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Foreign body in the larynx in a dog symptoms. Foreign bodies in tissues and organs of a dog

Dogs are very curious by nature. but sometimes their curiosity leads to trouble. This is especially true for dogs - “vacuum cleaners”, who eat a lot of strange things. What kind of items did the doctors of our clinics take out from the gastrointestinal tract of dogs - socks, panties, bags, ropes, threads, needles, toys, bones, sticks and many other finds!

The symptoms of a foreign body in a dog depend greatly on where the object is located - in the mouth, throat or esophagus, stomach or intestines.

A foreign body in a dog's mouth is usually sticks or bones that are stuck between the dog's back teeth. One of the first signs is frequent movement of the jaw, profuse salivation, the dog rubs its face with its paws, and there may also be slight bleeding from the mouth. Do not try to remove a stick or bone yourself! Even if you manage to loosen the object, it may move into the throat. Contact the nearest veterinary clinic "Your Doctor", a doctor's examination is necessary, and sedation may also be required to remove a foreign body from the dog's mouth.

A foreign body in a dog's throat often causes signs of sudden suffocation and nausea. This condition often requires immediate intervention! As first aid, the owner can lift the dog by the hind legs and shake it; in an emergency, you can sharply squeeze the chest from the sides several times.

A foreign body in a dog's esophagus: signs - vomiting after eating, dehydration. To check whether your animal is dehydrated or not, collect a fold of skin on the dog's withers and release it, it should return to its normal position quickly.

When a dog has a foreign body in the trachea and lungs, the general depression of the animal increases at an alarming rate. You must consult a doctor immediately!

A foreign body in a dog's stomach is more difficult to diagnose. Some foreign bodies can remain in the stomach for several years without visible problems. But if the foreign body moves, it can lead to periodic vomiting.

A foreign body in a dog's small intestine usually causes uncontrollable vomiting, dehydration, and severe pain in the abdominal wall.

A foreign body in the dog's rectum: if it is sharp objects - sticks, bone fragments, needles, etc. - the dog repeatedly hunches over, possible constipation, blood in the stool. It is important for owners to follow the rule: never pull on a foreign object that is protruding from your pet's rectum! This can be very dangerous, even leading to intestinal rupture. Contact the nearest veterinary clinic "Your Doctor".

Foreign body in a dog. Causes and symptoms

Almost all foreign bodies in the gastrointestinal tract are objects that are consumed by the animal. One exception is trichobezoars (hairballs). Threads and strings swallowed by your dog often become wrapped around the root of the tongue. Carefully examine your pet's oral cavity!

Symptoms that require you to contact a veterinarian:

  • Vomit
  • Diarrhea
  • Abdominal pain (the dog does not allow himself to be picked up, his back is hunched)
  • Anorexia (lack or decreased appetite)
  • Straining during bowel movements, constipation
  • Lethargy
  • Dehydration

Foreign body in a dog. Diagnostics

Diagnosis requires a general blood test, biochemical blood test, and urine test. These findings help rule out other causes of vomiting, diarrhea, anorexia, and abdominal pain. It is necessary to take x-rays using a contrast agent.

A foreign body in a dog that causes intestinal obstruction, prolonged vomiting, or diarrhea can lead to significant metabolic changes in the body. In addition, a foreign body can cause perforation of the organ wall and exit into the chest or abdominal cavity, leading to profound complications such as peritonitis, sepsis and death. Many foreign bodies consist of toxic materials that are absorbed by the body - this leads to profound systemic diseases.

Foreign body in a dog. Treatment Options

There are several treatment options depending on your dog's condition. If you have recently swallowed foreign objects, you may try to induce vomiting. It is also necessary to remove mineral oil, which facilitates the passage of foreign bodies through the gastrointestinal tract within 48 hours.

Some objects can be removed using an endoscope. If the animal has symptoms such as vomiting blood or severe pain, then intravenous infusions and painkillers are necessary. Your veterinarian will suggest admitting your dog to the clinic for observation. The decision to operate is usually made on the basis of x-rays and ultrasound results. A blockage in the intestines or stomach can reduce blood flow to the GI tissues, which can become necrotic. If the foreign body is in the stomach or intestines, the object is removed by making an incision in the intestines or stomach. If there are necrotic tissues and parts of the intestine, they are also removed.

After the operation, intensive therapy is carried out with intravenous fluids, painkillers and antibiotics are administered. Feeding the dog after surgery begins 1 to 2 days later. It is advisable to use special diets for nutrition at first.

