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Small Animal Med > Diseases of the Esophagus > Flashcards

Diseases of the Esophagus Flashcards

1
Q

What induces primary peristalsis?

A

the swallow reflex (involuntary)

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2
Q

When and where does secondary peristalsis occur?

A

in the thoracic esophagus in response to esophageal distention

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3
Q

Define Esophageal dysphagia

A

disorders of transport of bolus through the esophagus to the stomach

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4
Q

What are clinical signs of esophageal dysphagia?

A

-REGURGITATION
-odynophagia (pain on swallowing)
-exaggerated swallowing (multple attempts)
-Ptyalism (too much saliva)
-fever, cough, dyspnea

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5
Q

If you have a patient that you suspect has an esophageal dysphagia disorder, what are their vitals like + why

A

will have a fever, cough and dypsnea (labored breathing)
which could be:
secondary to aspiration pneumonia or esophageal perforation or
laryngitis due to acid burn (paired with a hacking cough)

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6
Q

If an owner is concerned about their pet vomiting (and it is true vomiting) where can I localize the underlying issue?

A

stomach or upper small intestine OR
neurologic cause

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7
Q

What are some clinical signs that may help me determine if a pet is truly vomiting?

A

it is preceded by: retching, vocalization, and repeated abdominal contractions

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8
Q

What is the exception to regurgitation occuring seconds after eating?

A

In the case of a giant dilated megaesophagus, then regurg can occur hours after.

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9
Q

If a patient is regurgitating, where can we localize the pathology?

A

to the esophagus.

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10
Q

What are my concerns if a pet presents with regurgitation?

A

esophageal disease
risk of aspiration pneumonia
bc regurg occurs w/o airway protection

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11
Q

What are some causes of esophageal dysphagia?

A

-esophagitis
-esophageal obstruction
-megaesophagus
-vascular ring anomaly
-esophageal neoplasia

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12
Q

My patient is showing CS of Esophageal dysphagia. If i wanted to diagnose esophagitis, how would I go about that?

A

Radiographs - to r/o other causes such as: GERD (air in distal esophagus) or focal esophageal dilation

Endoscopy!!!! is the most sensitive method

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13
Q

Via endoscopy, I diagnose my canine patient with esophagitis. what is my tx plan?

A
  1. remove the underlying cause (FB)
    2.) Feed a highly digestable GI diet (Fat restricted!) because it promotes gastric emptying
    3.) If it was a severe case and my p couldn’t keep food down, discontinue use for 24-48 hours
    RX the following:
    -omeprazole- antacid that lowers stomach acidity , sucralfate slurry- binds to damaged mucosa in esophagus + stomach
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14
Q

What are the types of esophageal obstruction?

A

intraluminal (FB)
intramural- (strictures/neoplasia )
peri-esophageal

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15
Q

What are the three most common locations for a esophageal foreign body?

A

thoracic inlet, base of the heart and diaphragmatic hiatus (right before it enterns the stomach)

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16
Q

Why are esophageal foreign bodies problematic?

A

they stimulate secondary peristalsis which can result in severe ulcerative esophagitis, esophageal perforation and esophageal stricture

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17
Q

What are some clinical signs of an esophageal foreign body?

A

anorexia, hypersalivation + drooling, odynophagia (may extend neck) and regurgitation

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18
Q

If I am suspicious of an esophageal foreign body, what diagnostics should I conduct?

A

cervical and thoracic rads (w/ or w/o contrast) I want a laternal neck and 3 view chest rads
I can also diagnose via endoscopy

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19
Q

After removing a foreign body, what are my post-removal treatment suggestions?

A

tx for esophagitis - rx: omeprazole, sucralfate
consider esophagostomy tube placement if we are worried about a stricture

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20
Q

What clinical signs correlate to a esophageal stricture?

A

-insult/injury occured to esophagus 1-4 weeks ago: this could be a FB,
- hx of anesthesia (gastroesophageal reflux),
-doxycycline or clindamycin hx in cats,
-persistant vomiting

21
Q

How do I diagnose an esophageal stricture?

A

via contrast esophogram (Rads or fluroscopy)
or endoscopy

22
Q

What are my treatment options for an esophageal stricture? What about prognosis?

A

-endoscopic balloon dilation w/ local steroid injections however this only works for thoracic strictures.
-feeding tube: esophagostomy tube or gastrostomy tube
- patient will have to eat a canned or slurry diet for the rest of its life.

