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Oesophagus

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Abstract

The majority of oesophageal disorders result in variable degrees of neuromuscular dysfunction and can be grouped into degenerative/idiopathic, inflammatory and immune-mediated diseases. The second group of oesophageal disorders comprises structural disorders causing obstruction. This chapter covers the aetiology, diagnosis, treatment and prognosis of a range of disorders affecting the oesophagus.

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Figures

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32.1 (a) Normal oesophagus of a healthy dog showing the typical longitudinal folds. (b) Normal oesophagus of a healthy cat. There are longitudinal and transverse folds from the level of the heart base distally. This combination of folds gives the characteristic herringbone pattern as seen on a barium swallow study.
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32.2 Distal oesophagitis in a 9-year-old Bernese Mountain Dog presented for a decreased appetite and lip-smacking. The gastro-oesophageal junction (Z-line), which marks the border between the oesophagus and the stomach, is denoted by the arrows.
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32.3 (a) Distal oesophagitis in a 12-year-old Labrador Retriever presented for halitosis and lip-smacking. (b) Gastric body and antrum with irregularly puckered and reddened mucosa. Histopathology of gastric biopsy samples revealed severe lymphocytic gastritis, but the diagnosis was ultimately confirmed as lymphoma.
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32.4 (a) Severe oesophagitis in a 7-year-old Husky. No cause was identified but there was suspicion of reflux oesophagitis. (b) The same case following treatment for 5 weeks with omeprazole at a dose of 1 mg/kg orally q12h. (Courtesy of M. Münster)
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32.5 Sharp demarcation line (Z-line) between the oesophageal and reddened gastric mucosa in a dog.
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32.6 Capsule in the distal oesophagus for continuous recording of oesophageal pH in a dog with suspicion of reflux disease.
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32.7 (a) A 3-month-old Husky/Berger Blanc Suisse crossbreed dog, presented with regurgitation and failure to thrive, in a Bailey chair. (b) Radiography revealed generalized megaoesophagus. Gradual normalization of bolus transport and oesophageal function was noted over time on high-resolution manometry, and the dog stopped regurgitating, but the oesophagus continued to appear dilated on radiography. At 17 months, the dog could be fed normally, manometric evaluation was near normal, however on radiographs the oesophagus was still dilated.
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32.8 Lateral radiograph of a 12-year-old female neutered Boxer presented with regurgitation. Extensive investigation revealed a degenerative (demyelinating) neuropathy.
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32.9 A 12-year-old male neutered Labrador Retriever was presented with acute vomiting and retching. (a) A lateral radiograph revealed an ill-defined soft tissue space-occupying lesion in the cranial mediastinum dorsal to the trachea. Note the displacement of the trachea ventrally and the accumulation of gas cranial to the lesion. There is mild narrowing of the intrathoracic trachea. The cardiac silhouette is of normal size and the pulmonary vessels are at the lower limit of normal size. (b) Endoscopic view of the mass. Histopathology confirmed a leiomyoma.
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32.10 Lateral thoracic radiograph of a dog showing moderate megaoesophagus and aerophagia and an associated severe interstitial pattern in the right middle lung lobe and a mild interstitial pattern in the right cranial lung lobe. A large intracranial extra-axial space-occupying lesion was identified in the pons and myelencephalon on magnetic resonance imaging. The diagnosis of meningothelial meningioma and multifocal to diffuse non-purulent meningitis was confirmed at post-mortem examination.
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32.11 Low-profile gastrostomy tube. (a) A normal percutaneous endoscopic gastrostomy (PEG) tube is in place initially and has created a stoma. (b) The PEG tube has been removed and is being replaced by a low-profile gastrostomy tube inserted through the stoma. (c) A low-profile gastrostomy tube is in place for long-term feeding in a Golden Retriever with idiopathic megaoesophagus which could not be managed otherwise. The patient lived for 3.5 years with no incidents of aspiration pneumonia. The tube had to be replaced approximately every 9 months due to valve leakage.
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32.12 A food-filled diverticulum could be palpated on extension of the neck in a 6-month-old Maine Coon kitten. (a) A lateral thoracic radiograph reveals focal oesophageal dilatation with accumulation of contrast material in the area of the thoracic inlet. (b) Endoscopic view of the diverticulum (top right) and normal oesophagus (lower left).
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32.13 A 2.5-month-old male Labrador Retriever was presented with regurgitation. Fluoroscopy revealed precardial formation of oesophageal diverticula and raised suspicion of a persistent right aortic arch (which was confirmed at surgery). The patient did well following surgery.
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32.14 (a) A 12-year-old Chihuahua presented with regurgitation due to the presence of a bony foreign body. (b) Lateral radiograph showing the foreign body at the level of the second intercostal space. Following surgery, a percutaneous endoscopic gastrostomy tube was placed in the hope that the oesophagus would heal without stricture formation. (c) The dog, presented 2 weeks later with recurring regurgitation and a stricture over the heart base was diagnosed on endoscopy. Note the presence of inflamed oesophageal mucosa proximal to the stricture. (d) A balloon dilation procedure was performed using a 15 mm diameter balloon. A second ballooning procedure was performed 2 weeks later and the outcome for the patient was good.
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32.15 A 10-year-old female neutered Cavalier King Charles Spaniel presented with a partial stricture in the mid-thoracic oesophagus following removal of a foreign body. Food collected proximal to the partial stricture and ultimately caused regurgitation. The dog improved after two balloon dilation procedures.
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32.16 A 10-year-old male neutered Domestic Shorthaired cat presented with chronic vomiting, lethargy, hypersalivation and lip-smacking. (a) A lateral radiograph revealed a soft tissue mass in the dorsal heart base, extending cranially to the third thoracic vertebra, demarcated by oesophageal gas accumulation. Note also the mild tracheal deviation and fluid in the caudal oesophagus. (b) Endoscopic view of the mass. Squamous cell carcinoma was confirmed on histology at post-mortem examination.
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32.17 (a) Lateral and (b) ventrodorsal views of a 7-year-old West Highland White Terrier presented with acute foreign body ingestion. (c) Endoscopy revealed a boiled potato that the dog had ingested before it was mashed.

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