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3. Equine > Diseases of the equine esophagus > Flashcards

Diseases of the equine esophagus Flashcards

1
Q

anatomy of the equine esophagus: length and parts

A
  • Length 125 – 200cm
  • Parts:
    1. Cervical 2. Thoracic 3. Abdominal
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2
Q

esophagus is Surrounded by important anatomical structures:

A
  • Trachea
  • Jugular vein
  • Common Carotid Artery
  • Vago-sympathetic trunk
  • Left recurrent laryngeal nerve
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2
Q

Thoracic and abdominal part of esophagus are close to what nerve? relevance?

A
  • Dorsal and ventral Vagal nerve
  • Rarely clinically relevant
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3
Q

layers of the esophaugs

A

The wall composed 4 layers:
1. Tunica mucosa – mucous membrane
2. Tunica submucosa - submucosal layer
3. Tunica muscularis – muscular layer
4. Tunica adventitia/serosa – fibrous layer

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3
Q

arterial supply of the esophaugs?

A
  • Cervical part: carotid a.
  • Thoracic/abdominal part: bronchoesophageal and gastric a.
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4
Q

innervation of the esophaugs?

A
  • IX, X cranial n.
  • Sympathetic trunk
  • Mesenteric ganglion cells
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5
Q

Evaluation of esophageal disease; broad methods

A
  • physical exam
    > visual exam
  • ultrasonography
  • radiography
    > several types of studies
  • endoscopy
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6
Q

equipment we need for physical exam and why?

A

Gloves – Rabies list of differential diagnosis

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7
Q

clinical signs of esophageal disease we can notice on physical exam

A

Clinical signs manifested by
- Ptyalism
- Dysphagia
- Coughing
- Regurgitation of food, water, saliva through mouth an nostrils

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8
Q

what we should check on our physical exam for esophagus issues

A
  • visual exam
  • Observation of the neck
  • Palpation of the neck
    > Simple food impaction cervical esophagus
    > Crepitation
  • Oral exam

Can also:
- Auscultation of the thorax
- Sedation
- Nasogastric tube

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9
Q

Ultrasound exam cervical esophagus is useful for finding:

A
  • Impaction, extramural masses
  • Esophageal rupture: gas and free fluid outside the lumen
  • Cellulitis
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10
Q

when is it important to use radiographs to evaluate esophageal disease? what study should we start with?

A
  • Important to complete an esophageal exam in problems other than simple obstruction.
  • Start baseline without contrast media.
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11
Q

how do we perform a positive contrast esophogram with barium paste? what normal structure will we see?
Sedation?

A
  • Barium paste (120mL) oral.
  • Normal longitudinal folds of the mucosa.
  • Avoid sedation.
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12
Q

what is a positive contrast esophogram with barium paste good for visualizing?

A
  • Complete obstruction of the esophagus.
  • Esophageal stricture.
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13
Q

what problems might we be able to see with a baseline esophogeal radiograph

A
  • Metallic foreign body.
  • Cranial esophageal sphincter
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14
Q

how do we perform a positive contrast esophagram with barium liquid? what diseases might we see?

A
  • Liquid barium (72% wt/vol with water, 480 ml).
  • Cuffed nasogastric tube.
  • Esophageal stricture.
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15
Q

how do we perform a double contrast study for the esophagus? what is it good for visualizing?

A
  • Liquid barium (480 ml) followed
    by air.
  • Examination of mucosal folds.
  • Best definition of mucosal lesions.
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16
Q

how do we perform a negative contrast esophagram and what area is it good for vs bad for?

A
  • Air insuflation.
  • Cranial cervical region.
  • Not useful for caudal cervical and thoracic esophagus
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17
Q

in a positive contrast esophagram, what can swallowing look like?

A
  • Swallowing produces false signs of esophageal stricture
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18
Q

purpose and use of endoscopy to investigate esophageal lesions? how do we use the endoscope?