Foreign body in a dog. Forecast

In most cases, dogs with foreign bodies that do not cause blockages have a good prognosis. However, in general, the prognosis depends on several factors:

  • object location
  • duration of obstruction caused by the object
  • size, shape and characteristics of the object
  • whether or not the object will cause secondary diseases
  • the general health of the dog before the foreign body enters

Foreign body in a dog. Prevention

  • eliminate bones from the diet
  • Don't let your dog chew sticks
  • Keep an eye on the animal during games and walks; if the dog is prone to wandering, put a muzzle on it
  • Ask your veterinarian for advice when choosing harmless toys for your dog.
  • if your dog often eats strange objects, consult the doctors at our clinics; there may be a general metabolic disorder

And remember - your pet's life is in your hands.

If you have had an attack of gastritis or another disease of the gastrointestinal tract at least once in your life, you yourself can imagine the importance of the digestive system and the consequences that arise when it “problems.” In animals, everything is exactly the same, except that they cannot see a doctor on their own, and therefore their illnesses can go undetected for a long time. Especially such as megaesophagus in dogs.

The name of the pathology consists of two Latin terms. The first means “large”, the second means “esophagus”. True, the length of the organ does not change in any way. It grows in width. More precisely, the lumen of the esophagus greatly increases, inside which a kind of “pocket” is formed. In particularly advanced cases, x-rays show a picture as if the dog had swallowed a balloon. At the same time, the lumen of the esophagus increases so that even a full stomach can be smaller in size.

Pathology can be divided into four main types: primary and secondary megaesophagus, congenital and acquired. In the first case, the “Megaesophagus” exists on its own, being the only disease. In the second, it is only a consequence of the pet’s existing pathology. Accordingly, the congenital variety is present in the dog from its very birth, in most cases being a consequence of disorders of intrauterine development and/or a genetic or autoimmune disease of the mother. Dogs become ill with acquired megaesophagus as a result of some acute or chronic diseases of the gastrointestinal tract.

But it is not always possible to draw an exact line between these types of ailments. Thus, esophagitis, that is, inflammation of the esophagus, can be both a consequence and a cause of dilatation (expansion) of the organ. And finding out what exactly appeared first is not possible in all cases.

The following signs may indicate that your pet has this disease:

  • and/or . These are very bad effects, as they may indicate the development of inflammation in the organs of the respiratory system.
  • , that is, increased salivation.
  • Strong , Moreover, mucopurulent exudate is released from the pet’s nostrils.
  • Decreased appetite.

Vomiting that occurs shortly after feeding is considered specific. But! Unlike other diseases of the gastrointestinal tract, the pet vomits after drinking or eating semi-liquid food. However, not all pets develop this symptom. Sometimes the disease is almost asymptomatic.

The danger of a “mega-esophagus”

What does enlargement of the esophagus entail, and why does it pose a danger to the health and even life of your pet? It’s simple - under normal conditions, this organ, which many people think of as a kind of “garbage chute,” actively participates in the assimilation of ingested food. When a food bolus, soaked in saliva and partially chewed, enters the esophagus, the latter begins to contract. This occurs due to the presence of striated muscles in its walls. If the walls of the esophagus are stretched to the point of a tightly stretched ball, there is no talk of any contractions.

What does this mean? Nothing good. Food that has entered the dilatation of the esophagus cannot move further. Since this organ lacks secretory glands that secrete digestive secretions, it simply rots. The dog also suffers from inflammation of the esophagus, which inevitably occurs against the background of the action of putrefactive microflora. Interestingly, one of the consequences of megaesophagus is: rhinitis, sinusitis, and even.

Read also: Methods of treatment and prevention of ascariasis in dogs

However, there is nothing strange in such a “bouquet”: putrefactive microflora from the esophagus can (for example, with vomit) enter the lumens of the respiratory system. This ends sadly, since such a “spillover” is fraught with the development of aspiration pneumonia. There is no information about the reverse process, when pathogenic microflora from the nose or bronchi could contribute to the appearance of a “mega-esophagus”.

Predisposing factors

Why can this even happen? There are many reasons. “Megaesophagus” is described by modern veterinarians as a disease specific to dogs. They also have a breed predisposition. Thus, miniature schnauzers and many types of “pocket” terriers get sick much more often, and their disease is often congenital. Because of this, breeders (conscientious, of course) try to exclude from the reproduction process those animals that had at least one ancestor with this disease in their family. However, this does not always work out.

For reasons that have not yet been clarified, there is a definite connection between pathologies of the endocrine glands and an increase in the lumen of the esophagus. In particular, with diseases of the thyroid gland and pituitary gland, the frequency of esophageal pathologies increases by 11-16%. Most likely, an excess or lack of hormones leads to degradation of the muscle tissue of the esophagus. But why exactly this organ reacts so sharply to endocrine disorders is unclear.

Diagnostics

It is impossible to determine megaesophagus by eye. That’s why the doctor resorts to using several diagnostic techniques:

  • Ultrasound examination easily helps to detect dilation of the esophagus. Difficulties can arise only in cases where the enlarged area is located in the chest.
  • X-rays are much more reliable when the organ cavity is first filled with a contrast solution of barium sulfate. Because of the risk of aspiration pneumonia, contrast fluoroscopy is not recommended in all cases unless a definitive diagnosis is otherwise possible.

