Digestion & Metabolism 2: LA Esophageal Dz Flashcards
3 PORTIONS of the esophagus?
esophagus also includes the ____ down to the ____
3 portions?
1. CERVICAL
2. THORACIC
3. ABDOMINAL
PHARYNX, CARDIA
how does CHEWING work for ruminants?
after chewing, goes down into rumen and COMES BACK UP A FEW TIMES before FINALLY GOING INTO OMASUM
esophageal anatomy…
lined by WHAT kind of epithelium?
are there SECRETIONS from the esophagus?
why is the esophagus EASILY DAMAGED?
4 layers?
esophagus lined by NON-KERATINIZED STRATIFIED SQ EPITHELIUM
NO SECRETIONS, so needs MOISTURE FROM SALIVA
easily damaged bc skin is NON-KERATINIZED
4 layers?
1. non-keratinized stratified squamous epithelium
2. submucosa
3. skeletal & smooth muscle
4. adventitia
HORSES vs. RUMINANT esophagus?
in HORSES, top is 2/3 SKELETAL muscle, then SMOOTH MUSCLE
in RUMINANTS, WHOLE THING IS SKELETAL MUSCLE due to need for REGURGITATION during rumination
diagnosis of LA esophageal dz…
MOST patients can be diagnosed with a really good what 2 things?
what other 2 diagnostics are most important for LA esophageal dz?
MOST patients can get dx via GOOD HISTORY & PE
2 other diagnostics?
1. ESOPHAGOSCOPY
2. PLAIN AND CONTRAST RADIOGRAPHY
what animals are PREDISPOSED to getting ESOPHAGEAL DZ? & include why (3)
which animal is NOT likely to get esophageal dz?
- GERIATRIC horses = teeth constantly erupting and GRINDING DOWN FOOD prior to swallowing, so OBSTRUCTION common
- FRESIAN BREED = likely to get MEGAESOPHAGUS or ESOPHAGEAL PERFORATION
- CAMELIDS = likely to get MEGAESOPHAGUS
RUMINANTS = RARELY get esophageal dz
DIET (2), DENTAL CARE (1) & VACCINE Hx (1) in ESOPHAGEAL Dz
DIET…
1. more likely to CHOKE ON ALFALFA CUBES and CARROTS
2. feeding an OLD HORSE HAY can cause PERFORATION/damage bc DOESN’T HAVE ENOUGH TEETH TO CHEW IT
DENTAL CARE…
1. history of QUIDDING = food DROPPING OUT OF MOUTH bc CHUNKS TOO BIG
VACCINE HISTORY…
1. DYSPHAGIA can be a SIGN OF RABIES
notable clinical signs in esophageal dz (5)
- DYSPHAGIA = difficulty or discomfort swallowing, and ESOPHAGUS IS THE LAST PHASE OF SWALLOWING
- SALIVA/FEED from NARES or MOUTH
- REGURGITATION (passive action)
- BRUXISM = GRINDING TEETH, manifestation of discomfort in esophagus/stomach
- PTYALISM = SALIVATION/FROTHING at mouth
four PE things we should do for ESOPHAGEAL DZ?
- RECTAL TEMP = for PERFORATION or ASPIRATION (if inc)
- RR/RE/HR
- MMs
- BORBORYGMI
when do we put in a NASOGASTRIC TUBE?
if we KNOW the horse has CHOKE (esophageal obstruction), then DO THIS IMMEDIATELY!!
ESOPHAGOSCOPY…
need to use WHAT SIZE endoscope for ADULT horses?
what 2 big causes of dz can we see?
how can this help with monitoring?
what is this tool NOT helpful for examining?
3 METER ENDOSCOPE for VIDEO
2 big causes…
1. ESOPHAGEAL OBSTRUCTION causing CHOKE
2. ESOPHAGEAL ULCERATION
can use this to MONITOR HEALING/TREATMENT EFFICACY
NOT HELPFUL FOR EXAMINING ESOPHAGEAL STRICTURES because we would need to DISTEND ESOPHAGUS, and this is not often done
ID LESION & DIAGNOSTIC TOOL
ULCERATIONS in ESOPHAGUS taken via VIDEO ESOPHAGOSCOPY
ID LESION & what TOOL we SHOULDN’T USE to visualize this
ESOPHAGEAL STRICTURE, ESOPHAGOSCOPY IS NOT GOOD FOR THIS
PLAIN & CONTRAST RADS for esophagus…
which one is BETTER for esophageal dz?
allows us to visualize WHAT lesion that esophagoscopy cannot?
what ELSE can it visualize?
