scott@vtx-cpd.com

Replying to Neus E. 05/03/2024 - 11:54

Thanks for sharing Neus.

I think you raise a good point… determining whether there is GI bleeding/ulceration is not always easy.

Unless there is obvious melena or haematemesis in these cases, it can be tricky!

Scott 🙂

Replying to Talia C. 05/03/2024 - 15:49

Hello Talia.

I am really pleased you enjoyed the lesson. The link between megaoesophagus and hypothyroidism is not a strong one. There are a few older papers and case reports:

https://pubmed.ncbi.nlm.nih.gov/21498218/

There is one recent survey paper that 8.8% of megaoesophagus cases had hypothyroidism. I will need to look at this paper in more detail as that seems like a lot! In many of these studies I would go back to the diagnosis of hypothyroidism as that is commonly misdiagnosed.

The hypoadrenocorticism link is also rare and based on case reports:

https://pubmed.ncbi.nlm.nih.gov/7783439/

Although hypothyroidism and hypoadrenocorticism are less likely, I would still consider screening for them in older dogs with megaoesophagus.

Hope that helps.

Scott 🙂

Replying to Talia C. 12/03/2024 - 08:25

Hello Talia.

Thank you for the brilliant questions. I hope you are enjoying the course.

Regarding the alpha-1-antitrypsin. There are a few papers looking at the use of it in dogs. Most of them are quite old, but I found this more recent one:

https://pubmed.ncbi.nlm.nih.gov/26631946/

Honestly, I am just not sure how useful it is in a practical clinical setting. I have never been in a situation where I thought it would be useful. I am not sure that it would change what I did treatment wise? I would be interested to hear other peoples thoughts. Maybe I am not using it right!

I would consider clopidogrel in cases of protein losing enteropathy, particularly the more severe cases.

This is a great question regarding ‘atypical hypoadrenocorticism’. The thinking is that these patients have preferential destruction of the adrenal gland and this will progress with time. I would be doing exactly what you are doing and monitor these cases carefully for progression to mineralocorticoid deficiency. The timescale is poorly determined, so difficult to predict.

Really interesting regarding the helicobacter! Could the strange smell have been digested blood? Would you be able to share the histopathology results from this case? The way they report the helicobacter can sometimes help decide whether to treat or not.

Thanks again for the great questions.

Scott 🙂

Replying to Helen G. 14/03/2024 - 17:25

Hello Helen!

I also qualified from Edinburgh and then worked and lived in Glasgow!

Thank you so much for joining the course. Please let me know if you have any questions.

Scott 🙂

Replying to Mahmoud M. 06/03/2024 - 08:49

Here is the full radiography report:

Skeleton:
There are no skeletal abnormalities

Thorax:
There is a an alveolar pattern with air bronchograms affecting predominently the right middle lung lobe. The other lung lobes are unremarkable.
The cardiac silhouette is within normal limits. There are no abnormalities in the cranial mediastinum, the oesophagus is mildly dilated with air on the left lateral view. The diaphragmatic line is clear on the right lateral view but obscured on the left lateral view.

Abdomen:
There is moderate ingesta and a small structure of bone opacity in the stomach. There is mild gas in the colon as expected. The remaining abdominal organs are unremarkable

DDx aspiration pneumonia, bronchopneumonia, haemorrhage, less likely oedema, torsion or neoplastic infiltrate

Replying to Erin B. 07/03/2024 - 14:03

Hello Erin!

Thank you for joining us. I really hope you enjoy the course. Happy to answer any questions or chat about any of your cases at any time!

Have a lovely weekend.

Scott 🙂