Intestinal obstruction is one of those pathologies in dogs in which a delay in medical care leads to death. Primary symptoms are not always immediately pronounced and are very similar to various poisonings. Unknowingly, some dog owners try to help their pet themselves, wasting valuable time and aggravating the situation. It is important to know about the causes of intestinal obstruction in a dog, what symptoms it is accompanied by, so that if you notice them immediately, consult a doctor.

There are many reasons for which blockage of the intestinal lumen occurs; they can be divided into three groups.

Mechanical obstruction occurs most often. Her reasons:

  • difficult to digest food. These can be boiled or raw bones, sinews, which are difficult for a dog to chew and he swallows them whole;
  • a large portion of food given to a dog that has been starving for a long time;
  • foreign objects that the dog swallows during games, pampering or training;
  • accumulation of a large number of worms in the intestines after deworming. This is mainly observed in puppies.

Mechanical obstruction occurs mainly due to the fault of the owner. When purchasing a dog, you should familiarize yourself with the rules of feeding your pet and learn what cannot be included in its diet.

Deworming should be carried out at least once every three months, even if the animal walks near the house and has little contact with its relatives.

For games and training, you must use only special objects and toys. Stones, small sticks with bark, rubber or foam objects should not be given to the dog under any circumstances.

If there are children in the house, then their toys should be inaccessible to the dog, as well as any small interior items and household items.

When walking, the pet must be on a leash and care must be taken that it does not try to swallow any objects. It happens that even trained dogs, having smelled an object with an attractive smell, forget about all their skills and inhibitions and swallow it.

Pathological obstruction - occurs due to a tumor in the intestine.

Physiological- this is a volvulus of the intestines or stomach due to activity immediately after eating, strangulation of a hernia, compression of the intestines by other organs, trauma to the abdominal cavity.

Intestinal obstruction can be acute or chronic:

  • Acute occurs suddenly, develops rapidly, and the symptoms are clearly expressed. This species is very dangerous, but due to the fact that the symptoms are noticeable, dog owners quickly react and go to the clinic - the prognosis for recovery is favorable.
  • Chronic obstruction does not immediately appear and is most often associated with diseases of the gastrointestinal tract.

How to recognize the disease

Symptoms are similar to those of poisoning:

  • weakness, malaise;
  • refusal of food and water;
  • vomit;
  • bloating;
  • stomach ache.

These signs appear the very first. When walking an animal, you should pay attention to whether there was a bowel movement during the walk.

Lack of bowel movements combined with vomiting, refusal to eat and abdominal pain is the main sign of intestinal obstruction.

If you notice these symptoms, you should contact a veterinary clinic as soon as possible, establish an accurate diagnosis and begin treatment.

Without treatment, the dog's condition will worsen:

  • The tone of the abdominal muscles will increase. In this case, the pet may try to stretch its hind legs, straining their tips;
  • gases accumulate in the stomach, which make themselves felt by strong rumbling;
  • severe belching, unpleasant odor from the mouth;
  • vomiting does not stop; in some cases, feces may come out along with the vomit.

At this stage, necrosis of part of the intestine occurs, its rupture, intoxication of the body, severe dehydration, loss of salts and protein. At this stage, it is not always possible to save the dog.

It should be borne in mind that intestinal obstruction may be partial. In this case, there is a small lumen in the intestine through which gases and some feces can escape. This can be confusing for a dog owner and deter them from visiting a doctor. You need to know that partial obstruction is just as dangerous as complete obstruction.

First aid for a dog

If you suspect an intestinal obstruction, you cannot treat your dog yourself.

Antiemetic drugs are contraindicated, you should not give laxatives for constipation, or force them to eat and drink.

To alleviate the condition, you can give your pet an antispasmodic or analgesic drug.

Every opportunity should be found to deliver the animal to the veterinary clinic as quickly as possible. The death of a dog due to intestinal blockage can occur in 2-3 days, in some cases a little later.

Diagnosis and treatment

For diagnosis the following is carried out:

  • palpation of the abdomen to identify compactions, increased tone and pain;
  • urine and blood analysis to determine the degree of intoxication of the body;
  • X-ray examination;

Some objects lodged in the intestines are not visible on x-rays. To clarify the obstruction and determine the location of the foreign object, the dog is given a contrast agent.

After this, several x-rays are taken at certain intervals. They trace the movement of the contrast agent through the esophagus, stomach and intestines. When its progress stops, it is possible to determine where the blockage has occurred in the intestine.

