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Small Animal Medicine II > Esophageal Disease > Flashcards

Esophageal Disease Flashcards

1
Q

GI tract:

A
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2
Q

What 3 functions does the GIT have?

A
  1. digest food
  2. absorb nutrients
  3. eliminate waste
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3
Q

What is the structure of the esophagus?

A
  • upper esophageal sphincter pushes bolus into esophagus
  • lower esophageal sphincter pushes bolus into stomach
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4
Q

What are 2 sources of esophageal motor innervation? What is normal motility like?

A
  1. spinal nerve in skeletal muscle segments - vagus nerve causes esophagus to constrict and push bolus through
  2. myenteric plexuses along the whole length - control/coordination

reflexive - once pharynx is engaged, the rest is beyond conscious control

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5
Q

What is primary and secondary peristalsis?

A

PRIMARY - waves of contraction push bolus into stomach, elicited by swallowing

SECONDARY - bulging of the esophageal wall due to a bolus stuck in the lumen induces more contraction to move it into the stomach

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6
Q

What 2 structures are found in the esophageal wall?

A
  1. MANY submucosal mucous glands - mucus facilitates swallowing
  2. stratified squamous epithelium - allows for wear and tear with each swallow
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7
Q

What are the 2 species differences in esophageal wall musculature?

A
  1. all skeletal - dog, ruminant
  2. cranial 2/3 skeletal, distal 1/3 smooth - cat, horse

muscle disorders also affect the stomach - polymyositis, myasthenia gravis

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8
Q

How do the esophageal sphincters lie at rest? What is the difference between the upper and lower esophageal sphincters?

A

held tonically closed to prevent air from getting in the esophagus - must relax in response to swallowing

UPPER - skeletal muscle (cricopharyngeus) + cartilage (cricoid); prevents air entry into the esophagus during breathing and reflux into the pharynx during swallowing

LOWER - smooth muscle; proximal to and overlaps gastric cardia, prevents reflux of acidic gastric contents into the esophagus

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9
Q

What are 3 common etiologies of esophageal dysfunction?

A
  1. myasthenia gravis - blocks Ach, causes flaccid paralysis –> megaesophagus, drooling, regurg
  2. sphincter tonicity or dyssynergia - cricopharyngeal aclasia, choking, dysphagia, regurg
  3. FB/stricture - gasping for air, choking, drooling, regurg, painful swallowing

regurgitation in common

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10
Q

What is the hallmark of esophageal disease? What are 4 other signs?

A

regurgitation

  1. ptyalism
  2. repeated or painful swallowing
  3. failure to thrive - thin, emaciated
  4. coughing or dyspnea due to aspiration pneumonia
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11
Q

What are the 3 major characteristics of regurgitation that differentiate it from vomiting?

A
  1. passive - vomiting is a more coordinated, active effort with abdominal contractions
  2. no bile - presence of bile = vomit
  3. induced by changes in position
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12
Q

What are the 3 major characteristics of vomiting that differentiate it from regurgitation?

A
  1. contains bile
  2. timing in associated with eating
  3. active - abdominal contraction, prodromal signs (nausea, lip smacking, drooling)
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13
Q

What are intraluminal and extraluminal causes of esophageal obstruction (choke)?

A

INTRA - FB, stricture, masses

EXTRA - vascular ring anomaly (PRAA, ligamentum arteriosum constricts esophagus at heart base), mediastinal masses, enlarged LN, cellulitis, abscess

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14
Q

What are the most common foreign bodies seen in dogs and cats?

A

DOGS - bones, Greenies, sticks, fishhooks, toys

CATS - trichobezoars, toys

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15
Q

What are the 2 major approached for visualizing esophageal foreign bodies?

A
  1. thoracic radiographs - start with plain, use contrast to look for strictures or radiolucent FB
  2. endoscopy - directly visualizes FB within esophagus
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16
Q

How are esophageal foreign bodies treated?

A

use endoscope to remove or push into stomach to be removed by gastrotomy

17
Q

What are 4 common consequences of esophageal foreign bodies?

A
  1. esophagitis
  2. esophageal perforation
  3. stricture
  4. pneumoia
18
Q

Stricture:

A
19
Q

Esophageal mass:

A

need ro r/o LN or within esophagus (if only using radiograph)

20
Q

Mediastinal mass:

A

extraluminal stricture

21
Q

What are the 3 most common causes of esophagitis?

A
  1. trauma
  2. chemical injury due to acid reflux - anesthesia, vomiting, GERD
  3. pill-induced - Doxycycline or Clindamycin pills get stuck and substances that make up the pill cause chemical injury (can compound or give with food)
22
Q

What 4 treatments are recommended with esophagitis?

A
  1. Sucralfate - protects mucosa
  2. H2 blocker or PPI - reduces acid secretion
  3. Metoclopramide + Cisapride - tightens LES and promotes gastric emptying (less time in stomach to allow reflux)
  4. feeding tube placement - consistent and adequate source of nutrition, able to bypass esophagus for healing
23
Q

What is megaesophagus? What are 3 secondary causes?

A

persistent diffusely dilated esophagus

  1. endocrinopathies - hypoadrenocorticism, hypothyroidism
  2. myopathies or neuropathies - polymyositis, myastenia gravis
  3. esophagitis

(idiopathic is most common cause!)

24
Q

What 6 parts of history are especially important in cases of esophageal disease?

A
  1. age of onset
  2. duration of signs
  3. timining of regurgitation in relation to eating - immediate, delayed (LES)
  4. contents of regurgitation - tolerance of liquids vs. solids
  5. known ingestion of FB
  6. recent anesthesia (regurgitation/vomiting due to anesthesia - healing results in stricture)
25
Q

A client claims their dog has been vomiting for the last 3 days. She describes:

  • vomits food and water in 5 minutes of eating
  • cannot hold down food, can hold down a little water
  • uncomfortable when swallowing
  • no abdominal contractions noted

Is the patient actually vomiting?

A

no –> regurgitation is a more passive process and timing/ability to hold down some water may indicate a stricture or FB

26
Q

History of regurgitation, thoracic radiograph:

A

FB –> looks like a bone!

  • removed by endoscopy, severe esophagitis noted –> treated with Sucralfate, PPI, H2 blockers, and PEG tube placement
27
Q

A 10 y/o MN GSD presents with a 1-month history of regurgitating hours after eating. What differential is at the highest of the list?

A

megaesophagus or esophagitis –> chronic, delayed, likely affecting lower esophagus

28
Q

What treatment is recommended for dogs with myasthenia gravis resulting in megaesophagus? What is the most common cause of death?

A

pyridostigmine + upright feedings (of slurry)

aspiration pneumonia

29
Q

How are esophageal strictures treated?

A

balloon dilation –> breaks up scar tissue

  • TGH - PPI, metoclopramide, steroids to decrease scar tissue reformation

Small Animal Medicine II (57 decks)

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