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THRALL - Thom > 30. Oesophagus > Flashcards

30. Oesophagus Flashcards

1
Q

List 10 diseases that static positive contrast oesophagrography is helpful for

A

Stricture

Mass

Vascular ring

Perforation

Diverticulum

Tracheo / Bronchooesophageal fistula

Hiatal hernia

Oesophagitis

FB (non-radio)

Dysphagia

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2
Q

List 1 indication for pneumooesophagography

A

Oesophageal ST mass

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3
Q

List 3 uses for oesophageal scintigraphy

A

Oesophageal transit time

Motility

Reflux

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4
Q

List 3 indications for use of endoscopic oesophageal US

A

Infiltrative disease

Perioesophageal masses

fistula / diverticula

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5
Q

What is another name for the cranial oesophageal sphincter?

A

Cricopharyngeal sphincter!

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6
Q

Which 2 muscles form the cricopharyngeal sphincter?

A

Criocpharyngeus

Thyropharyngeus

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7
Q

What 2 muscles run dorsal to the cranial thoracic oesophagus?

A

Longus coli

Longus capitis

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8
Q

Where are the vagal nerves relative to the oesophagus?

A

Run bilaterally on the sides of the oesophagus -> Travel dorsocaudally, joining to form VAGAL TRUNK, which passes through oesophageal hiatus

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9
Q

What are the four layers of the oesophagus?

A

Fibrous, muscularis, submucosa, mucosa

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10
Q

How does feline and canine oesophaeal anatomy differ ?

A

Dogs: ALL STRIATED muscle -> Lonitudinal folds

Cats: Cranial 2/3 striated, caudal 1/3 SMOOTH -> Oblique striated pattern (HERRINGBONE)

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11
Q

What 3 structures comprise the caudal oesophageal sphincter?

A

Thickening of oesophageal muscularis layer

Gastric folds

Muscular sling (formed by diaphragmatic crus and lesser curvature)

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12
Q

Describe the arterial supply to the oesophagus (4 different bits!)

A

Cervical: Thyroid arteries

Thoracic cranial 2/3rds: Main supply bronchooesophageal artery

Thoracic caudal 1/3rd: Oesophageal branches of aorta / intercostal arteries

Terminal: Left gastric artery

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13
Q

Describe the venous drainage of the oesophagus

A

Only mentions thoracic portion….

Left gastric vein and azygous vein

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14
Q

Describe innervation of the oesophagus / swallowing

A

Complex!! 25 paired ganglia from C2 to L5

5 x CN: V, VII, IX, X, XII

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15
Q

A small amount of oesophageal fluid can be seen normally in which lateral?

A

LEFT!!!! Makes sense…

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16
Q

BOX: Survey features of oesophageal disease

A
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17
Q

How do pneumomediatinum and oesophageal gas differ radiographically?

A

Pneumo: Highlights ADVENTITIAL surface of oesophagus and vessels

Oeso: Gas more contiguus, tracheal stripe, visualisation of longus coli

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18
Q

What creates the dorsal indentation pictured?

A

Azygous vein

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19
Q

How can the significance of oesophageal redundancy be established?

A

Dynamic oesophagography -> Motility can be ++ reduced

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20
Q

What is the tracheal stripe sign a reliable indicator of?

A

Oesophageal GAS (not megaO)

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21
Q

List pertinent complications of oesophageal contrast agents

BOX ATTACHED

A

Barium paste: Contraindicated if aspiration risk -> respiratory obstruction

All barium agents: Pneumonia and granuloma RARE complication of aspiration, CONTRAINDICATED if perf suspected

-> If alveolar, will stay permanently

IONIC: oedema if aspirated, GI influx

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22
Q

BOX on Oesophgram technique

A
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23
Q

BOX phases of swallowing including control mechanisms and rx features

A
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24
Q

What frame rate is required for videofluroscopic evaluation of swallowing?