The doctor’s task is to determine whether the foreign object can be removed without surgical intervention. If possible, then:

  • carry out intestinal lavage by introducing special preparations or herbal decoctions into it using an enema;
  • a medicine is prescribed that stimulates the intestines, it is administered as an injection or dropper;
  • it is necessary to administer saline solutions to restore the water-salt balance, which is disturbed due to intoxication and vomiting;
  • For severe pain, painkillers will be required.

In some cases, surgery is required for diagnosis. An operation is performed to determine the cause of the blockage, the severity of intestinal damage, and possible complications in the form of ruptures.

Simultaneously with the diagnosis, the cause of the obstruction is eliminated. In case of severe tissue damage and death, part of the intestine is removed.

Regenerative therapy

If the cause of obstruction was eliminated without surgical intervention, then restorative therapy includes:

  • diet;
  • peace at first;
  • as prescribed by the doctor - special physical exercises and therapeutic abdominal massage.

The food should consist of liquid food, it needs to be warmed up a little. The frequency of feedings is at least 5 times a day, the portions are small. The daily portion is increased gradually.

If the treatment was performed surgically, the recovery will be long. At first, the dog should be under the supervision of a doctor, anti-inflammatory and antibacterial drugs are prescribed. The animal is not fed for several days; the body is supported with saline solutions.

Prevention

There are several ways to prevent intestinal obstruction, which occurs due to the dog swallowing foreign objects:

  • strict training, during which the pet must clearly understand and remember that picking up objects is prohibited;
  • All small objects that the dog can play with during the owner’s absence must be removed from the dog’s access area;
  • if the dog is wayward, capricious, or not trained, then you should only walk it on a leash and control its actions;
  • Boiled and tubular bones are contraindicated;
  • toys should be purchased only in specialized stores.

If you suspect an intestinal blockage, you should contact the veterinary clinic immediately.

Foreign bodies in tissues and organs of a dog

Causes of the disease
Usually this is the ingestion of inedible objects during feeding, games, walks, etc. Most often these are nails, pins, needles, hooks, bones, wire, polyethylene, corks, rubber and other things that a stupid dog puts in its mouth. It happens that the owners are to blame. Sometimes
even sharp objects come out naturally on their own. Doctors have to work more often.
Symptoms
They depend on the “parking” of the foreign body in the dog’s body:
oral cavity - difficulty swallowing, drooling, vomiting, refusal to eat, restlessness, the dog rubs its cheek with its paw or on the grass;
larynx - refusal to eat, soreness, fever, swelling, difficulty breathing, suffocation, bleeding from wounds;
esophagus - complete and partial blockage, then inflammation and necrosis of the esophagus; if injured, rupture of the esophagus is possible; the dog stretches its neck, while eating - vomiting, possible lack of swallowing;
stomach and intestines - the dog’s condition worsens sharply, there is no appetite, thirst, vomiting, peristalsis weakens, there is no bowel movement. There is usually no bloating (if there is no damage to the walls).
L treatment
Sometimes it is possible to remove the object with a forceps (if it is visible in the throat, then irrigate the throat with an antiseptic and fast for a day on water). Using emetics and laxatives, you can remove a smooth object. Such procedures require skill and courage; the doctor will help in these and more severe cases. An extreme case is abdominal surgery.
Prevention
Treat your dog with care, like a small child, do not leave dangerous objects in an accessible place. Remove threads and needles.

Foreign bodies enter the body of dogs during games, walks over rough terrain, during hunting and service. These items most often include various needles, nails, screws, pins, hooks, metal and rubber balls, pieces of wood, chips, cartilage, bones, polyethylene, corks, rags, rubber, bullets, shot and other things that often get into fabrics and organs of dogs. There were cases when even when sharp objects (needles, nails) were swallowed, they were removed from the body without outside help.

Foreign bodies in the larynx. Foreign bodies in the larynx cause injury to surrounding tissues and get stuck in them. An inflammatory process develops, usually phlegmonous. Pain and developing tissue swelling make it difficult to take food and water.
The main signs are refusal to feed, pain, increased temperature, due to tissue swelling and closing of the lumen of the larynx, breathing becomes difficult, asphyxia develops, which is accompanied by a painful cough and foamy discharge from the nose, and suffocation occurs. When tissue is injured, bleeding may occur. The foreign body is removed from the larynx under general anesthesia and the bleeding is stopped. If a phlegmonous process is observed in the surrounding tissues, a longitudinal incision is made.
After the operation they follow a diet. The dog is not given anything for the first 2 days. From days 3 to 7, the diet includes milk and meat broth, then small pieces of meat, bread in milk, and liquid porridge. Regular feeding begins after the 10th day. Antibiotic therapy is prescribed in the first 5-6 days. The wound is treated with a solution of brilliant green. The sutures are removed on the 12-14th day.

