Digestion & Metabolism 2: LA Esophageal Dz

Question 1

3 PORTIONS of the esophagus?

esophagus also includes the ____ down to the ____

Answer 1

3 portions?
1. CERVICAL
2. THORACIC
3. ABDOMINAL

PHARYNX, CARDIA

Question 2

how does CHEWING work for ruminants?

Answer 2

after chewing, goes down into rumen and COMES BACK UP A FEW TIMES before FINALLY GOING INTO OMASUM

Question 3

esophageal anatomy…
lined by WHAT kind of epithelium?
are there SECRETIONS from the esophagus?
why is the esophagus EASILY DAMAGED?
4 layers?

Answer 3

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

Question 4

HORSES vs. RUMINANT esophagus?

Answer 4

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

Question 5

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?

Answer 5

MOST patients can get dx via GOOD HISTORY & PE

2 other diagnostics?
1. ESOPHAGOSCOPY
2. PLAIN AND CONTRAST RADIOGRAPHY

Question 6

what animals are PREDISPOSED to getting ESOPHAGEAL DZ? & include why (3)

which animal is NOT likely to get esophageal dz?

Answer 6

1. GERIATRIC horses = teeth constantly erupting and GRINDING DOWN FOOD prior to swallowing, so OBSTRUCTION common
2. FRESIAN BREED = likely to get MEGAESOPHAGUS or ESOPHAGEAL PERFORATION
3. CAMELIDS = likely to get MEGAESOPHAGUS

RUMINANTS = RARELY get esophageal dz

Question 7

DIET (2), DENTAL CARE (1) & VACCINE Hx (1) in ESOPHAGEAL Dz

Answer 7

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

Question 8

notable clinical signs in esophageal dz (5)

Answer 8

1. DYSPHAGIA = difficulty or discomfort swallowing, and ESOPHAGUS IS THE LAST PHASE OF SWALLOWING
2. SALIVA/FEED from NARES or MOUTH
3. REGURGITATION (passive action)
4. BRUXISM = GRINDING TEETH, manifestation of discomfort in esophagus/stomach
5. PTYALISM = SALIVATION/FROTHING at mouth

Question 9

four PE things we should do for ESOPHAGEAL DZ?

Answer 9

1. RECTAL TEMP = for PERFORATION or ASPIRATION (if inc)
2. RR/RE/HR
3. MMs
4. BORBORYGMI

Question 10

when do we put in a NASOGASTRIC TUBE?

Answer 10

if we KNOW the horse has CHOKE (esophageal obstruction), then DO THIS IMMEDIATELY!!

Question 11

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?

Answer 11

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

Question 12

ID LESION & DIAGNOSTIC TOOL

Answer 12

ULCERATIONS in ESOPHAGUS taken via VIDEO ESOPHAGOSCOPY

Question 13

ID LESION & what TOOL we SHOULDN’T USE to visualize this

Answer 13

ESOPHAGEAL STRICTURE, ESOPHAGOSCOPY IS NOT GOOD FOR THIS

Question 14

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?

Answer 14

CONTRAST rads are better for ESOPHAGUS

can VISUALIZE ESOPHAGEAL STRICTURES

can also visualize ESOPHAGEAL DIVERTICULUM, usually associated with STRICTURES

Question 15

ID LESION on this CONTRAST RADIOGRAPHY

Answer 15

ESOPHAGEAL STRICTURE

Question 16

ID LESION on this CONTRAST RADIOGRAPHY

Answer 16

ESOPHAGEAL DIVERTICULUM, there’s an obstruction so ESOPHAGUS IS DILATED

Question 17

what is the BEST METHOD to diagnose MEGAESOPHAGUS?

Answer 17

CONTRAST RADIOGRAPHY

Question 18

ID LESION on CONTRAST RAD

Answer 18

MEGAESOPHAGUS

Question 19

THORACIC US/RADS…
if we suspect a horse has an ____ _____, we ALWAYS DO AN ____
AUSCULTATION in HORSES is NOT…

Answer 19

ESOPHAGEAL OBSTRUCTION, US (on the thorax)

NOT VERY SENSITIVE IN HORSES, better to visualize

Question 20

what happens when the ESOPHAGUS RUPTURES?

Answer 20

PLEURAL EFFUSION & PLEURAL PNEUMONIA

Question 21

ID LESION ON US

Answer 21

ESOPHAGEAL PERFORATION

Question 22

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?

