Digestion & Metabolism 2: SA Esophageal & Swallowing Dz Flashcards
esophagus STRUCTURE in…
CATS?
DOGS?
CAT esophagus = SMOOTH muscle in DISTAL esophagus SPIRALS, then some SKELETAL
DOG esophagus = TWO OBLIQUE LAYERS OF SKELETAL MUSCLE
what is this STRUCTURE in the esophagus? WHAT SPECIES
SPIRAL formation/SMOOTH MUSCLE, NORMAL finding in CAT ESOPHAGUS
ID SPECIES of this esophagus
DOG, smoother than cat
NORMALLY, esophagus on rads…
IS NOT VISIBLE because it’s SILHOUETTED BY OTHER SOFT TISSUE STRUCTURES
for DYSPHAGIA…
2 affected areas?
2 diagnostic tests?
affected areas?
1. ORAL CAVITY
2. SWALLOWING MECHANISM
diagnostic test?
1. ORAL EXAM
2. VIDEOFLUOROSCOPIC BARIUM SWALLOW
for REGURGITATION…
2 affected areas? which one is more common?
2 diagnostic tests?
2 affected areas?
1. ESOPHAGUS is MORE COMMON
2. STOMACH (with DISTENSION)
2 diagnostic tests?
1. CHEST LATERAL RADS
2. NECK LATERAL RADS
if VOMITING…
affected area?
2 diagnostic tests?
affected area? = ABDOMEN
2 diagnostic tests?
1. ABDOMINAL RADS
2. ABDOMINAL US
what is the MOST IMPORTANT DIAGNOSTIC TEST for DIAGNOSING SWALLOWING DISORDERS?
VIDEO FLUOROSCOPIC BARIUM SWALLOW
___ ___ is the MOST COMMON esophageal disease in ____, but is VERY RARE in ___
GENERALIZED MEGAESOPHAGUS, DOGS
RARE in CATS
3 FORMS of megaesophagus?
3 common clinical signs?
2 diagnostic tests & done when WHAT clinical sign is present?
3 forms…
1. CONGENITAL
2. ACQUIRED IDIOPATHIC
3. ACQUIRED SECONDARY
3 common clinical signs?
1. REGURGITATION
2. WEIGHT LOSS
3. HYPERSALIVATION
2 diagnostic tests & done when WHAT clinical sign is present?
1. NECK rads
2. THORACIC rads
done when REGURGITATION is present
ID DZ
GENERALIZED MEGAESOPHAGUS
ID DZ
GENERALIZED MEGAESOPHAGUS
CONGENITAL megaesophagus…
RARELY reported in what species?
what AGE animals are predisposed?
what 3 BREEDS are predisposed?
diagnosis? (2, which one is MOST helpful?)
what disease do we need to RULE OUT?
RARELY in CATS
in YOUNG animals
3 DOG BREEDS…
1. MINI SCHNAUZER
2. WIREHAIRED FOX TERRIER
3. GERMAN SHEPHERD
diagnosis?
1. SURVEY rads of neck/thorax
2. VIDEO FLUOROSCOPIC BARIUM SWALLOW
we need to rule out VASCULAR RING ANOMALY (aorta wrapping around trachea/esophagus)
ACQUIRED SECONDARY MEGAESOPHAGUS…
what is the most COMMON cause of this?
what is the SECOND MOST COMMON CAUSE?
2 other common causes?
2 RARER causes?
most common = MYASTHENIA GRAVIS
SECOND most common = ADDISON’S DZ
2 other causes?
1. ESOPHAGITIS
2. OBSTRUCTION of esophagus
2 RARER?
1. NEUROLOGICAL
2. POLYMYOSITIS
diagnostic WORKUP for ACQUIRED SECONDARY MEGAESOPHAGUS (5, one is OPTIONAL)
- CBC/CHEM/UA
- THORACIC RADS
–> do TRACHEAL WASH if EVIDENCE of ASPIRATION PNEUMONIA - ACh receptor Ab TITER
- ACTH STIM TEST/BASELINE CORTISOL
- +/- ENDOSCOPY
____ _____ ____ is the MOST common form of ____esophagus in DOGS
ACQUIRED IDIOPATHIC MEGAESOPHAGUS, MEGA
ACQUIRED IDIOPATHIC MEGAESOPHAGUS…
AGE/BREED of dog?
