Here at McDowall Veterinary Practice we see all types of medical conditions which require some TLC. One of my favourite and most underrated duties as a vet nurse is taking care of the hospital patients. Yes we do more than cuddle puppies and kittens all day! Amongst other things, we are responsible for feeding, cleaning, monitoring anaesthetics and organising the day. To give you a little feel about a day in the life of a nurse I will talk you through how we dealt with one of our hospital patients recently with megaesophagus.
First things first, what is Megaesophagus? Yes, the name does sound ridiculous, but this disease needs to be taken seriously because it can be life threatening. It occurs when the tube between the mouth and stomach loses its tone and ability to contract properly, resulting in a large flaccid tube which tends to accumulate food and not push it into the stomach as it should. Have you ever heard of someone talking about their puppy constantly vomiting after food? This is often what we see occurring with this condition – tell them to come and see us ASAP!
Megaesophagus can occur for many different reasons. Animals can be born with this condition or it can occur as a result of another disease such as hypothyroidism. We normally diagnose this condition using X-rays and usually we administer barium by mouth to show up the massive distention in the oesophagus. (as can be seen below)
Unfortunately, if undiagnosed, megaesophagus can make patients very ill as they tend to inhale or aspirate food contents that back up in their throats. When we notice our patients coughing we are always on the lookout for aspiration pneumonia, due to the food material accidentally being inhaled into the lungs after being regurgitated into the throat.
On that note, most people do not realise that there is a difference between vomiting and regurgitating. Vomiting is an active process that is hard to miss! It starts with gagging and progresses to heaving as the body actively expels its stomach contents. Regurgitation, on the other hand is a passive process which can often be missed. It often occurs after eating and can be quite subtle.
Once the patient has been diagnosed with megaesophagus, a management plan must be put into place to help reduce the effects of this disease. Although the condition cannot be resolved completely, we can decrease the risk of aspiration pneumonia by using various drugs and adopting a feeding plan to help prevent the accumulation of food in the oesophagus.
One of the challenges we face with these patients, is helping them when they need anaesthesia for any reason, as they are at a greater risk of aspiration during anaesthesia. The first thing we do to help is administer anti-nausea medication upon arrival. Their sedative doses and drugs are carefully chosen to minimise nausea and once they have been sedated we closely monitor them leading up to the procedure.
Prior to induction and intubation, the nurse will ensure the patient is propped up correctly. As seen in this photo, this will be set up ready to go to make things run smoothly. We want to rapidly gain control of the airways to prevent any regurgitation, keeping the head and neck elevated during and after surgery. This can be accomplished by tilting the surgery table or by placing padding under the front half of the body. We always keep suction close by if needed, to clear the airways.
Once the vet has completed the surgery we work as a team to maintain elevation of the front end of the patient. This will allow any fluid that has accumulated in the oesophagus to drain into the stomach. Fluid build-up in the oesophagus is easily refluxed and can precipitate aspiration pneumonia. Although we want to keep the ET Tube in after the surgery until the patient is swallowing, we do not want to prompt vomiting. Once the patient has recovered from surgery and is up walking around we are able to offer them some food. As the nurse we stay with the patient from the beginning of the procedure right up until the patient is eating confidently.
With the dedication on the part of the owner and veterinarian, some of these pets can live relatively normal lives. Owners can be trained to monitor for signs of recurrent aspiration, loss of appetite, increased regurgitation, coughing or gagging. In patients with frequent recurrent aspiration pneumonia, most owners become adept at recognizing the associated signs quickly.
When feeding these patients, we can aid the function of the oesophagus by ensuring their head and neck are in an upright position during eating by raising their food bowls or using specially designed feeding stations. Most dogs adapt to this really easily and love their new routine!
As you can see, megoesophagus can be quite a challenging condition to manage in our pets, but once diagnosed, most patients do really well! It is really rewarding to watch them put on weight and thrive once their condition is well managed.
Megoesophagus is just one of the interesting conditions we get to deal with on a daily basis, helping to keep our day stimulating and varied. I hope this has helped to shed some light on one of the common causes of regurgitation. I bet you will never look at your pet’s vomit/ regurgitation in the same way again!