Foreign bodies in the stomach and intestines. Objects that are not eliminated from the body, entering the stomach and intestines, often injure the mucous membrane, even to the point of perforation of the walls. As a result, obstruction of the gastrointestinal tract occurs and, as a consequence, necrosis of some of its areas.
The general condition of the animal deteriorates sharply, appetite disappears, thirst and vomiting are observed, defecation stops, intestinal motility weakens. From the 2nd to 3rd day of illness, signs of general anxiety appear, followed by periods of severe depression. Abdominal bloating, as a rule, is absent.
During treatment, it is first recommended to administer subcutaneous emetics (papaverine - 0.1 g, etc.), but only when smooth foreign bodies are detected. If an object with sharp edges is identified on the x-ray, then surgery to remove it from the stomach or intestines is indicated.

Foreign bodies in the esophagus. Various objects that the dog swallows, stuck in the lumen of the esophagus, cause sudden blockage. If the esophagus is completely blocked, the dog becomes anxious, stretches its neck, drools, frequent swallowing movements and the urge to vomit. On palpation in the neck area, limited painful swelling is noted. In case of incomplete blockage, the animal's appetite may be preserved, but the dog may vomit while eating. There are cases when an acute foreign body ruptures the esophagus and an abscess or phlegmon develops in the tissues.
Before starting treatment, the nature of the foreign body should be determined. If smooth foreign bodies get stuck, the dog is given emetics (subcutaneous apomorphine - 0.01 g, papaverine - 0.1 g, etc.). You can carefully remove the foreign body using an esophagoscope or try to push it into the stomach with a probe, first add 2-3 teaspoons of Vaseline oil per dose. However, this method is used with caution, since the walls of the esophagus can be torn (which often happens). If these methods do not help, then surgery is performed.

Foreign bodies in the oral cavity. The disease occurs unexpectedly and is accompanied by excessive salivation, difficulty swallowing, the urge to vomit, the dog is worried, and due to the pain, it can rub its cheek on the grass and on its cheek with its paw. The animal refuses food or is reluctant to take it. If such signs are present, rabies should first be ruled out.
When providing assistance, bandage loops are placed on the upper and lower jaws and the mouth is opened. Insert an oral retainer and carefully examine the oral cavity, moving the tongue in different directions.
If a foreign body is detected in the oral cavity, remove it using a forceps, a hemostatic clamp, or by hand, while observing safety precautions. After removing the foreign body, the oral cavity is irrigated from a syringe with a solution of potassium permanganate 1:1000. For prophylactic purposes, antibiotics are administered intramuscularly after surgery. On the first day, they only give you something to drink.

Diseases of the esophagus in dogs are usually clinically manifested by regurgitation (regurgitation). Regurgitation is the passive retrograde release of esophageal contents into the oral cavity. Regurgitation is often mistaken for vomiting, but it can be differentiated from vomiting because it is not accompanied by retching. To differentiate regurgitation from vomiting or nausea, a very careful history must be taken. In some situations, these three phenomena cannot be distinguished by history or during examination of the animal. If esophageal disease is suspected, it is necessary to conduct a diagnostic examination, including using specific diagnostic methods, imaging methods and endoscopy.

Diagnostic examination
Radiography plays an important role in examining the esophagus. A standard x-ray can reveal abnormalities in the structure of the esophagus and foreign bodies. The presence of air in the esophagus, although not considered pathological, may be a clue to the diagnosis of esophageal disease. The area of ​​the radiograph must also include the cervical esophagus. In most cases, diagnosis is made using contrast studies with barium in the form of liquid, paste or mixed with food, and dynamic fluoroscopy is usually required to detect esophageal motility disorders. Barium contrast allows easy identification of obstructive lesions and most peristalsis disorders. Endoscopy is required to evaluate and biopsy mucosal lesions, areas of obstruction, and to remove foreign bodies. To identify primary megaesophagus in a dog, endoscopy is not very informative, but it can detect esophagitis or primary obstructive disease of the esophagus. In some cases, a mucosal biopsy is performed.

Megaesophagus
This descriptive term refers to dilatation of the esophagus caused by impaired peristalsis. In most cases, the prognosis of megaesophagus is unfavorable. It can be caused by a number of diseases in dogs; It is very rare in cats.

Congenital megaesophagus occurs in young dogs and is usually hereditary or due to abnormal development of the esophageal nerves. It is inherited in wire-haired terriers and schnauzers, and is found with high frequency in Irish setters, German shepherds, golden retrievers, Shar-Peis, Great Danes, Rhodesian Ridgebacks, and Labradors. Clinical signs in litters are often variable and the prognosis for spontaneous improvement is poor. Idiopathic megaesophagus in adult animals develops spontaneously in dogs aged 7 to 15 years, without a specific gender or breed predisposition, although it is more common in large breed dogs. Its etiology is associated with afferent disorders of the vagus nerve, and treatment is only symptomatic. There is no specific treatment.

