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Digestive System > Clinical Approach to Dysphagia and Regurgitation (Winston) > Flashcards

Clinical Approach to Dysphagia and Regurgitation (Winston) Flashcards

1
Q

The Oropharyngeal phase contains the:

A
  • Oral
  • Pharyngeal
  • Cricopharyngeal (UES relaxation)
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2
Q

What is a cardinal sign of esophageal disease?

A

Regurgitation

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3
Q

Diagnosis of swallowing disorders:
The following is a signalment for a…
- Congenital disease
- Cleft palate
- Cricopharyngeal achalasia (golden)
- Congenital megaesophagus (great dane)
- Vascular ring anomaly
- Hiatal hernia (shar pei, bull dog)
- Esophageal foreign body
- Infectious disease (uncommon)

A

Young Animal

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4
Q

Diagnosis of swallowing disorders:
The following is a signalment for a…
- Degenerative disease
- Acquired neuromuscular disorder
- Idiopathic Megaesophagus (german)
- Neoplasia

A

Older Animal

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5
Q

(T/F) Dysphagia is common in cats

A

False, it is uncommon. Usually secondary issues structural abnormalities

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6
Q

(T/F) If a cat comes in after having doxycycline, it may come in with esophageal stricture

A

True

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7
Q

Definition:
Is an abnormal tightening or narrowing of the esophagus

A

esophageal stricture

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8
Q

A patient presents with dysphagia, what do you think this animal has?
Clinical Signs include:
- Hypersalivation, gagging, multiple swallowing attempts
- +/- poor drinking ability
- +/- dropping food

A

Oropharyngeal disease

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9
Q

Fluoroscopic barium swallowing study to localize the functional cause of dysphagia:
Failure to prehend food, masticate food, form food bolus at base of the tongue, thrust food bolus into pharynx

A

Oral Dysphagia

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10
Q

Fluoroscopic barium swallowing study to localize the functional cause of dysphagia:
Failure to contract due to neuromuscular weakness or fibrosis

A

Pharyngeal Dysphagia

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11
Q

Fluoroscopic barium swallowing study to localize the functional cause of dysphagia:
Failure of UES to relax or failure to contract or does not relax at the right time

A

Cricopharyngeal Dysphagia

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12
Q

What do you HAVE to rule out first?
- Structural disease or Functional disease

A

Structural disease

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13
Q

A patient comes in with regurgitation, what do you think it is?
Clinical signs include:
- Normal drinking ability
- No dropping of food
- +/- Dysphagia
- +/- Hypersalivation, gagging, & multiple swallowing attempts

A

Esophageal disease

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14
Q

A patient with abnormal LES relaxation can present with:

A
  • Regurgitation
  • Reflux
  • Repeated swallowing
  • +/- Cough
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15
Q

A patient that has regurgitation, reflux, repeated swallowing, +/- cough, AND determined to have an abnormal LES relaxation…

A

Gastroesophageal disease

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16
Q

(T/F) Aspiration pneumonia is a common complication of dysphagia in dogs and cats

A

True

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17
Q

(T/F) When distinguishing regurgitation from vomiting, rely exclusively on what the “vomit” looks like

A

False

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18
Q

What diagnostic plans rule out structural disease?

A
  • Radiograph of the thorax AND neck
  • Esophagoscopy (esophageal endoscopy)
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19
Q

(T/F) Radiographs can rule-in esophageal disease, but when the thoracic radiographs are normal you cannot rule it out

A

True

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20
Q

(T/F) Esophagoscopy can rule-out structural disease, but does not give you any information about esophageal function

A

True

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21
Q

What diagnostic plan rules out functional disease?

A

Barium swallowing study (fluoroscopic)

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22
Q

Definition:
Acute or chronic inflammatory disorder of the esophageal mucosa

A

Esophagitis

23
Q

What is the most commonly recognized cause of reflux esophagitis in dogs and cats?

A

Recent general anesthesia
*Endogenous cause

24
Q

“Pill-induced” esophagitis in cats is most commonly caused by what drugs?

A
  • Doxycycline
  • Clindamycin
    *Exogenous cause
25
Q

What can gastroesophageal reflux under general anesthesia result on?

A
  • Reflux esophagitis
  • Esophageal strictures
  • Aspiration pneumonia
26
Q

Why is general anesthesia may predispose to reflux esophagitis?

A
  • decrease LES pressure
  • anesthesia inhibits esophageal motility and clearance
  • body position and gravity
  • lack of endotracheal tube
27
Q

(T/F) Endoscopy is more sensitive than radiography for detecting esophagitis

A

True

28
Q

(T/F) PPIs are superior to H2 receptor antagonists in raising gastric pH (more basic)

A

True, especially important for esophagitis involving the DISTAL esophagus

29
Q

What is the ideal treatment for mild esophagitis?

