Page 135 - BSAVA Guide to Pain Management in Small Animal Practice

BSAVA Guide to Pain Management in Small Animal Practice

VetBooks.ir e ex p e 3 Oesophagitis

astrointestinal pain is often
underestimated, particularly pain involving
the oesophagus. esophagitis is under-
recognized as there are no pathognomonic
signs and diagnosis in the veterinary eld
re uires endoscopic visualization of an
erythematous, oedematous and ulcerated
oesophageal mucosa.
HISTORY AND PRESENTATION
It commonly results from gastro-oesophageal
re ux but also from local damage of the This dog shows a tucked-up tail, slight
oesophageal barrier when ingesting irritant hunching of the back and appears
materials and possibly from local neoplasia. unsettled and uncomfortable following abdominal
Re ux can develop with prolonged fasting, surgery. The anorexia in this case could be
due to abdominal pain; however, the dog had
intra-abdominal surgery, certain drugs, gastrointestinal re ux during anaesthesia prompting
anatomical abnormalities including hiatal the concern for concurrent oesophagitis.
hernia, upper airway obstruction, disorders of
gastric emptying and chronic vomiting.
underappreciated; analgesia should be
CLINICAL SIGNS AND SIGNS OF PAIN considered a priority, particularly in severe
cases. Analgesia could include opioids,
Clinical signs are often non speci c and lidocaine (dogs only), ketamine and
in uenced by underlying conditions. Signs paracetamol (dogs only). Supportive
that have been associated with oesophagitis treatment includes the use of cytoprotective
include regurgitation, ptyalism, odynophagia, agents (sucralfate), antacids (omeprazole
anorexia, extending head and neck with 1 mg kg 1 h and prokinetics
swallowing, repeated swallowing, retching, (metoclopramide and cisapride; these can
gagging, coughing and vocalizing after eating increase lower oesophageal sphincter tone,
especially cats . A ected animals can simply increase gastric motility and possibly
show signs of discomfort, restlessness and oesophageal motility in cats). Oral provision of
non locali able pain igure 7.8 . food may need to be withheld temporarily in
some cases with nutrition provided through
TREATMENT other routes. Longer term, low-fat diets are
recommended, and late night feeding should
Oesophagitis is self-perpetuating; therefore, it be avoided. Successful treatment requires
is imperative to treat it aggressively. The pain identi cation and management of any
resulting from oesophagitis is often underlying conditions where possible.

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