A
  • Define the severity and extent of the lesions observed in radiography
  • Endoscope 200cm or longer.
  • Start with the endoscope fully inserted.
  • Insufflate the esophageal lumen.
  • Slow withdrawal.
  • After each swallow clear the scope and dilate before withdrawal.
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19
Q

Most common obstructive esophageal disease?

A

Impaction ”Choke”

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20
Q

Impaction ”Choke” is associated usually with what?

A
  • Associated with ingesta or bedding.
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21
Q

clinical signs of impaction “choke”

A
  • Ptyalism
  • Dysphagia
  • Coughing
  • Regurgitation of food, water and saliva from the mouth and nostrils
22
Q

Impaction ”Choke”;
Attempts of ingestion are followed by:

A
  • Odynophagia – painful swallowing
  • Repeated extension of the head and neck. - Distress, agitation
23
Q

when investigating Impaction ”Choke”;
Intermittent signs of choke followed by periods of relief may indicate what?

A

Intermittent signs of choke followed by periods of relief may indicate a disease other than a simple impaction.

24
Q

Impaction ”Choke”;
problems associated with cases of long duration

A
  • Anorexia.
  • Electrolyte imbalances.
  • Dehydration.
25
Q

Impaction ”Choke”; what frequently followis esophageal obstruction? when can clinical signs begin? how can we investigate this?

A
  • Aspiration pneumonia frequently follows esophageal obstrcution.
  • Clinical signs can be present 1 day after the onset of choke

> Ultrasonographic/radiographic exam

26
Q

Impaction ”Choke”; what we need to do on physical exam to investigate?

A
  • Observation of the neck.
  • Palpation of the neck > Crepitation.
  • Oral exam.
  • Thoracic auscultation.
27
Q

what kind of radiographic study would we generally use for impaction “choke”

A
  • No constrast.
28
Q

what would we see in impaction choke on endoscopic exam?

A
  • esophagus filled with ingesta
29
Q

Impaction ”Choke”; usual procedure to treat

A
  • Under sedation
    > Xylazine 0.25-0.5 mg/kg IV.
    > Detomidine 0.01-0.02 mg/kg IV
  • Nasogastric intubation.
    > With the head and neck down
  • Gentle lavage > warm water.
  • Do not push.
30
Q

alternative techniques to treat impaction choke

A
  • Cuffed endotracheal tube.
  • Lavage under pressure with stomach pump.
  • External massage.
  • Endoscopic basket.
31
Q

if we have no success with our initial treatment of impaction choke, what do we do?

A
  • Muzzle the horse
  • Stall without bedding
  • off feed/water
  • Repeat treatment in 8-12hours

If there is no success:
- Surgical treatment Esophagotomy

32
Q

Impaction ”Choke”
Adjunctive therapies and retionale:

A
  • Acepromazine (0.05mg/kg IV)
    > esophageal relaxation.
  • Oxytocin (0.11 and 0.2IU/kg IM)
    > short term esophageal relaxation.
  • N-butylscopolammonium bromide (0.3 mg/kg IV)
    > smooth muscle relaxation
  • Esophageal instillation of lidocaine (30-60mL 1%)
    > smooth muscle relaxation.
33
Q

Impaction ”Choke”
Systemic effects from prolonged loss of salivary water/electrolytes:

A
  • Dehydration
  • Hyponatremia
  • Hypochloremia
  • Hypopotassemia.
  • Metabolic alkalosis
34
Q

Impaction ”Choke”
Treatment (after procedure):

A
  • Polyionic fluids with electrolyte supplementation
  • Broad spectrum antibiotic therapy
  • NSAID Flunixin meglumine – judicious use
    > reduce the development of strictures
    > can worsen esophageal mucosa injury
  • Sucralfate (20mg/kg PO q 6h) – healing of esophageal ulceration
    ()
  • Food withheld 24-48h or longer after resolution
  • Introduce soft food > pelleted feed mashes
    > small amounts, gradually increase
    > transition to high quality roughage diet over 7 – 21 days depending on the esophageal damage.
35
Q

Impaction ”Choke”
Rate of reobstruction and prognosis for survival

A

Rate of reobstruction – 37%
Prognosis for survival – 78-88%
- Horses may require permanent diet changes.

