopathic
(nucleated red blood cells and basophilic stippling in the Achalasia-like syndrome (not sure how common)
CBC, serum and urine lead concentrations), canine distem- Acquired Causes
per (retinal lesions), and various neuropathy-myopathies
(electromyography, nerve biopsy, muscle biopsy). Chagas Myasthenia (generalized or localized) (important)
Hypoadrenocorticism (uncommon but important)
Severe esophagitis
Gastroesophageal reflux
• Hiatal hernia
BOX 26.4 • Anesthesia-associated reflux (uncommon but
important)
Causes of Esophageal Obstruction • Spontaneous reflux
Foreign body (uncommon but important)
Congenital Causes Caustic ingestion
Vascular ring anomaly • Iatrogenic (e.g., doxycycline, clindamycin,
Persistent fourth right aortic arch (most common type) ciprofloxacin, nonsteroidal anti-inflammatory drugs
Other vascular rings [NSAID])
Esophageal web (rare) • Disinfectants, chemicals, etc.
Persistent vomiting
Acquired Causes Excessive gastric acidity
Foreign object (especially when there is a sudden onset) • Gastrinoma
Cicatrix/stricture (not common but very important) • Mast cell tumor
Neoplasia Fungal organisms (e.g., pythiosis)
Esophageal tumors Myopathies (including muscular dystrophy)/neuropathies
• Carcinoma Miscellaneous causes
• Sarcoma caused by Spirocerca lupi Achalasia-like syndrome
• Leiomyoma of lower esophageal sphincter Dysautonomia
Extraesophageal tumors Spirocerca lupi
• Thyroid carcinoma Dermatomyositis (principally in Collies)
• Pulmonary carcinoma Botulism
• Mediastinal lymphosarcoma Tetanus
Achalasia of the lower esophageal sphincter (sometimes Lead poisoning
found in dogs) Canine distemper
Gastroesophageal intussusception (very rare) Idiopathic