Page 633 - Problem-Based Feline Medicine

29 – THE CAT WITH SIGNS OF REGURGITATION 625

Prognosis Diagnosis

The prognosis for cats with an esophageal diverticulum Survey radiographs of the thorax may reveal a soft
depends on its cause and size. tissue density and gas in the region of the caudal
dorsal mediastinum, but contrast radiography will
In cats that have a small diverticulum for which the
confirm the presence of the hernia (unless it is a sliding
cause has been identified and removed, the prognosis is
hernia that is in the normal position at the time of radi-
guarded to good.
ographs) or untussusception.
If the diverticulum is large, the cause is uncor-
In some cases fluoroscopy will assist in identifying a
rectable, or there is no response to conservative
sliding hernia.
management, the prognosis is poor.
HIATAL HERNIA/GASTROESOPHAGEAL Differential diagnosis
INTUSSUSCEPTION
Diagnosis may be difficult if the hernia is sliding or
Classical signs the intussusception is intermittent and the signs are
intermittent in nature. All the major esophageal disor-
● Intermittent or persistent regurgitation or
ders (esophagitis, hypomotility, stricture, etc) should be
vomiting. considered and ruled out by appropriate testing.

Pathogenesis
Treatment
Hiatal hernia is the protrusion of any abdominal con-
If the cat is symptomatic, treatment is as for reflux
tents through the esophageal hiatus of the diaphragm
esophagitis (histamine-2 blockers, metoclopramide
into the thorax. With gastroesophageal intussusception,
and sucralfate as needed).
the stomach is prolapsed into the lumen of the distal
esophagus. In cats with persistent clinical signs that do not
improve with conservative medical therapy, surgical
Hiatal hernia is an uncommon problem in cats, but
intervention is indicated.
occurs due to enlargement of the hiatal membrane
(may occur from trauma) or as a result of laxity in
the phrenoesophageal membrane. Hiatal hernias Prognosis
have been reported in association with generalized
Fair to good, especially since cats with hiatal hernias
tetanus.
or gastroesophageal intussusceptions tend to have inter-
Cats more commonly have sliding hiatal hernias, with mittent clinical signs.
cranial displacement of the abdominal esophagus and
part of the stomach through the esophageal hiatus.
ESOPHAGEAL FISTULA
Gastroesophageal intussusception can cause both
esophagitis and esophageal obstruction. Classical signs
● Regurgitation or dysphagia occurring in
Clinical signs
conjunction with coughing or respiratory
Intermittent or persistent regurgitation or vomiting distress.
are the most common signs.
Some cats may show abdominal pain on palpation of Pathogenesis
the anterior abdomen.
Fistula development is the result of esophageal
Respiratory distress may be seen with large hiatal her- ischemia and necrosis that ultimately leads to a small
nias or gastroesophageal intussusceptions. perforation. The process of healing leads to develop-