讲义教程说明

THERAPEUTICThereasonwearehere我们今天何故聚首在DEFININGTHE

REGURGUsually常 No Usually常 NoBile胆 Sometimes偶 NoDigested

Sometimes偶 NoIfitlookslikevomiting,itisprobablyvomitingIfitlookslikeregurgitation,thenyoudon’treallyknowforsureTAMUSig:4monthFGermanshepherdCC:Febrile主诉：发热HPI:1monthago:dogfebrile+soft,moistcoughWascuredwithantibiotics3daysagohadsame T=39.7CInspiratorycrackelsinright体格检查：T= 右肺吸气阶 Sig:10yrM(c)Mixedbreed基本信息：10岁，雄性(已去势），混种CC:Coughing主诉：咳HPI:Coughingbegan2yearsagoandisnot withanymedications.Dogvomitingforlast2months病史：2年前开始咳嗽，使用任何药物均无制。近两个月出 TAMUSig:2yrM(n) “Vomiting”,coughing主诉：“ HPI:Problemsbegan10daysagoNowarningwhenthrowsNobile MajorCausesofAcquiredEsophagealWeaknessMyastheniagravisHypoadrenocorticism(usuallyVariousSpirocerca获得性食道迟缓的主要原肾上腺皮质机能减退（通常 型TAMUAntibodiestoAcetylcholine0.1nmol/L(<0.1nmol/L(<Localizedandgeneralized局灶性和全身Mostcommonlydiagnosedcauseofacquiredmegaesophagus最常被诊断为获得性巨食道症的病因BesttestisAnti-acetylcholinereceptorsMayneedtorepeattestin6monthsSpontaneousremissionsoftenMustkeepaliveuntilTHERAPYFOREnhancemotilityPyridostigmineNOTphysostigmineorTreattheimmunebasisoftheAzathioprine(Imuran)–maybeNOTTAMUCreatinine肌酐=1.9mg/dl(<2.0)Calcium钙= 11.3mg/dl(9.3-11.8)Glucose136mg/dl60-Sodium=Potassium=Albumin白蛋白=