Answer 22

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!

Question 23

ESOPHAGEAL OBSTRUCTION, “CHOKE”…
commonality?
what 2 equines are PREDISPOSED?
3 COMMON etiologies?
1 UNCOMMON etiology?
frequency/what it can cause?
the obstruction could POTENTIALLY…

Answer 23

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

Question 24

WHERE can esophageal obstruction/choke OCCUR? (3 locations)

Answer 24

1. JUST PAST THE PHARYNX –> WORRY ABOUT ASPIRATION
2. THORACIC INLET
3. AT BASE OF HEART (just before entering stomach)

Question 25

in CHOKE, nasogastric intubation is both ___ & ____ how do we know when NG tube is IN STOMACH? (2)

Answer 25

DIAGNOSTIC & THERAPEUTIC NG tube in stomach? 1. SMELL 2. GAS can be heard over DIAPHRAGM

Question 26

TREATMENT for esophageal obstruction/choke... if it RESOLVES? (4) if UNRESOLVED? (4) if UNRESOLVED but NOW RESOLVED? (3) if UNRESOLVED and PERSISTENT? (1)

Answer 26

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

Question 27

why should we MONITOR for ESOPHAGEAL STRICTURES? how QUICKLY does the esophagus remodel?

Answer 27

ESOPHAGUS REMODELS in 30-60 DAYS if STRICTURES FORM, CAN CAUSE OBSTRUCTION --> CHOKE

Question 28

esophageal perforation is often...

Answer 28

FATAL

Question 29

VASCULAR RING ANOMALY = ??? it can cause WHAT?

Answer 29

occurs when the AORTA ENCIRCLES & CONSTRICTS around both TRACHEA & ESOPHAGUS can POTENTIALLY cause ESOPHAGEAL OBSTRUCTION/CHOKE

Question 30

if esophageal obstruction is RECURRENT, what UNDERLYING DZs should we consider? (8, including ONE RARE ONE)

Answer 30

1. VASCULAR RING ANOMALY 2. GRANULATION TISSUE 3. NEOPLASIA 4. STRICTURE 5. MEGAESOPHAGUS 6. DIVERTICULUM 7. GASTRIC IMPACTION 8. OTHER diseases causing PHARYNGEAL/LARYNGEAL dysfunction, but RARE

Question 31

TREATMENT for esophageal strictures... (4)

Answer 31

1. DIET MANAGEMENT until REMODELING occurs 2. BOUGIENAGE = difficult & usually UNSUCCESSFUL 3. MYOTOMY = cut muscles so esophagus can EXPAND, only done if EXTERNAL trauma caused injury to muscle 4. ESOPHAGOSTOMY = put a tube down esophagus that exits through SKIN

Question 32

ID PROCEDURE & WHY IT'S BEING DONE what DIRECTION do we enter the INCISION from?

Answer 32

ESOPHAGOSTOMY for ESOPHAGEAL STRICTURE VENTRAL incision

Question 33

ESOPHAGEAL DIVERTICULUM... 2 lesions w/ commonality & what they are

Answer 33

1. PULSION = RARE --> occurs when there's DAMAGE TO THE MUSCLE LAYER OF ESOPHAGUS, so OTHER LAYERS BULGE OUT 2. TRACTION = MUCOSA & SUBMUCOSA PULLED OUT

Question 34

TRACTION esophageal diverticulum... is usually secondary to WHAT 2 THINGS? how is it DIAGNOSED? how does it PRESENT/what is it USED FOR?

Answer 34

secondary to... 1. CERVICAL TRAUMA 2. ESOPHAGOSTOMY diagnosis? = CONTRAST RADS presentation/use? 1. SUBCLINICAL 2. used usually for ESOPHAGEAL STRICTURES

Question 35

MEGAESOPHAGUS... what 2 species are predisposed? give one reason for one, 2 for another 6 clinical signs? diagnosed via...

Answer 35

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

Question 36

TREATMENT of megaesophagus... is MOSTLY ___ ____ and if not, likely ____ is the next best option prognosis?

Answer 36

is MOSTLY DIETARY MANAGEMENT! EUTHANASIA is likely the next best option POOR PROGNOSIS

Question 37

ESOPHAGEAL PERFORATION... history/causes? (5, first 2 common, last is uncommon) 5 clinical signs? treatment? (trick question)

Answer 37

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