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!Small Animal Medicine > Esophageal Disease > Flashcards

Esophageal Disease Flashcards

1
Q

Clinical findings associate with esophageal disease

A

Regurgitation, WL and anorexia/ polyphagia
Poor BCS, halitosis, drooling, coughing, nasal discharge, pyrexia, wet lungs sounds
Dilated, cervical esophagus, food slopping in esophagus, mass/ FB

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2
Q

Diagnostics to assess regurgitation

A

Routine + rads (contrast- barium), endoscopy
Special tests: thyroid, ACTH stimulation, ACHR, Ab serology, ANA titer and lead levels

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3
Q

What is the next best step after radiology?

A

Endoscopy: direct visualization of mucosal lesion and luminal content
Determines the extent of injury

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4
Q

Esophagitis

A

Inflammation of the esophagus
Mild to severe
Mucosa to muscularis layer

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4
Q

Anatomic differentials of regurgitation

A

Megaesophagus
esophagitis
Esophageal obstruction, diverticulum
Vascular ring anomaly
Pyloric outflow obstruction
Hiatal hernia

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5
Q

What is esophagitis secondary to?

A

Chemical injury
GERD,
Chr. vomit,
Oral abx (doxycycline and clindamycin)
Heat injury
Direct mucosal damage (FBs, masses)

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6
Q

CS of esophagitis

A

Asymptomatic
Anorexia, dysphagia, odynophagia and hypersalivation
Cachexia, WL, cough, dyspnea and pyrexia

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7
Q

________ + _________ is a definitive dx for esophagitis

A

Endoscopy and biopsy
endoscopic changes alone may indicate presence of esophagitis

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8
Q

Based on location in the esophagus, what could cause esophagitis?

A

Upper esoph (past upper sphincter): oral doxy/ clindamycin
Dist. esoph. (cr. to lower sphincter): anesthesia related or GI reflux

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9
Q

Esophagitis tx

A

Remove cause and prevent exposure to acidic substance
Soft diet, small frequent meals, easily digestible diet, fat restricted

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10
Q

Medical esophagitis tx

A

Oral sucralfate (protects from reflux)
Parenteral followed by oral prokinetic agent (↑ gastric emptying)
Parenteral followed by oral H2 blocker or proton pump inhibitor (reduce acidity, helps with GERD)

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11
Q

Esophagitis medication duration

A

Mild: 5-7d
Moderate- severe: 2-3w
Recheck 1w after discharge and 1w after meds stopped
severe if strictures occur

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12
Q

Types of esophageal FBs

A

Bones (76.5%)
Fishhooks, rawhides chews, greenies, hairballs
Play toys (cats)

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13
Q

CS associated with FBs

A

Salivation, regurg, anorexia, odynophagia, halitosis

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14
Q

Tx of FBs

A

Remove immediately (sharps, large, metal, obstructive)
Rigid sigmoidoscope with grasping forceps (cr. esoph FBs only)
Flexible endoscope
Sx (dist. esoph or pushed into stomach)

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15
Q

Esophageal FB post removal therapy

A

Fast 24-48 hrs
Fluid therapy with dehydration
Gastrostomy tube with severe esophagitis
Same therapy as esophagitis

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16
Q

Esophageal strictures

A

Circular band of scar tissue leading to abnormal narrowing of esoph.
Muscularis layer damaged → inflamm. → fibroplasia

17
Q

Pilled induced esophageal chemical injury (cats)

A

Oral admin of doxy or clindamycin (acidic properties)
↓ esophageal lubrication
Prevent by using liquid preps

18
Q

Which medications cause anesthesia related GI reflux?

A

Atropine, iso, morphine, acepromazine, thiopental

19
Q

Additional causes of esophageal strictures

A

FB injury
Esoph. sx
Intraluminal and extraluminal mass lesions (abscess, neoplasia, granuloma)

20
Q

Esophageal stricture CS

A

Progressive regurg.
Swallowing impairment (↑ effort, hard to swallow)
Pytalism, anorexia, WL, coughing

21
Q

Differentials to esophageal stricture

A

Esophagitis, megaesophagus, FB, mass lesions

22
Q

Esophageal stricture tx

A

Mechanical dilation
Balloon dilation via endoscopic guidance (repeat in 5-7d)
Bougienage
Indwelling balloon dilation esophagostomy tube (BE-tube)

23
Q

Post dilation tx for esophageal strictures

A

H2 blockers, proton pump inhibtors
Metoclopramide, sucralfate, pred, pain meds
Intraluminal stents if CS persist

24
Q

Megaesophagus

A

Most common cause of regurg in dogs
Focal or diffuse esoph. dilation
Esoph. dysmotility
Secondary to NM dz (acquired)

25
Q

Primary megaesophagus

A

Congential (idiopathic)
Acquired (idiopathic)
MG (congenital, focal, concurrent skeletal m.)

26
Q

Congenital megaesophagus

A

Hypomotility and dilation of esoph.
Regurg and failure to thrive after weaning to solid food
Familial predisposition, prevalence in siamese cats

27
Q

Pathophysiology of Congenital megaesophagus

A

Defect in afferent vagal nerve
↓ esophageal motility

28
Q

Signalment of acquired megaesophagus

A

Dogs or cat middle ages
Rare in cats

29
Q

Causes of acquired megaesophagus

A

MG, hypoadrenocorticism, hypothyroidism, etc

30
Q

CS of megaesophagus

A

Regurg.
Aspiration pneumonia (acute/ chronic cough, fever, dyspnea)
Malnutrition/ WL/ emaciation
M. weakness, GI signs, m. pain, stiff gait

31
Q

Ancillary tests for megaesophagus

A

ANA titer, Thyroid profile, blood lead level, esophagoscopy, electromyography, nerve conduction studies

32
Q

Prognosis of megaesophagus

A

Guarded to poor with primary
Congenital may improve with time
Better prog with secondary

33
Q

Medical management for megaesphagus (regurg and achalasia)

A

↓ acidity with omepraxol or pantoprazole
Prokinetics (cats) with cisapride
Sienafil (congential)
Injection of botulism toxin into LES
Pneumatic dilation via endoscopy (temporary)

34
Q

Sx for megaesophagus (regurg and achalasia)

A

Heller myotomy with partial fundoplication (permanent)

35
Q

Megaesophagus tx for aspiration pneumonia)

A

Abx broad spectrum, correct dehydration and coupage
Prevention: gastrostomy tube for feeding and intermittent fenestrated esophagoscopy tube

36
Q

Myasthenia Gravis

A

Autoantibodies against AcH receptors
Skeletal m. weakness

37
Q

Generalized MG

A

Tetraparesis
Dx with AcH ab titer: > 0.6 in dogs and > 0.3 in cats

38
Q

Focal MG

A

Regurg.
Dx with tensilon test (exercise → give endrophonium chloride)

39
Q

Tx for MG

A

Pyridostigmine
Glucocorticoids immunosupproessive dose
Tx megaesphagus

!Small Animal Medicine (14 decks)

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