156mEq/L(138-3.0mEq/L(3.8-3.2gm/dl(2.5-ALT98IU/lTAMURestingcortisol

0.90.9PostACTHcortisol= 0.9ug/dlACTH刺激后可的松浓度=0.9ug/dlInfrequentlycausesmegaesophagus,espcommoninpoodles(espblackseldomcauses↓Naor↑Kwhenitproducesmegaesophagus(atypical) restingcortisolisgoodscreeningeasyandrewardingtodon’tusesteroidsastherapeutictrialunless经常引起巨食道症，但是restingcortisolisgoodscreening刺激前可的松检测时很好的排查检easyandrewardingto治疗简单且见效don’tusesteroidsastherapeutictrialunlessyouareSUREdoghas经常引起巨食道症，但是don’tusesteroidsastherapeutictrialunlessyouareSUREdoghasMajorCauseofCongenitalEsophagealWeaknessTHERAPYFORCONGENITALDietarymodificationGruelfromanelevatedTHERAPYFORCONGENITALDietarymodificationGruelMeatballs(espwithpartialCannedfoodDryfoodMSUSig:5yrF(s)CC:“Vomiting”主诉 HPI:Vomitingbegan1weekago.Noprodromalsigns;producesfoodbutnobileorblood PE:Obese,“...manydoctorsinthisspeciality[radiology]relyheavilyonfirstimpression–gestalt–rapidlydistinguishingnormalfromabnormal,drawingconclusionswithinsecondsofviewinganimage.”page179,J.Thenextthreedogsallhavethesamedisease–whatisit?—TAMUSig:2yrM(c)CC:“Vomiting”主诉 HPI:Presentsincegotdog1month ago.Dogeatsravenously,thenvomitsfoodwithin3-4minutesofeating.Nobileorbloodseen.Dogdroolsconstantly.Recentlyhastroubleswallowing NotSig:5monthFGermanshorthairedCC:“Vomiting”主诉 HPI:Startedvomiting8daysago.Startedvomitingclearliquid.Nextdayvomitedbloodandsticks.Laparotomyshowedinflamedduodenum&bloodinstomach.Appetitebetter,nowvomitsfluid&blood. PCV=20%(35-红细胞压积=20%（35-Profile:Albumin=1.9gm/dl(2.5-白蛋白=1.9mg/dl（2.5- Sig:10yrF(s) HPI:Beganvomitingbile21daysago.Surgery–removedlinearforeignobjecton12daysago.Vomitingcontinues:2ndsurgery9daysago–find Depressed,tightWhichdiseasedothesedogsMegaesophagusEsophagealforeignbodyHiatalherniaEsophagealtumorEsophagitisEsophagealstrictureSpirocercalupiE-ESOPHAGITIS:Organisms(especiallyESOPHAGITIS:Organisms ForeignobjectsESOPHAGITIS:Organisms ForeignobjectsESOPHAGITIS:Organisms Foreignobjectsdoxycycline多西环素clindamycin克林霉素NSAIDs非甾体类抗炎药ESOPHAGITIS:Organisms Foreignobjects异物Causticagents刺激性物质Gastricacid胃酸ExcessivegastricacidityESOPHAGITIS:Organisms Foreignobjects异物Causticagents刺激性物质Gastricacid胃酸ExcessivegastricacidityExcessive ESOPHAGITIS:Organisms 源（真菌Foreignobjects异物Causticagents刺激性物质Gastricacid胃酸ExcessivegastricacidityExcessive 过Iatrogenic(postanesthesia医源性（麻醉后ESOPHAGITIS:Organisms 源（真菌Foreignobjects异物Causticagents刺激性物质Gastricacid胃酸ExcessivegastricacidityExcessive 过Iatrogenicpostanesthesia医源性（麻醉后Spontaneousgastric自发性胃酸反ESOPHAGITIS:CLINICALMilddisease:“spitup”whiteESOPHAGITIS:CLINICALMilddisease:“spitup”whiteModeratedisease:poorappetite,regurgitatefoodESOPHAGITIS:CLINICALMilddisease:“spitup”whiteModeratedisease:poorappetite,regurgitatefoodSeveredisease:anorexia,drooling,severepain,regurgitation,vomitingESOPHAGITIS:History(e.g.,repeatedvomiting,prior病史（如：术前反 ESOPHAGITIS:History(e.g.,repeatedvomiting,prior病史（如：术前反 Physicalexamination(oral体格检查（口腔病变ESOPHAGITIS:History(e.g.,repeatedvomiting,prior病史（如：术前反 Physicalexamination(oral体格检查（口腔病变Radiographs(lesionsmaybeX线检查（病变可能很轻微ESOPHAGITIS:History(e.g.,repeatedvomiting,prior病史（如：术前反 Physicalexamination(oral体格检查（口腔病变Radiographs(lesionsmaybeX线检查（病变可能很轻微Endoscopy(mostsensitive&内窥镜检查（敏感性和特异性均最佳TheesophagusisNOTsensitiveTheulcerated/erodedesophagusisULTRA-SENSITIVEtoevenminuteamountsofacidYoumusttrytocomple y“clear”thestomachofacidESOPHAGITIS:AntacidsProtonpumpH-2receptorANTI-ACIDDRUGS:Protonpumpinhibitors质子泵抑制IrreversiblyinhibitH+-K+Omeprazole(1-2mg/kgPOq12-奥美拉唑（1-2mg/kgPOq12-Lansoprazole(1mg/kgIV兰索拉唑（1mg/kgIVPantoprazole(1mg/kgIV泮托拉唑（1mg/kgIV艾美拉唑（1mg/kgIV艾美拉唑（1mg/kgIVANTI-ACIDDRUGS:Startworkingimmedia y,butrequire2-5daystoachieve aleffectCancause可能引起腹ESOPHAGITIS:Reflux:thetwo-edgedsword反流：双向Gastroesophageal

ESOPHAGITIS:Reflux:thetwo-edgedsword反流：双向Gastroesophageal

GastroesophagealESOPHAGITIS:Reflux:thetwo-edgedsword反流：双向Gastroesophageal

GastroesophagealESOPHAGITIS:PROKINETICSCisapride(0.1-0.5mg/kgPOq12-24h)betterthanmetoclopramideMosaprideavailablesoon?Erythromycin(1-5mg/kgPO,IV,q8-Metoclopramide(0.25mg/kgIV,PO,q8-12h)moreeffectiveonliquidsRanitidine(2.2-4.4mg/kgPO,IVq8- (0.1-0.5mg/kgq12-24h)比甲氧氯普胺(0.25mg/kgIVPOq8-12h)注射剂更雷尼替丁(2.2-4.4mg/kgPO,IVq8-ESOPHAGITIS:PROKINETICSgesics(espESOPHAGITIS:PROKINETICSgesicsGastrostomytuberarelyneeded)胃管（ESOPHAGITIS:PROKINETICSgesicsGastrostomytuberarelyneeded)胃管（Carafate胃溃宁（硫糖铝ESOPHAGITIS:PROKI