Surgical Probs Of Eso

Front 1

what size is the collapsed esophagus in an average dog?

Back 1

2cm (can double or triple when swallowing)

Front 2

what are the most common locations for foreign bodies?

Back 2

origin
thoracic inlet
heart base
termination

Front 3

T/F esophagus is normally seen on radiographs?

Back 3

F

Front 4

where does the esophagus lie?

Back 4

dorsal to trachea except in caudal cervical region where it runs to the left.

Front 5

what are the 4 layers of the esophagus?

Back 5

mucosa
submucosa
muscularis
adventitia

Front 6

which of the 4 layers is your holding layer in surgery?

Back 6

submucosa

Front 7

how many sphincters are there in the esophagus?

Back 7

2 upper & lower

Front 8

T/F the esophagus has segmental blood supply?

Back 8

True

Front 9

name the blood supply to the following sections of the esophagus:
cervical
thoracic
terminal

Back 9

cervical: thyroid arteries & branches of the carotids
thoracic: bronchoesophageal artery
terminal: esophageal branches of the aorta & left gastric artery

Front 10

what are the principles of esophageal surgery?

Back 10

-atruamatic meticulous technique
-healing is challenged

Front 11

what are 5 of the reasons why healing is challenged in esophageal surgery?

Back 11

no serosa
no omentum
segmental blood supply
constant motion & bolus distention
intolerance of longitudinal stretching

Front 12

what are the principles of esophageal surgery?

Back 12

-atruamatic meticulous tech
-healing is challenged
-preserve vasculature
-suction lumen before incising
-incorporate submucosa in closure
-single or 2 layer closure

Front 13

common surgical diseases?

Back 13

foreign body
perforation
hiatal hernia
strictures (vascular ring anomalies)

Front 14

rare surgical disease?

Back 14

tumors
gastroesphageal intussusception
diverticula
fistula
cricopharyngeal achalasia

Front 15

an animal presenting with regurgitation what clinical sign do you look for next?

Back 15

dysphagia or no dysphagia

Front 16

IF you find regurgitation with dysphagia in a patient what should you do next?

Back 16

evaluate for oral, pharyngeal, or cricpharyngeal dysfunction

Front 17

developmental anomalies of the great vessels result in what?

Back 17

encircling of the esophagus & trachea by complete or incomplete ring of vessels

Front 18

what type of vascular rin anomalie accounts for 95% of reported cases

Back 18

PRAA w/left ligamentum arteriosum

Front 19

describe the signalment of a patient with PRAA?

Back 19

>15kg dog as an adult, (GSD, irish setters) or cat (persian or siamese), no sex predilection, mult animals from one litter

Front 20

History of an animal with PRAA?

Back 20

normal till weaning (often 3-4 months old at presentation), no problem with liquids, postprandial regurgitation (undigested) after solid food, ravenous appetite but appear malnourished, enlarged cervical esophagus (palpable), coughing & resp distress (aspiration pnuemonia)

Front 21

what would radiographs of a dog with a PRAA appear like?

Back 21

dialated esophagus cranial to the heart, descending aorta on the right side of the esophagus, aspiration pnuemonia.

Front 22

what would positive contrast radiographs look like on a patient with PRAA?

Back 22

a dialated esohpagus cranial to the stricture if it is also dialted caudally to the stricture prognosis is poor. ( can use barium, fluoroscopy, angiography)

Front 23

what medium would you use to rule out other causes of obstruction when suspecting PRAA?

Back 23

esophagoscopy - look for erosions or ulcers (often hard to see because of residual food)

Front 24

what is the pre-op medical tx for PRAA?

Back 24

-elevated feeding of slurry diet
-gastrostomy tube feeding (severe)
-Abx, nebulization & coupage for aspiration pnuemonia

Front 25

what is post-op care of PRAA patients?

Back 25

elevated feeding starting at 12 hrs post surgery, continued for 2-4 weeks gradually reducing the amt of water in the food
-switch to normal feeding when solid food is not regurg
-some animals will require this tx all their lives

Front 26

what are 3 poor prognostic indicators?

Back 26

-presence of esophageal dialation cd to PRAA
-presence & severity of aspiration pnuemonia
-severity of debilitation

Front 27

what commonly causes esophageal FB in dogs? in cats?

Back 27

dogs- ingested bones
cats-(occasional not common) fishhooks, needles & string FB's

Front 28

what are the 3 most common locations for FB w/in the esophagus?

Back 28

thoracic inlet, heart base, caudal esophagus

Front 29

where do bone FB most commonly lodge?

Back 29

b/w the heart & diaphragm

Front 30

where do fishhook FBs most commonly lodge?

Back 30

pharyngeal esophagus

Front 31

what is the most common clinical presentatin of esophageal FBs?

Back 31

sm breed dog (terrier), <3yrs old, duration is hrs-mnths, HX of roaming/garbage ingestion, regurg w/in a few mins of eating, water is usually retained

Front 32

esophageal FB clinical signs?

Back 32

retching, gagging, salivation, restlessness, wt loss, resp signs

Front 33

on radiographs what would you see with esophageal FB?

Back 33

soft tissue density, gas in esophagus, radioopaque FB, aspiratin pnuemonia, pnuemothorax.

Front 34

T/F endoscopy allows 2 possibilities in aleviating the FB?

Back 34

T- push it into the stomach or retreive it

Front 35

other than FB retreival what is endoscopy used for in the esophagus?

Back 35

erosions/ulcers, perforations

Front 36

T/F surgery is only required 20% of the time with FBs?

Back 36

F its only 8%

Front 37

when do you choose to do surgery with a FB?

Back 37

retreival or advancement fails, significant risk for lacerations of the esophagus or major vessels are present, perforated fish hooks (combo approach)

Front 38

how would you remove a FB from between heart & diaphragm?

Back 38

via gastrotomy

Front 39

what type of suture pattern would you do for esophageal surgery?

Back 39

simple interrupted

Front 40

what is post-op care for esophageal surgery?

Back 40

thoracostomy tube
observe for 2-4 d for signs of leakage
no oral intake for at least 72 hrs (gastrostomy tube)
H2 blockers and sucralfate slurry

Front 41

prognosis for esophageal surgery?

Back 41

excellent (except if thoracic perforation)

Front 42

what are possible complications of esophageal surgery?

Back 42

esophagitis
ischemic necrosis
dehiscence
stricture formation

Front 43

what are some of the OTHER esophageal problems not discussed previously?

Back 43

esophageal stricture (congenital or acquired)
esophageal diverticula (congen or aq)
esophageal fistulas
cricopharyngeal achalasia (dysphagia)

Front 44

how is the surgery for PRAA performed?

Back 44

L 4th intercostal thoracotomy (5th cats)
divide the vascular band (ligate 40% patent)
transect periesophageal fibrous bands (careful not to enter the lumen)