Feeding is used in a standing position, aspiration pneumonia is treated, and feeding is performed through a tube. In an observation of 49 idiopathic cases of the disease, 73% of animals died or were euthanized several months after diagnosis. In a very small population of dogs, megaesophagus has been described to be tolerated with minimal complications.

Secondary megaesophagus
Other conditions also directly affect the function of the neuromuscular junction; the most common of them are myasthenia gravis (MG), adrenal insufficiency, systemic lupus erythematosus (SLE), poliomyelitis, hypothyroidism, autonomic dystonia, immune-mediated polyneuritis. Focal myasthenia gravis affects only the esophagus. This variant of myasthenia gravis is the most common of the secondary forms of the disease and is detected in approximately a quarter of cases of megaesophagus. The disease affects both young and older dogs; It is most often detected in German Shepherds and Golden Retrievers. The diagnosis of MG is confirmed by a positive anti-acetylcholine (ACh) receptor antibody test. In approximately half of the cases, the course of focal myasthenia in dogs is accompanied by an improvement in the condition or leads to remission of clinical manifestations. Therapy with the anticholinesterase drug pyridostigmine bromide (Mestinon, 0.5–1.0 mg/kg three or two times a day) is indicated. In some patients, steroids or immunosuppressive therapy must also be used, but in such cases treatment should be similar to that for generalized MG.

Reversible megaesophagus in dogs may be caused by hypoadrenocorticism. The disease can manifest itself with typical symptoms of Addison's disease or atypically, only megaesophagus. The diagnosis is confirmed by measuring cortisol levels before and after ACTH stimulation. At resting cortisol levels greater than 2.0 mcg/dL, the diagnosis of hypoadrenocorticism is unlikely. Adequate replacement therapy with glucocorticoids and/or mineralocorticoids leads to rapid resolution of megaesophagus. Myositis is rare but is sometimes accompanied by esophageal dysfunction, and clues to the diagnosis include signs of systemic involvement and elevated creatine kinase (CK) levels, as well as improvement with steroid therapy.

Autonomic dystonia is caused by degenerative changes with damage to neurons of the autonomic nervous system. The disease is manifested by dysfunction of the autonomic nervous system. In addition to megaesophagus and regurgitation, dilated pupils, dry eyes, prolapse of the lacrimal gland of the third eyelid, dilatation of the anal sphincter, distension of the bladder, fecal and urinary incontinence, and delayed gastric emptying develop. The prognosis for these cases is very cautious.

Esophagitis
Esophagitis is an inflammation of the wall of the esophagus, ranging from mild inflammatory changes to severe ulceration and transmural damage to the mucous membrane. The causes of primary esophagitis are most often associated with direct contact with an ingested irritating or damaging substance or with gastric reflux. The incidence of esophagitis is unknown, but the most common form of esophagitis, gastroesophageal reflux disease (GERD), may occur more frequently than previously thought. Clinically, it can manifest as anorexia, dysphagia, odynophagia, increased salivation, and regurgitation. In this case, a thick layer of viscous saliva is regurgitated, which may be bloody or, as a result of secondary hypokinesia of the esophagus, contain food. If the inflammatory process in the esophagus is accompanied by pharyngitis and laryngitis, complications may develop, such as aspiration pneumonia. Deep ulceration of the esophagus can lead to stenosis.

Gastroesophageal reflux
Many factors can lead to the development of GERD. The leading role of acidic gastric juice in damage to the mucous membrane has long been known. Although the acid itself already has a damaging effect, it becomes especially pronounced when combined with pepsin. Currently, pepsin is considered the main factor causing the initial disruption of the barrier function of the esophageal mucosa and the reverse diffusion of hydrogen ions, which then damage the mucosa itself. Also, inflammatory changes in the wall of the esophagus, similar to those due to acid reflux, cause alkaline gastroesophageal reflux. Alkaline pH alone does not cause damage, but in the presence of the pancreatic enzyme trypsin it has been shown to cause very serious damage. The optimal pH range for the proteolytic activity of trypsin is from 5 to 8. It has also been shown that in an alkaline environment the action of trypsin can be potentiated by bile salts. After damage to the wall of the esophagus, the function of the lower esophageal sphincter (LES) is impaired, which starts a “vicious circle”.

The most common causes associated with reflux esophagitis in small animals are factors that change pressure in the LES, general anesthesia, clinical manifestations of a hiatal hernia, and persistent vomiting. Gastric motility disorders and increased intra-abdominal pressure are also associated with GERD. Gastroesophageal reflux and hiatal hernia may result from upper airway obstruction secondary to increased negative intrathoracic pressure. Reflux esophagitis is quite common in brachycephalic breeds, presumably due to their frequent respiratory problems. Also, obesity or any other condition that causes increased intra-abdominal pressure, such as ascites, can predispose to reflux esophagitis.

