Monday, April 28, 2014

Megaesophagus

So megaesophagus is the condition Gigi has (see my post from yesterday).  I have decided to do a little more digging into it.



First off, I wonder if it happens just like that or is that develop over time?

Gigi was really skinny and was chronic vomiting a few years back, but since she is on Honest Kitchen, she is totally well.  So if ME was already a condition, then she was not affected by it.  And when she was puking, there was retching involved.

Do you know that human can also has it?



What Is Canine Megaesophagus?
  • Megaesophagus is difficult to detect and diagnose, and the medical options are few. But, many of these pets can be managed and lead relatively normal lives. The condition is reported in humans, dogs, cats, ferrets and other animals. (For simplicity sake we will use the dog as the typical patient in discussions on this site.)
  • The muscles of the esophagus fail and it cannot propel food or water into the stomach. (Its like a balloon that has been inflated several times and then hangs limp.)
  • The result is that ingested food sits in the esophagus within the chest cavity and never makes it to the stomach.
  • The most serious complication is that digestive fluid/food will at some point pool in the esophagus which generally results in aspiration of digestive fluid/food, leading to pneumonia. (Aspiration Pneumonia)
  • Megaesophagus can occur at any age as a puppy, or as an older dog. If it afflicts a puppy, the cause is usually genetic, or can be due to a surgically repairable condition called PRAA (Persistant Right Aortic Arch). If not secondary to another disorder in adult animals, it is called "idiopathic" (cause unknown).
  • Megaesophagus can be secondary to other diseases such as Myasthenia Gravis, Thyroid, Addisons and other Neurological disorders.
Symptoms:
  • Regurgitation of water, mucous or food. (Regurgitation is throwing up without any warning; "vomiting" is associated with retching.)
  • Loss of appetite or refusal to eat.
  • Sudden weight loss.
  • Swallowing difficulty, exaggerated and/or frequent swallowing.
  • They will also try to clear their throat frequently with a "hacking" sound.
  • Sour and/or foul smelling breath.
  • Many canines may be mis-diagnosed with a gastro-intestinal problem.
  • Aspiration pneumonia is a frequent complication.
Management:
  • Your canine needs to be placed in a vertical feeding position immediately to avoid starvation and/or aspiration pneumonia. (Note: Not an "elevated bowl." Elevating the bowl does not place the esophagus in the proper orientation so that gravity will work.)
  • Vertical feeding can be accomplished with the Bailey Chair. The canine must remain in the chair for 20-30 minutes post feeding to allow gravity to work.
  • A low-fat or low residue canned food fed either in a milkshake consistency or in "meatballs" works best. (If using the meatball method, they must be swallowed whole.) Each dog is different and experimentation with food consistency is required.
  • Multiple feedings, 3-4 meals per day, is also suggested.
  • Fluids must be consumed in the vertical position as well.
  • Medications may include an acid reducer (like Pepcid-AD or Prilosec) 1 or 2 times per day; motility drugs (metoclopromide/reglan, cisapride/propulsid/, low dose erythromycin) to help empty the stomach to minimize reflux from the stomach into the esophagus; and/or an esophageal "bandage" for esophagitis, (carafate/sucralfate). Antibiotics for aspiration pneumonia, or for antibiotic responsive gastroenteritis may also be required
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Megaesophagus (also known as ME) is a condition in humans, cats and dogs where peristalsis fails to occur properly and the esophagus is enlarged. Normally, when the animal's esophagus is functioning properly, it acts as a muscle and pushes the food down the esophagus into the stomach. However, when an animal has megaesophagus, the esophagus stays enlarged and does not push the food down to the stomach. Therefore, the food fails to enter the stomach and often stays in the esophagus, and is eventually regurgitated, or enters the lungs through breathing, or decays in the esophagus.
In human pathology a condition known as achalasia may predispose a person to slowly develop megaesophagus. Achalasia is due to the loss of ganglion cells of the myenteric plexus. It occurs mostly in middle aged adults. There is a marked lack of contraction within the muscles involved in peristalsis with a constant contraction of the lower esophageal sphincter. Dilation of the esophagus results in difficulty swallowing. Retention of food bolusis also noted. Chagas disease is one cause of megaesophagus in humans. Achalasia also predisposes to esophageal carcinoma.
Megaesophagus can also be a symptom of another disease in dogs called myasthenia gravis. Myasthenia gravis is a neuromuscular disease where the primary symptom is weakness in various body parts of the dog. However, when myasthenia gravis occurs in older dogs it is thought of as an immune-mediated disease. Often when myasthenia gravis is diagnosed in older dogs the first symptom the dog may manifest is megaesophagus.
Myasthenia gravis occurs when acetylcholine receptors (nicotinic acetylcholine receptors or AChRs) fail to function properly. Due to the inability of the nerve receptors to function appropriately, the muscles fail to have a stimulus that causes them to contract.
An important distinction in recognizing megaesophagus is the difference between when a dog regurgitates or vomits. Regurgitating is a common symptom of megaesophagus while vomiting is not necessarily associated with megaesophagus. When a dog regurgitates there is usually not as much effort involved as when a dog vomits. Often when regurgitating, the dog will tip its head down and the liquid and/or food will almost appear to "spill out" of its throat. Also another side when the dog regurgitates, the food is tube shape.
One of the primary dangers to a dog with megaesophagus is aspiration pneumonia. Because the food stays lodged in the throat, it can often be inhaled into the lungs causing aspiration pneumonia. One way to avoid this is to make sure that every time the dog eats or drinks anything, that the dog sits for at least 10 minutes afterwards or is held in a sitting up or begging position. This requires that all food and liquid intake be closely monitored and specifically administered to the dog in regular intervals (sometimes as often as 2–3 hours) in smaller quantities. Obviously, if smaller quantities of food and water are administered, one needs to take the necessary precaution to ensure the dog has a sufficient caloric and water intake. According to many specialists, this disorder has a guarded prognosis, however, since 2004 many owners have found a number of successful management techniques, one of which is vertical feeding (see "Bailey Chair megaesophagus").

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{Will update this more as I gathered more info}