CONTRAST rads are better for ESOPHAGUS
can VISUALIZE ESOPHAGEAL STRICTURES
can also visualize ESOPHAGEAL DIVERTICULUM, usually associated with STRICTURES
ID LESION on this CONTRAST RADIOGRAPHY
ESOPHAGEAL STRICTURE
ID LESION on this CONTRAST RADIOGRAPHY
ESOPHAGEAL DIVERTICULUM, there’s an obstruction so ESOPHAGUS IS DILATED
what is the BEST METHOD to diagnose MEGAESOPHAGUS?
CONTRAST RADIOGRAPHY
ID LESION on CONTRAST RAD
MEGAESOPHAGUS
THORACIC US/RADS…
if we suspect a horse has an ____ _____, we ALWAYS DO AN ____
AUSCULTATION in HORSES is NOT…
ESOPHAGEAL OBSTRUCTION, US (on the thorax)
NOT VERY SENSITIVE IN HORSES, better to visualize
what happens when the ESOPHAGUS RUPTURES?
PLEURAL EFFUSION & PLEURAL PNEUMONIA
ID LESION ON US
ESOPHAGEAL PERFORATION
2 CBC findings for esophageal dz? only done if we’re concerned about WHAT dz/see WHAT value?
2 things we can assess with CHEM?
what do they help DO for dz?
CBC = can see ELEVATED…
1. SAA
2. FIBRINOGEN
–> done mostly if concerned about ASPIRATION PNEUMONIA (fibrinogen >1,000)
CHEM =
1. check ELECTROLYTES to ASSESS DEHYDRATION
2. CREATININE CONCENTRATION should be checked to confirm KIDNEY FUNCTION
CBC/CHEM only help MONITOR dz, NOT DIAGNOSE!
ESOPHAGEAL OBSTRUCTION, “CHOKE”…
commonality?
what 2 equines are PREDISPOSED?
3 COMMON etiologies?
1 UNCOMMON etiology?
frequency/what it can cause?
the obstruction could POTENTIALLY…
VERY common in horses, SEEN OFTEN IN PRIMARY CARE
predisposed?
1. GERIATRIC horses
2. PONIES
COMMON etiologies?
1. POOR DENTITION
2. behavior –> if greedy/eat too fast, have PROBLEMS SWALLOWING
3. from EATING after SEDATION
RARE etiology?
1. FOREIGN BODY
frequency? = this can become a RECURRENT PROBLEM and cause STRICTURE
obstruction could POTENTIALLY RESOLVE SPONTANEOUSLY
WHERE can esophageal obstruction/choke OCCUR? (3 locations)
- JUST PAST THE PHARYNX –> WORRY ABOUT ASPIRATION
- THORACIC INLET
- AT BASE OF HEART (just before entering stomach)
in CHOKE, nasogastric intubation is both ___ & ____
how do we know when NG tube is IN STOMACH? (2)
DIAGNOSTIC & THERAPEUTIC
NG tube in stomach?
1. SMELL
2. GAS can be heard over DIAPHRAGM
TREATMENT for esophageal obstruction/choke…
if it RESOLVES? (4)
if UNRESOLVED? (4)
if UNRESOLVED but NOW RESOLVED? (3)
if UNRESOLVED and PERSISTENT? (1)
if it RESOLVES…
1. SOFT FEED for a few days
2. SUCRALFATE (protective barrier over GI mucosa)
3. NSAIDs for 24 hours
4. MONITOR
if UNRESOLVED…
1. ESOPHAGOSCOPY
2. IV FLUIDS/ANTIMICROBIALS/NSAIDS
3. PERIODICALLY LAVAGE esophagus with horse SEDATED
4. NPO (no food)
if UNRESOLVED but NOW RESOLVED…
1. ASSESS INJURY/ASPIRATION PNEUMONIA
2. transition from SOFT FEED to NORMAL FEED SLOWLY
3. NSAIDs/SUCRALFATE
if UNRESOLVED & PERSISTENT…
1. GA to REMOVE OBSTRUCTION
why should we MONITOR for ESOPHAGEAL STRICTURES?
how QUICKLY does the esophagus remodel?
