Regurgitating water

Re: Regurgitating water

CatherineThomas — Fri, 18 May 2012 17:53:03 GMT

I did also give him some antepsin although he didn't start that until Wednesday and the owner says he was cured by the time he went home on Tuesday. So the antepsin could have something to do with it.

Re: Regurgitating water

Julian Earl — Fri, 18 May 2012 17:07:25 GMT

[quote user="Martin Atkinson"]

... but don't under-estimate the power of placebo or my previous post on this subject.

[/quote]

Blimey Martin, will you post something every time we each have a difficult case? That's a miracle cure if ever I heard one!

Re: Regurgitating water

Martin Atkinson — Fri, 18 May 2012 16:53:18 GMT

Its amazing how often barium cures vomiting dogs, a bit like an ex lap to let out the evil spiritsbut less invasive! I sometimes wonder if we should put it in bottles and sell it as an anti-vomiting cure. Seriously though I wonder how often there is some sort of gastritis and and antacid soothing medicine helps, might be worth trying sucralphate if it recurs but don't under-estimate the power of placebo or my previous post on this subject.

Re: Regurgitating water

CatherineThomas — Fri, 18 May 2012 16:09:53 GMT

Well apparently we have cured the dog. Since he came in for the barium study on Tuesday he hasn't regurgitated anything. Apparently he passed faeces containing a large mass of hair and barium when they got him home and the owner thinks this has sorted him. It all seems very strange as she insists he was doing it several times a day for 6 months or more. I've asked her to call me in a week to let me know how he is and if there have been any more problems.

Re: Regurgitating water

Martin Atkinson — Wed, 16 May 2012 14:46:47 GMT

[quote user="CatherineBoden"]The owner does not seem to be the kind who exagerates things[/quote] mmm...me thinks. Notwithstanding all the possible explanations for this potential problem the one thing that stands out from the OP is that although this dog, according to the owner, supposedly regurgitates water within 2-3 minutes of even a small drink, on the occasion it was observed in the surgery it didn't do anything after drinking a whole bowl.

Re: Regurgitating water

james herriot lied — Wed, 16 May 2012 13:37:31 GMT

[quote user="CatherineBoden"]

No, there was nothing in the oesophagus to show that it is or isn't a megaoesophagus.

If it is megaoesophagus why is it that only water is a problem and not food?

[/quote]

The dynamics of deglutition / regurgitation are pretty complex, and it's not always that simple to second-guess some of these disorders. I'd agree with Nicola and Julian that the cardiac sphincter, or whatever we're calling it these days, is great at distinguishing between gas/liquid/solid fractions and dysfunction here could easily explain the difference in retention between solids and liquids. But megaoesophagus has to be one of the primary differentials in any regurgitation syndromes, and unless you're able to entirely disprove it, you can't rule it out. I quite like iodine-contrast for these, as aspiration is much less of a problem than for barium. You can literally squirt it in and press the button (adhering, of course to all ionising radiation regs on the way out). Detail can be lacking, but it pools well and gives good outlines.

Also, I know that the two most common answers to any clinical questions hereabouts are pain relief and thyroid, but have you looked at thyroid dysfunction? Relatively cheap, and often underlying a number of focal and vague neuro dysfunctions. Can the dog bark?

Re: Regurgitating water

Julian Earl — Wed, 16 May 2012 12:15:09 GMT

[quote user="CatherineBoden"]

No, there was nothing in the oesophagus to show that it is or isn't a megaoesophagus.

If it is megaoesophagus why is it that only water is a problem and not food?

[/quote]

The obvious difference has to be the liquid/solid aspect so if it is a problem with the cardiac opening of the stomach then both may reach the stomach but water, being runny, will flow back a lot more easily than food, e.g. if the cardiac opening is merely slightly enlarged compared to normal.

Re: Regurgitating water

CatherineThomas — Wed, 16 May 2012 11:58:25 GMT

No, we don't have an endoscope. We've asked for one but I don't think we'll get it in the immediate future.

Re: Regurgitating water

Hannah Wynne Richards — Wed, 16 May 2012 11:39:28 GMT

Do you have an endoscope?

Wynne

Re: Regurgitating water

CatherineThomas — Wed, 16 May 2012 11:29:34 GMT

No, there was nothing in the oesophagus to show that it is or isn't a megaoesophagus.

If it is megaoesophagus why is it that only water is a problem and not food?

Re: Regurgitating water

james herriot lied — Wed, 16 May 2012 11:20:31 GMT

Catherine

When you say that the food was already in the stomach, did you have any residual contrast in the oesophagus - i.e., could you definitively trace the outline of the gullet and demonstrate that there WASN'T a megaoesophagus (which can sometimes be a very different thing to demonstrating that there IS)?

Re: Regurgitating water

Nicola Lawlor — Wed, 16 May 2012 11:18:53 GMT

Could be a hiatal hernia - not easy to rule out diagnostically and maybe only a definative answer either way at surgery? Can she work to gradually raising the height of the water bowl so the dog hardly notices the difference in height happening over a period and see how this goes?