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Thrall > Chapter 27 - Esophagus > Flashcards

Chapter 27 - Esophagus Flashcards

1
Q

What structures make up the upper esophageal sphincter?

A

Cricopharyngeus

Thyropharyngeus

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2
Q

What is the path of the esophagus - where does it lie in regards to the trachea?

A

Proximal - ventral and to the right of the trachea
Cervical - slightly to left of trachea
Thoracic inlet - to the left of trachea and courses dorsally

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3
Q

What are hte layers of the esophagus?

A

fibrous, muscular, submucosa, mucosa

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4
Q

What is the difference between a dog and cat esophagus histologically?

A

Dog - striated the entire length

Cat - caudal third is smooth muscle - striated/herringbone appearance

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5
Q

What is the blood supply to the esophagus?

A

Thyroid arteries - supply cervical portion
Bronchoesophageal artery - cranial 2/3 of thoracic portion
Esophageal branches of aorta/intercostal arteries - supply remaining intra-thoracic structures
Left gastric - terminal most portion fo esophagus/sphincter

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6
Q

What are radiographic signs of esophageal disease? (very general)

A

Increased opacity of mediastinum - foreign body, retention of ingesta, esophageal mass

Increased radiolucency of mediastinum: esophageal dilation, pneumomediastinum, pneumothorax

Ventral displacement of trachea
Tracheal stripe
Visaulization of longus colli
Pleural effusion
Aspiration pneumonia
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7
Q

What are broad categories of causes for dysphagia?

A

morphologic

functional

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8
Q

What are the phases of swallowing?

A

Oropharyngeal, esophageal and gastroesophageal

Oropharyngeal phase contains 3 portions: oral, pharyngeal, pharyngoesophageal phase.

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9
Q

The first stage of swallowing has 3 stages. What are they?

A

Oropharyngeal phase

1) oral
2) pharyngeal
3) pharyngoesophageal

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10
Q

Describe the three oropharyngeal stages in the oropharyngeal phase of swallowing.

Normal swallowing in the dog: a cineradiographic study VRU 1979

A

Oral: voluntary stage. Stripping action of tongue to organize a bolus in the oropharynx. Bolus formation at the oropharynx elicits the next 2 stages

Pharyngeal: Peristaltic cranial contraction of pharynx and propulsion of bolus from the tongue into the laryngopharynx. Blockage of egresses (tongue - plunger like action to roof of mouth to block oropharynx, pharyngeal arch - nasopharynx, and epiglottis - larynx). At time of pharynx contraction - cricopharyngeal sphincter opened and allowed passage of bolus into the esophagus.

Pharyngoesophageal stage - closure of cricopharyngeal sphincter and relaxation of pharynx, epiglottis, tongue and pharyngeal arch.

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11
Q

Morphologic vs functional causes of dysphagia?

Quantitative evaluation of pharyngeal function in the dog. VRU 41.5

A

Morphologic: foreign body, neoplasia, trauma
Functional: inability of muscles to relax, incoordination of ontraction, flaccidity of muscles

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12
Q

What will dogs with oral dysphagia do clinically?

What will radiographic signs appear?

A

Clinically: animal will not be able to prehend, form a bolus, or transport the bolus tot he pharynx

Signs: dropping food, drooling, lots oflicking

Fluoro: retention of contrast in oropharynx, lack of contrast in pharynx, pooling in vestibule

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13
Q

What will a pharyngeal dysphagia appear as?

On fluoroscopic exam, how will this appear?

A

Multiple swallowing attempts before moving a bolus into the proximal esphagus

Having this abnormality on its own is rare (usually in conjunction with cricopharyngeal phase)

Abnormality in pharyngeal contraction (incomplete enclosure of the bolus, incomplete rostral and dorsal movement of bolus into the larynx, absent contraction forcing bolus through the UES)

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14
Q

What will a dog with a cricopharyngeal dysphagia appear as clinically? on fluoroscopic examination?

A

Clinically - failure of the cricopharyngeal sphincter to open fully (achalasia) or at the appropriate time with contraction of pharynx (dyssynchrony)

Time from onset of swallowing (closure of epiglottis) to opening of sphincter is dealyed

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15
Q

What is normal opening times for the cricopharyngeal sphincter after closure of the epiglottis for liquids? kibble?

A
  1. 09s for liquids

0. 1s for solids

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16
Q

What is abnormal opening times for the cricopharyngeal sphincter after closure of the epiglottis for liquids in dogs with dysphagia? kibble?

A
  1. 31s for liquids

0. 37s for solids

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17
Q

What is achalasia vs chalasia?

A

Achalasia - not fully relaxing

Chalasia - not maintaining positive pressure between swallows

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18
Q

What mechanisms are important in the oral phase of swallowing?

A 
hyoid apparatus
tongue
facial nerve
vagus nerve
hypoglossal nerve
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19
Q

What structures are important in the pharyngeal phase?

A

pharyngeal musculature
facial nerve
vagus nerve
glossopharyngeal nerve

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20
Q

What are fluoroscopic features are seen in the oral phase of dysphagia?

A 
Bolus not formed or delaye dformation
Bolus not propelled to pharynx
weak plungerlike movement of tongue
weak pharyngeal contractions
subsequent phases are normal
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21
Q

What are fluoroscopic features are seen in the pharyngeal phase of dysphagia?