ESOPHAGUS REMODELS in 30-60 DAYS
if STRICTURES FORM, CAN CAUSE OBSTRUCTION –> CHOKE
esophageal perforation is often…
FATAL
VASCULAR RING ANOMALY = ???
it can cause WHAT?
occurs when the AORTA ENCIRCLES & CONSTRICTS around both TRACHEA & ESOPHAGUS
can POTENTIALLY cause ESOPHAGEAL OBSTRUCTION/CHOKE
if esophageal obstruction is RECURRENT, what UNDERLYING DZs should we consider? (8, including ONE RARE ONE)
- VASCULAR RING ANOMALY
- GRANULATION TISSUE
- NEOPLASIA
- STRICTURE
- MEGAESOPHAGUS
- DIVERTICULUM
- GASTRIC IMPACTION
- OTHER diseases causing PHARYNGEAL/LARYNGEAL dysfunction, but RARE
TREATMENT for esophageal strictures… (4)
- DIET MANAGEMENT until REMODELING occurs
- BOUGIENAGE = difficult & usually UNSUCCESSFUL
- MYOTOMY = cut muscles so esophagus can EXPAND, only done if EXTERNAL trauma caused injury to muscle
- ESOPHAGOSTOMY = put a tube down esophagus that exits through SKIN
ID PROCEDURE & WHY IT’S BEING DONE
what DIRECTION do we enter the INCISION from?
ESOPHAGOSTOMY for ESOPHAGEAL STRICTURE
VENTRAL incision
ESOPHAGEAL DIVERTICULUM…
2 lesions w/ commonality & what they are
- PULSION = RARE
–> occurs when there’s DAMAGE TO THE MUSCLE LAYER OF ESOPHAGUS, so OTHER LAYERS BULGE OUT - TRACTION = MUCOSA & SUBMUCOSA PULLED OUT
TRACTION esophageal diverticulum…
is usually secondary to WHAT 2 THINGS?
how is it DIAGNOSED?
how does it PRESENT/what is it USED FOR?
secondary to…
1. CERVICAL TRAUMA
2. ESOPHAGOSTOMY
diagnosis? = CONTRAST RADS
presentation/use?
1. SUBCLINICAL
2. used usually for ESOPHAGEAL STRICTURES
MEGAESOPHAGUS…
what 2 species are predisposed?
give one reason for one, 2 for another
6 clinical signs?
diagnosed via…
2 species?
1. CAMELIDS
2. FRESIAN HORSE BREED
CAMELID = mostly UNKNOWN
FRESIAN =
1. GENETIC CT DISORDER
2. CHRONIC ESOPHAGEAL DILATION
6 clinical signs?
1. WEIGHT LOSS
2. DYSPHAGIA
3. POSTPRANDIAL REGURGITATION
4. PTYALISM
5. FROTHING at mouth
6. ABNORMAL RUMINATION (camelids)
diagnosed via CONTRAST RADS
TREATMENT of megaesophagus…
is MOSTLY ___ ____
and if not, likely ____ is the next best option
prognosis?
is MOSTLY DIETARY MANAGEMENT!
EUTHANASIA is likely the next best option
POOR PROGNOSIS
ESOPHAGEAL PERFORATION…
history/causes? (5, first 2 common, last is uncommon)
5 clinical signs?
treatment? (trick question)
history/causes?
1. ESOPHAGEAL OBSTRUCTION = COMMON
2. NG TUBE PASSAGE = COMMON
3. FOREIGN BODY
4. MEGAESOPHAGUS
5. TRAUMA = NOT COMMON
clinical sings?
1. DULL DEMEANOR
2. FEVER
3. TACHYCARDIA/TACHYPNEA
4. INJECTED MMs
5. RELUCTANCE to eat/swallow
THIS DISEASE CANNOT BE TREATED!! but SOMETIMES can do ESOPHAGOSTOMY