36
Q

Impaction ”Choke”
Complications:

A
  • Pharyngeal inflammation
  • Mucosal bruising
  • Mucosa stripped off the submucosa
  • Stricture
  • Ruptured esophagus.
  • Periesophageal abscess.
  • Fistula
  • Esophageal diverticulum
37
Q

what is an esophageal stricture? what is it secondary to?

A
  • Narrowing of the esophageal lumen.
  • Secondary to:
    > External trauma
    > Internal trauma especially after impactions
38
Q

Three types of strictures based on the anatomic location:

A
  • Type I mural lesions – involve the
    adventitia and muscularis
  • Type II esophageal rings or webs – involve mucosa and submucosa
  • Type III annular stenosis – all layers
39
Q

Strictures
Clinical signs:

A
  • Similar to simple impactions
40
Q

Strictures
diagnostics, timeline for medical management

A
  • contrast radiographs, endoscopy

Following a simple impaction:
- Maximal reduction of the lumen occurs within 30 days of the impaction
- Medical management is recommended first – the esophagus continues to remodel for up to 60 days following ulceration.

41
Q

Strictures
Medical management:

A
  • Balloon dilation
42
Q

Strictures
Surgical treatment options

A
  • Esophagomyotomy
  • Partial/complete resection and anastomosis
  • Creation of a traction diverticulum
  • Patch grafting
  • Esophagostomy
43
Q

Esophageal rupture is secondary to:

A
  • Long standing obstruction
  • Repeated or aggressive nasogastric intubation
  • Foreign body perforation
  • External trauma to the cervical area
    – kick
  • Extension of an infection
44
Q

Esophageal rupture clinical signs?

A
  • Discomfort, depressed
  • Head/Cervical swelling
  • Subcutaneous emphysema
    – swallowed air escapes - Cellulitis
45
Q

esophageal rupture diagnostics

A
  • Endoscopy
  • Positive contrast esophagram
46
Q

in a case of esophageal rupture, why is it
important to establish drainage on the ventral midline?

A

If not, complications that can occur:
- Mediastinitis, pleuritis, septicemia
- Horner’s syndrome, laryngeal hemiplegia
- Jugular thrombosis, carotid rupture

47
Q

esophageal rupture treatment?

A
  • Surgical repair within 12 hours of perforation
  • In case of infection, contamination with ingesta
    > Drainage needs to be provided
    > Second intention healing
  • Antibiotic, anti-inflammatory and fluid therapy + elytes
48
Q

how can we feed a horse that has undergone surgery for esophageal rupture while it heals?

A
  • Feed through a tube located in
    the defect
  • Feed through a tube located distally (esophagostomy)
49
Q

2 types of esophageal divertilculi

A

A. Traction or true diverticulum
B. Pulsion or false diverticulum

50
Q

Traction or true diverticulum
- how does this arise? what does it cause?
- where does it develop?

A
  • Acquired lesion that result from
    contraction of periesophageal scar
    tissue.
  • Cause outward rotation and tenting of
    all layers
    <><>
  • Develops at the site of esphagostomy
  • Second intention healing sites
51
Q

Pulsion or false diverticulum
- definition?
- cause?

A
  • Protrusion of mucosa and submucosa
    through a defect in the esophageal
    muscularis
  • Caused by changes in pressure
52
Q

how will the neck look on imaging for a traction diverticulum vs pulsion diverticulum?

A

traction - wide neck
pulsion - narrow neck

53
Q

Pulsion or false diverticulum
- progression?
- possible sequelae risks?
- Tx?

A
  • Tends to enlarge progressively
  • Risk of obstruction and rupture
  • Surgery is indicated
54
Q

Traction diverticulum
- signs? Tx?

A
  • Few clinical signs
  • Seldom requires treatment
55
Q

surgical treatment options for pulsion /false diverticulum?

A
  • Diverticulectomy
  • Mucosa inversion - preferred

3. Equine (17 decks)

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