4 - Esophagus Flashcards
What are the main indications for sx of the esophagus?
foreign bodies and esophageal feeding tubes
What are clinical signs associated with potential esophageal sx?
Regurgitation, dysphagia, ptyalism, altered appetite, coughing, dyspnea, fever, weight loss
What is regurgitation?
PASSIVE expulsion from esophagus
What is vomiting?
Centrally mediated reflux;
FORCEFUL expulsion from stomach or duodenum
What are the 3 approaches to esophageal sx?
- Cervical
- Thoracic
- Abdominal/transdiaphragmatic
Where does the thoracic esophagus get its blood supply?
Bronchoesophageal aa and segmental aortic branches
What are the 5 techniques that can be done on the esophagus?
- Esophagostomy
- Esophagectomy
- Esophagopexy
- Esophageal patching
- Esophageal substitution
What are the 4 layers of the esophagus?
- Mucosa
- Submucosa
- Muscularis
- Adventitia
What does the mucosa of the dog esophagus look like?
linear striations
What does the mucosa of the cat esophagus look like?
Distal portion = circular folds, herringbone pattern
What is the holding strength layer of the esophagus?
submucosa
The esophageal muscularis includes segmental _____.
blood supply
The esophagus has an adventitia instead of a _____. Because of this, the esophagus does not _____.
serosa, heal very well
What are 5 factors challenging healing of the esophagus?
- Segmental blood supply
- Lack of serosa and no omentum
- Constant motion and bolus distention
- Intolerance of longitudinal stretching/tension
- Passage of food and saliva
What layer should be incorporated in all sutures?
submucosa
What is an esophagotomy?
Incision into the esophageal lumen
What is an esophagectomy?
Partial resection of the esophagus
What is an esophagopexy?
Suture esophagus to another structure
What is esophageal patching?
Reinforce defect with muscle or other tissue
What is esophageal substitution?
Replace esophagus with other tissue (skin tube or intestine)
Up to ___% of the circumference can be debrided and edges apposed.
25%
What side of the esophagus should be sutured first and why?
Far side because you don’t have access to both sides
What side is the esophagus tacked to in an esophagopexy?
left
What are 3 complications of esophageal surgery?
- Leakage
- Stricture formation
- Fistula formation
What are the 8 special considerations related to surgery of the esophagus?
- Suspect concurrent aspiration pneumonia and esophagitis
- Perforations may be fatal
- Relatively fixed position; 3-5 cm resectable
- No serosa - slower sealing
- Segmental blood supply
- Constant motion: bolus passage and respiration
- 2-layer simple interrupted blosure, luminal knots
- No omentum
What conditions call for esophageal surgery?
Foreign bodies, strictures, diverticula, paraesophageal abscess, tumors, hiatal hernia, cricopharyngeal achalasia, vascular ring anomalies
What esophageal condition is not surgical?
Congenital/acquired megaesophagus
Most esophageal foreign bodies can be removed _____. Surgical removal is indicated if _____ or _____.
endoscopically, perforated, can’t be safely dislodged
What is an esophageal stricture and what are clinical signs?
Circumferential mucosal trauma;
Regurgitation +/- perforation
What are the types of esophageal diverticula and how often do we see them?
Acquired or congenital (pulsion or traction);
They are rare
How common are esophageal tumors and what type are they, usually?
They are rare and usually malignant
What is the prognosis for an esophageal tumor once it is diagnosed?
guarded/poor because it is usually at an advanged stage at the time of diagnosis
What is the most common cause of hiatal hernias and what breeds are likely to get them?
Most are congenital;
Brachycephalic breeds more prone - Sharpei, English bulldogs
What are clinical signs of hiatal hernias?
Intermittent regurgitation, dysphagia, hypersalivation
What is the prognosis for medical treatment of a hiatal hernia?
fair/good
What is the prognosis for surgical treatment of a hiatal hernia?
fair/good
What is gastroesophageal intussusception?
Invagination of the stomach and other organs into the esophagus
What dogs commonly get gastroesophageal intussusception?
Young/large breed - EX: German Shepherd
What 3 things can cause cricopharyngeal dysphagia?
- Achalasia
- Dyssynchrony
- Myasthenia gravis
What is achalasia? What breeds are prone?
Failure of cricopharyngeus muscle to completely relax or open –> interruption of bolus passage from oropharynx to esophagus
Idiopathic hypertrophy of CP m.;
Mini-Dachshunds, Small breeds
What is dyssynchrony? What breeds are prone?
Inappropriate bolus presentation to the UES;
Idiopathic - suspected neuropathy;
Golden Retrievers, Cocker Spaniels
When can achalasia be diagnosed and why?
At weaning - switch from liquid to solid food
What is the most common vascular ring anomaly and what can it lead to?
Persistent R aortic arch (95%);
Can lead to megaesophagus (cranial +/- caudal)
What breed is most prone to vascular ring anomalies?
German Shepherds
What should be ruled out if you suspect a vascular ring anomaly, especially in GSD?
Congenital megaesophagus
What are indications for placement of an esophageal feeding tube?
Oropharyngeal disease/trauma, long term feeding
What are contraindications for an esophageal feeding tube?
Esophageal disease