A

30-60 frames per sec

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25
BOX Types of dysphagia
26
What variables have been shown to be affected by variation in bolus form and size (in normal dogs in lateral)?
Degree of pharyngeal contraction Opening of cranial sphincter Thoracic oesophageal transit time Peristalsis
27
What clinical features are consistent with oral phase dysphagia?
Difficulty with prehension Failure of bolus formation Failure of transport to pharynx =\> CS: Dropping food, drooling
28
Features of pharyngeal dysphagia
Challenging! Nonspecific, e.g. gagging, retching, multiple swallow attempts Dx = When oral bolus is propelled inadequately across pharynx to cricopharyngeal sphincter RARE as a SOLE ABNORMALITY
29
What measure has been established for assessing pharyngeal contraction? How is it interpreted?
Pharyngeal constriction ratio =\> Pharyngeal area in contraction : area at rest Dogs with pharyngeal dysphagia have markedly HIGHER ratio than healthy dogs NB: CAN BE INCREASED WITH CRICOPHARYNGEAL DYSPHAGIA
30
What differs between pharyngeal and cricopharyngeal dysphagia if similar constriction ratio present?
Time to criopharngeal sphincter opening -\> delayed in CP dysphagia (sig shorter in pharyngeal)
31
Features of cricopharyngeal dyphagia
- Failure of CP sphincter to open OR dyssynchrony - CS: Similar to pharyngeal - TOY BREEDS, shortly after weaning (?congenital) - Rx: pharyngeal stasis / barium retention; hypertrophy cricopharyngeaus mm, oesophageal contrast retention, airway contrast! abnormal swallows interspersed with normal ones CRITICAL: DELAY OR FAILURE OF SPHINCTER OPENING LACK OF COORDINATION BETWEEN PHAR CONTRACTION AND OPENING
32
What is the difference in timings of swallow -\> Sphincter opening in achalasia vs normal?
TIME DELAY from closure of epiglottis to opening of sphincter Kibble: 0.31 vs 0.09 Wet: 0.37 vs 0.1 \*\*ALSO difference in sphincter closure times\*\*
33
DIfference between cricopharyngeal achalasia and chalasia?
Achalasia: Delayed / dysynchronous opening Chalasia: Lack of positive pressure (remains open) -\> Can happen with myasthenia gravis. INCREASED ASPIRATION RISK, do not use barium. May see gas at rest in sphincter.
34
What is the most common type of dysphagia in cats (RARER THAN IN DOGS)? 3 most common causes?
OESOPHAGEAL - Hiatal hernia, dysmotility, stricture
35
How do quatitative measures of swallowing (phar constric etc) compare between cats with oesophageal dysphagia and NORMAL dogs?
Similar! Data lacking on normal cats
36
What fluroscopic features of oesphageal studies differ in dogs depending on recumbency?
Sternal: - SHORTER oesophageal transit time - GREATER % primary waves (kibble and liquid) Lateral - GREATER % swallows with no peristaltic waves
37
Oesophageal dysfunction has an association with which disease in dogs?
Layrngeal paralysis
38
List 4 measures of oesophageal dysmotility (In the absence of megaO)?
- Abnormal 1ry waves -\> bolus \<5cm - Abnormal 2ry waves -\> retenion in oesophagus after 2 swallows - Retrograde bolus motion \>10cm - Prolonged transit time \>5secs
39
List Ddx for cause of segmental (++) vs generalised O dilation
Generalised - FUNCTIONAL DISEASE Segmental - Hiatal - infiltrative - FB - Redundant - stricture - vascular ring - Segmentlal motor
40
What does mega O describe?
DILATED ANDHYPOMOTILE! -\> resulting from neuromuscular dysfunction, often idiopathic
41
Megaoesophagus in the cat has been described in association with what?
Pylorospasm -\> MegaO rare entity in the cat
42
What is the most common cause of regurg in the dog?
MegaO =\> ALSO most common O motility disorder
43
Which components of the neuro system can be affected to produce MegaO?
- Muscle (myopathy) - Neuromuscular (MG) - Peripheral (Polyneuropathy) - CNS (inflamm, tox, neoplasia)
