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82 Cards in this Set
- Front
- Back
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What are the three parts of the esophagus
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Cervical esophagus
Thoracic esopgagus Abdominal esophagus |
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What kind of muscle comprises the upper esophageal sphincter
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Skeletal (striated) muscle
specifically the cricopharyngeus muscles |
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What kind of muscle comprises the lower esophageal sphincter
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Smooth muscle
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What is the difference between the dog and cat esophagus
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Dog is skeltal muscle for the whole length and the distal 1/3 of cats is comprised of smooth muscle
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What nerve innervates the esophagus
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The Vagus nerve and its branches
Recurrent laryngeal Pharyngeal Glosopharyngeal |
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True or False in a normal fasting patient both the UES and LES are tightly closed
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True
Maintains unidirectional flow and prevents reflux |
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What are the clinical signs indicating the esophagus
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Regurgitiation
Dysphasia Odynophagia (painful swallowing) Ptyalism Cough Nasal discharge Poor body condition failure to grow |
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What is the most consistant sign of esophageal disease
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Regurgitation
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What is a common client complaint for patients with dysphagia or odonophagia
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Client may complain that animal takes a long time to eat
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True or False patients with esophageal disease are often anorectic
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FALSE
but they may refuse to eat due to pain or fear of aspiration |
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True or False normal salivation levels appear increased with impaired swallowing
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TRUE known as pseudoptyalism
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True or False both coughing and nasal discharge may be present with esophageal diseases
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True coughing may be the presenting complaint for esophageal diseases
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What are causes for coughing with esophageal diseases
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Regurgitated ingesta in the pharynx
Aspiration Pneumonia |
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What are causes for nasal discharge with esophageal diseases
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From rhinitis secondary to regurgitation into the nasal cavities
Aspiration pneumonia |
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What diagnostic tests are applicable to esophageal diseases
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CBC, serum biochem, UA
Survey cervical and thoracic rads Contrast radiography Fluroscopy Endoscopy Specialized serum assays |
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What are the esophageal disorders of interest
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Cricopharyngeal dysphagia
Vascular ring anomaly megaesophagus sliding hiatal hernia esophageal neoplasia esophagitis esophageal FB esophageal stricture esophageal fistulas |
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What conditions are associated with cricopharyngeal dysphagia
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Achalasia - failure of UES to relax
Asynchrony - lack of co-ordination between UES relaxation and pharyngeal contraction |
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Cricopharyngeal dysphagia is more common is cats or dogs
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cricopharyngeal dysphagia is more common in dogs
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when does cricopharyngeal dysphgia typically appear
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at time of weaning
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What are the clinical signs of cricopharyngeal dysphagia
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repeated attempts to swallow
gagging, retching, regurgitation after eating weight loss and failure to thrive aspiration pneumonia |
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What is the diagnostic test of choice for cricopharyngeal dysphagia
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Fluroscopy
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What is seen on fluroscopy with cricopharyngel dysphagia
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intermittant or persistant failure of UES to relax
barium retention in the pharynx aspiration in the trachea |
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What are treatment options for cricopharyngeal dysphagia
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Surgery - cricopharyngeal myotomy (better for achlasia then asynchrony)
Medical - enteral feeding tube and Tx of aspiration pneumonia |
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What is the most common vascular ring anomaly
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Persistant right aortic arch
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With PRAA what structures are involved with trapping the esophagus
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Aorta
Ligamentum arteriosum Pulmonary trunk Heart base |
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What breeds are predisposed to vascular ring anomalies
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German shepherds
Irish setters |
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When do clinical signs of a vascular ring anomaly appear
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At weaning
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What diagnostics are performed to diagnose a vascular ring anomaly
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survey rads
esophagram esophagoscopy |
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what is done to surgically manage a PRAA
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ligation and transection of ligamentum arteriosum
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What is megaesophagus
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diffuse esophageal dilation and aperistalsis
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What are the types of megaesophagus
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congenital and acquired
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what is the pathogenisis of congenital megaesophagus
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poorly understood may be a defect in vagal afferent innervation
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What is the pathogenisis of acquired megaesophagus
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primary - idiopathic
secondary - neuromuscular disease (Myasthenia gravis, toxicity (lead), esophageal obstruction, Addisons disease, GDV etc... |
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What are the clinical signs of megaesophagus
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regurgitation is most common sign
A rattling cough in some Weight loss and failure to thrive |
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What specific tests may be run for megaesophagus
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Acetylcholine receptor antibody titer
Lead levels ACTH stimulation test |
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what are some treatments for secondary causes of megaesophagus
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Pyridostigmine for M. gravis
Chelation for lead toxicity Glucocorticoid supplementation for Addison's |
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True or False promotility drugs are a mainstay for the treatment of megaesophagus
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FALSE promotility drugs affect smooth muscle and the esophagus is composed of skeletal muscle
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who gets acquired congentital hernias
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Males dogs and Shar pei's
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Who gets acquired hernias
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Geriatric cats
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What is a sliding hiatal hernia
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cranial displacement of distal esophagus and stomach into mediastinum through the esophageal hiatus
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What is the physiological problem with a sliding hiatal hernia
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reduces LES pressure -> gastroesophageal reflux esophagitis, segmental or diffuse esophageal hypomotility
