02 - esophagus and disorders of swallowing

Question 1

Question 2

(oropharyngeal dysphagia)

1. oral dysphagia = ?
2. pharyngel dysphaga = difficulty with transport of bolus where?

Answer 2

1. difficulty with prehension or transport of food to pharynx
2. from oropharynx through the cranial esophageal sphincter

Question 3

(oropharyngeal dysphagia)

Cx

1. oral dysphagia?
2. pharyngeal dysphagia?

Answer 3

1. abnormal prehension/mastication
2. unsuccesful swalloing (gagging, retching), aspiration pneumonia common

Question 4

causes of regurg?

Answer 4

megaesophagus, muscle weakness, neuro deficits

Question 5

(imaging)

1. what is required for diagnosis of functional abnormalities?

Answer 5

1. fluoroscopy with a barium swallow

Question 6

(esophageal hypomotility)

1. may be segmental or diffuse, congenital or acquired
2. most common cause of megaesophagus in dogs?
3. acquired megaesophagus may occur secondary to diseases causing what?

Answer 6

2. idiopathic
3. diffuse neuromuscular dysfx

Question 7

(esophageal hypomotility)

1. primary Cx?
2. dyspnea, cough, and fever suggest what?

Answer 7

1. regurg
2. aspiration pneumonia

Question 8

(esophageal hypomotility)

(megaesophagus)

1. dx?
2. congenital disorders suggested when signs first noticed when?
3. what kind of dogs?

Answer 8

1. exclusion
2. at the time of weaning
3. larger dogs (+siamese cat)

Question 9

(esophageal hypomotility)

(megaesophagus)

1. may be unremarkable except for what?
2. lab test to test for what?

Answer 9

1. weight loss
2. acetylcholine receptor antibody titer to test for acquired myasthenia gravis

Question 10

(esophageal hypomotility)

(megaesophagus)

1. tx?

Answer 10

1. usually symptomatic and supportive - frequent small meals in upright position (liquid food)

Question 11

is idiopathic megaesophagus usually reversible?

Answer 11

no

Question 12

(esophageal FB)

1. lodge what 3 places?
2. complications?

Answer 12

1. thoracic inlet, base of heart, hiatus of diaphragm
2. esophagitis, perf, stricture,

Question 13

(esophageal FB)

1. dx usually confirmed by what?

Answer 13

1. radiography, barium contrast esophageal radiography, or esophagoscopy

(check for aspiration pneumonia - pneumomediastinum, pneumothorax, mediastinal or pleural effusion suggest esophageal perf)

Question 14

(esophageal FB)

1. tx?

Answer 14

1. endoscopic removal best (if can’t get out mouth push into stomach to remove by gastronomy)

if neither of these work esophagotomy indicated

Question 15

(esophageal perforation)

1. most common cause?
2. Cx?

Answer 15

1. foreign bodies
2. anorexia, depression, odynophagia, and a rigid stance

Question 16

(esophageal perforation)

1. radiographs show what?
2. CBC shows what?

Answer 16

1. pneumomediastinum, pneumothorax, and mediastinal or pleural effusion
2. neutrophilia with left shift

Question 17

(esophageal perforation)

1. tx for small tears?
2. for large?

Answer 17

1. medical mgmt: abx, fluids, no feeding for a week
2. sx

Question 18

(esophagitis)

1. 4 causes?
2. infection that causes?

Answer 18

1. FB, oral meds (doxycycline), thermal/caustic injury, reflux
2. pynthium insodium

Question 19

(esophagitis)

1. what is the most sensitive method of diagnosis?

Answer 19

1. esophagoscopy

Question 20

(esophagitis)

1. general tx?
2. for reflux?

Answer 20

1. abx and frequent feedings of small portions of soft food
2. promotility agents (metoclopramide), H2 blockers, sucralfate, prednisolone

Question 21

(esophageal stricture)

1. may result from what?
2. radiographs may show what proximal to the stricture?
3. most common tx?

Answer 21

1. severe esophagitis or esophageal sx
2. distension (contrast studies or endoscopy may be helpful in the dx)
3. balloon catheter dilation (prednisolone to prevent further fibrosis and stricture)

Question 22

(esophageal diverticula)

1. what are these?
2. tx for small?

for large?

Answer 22

1. pouchlike sacculations of the esophageal wall and may be congenital or acquired (may become impacted -> esophagitis)
2. freq small meals of soft food
3. surgical resection

Question 23

(esophageal fistula)

1. communication between esophagus and what?
2. acquired or congenital more common?
3. Cx signs (coughing, fever, dyspnea) result from what?

Answer 23

1. airways (bronchi most common)
2. acquired (FB, trauma, malignancy, infection)
3. contamination of airways with fluid and food

Question 24

(vascular ring anomalies)

1. most common?
2. what happens?

Answer 24

1. PRAA (95%)
2. right rather than the left fourth aortic arch is retained -> compression of the esophagus between the ligamentum arteriosum, the aorta, the pulmonary trunk, and base of the heart

Question 25

(vascular ring anomalies)

1. Cx

Answer 25

1. regurg at time of weaning, no weight gain, cough and dyspnea

Question 26

(vascular ring anomalies)

1. radio finding2?

Answer 26

1. esophageal dilation cranial to the heart, absence of normal bulge of aortic arch, leftward tracheal deviation cranial to the heart

Question 27

(vascular ring anomalies)

1. treatment?

Answer 27

1. sx ligation

Question 28

(hiatal disorders)

1. hiatal hernia = ?
2. gastroesophageal intussusception = ?

Answer 28

1. protrusion of the distal esophagus and stomach through esophageal hiatus
2. invagination of the stomach into the distal esophagus (seen with congenital idiopathic megaesophagus)

Question 29

Cx signs of small hiatal hernias are due primarily to what?

Cx signs for large displacements?

Answer 29

reflux esophagitis

signs of obstruction (dyspnea, hematemesis, collapse, rapid deterioration, death)

Question 30

tx for large hernias?

for small?

Answer 30

surgery

medical (tx for reflux and small food portions)

Question 31

(periesophageal obstruction)

1. what is this?
2. Cx include what?

Answer 31

1. extraluminal compression can be caused by cervical or mediastinal masses
2. regurgitation, dysphagia, hypersalivation

Question 32

(esophgeal neoplasia)

1. how common is primary neoplasia?
2. most common in dogs? cats?
3. osteosarc and fibrosarc may develop with malignant transformation of a granuloma cause by what?
4. endoscopy and biopsy required for definitive dx, surgical excision is required

Answer 32

1. rare
2. leiomyoma, SCC
3. spirocerca lupi