A

Minimal treatment, feeding smaller-sized fat-restricted meals (enhanced gastric emptying)
- prognosis is good

30
Q

What is the ideal treatment for moderate to severe esophagitis?

A

Gastric acid suppression and prokinetics
- prognosis is guarded or poor in severe cases

31
Q

Treatment for esophagitis:
Binds to eroded mucosa and promotes effective mucosal barrier protection

A

Sucralfate

32
Q

Treatment:
List the gastric acid suppression proton pump inhibitors:

A

Omeprazole

33
Q

Treatment for esophagitis:
List the gastric acid suppression H2 receptor antagonists:

A

Famotidine & Ranitidine

34
Q

Esophagitis treatment:
What is a more potent prokinetic and is more effective at reducing GER in dogs?

A

Cisapride (compared to metoclopramide)

35
Q

The following clinical signs are for…
- gagging, salivation, dysphagia, regurgitation/vomiting (ACUTE)
- Depression, anorexia
- Cough, dyspnea, and fever
- Palpable cervical esophageal mass
(Warning: Aspiration pneumonia, esophageal perforation)

A

Esophageal Foreign Body

36
Q

(T/F) Surgical removal (esophagotomy) only if endoscopic failure

A

True

37
Q

What can be some complications if the FB is left for too long in the esophageal?

A
  • Esophagitis (which may heal as a stricture)
  • Esophageal perforation
38
Q

Definition:
Abnormal narrowing of the esophageal lumen

A

Esophageal Stricture

39
Q

Oral doxycycline/clindamycin tablets in cats is one of the most common causes for _______________

A

Esophageal Stricture

40
Q

The following are clinical signs for…
- Initially, subtle “hard to swallow” that can be missed by owners
- Progressive dysphagia and odynophagia (painful swallowing) for solid foods
- Regurgitation
- Ravenous appetite
- Weight loss

A

Esophageal Stricture

41
Q

What is a definitive procedure for differentiating benign from malignant esophageal stricture?

A

Esophagoscopy

42
Q

(T/F) A balloon dilation of esophageal stricture is typically a “one and done” procedure

A

False, it typically requires multiple dilations under general anesthesia every 5-7 days (average is 3 to 5 times)

43
Q

Defenition:
Congenital malformation of great vessels and branches that entraps the intrathoracic esophagus

A

Vascular Ring Anomaly

44
Q

What is the most common vascular ring anomaly in dogs and cats?

A

Persistent right aortic arch (PRAA)

45
Q

The following clinical signs are describebing …
- Regurgitation of solid food at weaning
- Usually < 6 months of age
- Weight loss or failure to gain weight (despite a good appetite)
- Cough, dyspnea, fever, pulmonary crackles (Secondary to aspiration pneumonia)

A

Vascular Ring Anomaly

46
Q

Signalment (young animal) and compatible history of regurgitation during weaning are highly suggestive of a ________________________

A

Vascular Ring Anomaly (german, Irish setters)

47
Q

Definition:
Severe lack of motility of the esophagus resulting in a dilated flaccid esophagus

A

Megaesophagus

48
Q

Although there are many potential causes of megaesophagus in dogs, what is the most common diagnosis?

A

Idiopathic Megaesophagus

49
Q

(T/F) Megaesophagus is also common in cats

A

False, it is uncommon in cats, Hiatial hernia and reflux esophagitis appear to be important underlying causes

50
Q

When considering megaesophagus as a diagnosis, what do you need to make sure to rule out first?

A

Rule out obstruction in the distal esophagus as this can also result in a diffusely dilated esophagus

51
Q

List some of the secondary causes of Megaesophagus:

A
  • Neurogenic
  • Neuromuscular junction (myasthenia gravis, others)
  • Muscular (myopathy, myositis)
  • Other (hypoadrenocorticism, lead toxicity, etc.)
52
Q

What is the first part of the diagnosis of megaesophagus and complications?

A
  • Survey neck and thoracic radiographs
  • Barium swallow (tend not to do them)
53
Q

Myasthenia gravis accounts for 25-30% of dogs with acquired megaesophagus. Therefore, an _____________________ (for diagnosis of myasthenia gravis) should be performed in every dog with acquired megaesophagus.

A

acetylcholine receptor antibody titer

54
Q

______________ may present with facial, pharyngeal, laryngeal, and esophageal involvement without appendicular weakness and mimic idiopathic megaesophagus.

A

Focal myasthenia

Digestive System (7 decks)

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