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Where are the defects typically located for a sliding hiatal hernia
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esophageal hiatus
phrenicoesophageal ligament |
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what do acquired hiatal hernias occur secondary to
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trauma
respiratory distress old age |
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what are the clinical signs of a sliding hiatal hernia
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odontaphagia
signs of esophagitis - regurgitation, vomiting, hypersalivation weight loss and failure to thrive dyspnea due to aspiration pneumonia or compression of lungs with large hernias |
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What is commonly seen on survey thoracic rads for sliding hiatal hernia
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A caudodorsal gas filled soft tissue opacity
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what is done for medical managment for sliding hiatal hernias
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H2 receptor antagonists or proton pump inhibitors - reduce gastric acidity
sulcrate suspensions promotility drugs to enhanse LES tone |
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True or False tumors of the esophagus are rare
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TRUE <0.5% of all cancers
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True or False tumors of the esophagus are rare
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TRUE they account for only about 0.5% of all tumors
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What are the most common types of esophageal neoplasia in dogs
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Fibrosarcoma
Osteosarcoma From Spiacerca lupi infection |
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What is the most common type of esophageal neoplasia in cats
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Squamous cell carcinoma
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How do animals with esophageal neoplasia typically present
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CLinical signs consistant with chronic progressive esophageal obstruction
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How is esophageal neoplasia diagnosed
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Survey rads
Esophagram Esophagoscopy |
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What substance is used to treat Spiracerci lupis associated granulomas
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Doramectin
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What is the prognosis for benign esophageal neoplasms (leiomyoma) with surgical resection
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Good
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What are some causes of esophagitis
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Chemical injury from ingested substances (corrosives, pill or capsule retention, tetracyclines)
Gastroesophageal reflux (from general anesthesia, hiatal defects, pesistant vomiting etc..) Esophageal foreign bodies |
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What can be done with cats to prevent esophagitis associated with medication administration
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Give a water bolus with medication given per os
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What are some sequellae of esophagitis
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Esophageal inflammation causes a decrease in LES tone -> more reflux and mucosal inflammation
Disturbances of esophageal motility |
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What are the clinical signs of esophagitis
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Mild cases may be assymptomatic
Anorexia Dysphagia Odonophagia Regurgatation Ptyalism |
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How is esophagitis diagnosed
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Esophagitis is an endoscopic diagnosis
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How is mild esophagitis treated
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Frequent small low fat high protein meals -> enhances LES tone and decreased gastric acidity
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How is moderate esophagitis treated
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H2 antoagonists and proton pump inhibitors to reduce acidity
Sucralfate Promotility drugs to enhance LES tone |
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How is severe esophagitis treated
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May need a gastrotomy tube to rest the esophagus
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What are the most common sites of esophageal foreign bodies
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Thoracic inlet
Heart base Diaphragmatic hiatus All points of minimal distention |
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What are the most common foreign bodies
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Bones
Chew toys Fish hooks Needles Sticks Trichobezars |
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What are possible sequellae to FB that cause obstruction
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Muscle spasm and tissue edema worsening the obstruction
Mucosal abrasion Laceration Perforation |
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What are the benifits od esophagoscopy for foreign bodies
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May be diagnostic
Allows for assessment of secondary mucosal damage May be able to remove the objest via this method |
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What contrast agent should be used for foeign body rads
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iohexol gastrografin in case there is an esophageal perforation do NOT use barium sulphate
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True or False esophageal foreign bodies are considered emergencies and should be immediately removed
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TRUE
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Why would thoracic radiographs be taken after a foreign body removal surgery
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To assess for pneumomediastinum or pneumothorax
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What are some sequellae of esophageal foreign bodies
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fistula
diverticulum stricture formation segmental defects in motility |
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what is an esophageal stricture
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a circular band of scar tissue that forms secondary to severe esophagitis
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what are the most common causes of strictures
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gastroesophageal reflux (secondary to general anesthesia)
esophageal foreign bodies tetracycline administration (cats) |
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How are mild esophageal strictures dealt with
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thinning the consistancy of the diet
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how are moderate-severe strictures treated
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dilated with endoscopically guided balloons
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What are the types of esphageal fistulas
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tracheoesophageal fistula
bronchoesophageal fistula |
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what is the etiology of esophageal fistulas
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congenital
acquired - secondary to severe esophagitis, or foreign bodie i.e. bones |
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how do forewign bodies cause fistulas
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foreign body causes mucosal necrosis, esophageal perforation -> leakage of esophagfeal contents -> healing leads to development of fistula
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True or False esophageal fistulas are rare in cats and common in dogs
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FALSE esophageal fistulas are rare in both cats and dogs
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What is the most common sign of an esophageal fistula
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respiratory signs
coughing after drinking, dyspnea |
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what are the radiographic findings with esophageal fistulas
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localized alveolar, bronchial, or interstitial pattern Rt Cd lung lobe dogs and Lt Cd and accessory lobes in cats
May see radiopaque foreign bodies in esophagus |
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What is the treatment for esophageal fistulas
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Surgery
esophagostomy for retained esophageal foreign body Lung lobectomy if required |
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What are negative prognosticators for esophageal fistulas
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dehiscence of surgery site
stricture formation pulmonary abscessation is present |