23
Q

In what animals am I more likely to see idiopathic megaesophagus in?

A

dogs! it is the most common cause of chronic regurgitation in dogs. it is rare in cats.
can be congenital or acquired.

24
Q

How do I r/o a secondary cause of megaesophagus due to myasthenia gravis?

A

obtain an acetylcholine receptor antibody titer. if negative, repeat in 2-3 months

25
Q

How do I rule out polymyositis/ polymyopathies as an underlying cause

A

Run a Creatine Kinase
if creatine kinase is elevated, you may want to consider a muscular cause

26
Q

How do I screen to see if hypoadrenocorticism (Addisons) is the cause of megaesophagus?

A

run a resting cortisol

27
Q

What are other secondary causes to megaesophagus?

A

dysautonomia -no tx. more common in cats. smooth m. all over the body
lead poisoning
chronic esophageal disease

28
Q

How do I diagnose megaesophagus?

A

cervical and thoracic rads
fluoroscopic swallow study

29
Q

What are my treatment options for megaesophagus

A
30
Q

Why are cisapride and metoclopramide contraindicated in megaesophagus patients?

A

they tighten the lower esophageal sphincter

31
Q

What is a vascular ring anomaly

A

congenital malformation of major arteries of the heart that causes entrapement of the intrathoracic esophagus a persistant right aortic arch are most common

32
Q

What are some clinical signs of a vascular ring anomaly?

A

-regurgitation of solid foods at the time of weaning
-patient usually does well with liquids
-weight loss and failure to thrive despite a good appetite

33
Q

How do I diagnose a patient with a vascular ring anomaly?

A

R/o congenital megaesophagus, FB, stricture
-rads will show esophageal dilation cranial to the heart base
-contrast esophagram

34
Q

What differentiates an intraluminal stricture from extraluminal compression?

A

esophagoscopy

35
Q

What is the tx of a vascular ring anomaly?

A

surgical ligation of ligamentum arteriosum
esophageal hypomotility and regurg may still persist

36
Q

WHat are some common neoplasias that can present with esophagitis signs?

A

squam cell carcinoma (cats)
leiomyosarcomas (dogs)
fibrosarcomas
osteosarcomas, etc.

37
Q

How to diagnose and Treat Spirocerca lupi

A

dx: via endoscopy, fecal PCR, diagnosis of esophageal nodules with eggs in fecal sample
tx: Doramectin

38
Q

What is a hiatal hernia

A

a protrusion of abdominal contents (usually the stomach) through the esophageal hiatus of the diaphragm

39
Q

What are clinical signs of a Hiatal hernia

A

regurgitation, esophagitis,
brachycephalics are predisposed

40
Q

What are some causes of Hiatal Hernias?

A

congenital or acquired due to increase in intra-abdominal pressure- due to trauma or upper or lower respiratory disease

41
Q

What is the presumptive diagnosis for this patient + how do you know?

A

Hiatal hernia
I will see a gas filled, intrathoracic soft tissue opacity in the caudodorsal lung field

42
Q

Can I rule out a hiatal hernia if I see a normal contrast videofluoroscopy and normal rads?

A

no, if it is a sliding hernia i could miss it on rads.

43
Q

What are the treatment options for a hiatal hernia

A

medically- tx for esophagitis
suggest brachycephalic syndrome sx

44
Q

If medical management of a hiatal hernia fails, what are our next tx options?

A

diaphragmatic crural apposition
or in recurrent cases- esophagoplexy or left fundic gastropexy

45
Q

What is a gastroesophageal intussusception

A

it is when the stomach invaginates into the esophagus
the gastroesophageal junctions remain in normal anatomic position

46
Q

What is the classic signalment for a gastroesophageal intussusception?

A

young animal less than 15 months of age, male, german shephard

47
Q

What are clincial signs of gastroesophageal intussusception

A

dyspnea (dependant on how much stomach is in the esophagus), regurgitation, vomiting
50% of dogs have preexisting esophageal abnormalities ex: megaesophagus, dysmotility disorder or laxity of esophageal hiatus

48
Q

How do I diagnose a gastroesophageal intussusception?

A
49
Q

What are the treatment options for a gastroesophageal intussussception

A

sx: reduction of intussusception
bilateral gastropexy to prevent reoccurance

Small Animal Med (9 decks)

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