A

normal oral stage
remains synchronous with cricopharyngeal phase
retention of contrast medium int eh pharynx
no change im time to cricopharyngeal sphicnter opening
inadequate pharyngeal contraction
mis-direction of bolus into larynx or nasopharynx

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22
Q

What are fluoroscopic features are seen in the cricopharyngeal chalasia?

A

Relaxation of incompetence of cricopharyngeal sphincter
Prolonged opening time of scphincter
Weak pharyngeal contractions may be present
aspiration of contrast into lraynx or trachea

23
Q

What are fluoroscopic features are seen in the cricopharyngeal achalasia?

A

incomplete or lack of opening of the cricopharyngeal sphincter
vigorous attempts to pass bolus to cricopharyngeal sphincter
synchrony/timing with pharyngeal contraction is off
delayed opening time of sphincter
barium tention
aspiration of contrast

24
Q

What are causes of cricopharyngeal achalasia?

A

idiopathic

25
Q

Causes for cricopharyngeal chaslaia

A

cricopharyngeus myotomy
radiation therapy
myasthenia gravis

26
Q

Causes for pharyngeal dysphagia?

A 
myositis/myopathy
cricopharyngeus myectomy
NM disease
inflammation
trauma
idiopathic
27
Q

Causes for oral dysphagia

A

NM disease
inflammation
oral foreign body
tongue abscess

28
Q

Disease of what structures may lead to generalized esophageal dilation?

A

disease of neuromuscular junction (myasthenia), striated muscle (myositis), peripheral nerves (polyneuropathy), CNS disease (toxin, neoplasia)

29
Q

DDx for dilated esophagus?

A 
hypothyroidism
hypoadrenocorticism
myasthenia
thymoma
idiopathic
VRA
lead/organophosphates other toxins
esophagitis
30
Q

What are the two types of hernias associated with the esophageal hiatus?

A

sliding hiatal hernia

paresophageal hernias

31
Q

Which breed is pre-disposed to sliding hiatal hernias?

A

shar-peis

32
Q

What is a sliding hiatal hernia

A

caudal esophageal sphincter and part of the gastric fundus move in and out of the caudal mediastinum through a weakened esophageal hiatus at the diaphragm.

33
Q

What does a sliding hiatal hernia appear like on radiographs?

A

soft tissue/gas between aorta and CVC on lateral radiographs that silhouettes with the cranial diaphragmatic contour

34
Q

What is a paresophageal hernia?

A

fundus herniated within the mediastinum alongside of the esophagus with the caudal esophageal sphincter remaining in the abdomen

35
Q

What is gastroesophageal intussusception, how does this differ radiographically from other hernias?

A

Stomach/spleen evert into the esophageal lumen

(a) Feature that distinguishes gastroesophageal intussusception from sliding/paraesophageal hernia is sharply marginated cranial edge of intussusceptum contrast against gas-filled esophageal lumen

36
Q

What are most common locations for an esophageal foreign body?

A

thoracic inlet
base of heart
cranial to diaphragm

37
Q

What are contraindications for performing a positive contrast esophageal/swallow study?

A

Concern for perforation, evidence of pneumomediastinum, pleural fluid

Use a non-ionic compound instead

38
Q

What are the types of vascular ring anomalies? (VRA)

A

Types 1-7
1-3 - persistent right aortic arch
IV - double aortic arch
V-VII - left aortic arch with persistent right ligamentum arteriosum and subclavian arteries

39
Q

What is the most common type of VRA?

Why do these occur embryologically/anatomically

A

persistent right aortic arch

Normally - aortic arch, MPA, interconnecting ligamentum arteriosum are all on the left side of the trachea and esophagus

If aortic arch persists on the right side - leads to entrapment by lgiament arteriosum between the right sided aorta and the left pulmonary artery

40
Q

What is difference between a right fourth aortic arch VRA and a subclavian artery?

A

Subclavian is more cranially located (not over heart base)

41
Q

What structure will be displaced by a VRA, and which direction?

A

Trachea

ventrally and towards the left side

42
Q

DDx for esophagitis?

A

infection, corrosive substances, vomiting, GE reflux, obstruction with FB, megaesophagus

43
Q

What does esophagitis appear like on contrast study?

A

segmental narrowing, irregular contour, indistinct folds, thickened esophageal wall

44
Q

What are common causes of esophageal strictures?

A

Secondary to FB or reflux

45
Q

What can cause an extramural narrowing of the esophagus?

A

lymphadenopathy
abscess
neoplasia

46
Q

Most common esophageal tumor?

A

neoplastic transformation of spirocerca lupi granulomas –> osteosarcoma

47
Q

What are differentials for esophageal diverticula?

A

Acquired: esophagitis, strictures, ucleration from FB, VRA, periesophageal inflammation, hiatal hernia, parasites

48
Q

What are two forms of esophageal diverticula?

A

Pulsion or traction

49
Q

What is a pulsion diverticula?

A

Increased intraluminal pressure from FB or chronic functional obstruction

50
Q

What is a traction diverticula?

A

adhesions on esophageal wall

51
Q

What do diverticular appear like radiographically?

A

Circumscribed soft tissue mass or outpouching of esophagus which may be filled with impacted ingesta/contrast, or air/soft tissue

52
Q

What are esophageal fistulas?

A

abnormal communication between esophagus and other structures.

53
Q

What is most common congenital esophageal fistula?

A

Bronchoesophageal is the most common congenital

54
Q

What is most common acquired esophageal fistulas?

A

communication with the lung or trachea

Thrall (4 decks)

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