44
Which breed has congenital oesophageal hernia?
Shar pei
45
List the 3 described types of hiatal hernia
Sliding: Movement of caudal sphincter into thorax Paraoesophageal: Movement of fundus into thorax (sphincter in abdomen) GO intussuception: Stomach (or other organ) telescopes into oesophagus
46
What risk factors have been associated with GO intussception?
- Oesophageal dilation - Caudal oesophageal sphincter surgery -\> resultant chalasia
47
What breeds are predisposed to O FBs?
Terriers Dogs\>Cats
48
What are the 3 most common sites of O FB?
Thoracic inlet Heart base Cranial to diaphragm
49
What are contraindications for barium in O FB?
INdicators of perf! - Pneumomediastinum - Pneumothorax - Pleural effusion
50
Which structure forms the aortic arch in the NORMAL dog?
Left fourth aortic arch
51
What is the classification system for vascular rings?! How many types are there?
SEVEN! - 1-3 = PRAA variants - 4 = DOUBLE aortic arch - 5-7 = LEFT aorti arch with combos of persistent right lig art and R subclavian
52
In approx terms, how do PRAA and normal anatomy differ?
Normal: Aorta, MPA and lig art ALL LEFT SIDED PRAA: Aorta RIGHT SIDED (r side of trachea), other left sided -\> Compression of oesophagus against trachea by lig art PRAA MOST COMMON VARIANT
53
What argument is there for performing videofluoro in PRAA cases?
Check caudal oesophageal motility -\> Affects px
54
Which CONCURRENT vascular malformation is commonly seen with PRAA, and can effect management?
PERSISTENT LEFT CRANIAL VENA CAVA! -\> Prevent left thoracotomy for correction
55
Where does an aberrant right subclavian artery originate? And normally?
Normally: Brachiocephalic trunk Aberrant: Direct from AA (three vessels instead), distal to LSA
56
Where do oesophageal strictures tend to occur when they result from GO reflux under GA?
Caudal to level of heart base
57
Oesophageal neoplasia is rare! List some (9)!
OSA, FSA (in S.lupi areas) SCC Adenocarcinoma Branchioma Branchial cleft cysts Papilloma Angioleiomyosarcoma Leiomyosarcoma
58
Features of Spirocerca lupi
- Tropical and subtropical locations - Mainly affects oesophagus, aorta -\> GI, resp and circulatory signs - Caudal mediastinal (oesophageal) mass =\> GRANULOMA - ALSO: ventral changes thoracic vertebra dorsal to mass Enlargement of descending Ao (aneurysm) =\> NEOPLASTIC TRANSFORMATION: OSA / FSA
59
Which radiographs are advised for S.lupi?
R lateral DV =\> avoid interpretaton of normal o fluid in LL as mass, better Ao visualisation
60
What CT features have been demonstrated in S.lupi?
Variable vascularity in non-neoplastic vs neoplastic lesions OESOPHAGEAL SARCOMAS SIG LESS ENHANCING THAN GRANULOMAS
61
How are oesophageal diverticulae categorised?
1) Congenital vs acquired 2) Acquired - Pulsion vs traction PULSION - e.g. obstruction - Most commonly between heart and diaphragm TRACTION -\> e.g. mediastinal adhesions - Most commonly cranial and midthoracic oesophagus
62
What are the reported risk factors for complications associated with Oesophageal FB? What is the reported complication rate for O FBs?
Bony FBs Bodyweight \<10kg \>3 days duration 12.7%! =\> perf, stricture, diverticula, abscess, pneumo, pleural effusion, resp arrest CERVICAL PERF BETTER PX THAN THORACIC
63
Oesophageal varices may result from which pathological states?
Portal hypertension -\> specifically, flow via L gastric into venous plexus of oesophagus Obstruction of cranial cava -\> oesophageal / paraoesophageal varices
64
What condition should be included as a DDx for oesophageal varices?
BRONCHOESOPHAGEAL ARTERY HYPERTROPHY - occurs secondary to chronic pulmonary or TE disease - Can occur concomittantly with varices

THRALL - Thom (40 decks)

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