Page 600 - Problem-Based Feline Medicine

592 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

Concomitant oral ulceration and stomatitis may indi- Treatment
cate caustic chemical ingestion.
Acute reflux or chemical esophagitis must be
Regurgitation of food and/or vomiting can occur in treated aggressively in the early stage in an attempt
milder cases of esophagitis, hiatal hernia or to prevent fibrous esophageal stricture.
healing/stricture phase of severe acute esophagitis.
Preferably, all medication should be given parenter-
ally for the first 5–6 days.
Diagnosis
Broad-spectrum antibiotics to control secondary bacter-
History of chemical exposure, ingestion of a foreign ial infections (amoxicillin/clavulanic acid).
body or a recent anesthetic.
Corticosteroids to prevent stricture (dexamethasone
Survey radiographs of the esophagus are often unre- 0.2 mg/kg IM or IV q 12–24 h).
markable.
Sucralfate suspension to protect mucosa per os if not
Endoscopy reveals variable hyperemia, bleeding, vomiting (0.25 g PO q 8–12 h).
ulceration and pseudomembranes of the esophageal
Cimetidine (10 mg/kg IV, IM PO q 6–8 h) or raniti-
mucosa, or a foreign body.
dine (2.5 mg/kg IV q 12 h; 3.5 mg/kg PO q 12 h) to
Post-anesthetic reflux esophagitis lesions are character- reduce gastric acidity.
istically in the region over the base of the heart.
Metoclopramide (0.2 mg/kg IV, IM, PO q 6–8 h) or
Reflux due to severe vomiting or hiatal hernia char- cisapride (5 mg/cat q 8–12 h) to promote gastric emp-
acteristically causes esophagitis in the distal esopha- tying.
gus.
Narcotics for pain control e.g. methadone 0.1–0.5
Endoscopy can differentiate a functional esophageal mg/kg IV or IM q 4–6 h
stricture due to severe mucosal and sub-mucosal
Placement of gastrotomy or esophagotomy tube for
inflammation and edema from a fibrous stricture
nutrition while “resting esophagus” – leave in place
(forming subsequent to severe esophagitis).
5–7 days.
Differential diagnosis Surgical repair of hiatal hernia, gastroesophageal her-
nia or diaphragmatic hernia.
Hiatal hernia usually causes intermittent signs of
vomiting, ptyalism, regurgitation and dyspnea. Plain Prognosis
radiography shows a soft tissue density dorsal to the
Esophageal stricture due to fibrosis and scarring sec-
vena cava in the caudal thorax. Contrast radiography
ondary to esophagitis is common and is characterized
reveals the gastric fundus in the region of the terminal
by repeated regurgitation after eating.
esophagus.
This can be treated with gradual dilatation of stricture
Gastroesophageal intussusception – may cause inter-
by balloon dilation catheter or bouginage. Often
mittent signs but often causes persistent and severe
requires repeated dilation over weeks or months to
clinical signs of vomiting and salivation leading to
achieve resolution of signs.
rapid onset of vascular shock and death. Plain or con-
trast radiography or endoscopy to confirm.
HIATAL HERNIA/GASTROESOPHAGEAL
Diaphragmatic hernia involving the stomach – rapid
INTUSSUSCEPTION
expansion of incarcerated stomach after eating due to
accumulating gases causes rapid onset of dyspnea, sali-
Classical signs
vation and attempts to vomit. Plain or contrast radiog-
raphy to confirm presence of stomach in the chest. ● Ptyalism.
Often history of feeding immediately prior to onset ● Vomiting/regurgitation.
of signs.