Can this be hiatal hernia?

RE: Can this be hiatal hernia?

Dinu Catilina — Wed, 24 Apr 2024 21:52:01 GMT

Update on this case. She had surgery 13 days ago, mattress suture on the ventral aspect of the hiatus, oesophagus pexied to diaphragm and left gastropexy. Recovered well but continued to have symptoms of esophagitis in spite of being on metoclopramide, omeprazole, sucralfate, prednisolone and methadone/paracetamol as pain relief. About 5 days after the surgery the pain was so severe that I discussed with owners euthanasia. They weren't ready so we got her on medetomidine/methadone CRI for 24 hours and the symptoms just stopped. We continued hospitalisation for another few days to be sure and then sent her home. Today she had a whole hour walk with the other dog with no symptoms which is the first time since December. I'm still worried that maybe something else is going on that we're missing but I guess I'll find out over the next few months.

The other case had surgery on Thursday but did well straight away. I did scope him again on the day of surgery and occluded the endotracheal tube during the J manoeuvre, you can see the gastric mucosa rolling out in the oesophagus, quite spectacular. I'm not convinced it should be called a hernia though. I'm rechecking him tomorrow.

Thank you again for the advice.

RE: Can this be hiatal hernia?

Dinu Catilina — Sun, 07 Apr 2024 21:49:39 GMT

[quote userid="8663" url="~/f/clinical-questions/30929/can-this-be-hiatal-hernia/244259#244259"]one more thing, before the dog does this,is it dyslnoic? EBTs get a form of laryngeal paralysis[/quote]

No usual signs of laryngeal paralysis. I did not look specifically but this can be rectified easily tomorrow. I know there is a predisposition in these dogs but I saw it more often in minis that standards. Thank you

RE: Can this be hiatal hernia?

Alasdair Hotston Moore — Sun, 07 Apr 2024 20:19:33 GMT

[quote userid="9239" url="~/f/clinical-questions/30929/can-this-be-hiatal-hernia/244256#244256"]How do you do this? contrast or not in the stomach? Do you compress manually? How often do you see a change?[/quote]

Air in the stomach should do it. With X-ray people suggest a paddle to push down on the stomach. I’ve no idea how often it helps.
one more thing, before the dog does this,is it dyslnoic? EBTs get a form of laryngeal paralysis

RE: Can this be hiatal hernia?

Alasdair Hotston Moore — Sun, 07 Apr 2024 20:17:04 GMT

[quote userid="9239" url="~/f/clinical-questions/30929/can-this-be-hiatal-hernia/244256#244256"]

Thank you Alasdair, it did not cross my mind to try that but it does make sense. I take it you would see the stomach bulging out?

[/quote]

Any change in shape of the hiatus. For example, more slit like than usual

RE: Can this be hiatal hernia?

Dinu Catilina — Sun, 07 Apr 2024 19:01:24 GMT

[quote userid="8663" url="~/f/clinical-questions/30929/can-this-be-hiatal-hernia/244251#244251"]I also like to go into the stomach and get a retro flex view when this change can be more obvious.[/quote]

Thank you Alasdair, it did not cross my mind to try that but it does make sense. I take it you would see the stomach bulging out?

[quote userid="8663" url="~/f/clinical-questions/30929/can-this-be-hiatal-hernia/244251#244251"]d lateral X-ray with abdo compression [/quote]

How do you do this? contrast or not in the stomach? Do you compress manually? How often do you see a change?

Thank you both again.

RE: Can this be hiatal hernia?

Dinu Catilina — Sun, 07 Apr 2024 18:57:08 GMT

Thank you both, I will speak to the owner in the morning and see if they have enough money for referral. I scoped it for free this week, I think they went through quite a bit of money at the first place (no criticism, I would have done the same tests) where the initial scope and CT was done.

I had the bitch with me at home over the weekend. It's 100% percent excitement induced, as soon as I pull the lead out or another dog appears she gets very happy and within a minute retching, foaming, etc. Checked on the camera and she is fine for hours if calm. Hence my concerns re hiatal hernia.

RE: Can this be hiatal hernia?

Alasdair Hotston Moore — Sun, 07 Apr 2024 12:26:56 GMT

I agree with Andy that diagnosis of HH is difficult n=by a technique. On your endoscopy the hiatus looks slit like on some frames which I think is a feature. I also like to go into the stomach and get a retro flex view when this change can be more obvious.

But often the diagnosis is speculative. CT might be useful (some do show up) and lateral X-ray with abdo compression (I guess this could be done in CT too with an abdominal wrap.

The poor dog certainly looks like he could have heartburn in your video.

I’d try a CT if funds allow, rescope on another day and/or offer surgery on a informed consent: we won’t know until afterwards

RE: Can this be hiatal hernia?

Andrew Kent — Sun, 07 Apr 2024 10:45:09 GMT

I struggle a bit with the endoscopic diagnosis of hiatal hernia. You can certainly see some bulging and eversion of the gastric mucosa and you induce some reflux. Equally there seems to be some oesophagitis. However - if you alter the thoracic pressure dynamics you can sometimes do that in normal dogs. So I find it difficult to correlate findings with presence or absence of clinical signs. Which is why this can still be an elusive diagnosis in some cases but I probably still favour a fluoroscopic swallow study where possible as we can evaluate in the conscious animal.

it’s certainly possible this is gastrooesophageal reflux or a hiatal hernia and I would continue medical therapy for that in the short term. That would generally be omeprazole (dosed BID), cisapride or metoclopramide and a wet ultra low fat diet. If that controls the signs then argues for that diagnosis.

I’m not convinced by gut disease and the biopsies are pretty unexciting. Ever measure B12?

i would also consider the salivary gland disorders (sialadenosis) as they commonly present in a similar way and get confused for reflux disorders. Were the salivary glands on the previous CT?

interesting case - keep us posted.

Andy

RE: Can this be hiatal hernia?

Dinu Catilina — Sat, 06 Apr 2024 09:12:23 GMT

Thank you Richard, the abdomen is always soft and non painful at palpation and only once we saw the stomach filled with air on radiographs. Being a singular finding I speculated that's it's more likely aerophagia. Overall she probably had over 50 episodes since December.

RE: Can this be hiatal hernia?

Richard Carter — Fri, 05 Apr 2024 17:51:35 GMT

The first I would say has mild bloat and possible torsion- I had a Labrador that would have partial torsion that resolved with vomiting and being stood vertically so the stomach could unwind. Resolved with going onto tinned loaf, no biscuits