Clinically, GERD in dogs appears similar to esophagitis. Contrast fluoroscopy is usually required to detect gastroesophageal reflux. If GERD is suspected and cannot be confirmed by static or dynamic X-ray contrast studies, after filling the stomach with contrast, apply pressure to the stomach area to try to induce reflux. To confirm changes in the mucosa corresponding to reflux esophagitis, the best clinical method is endoscopy. In most, but not all dogs and cats, the LES should be normally closed, and the endoscopic appearance of a large gaping LES coupled with red, hyperemic mucosa in the distal esophagus is consistent with the diagnosis of GERD. This disease can also be suspected when loose and bleeding mucosa is detected or fluid from the stomach refluxes into the lumen of the esophagus. Inflammation of the mucous membrane is confirmed by a biopsy of the esophagus performed during endoscopy.

The rational choice of therapy for GERD depends on the treatment goals. Drug therapy may be given to relieve symptoms or to treat the primary underlying condition. For example, reflux can be controlled by weight loss in obese patients, correction of upper airway obstruction, management of gastric emptying disorders, or surgical correction of a hiatal hernia or LES disorder. Drug therapy is carried out to reduce the severity of esophagitis, increase pressure in the LES, and protect the mucous membrane from damage by reflux masses.

Therapy should begin with dietary advice, including frequent feeding of small, high-protein, low-fat foods to maximize LES pressure and minimize gastric volume. The presence of fat in the diet will reduce pressure in the lower esophagus and slow gastric emptying, while a diet rich in protein will increase pressure in the LES. The application of ligatures with sucralfate promotes the healing of esophagitis and protects the mucous membrane from damage by masses entering the esophagus from the stomach. In experiments in cats, sucralfate has been shown to prevent acid-induced reflux esophagitis. Reflux esophagitis is also treated by reducing acid reflux with proton pump blockers such as omeprazole (0.7 mg/kg daily). Since H2 blockers do not completely block acid secretion, I do not recommend their use. Drugs that suppress gastric motility, such as metoclopramide (Reglan, 0.2–0.4 mg/kg three to four times daily), cisapride (0.1 mg/kg two to three times daily), or erythromycin ( 0.5-1.0 mg/kg two to three times a day), increase pressure in the LES and, due to increased contraction of the stomach, stimulate its more active emptying. The prognosis for drug therapy for reflux esophagitis in most animals is favorable. In animals with severe reflux or hiatal hernia that does not respond well to drug therapy, surgical correction of the disorder is indicated to increase the tone of the caudal esophageal sphincter.

Esophageal strictures
Esophageal strictures form after fibrosis of deep submucosal ulcers. In a review of 23 case reports, anesthesia-related gastric reflux occurred in 65% of cases, 9% of cases were associated with foreign bodies, and the rest with other causes, such as pills, trauma, or insertion of a tube into the esophagus. The association of anesthesia with gastroesophageal reflux occurs in approximately 10–15% of dogs undergoing anesthesia. If a stricture forms, it occurs approximately 1–2 weeks after the anesthesia. Animals regurgitate solid food but are able to retain liquid, with regurgitation usually occurring immediately after eating. We have described a number of cases of cats developing esophageal stricture while taking doxycycline tablets. In humans, of all the drugs, doxycycline and nonsteroidal anti-inflammatory drugs (NSAIDs) lead to the formation of strictures most often. Recently, our laboratory conducted studies showing that giving cats tablets without liquid led to a delay in their passage through the esophagus, but if the tablet was given with 3-6 ml of water, it passed into the stomach. Pill-associated strictures develop in the cervical esophagus. Treatment for esophageal strictures involves either liquid feeding or balloon dilatation therapy. Several balloons of increasing size are placed sequentially in the area of ​​the stricture, mechanically expanding the lumen of the esophagus. Reflux esophagitis is then treated and steroids are prescribed to reduce stricture re-formation. A review of 23 clinical cases found a favorable outcome in 84% of cases, on average, after three separate balloon dilatation procedures performed one week apart. We currently perform endoscopy and inject triamcinolone around the stricture area before dilatation. In severe cases, we place a gastric feeding tube and treat all cases of stricture in a similar manner to GERD.

Hiatal hernia
A hiatal hernia is defined as an abnormal protrusion into the chest cavity through the hiatus of the diaphragm of a portion of the esophagus from the abdominal cavity, the gastroesophageal junction (GEJ), and/or part of the stomach. Typically, a hiatal hernia is clinically manifested as reflux esophagitis. Normally in animals, part of the distal esophagus and the gastroesophageal junction are located in the abdominal cavity. The esophageal ligament is fixed by the diaphragmatic-esophageal ligament and the esophageal hiatus of the diaphragm. For the phrenoesophageal ligament to move through the diaphragm into the caudal mediastinum, the phrenoesophageal ligament must be stretched, and the esophageal hiatus of the diaphragm must have a diameter large enough to allow such displacement in the cranial direction.