2 Hx findings?
MIDDLE-AGED to OLDER
LARGE BREED DOGS
2 Hx findings?
1. REGURGITATION
2. COUGH
PROKINETIC drugs…
used to treat WHAT dz?
2 EXAMPLES? are they good..?
MEGAESOPHAGUS
examples? THEY’RE NOT THE BEST bc they work on SMOOTH MUSCLE
1. METOCLOPRAMIDE
2. SILDENAFIL
PROGNOSIS for MEGAESOPHAGUS…
for CONGENITAL? (2)
for ACQUIRED SECONDARY? (2)
for ACQUIRED IDIOPATHIC? (3)
CONGENITAL..
1. FAIR to GUARDED
2. about HALF SPONTANEOUSLY RECOVER if MANAGED THROUGH CLINICAL PERIODS
SECONDARY…
1. depends on UNDERLYING DZ
2. MYASTHENIA GRAVIS = 50-50 prognosis for survival
IDIOPATHIC…
1. GUARDED to POOR
2. RARELY spontaneously resolves
3. most dogs die from RECURRENT ASPIRATION PNEUMONIA
TOP & BOTTOM finding?
TOP = MEGAESOPHAGUS
BOTTOM = AIR BRONCHOGRAM from ASPIRATION PNEUMONIA
ESOPHAGEAL FOREIGN BODY…
we SHOULD NOT rule it out when the animal has been ____ for _____ weeks
diagnosis?
considered a MEDICAL ____ because…
SHOULD NOT rule it out when animal has been REGURGITATING for TWO WEEKS
diagnosis? = SURVEY NECK/THORACIC RADS
EMERGENCY because the LONGER IT REMAINS IN ESOPHAGUS, more likely for NECROSIS –> STRICTURE
ID LESION
ESOPHAGEAL FB
TREATMENT for ESOPHAGEAL FOREIGN BODIES via ENDOSCOPY?
ENDOSCOPY & REMOVAL if able, and if not PUSH INTO STOMACH
ESOPHAGEAL Sx for FBs carries a ___ PROGNOSIS, and instead we should consider….
POOR, GASTROTOMY TUBE
THREE DRUGS to be used for ESOPHAGEAL FB?
- ANTACIDS
- SUCRALFATE to prevent ESOPHAGITIS post-removal
- ANTI-INFLAMMATORIES/STEROIDS (prednisone)
overall PROGNOSIS for ESOPHAGEAL FOREIGN BODIES is generally ___ but depends on the….
GOOD, SEVERITY OF ESOPHAGITIS
what is the MOST COMMON cause of ESOPHAGITIS?
PROLONGED ANESTHESIA so that LES relaxes and GASTRIC ACID GETS UP INTO ESOPHAGUS
DIAGNOSIS for ESOPHAGITIS is usually based on….
but we can ALSO use…
what is required for DEFINITIVE diagnosis?
usually based on CLINICAL SUSPICION
but we can use ENDOSCOPY occasionally
need BIOPSY for definitive
ID LESION
ESOPHAGITIS
ID LESION
ESOPHAGITIS w/ STREAKS OF INFLAMMATION
TREATMENT of esophagitis…
2 drug combo?
2 other options?
drugs? = SUCRALFATE (slurry) + ANTACIDS
2 other options?
1. PROKINETICS = help INCREASE ESOPHAGEAL SPHINCTER TONE & INCREASE GASTRIC GASTRIC EMPTYING RATE
- feed LOW-FAT DIET
PROGNOSIS for esophagitis in…
MILD cases?
SEVERE cases?
what is the MOST COMMON COMPLICATION?
what are 2 other POTENTIAL complications?
EXCELLENT for MILD CASES & do well w/ SUPPORTIVE THERAPY
GUARDED to POOR for SEVERE cases
most COMMON complication = ESOPHAGEAL STRICTURE
2 other complications?
1. ESOPHAGEAL PERFORATION
2. BACTERIAL SEPSIS