A predisposition to this disease has been identified in some dog breeds, such as the Chinese Shar-Pei, as well as in some brachycephalic breeds, such as the Boston Terrier and Shar-Pei. We have also seen hiatal hernia in cats. Gastroesophageal reflux is usually accompanied by reflux esophagitis and associated symptoms (belching, anorexia, drooling, vomiting).

A hiatal hernia is usually diagnosed by radiological methods. A plain radiograph may reveal dilatation of the esophagus and increased density in the distal esophagus due to displacement of the gastrointestinal tract and stomach into the caudal part of the esophagus. To diagnose a sliding hiatal hernia, barium contrast studies are usually required. Because hiatal hernia is often not permanent, repeat fluoroscopy may be required to confirm the diagnosis. A non-permanent hiatal hernia is more likely to be detected by applying direct pressure to the abdominal wall or squeezing the upper airway with your hand.

Endoscopy provides additional evidence to support the diagnosis of a sliding hiatal hernia and may be the best method to confirm its presence. Reflux esophagitis also confirms the diagnosis. The endoscope must be passed into the stomach and directed in the opposite direction to examine the LES from the stomach. With a weakened or enlarged esophageal opening of the diaphragm, the stomach inflated with air during endoscopy can displace the lower esophageal sphincter and the cardiac region of the stomach cranially. In the cardiac part of the stomach, you can see impressions formed by the tissue along the edges of the dilated esophageal opening of the diaphragm. Endoscopic data on the cranial displacement of the LES and the large size of the hiatal hiatus, along with the corresponding clinical data, require the exclusion of a sliding hiatal hernia.

If clinical signs have developed, then in the treatment of gastroesophageal reflux, drug therapy for reflux esophagitis should first be carried out. The underlying condition causing the hiatal hernia, such as pre-existing upper airway obstruction, obesity, and other causes of increased intra-abdominal pressure, should always be treated. In brachycephalic dogs, clinical manifestations of the disease often resolve after correction of upper airway obstruction. In severe cases or when drug treatment is ineffective, surgery is indicated.

Many acquired sliding hiatal hernias are treated with medication, while congenital forms often require surgical correction. The most effective surgical methods for treating hiatal hernia have not been fully established. In their treatment, with good results, various combinations of apposition of the diaphragmatic legs, fixation of the esophagus to the diaphragmatic leg (esophagopexy) and left-sided gastropexy with a probe in the fundus of the stomach are used. Fundoplication is usually not required, but has previously been recommended. The outcome of surgical treatment of hiatal hernias in dogs and cats is generally favorable, with resolution of clinical signs.

Foreign body of the esophagus
The most common foreign bodies that enter the esophagus are bones. This is most often seen in terriers because the area at the level of the distal esophagus, base of the heart, and thoracic outlet is narrowest.

After diagnosis, surgical removal of the foreign body is recommended. The longer a foreign body remains in the esophagus, the more the mucosa is damaged and the more likely secondary complications such as stricture or perforation develop.

The first attempt should be to conservatively remove the foreign body either by pushing it with a gastric tube, removing it using a Foley catheter or by esophagoscopy. Current recommendations suggest using a rigid or fiber-optic endoscope. A disadvantage of endoscopic removal with a fiber endoscope is the small size of the foreign body grasping instruments that can be used. Removal of large foreign bodies such as bone often requires the use of stiffer, curved forceps. They can be carried out either by attaching them to a fiber endoscope or through the channel of a rigid endoscope. The advantage of a rigid endoscope is that it mechanically expands the esophagus and allows large forceps to be passed through the central channel of the endoscope to remove a foreign body. Often, a foreign body can be pulled into the endoscope channel, after which it can be easily removed.

There are inexpensive rigid esophagoscopes or rigid proctoscopes on the market. You can also make your own esophagoscope from plastic (PVC) tubes of various sizes. The esophagus should then be examined through a tube under bright light. Grasping tongs can also be purchased at most hardware or automotive stores. They are used to grab dropped nuts and bolts from hard to reach areas and are useful for grabbing bones and other foreign bodies. If large bones from the distal esophagus cannot be removed through the mouth, an attempt should be made to push them into the stomach. The bones that enter the stomach are gradually digested.

Single barbed fish hooks attached to fishing line are easily removed if the line can be pulled out with a rigid esophagoscope. Then the endoscope is passed to the area of ​​the hook, the hook is removed from the wall of the esophagus, and then pulled into the endoscope and removed along with the fishing line.

David C. Twedt, DVM, DACVIM,
College of Veterinary Medicine and Biomedical Sciences
Colorado State University, Fort Collins, Colorado, USA