Esophageal Disease Flashcards
Clinical findings associate with esophageal disease
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
Diagnostics to assess regurgitation
Routine + rads (contrast- barium), endoscopy
Special tests: thyroid, ACTH stimulation, ACHR, Ab serology, ANA titer and lead levels
What is the next best step after radiology?
Endoscopy: direct visualization of mucosal lesion and luminal content
Determines the extent of injury
Esophagitis
Inflammation of the esophagus
Mild to severe
Mucosa to muscularis layer
Anatomic differentials of regurgitation
Megaesophagus
esophagitis
Esophageal obstruction, diverticulum
Vascular ring anomaly
Pyloric outflow obstruction
Hiatal hernia
What is esophagitis secondary to?
Chemical injury
GERD,
Chr. vomit,
Oral abx (doxycycline and clindamycin)
Heat injury
Direct mucosal damage (FBs, masses)
CS of esophagitis
Asymptomatic
Anorexia, dysphagia, odynophagia and hypersalivation
Cachexia, WL, cough, dyspnea and pyrexia
________ + _________ is a definitive dx for esophagitis
Endoscopy and biopsy
endoscopic changes alone may indicate presence of esophagitis
Based on location in the esophagus, what could cause esophagitis?
Upper esoph (past upper sphincter): oral doxy/ clindamycin
Dist. esoph. (cr. to lower sphincter): anesthesia related or GI reflux
Esophagitis tx
Remove cause and prevent exposure to acidic substance
Soft diet, small frequent meals, easily digestible diet, fat restricted
Medical esophagitis tx
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)
Esophagitis medication duration
Mild: 5-7d
Moderate- severe: 2-3w
Recheck 1w after discharge and 1w after meds stopped
severe if strictures occur
Types of esophageal FBs
Bones (76.5%)
Fishhooks, rawhides chews, greenies, hairballs
Play toys (cats)
CS associated with FBs
Salivation, regurg, anorexia, odynophagia, halitosis
Tx of FBs
Remove immediately (sharps, large, metal, obstructive)
Rigid sigmoidoscope with grasping forceps (cr. esoph FBs only)
Flexible endoscope
Sx (dist. esoph or pushed into stomach)
Esophageal FB post removal therapy
Fast 24-48 hrs
Fluid therapy with dehydration
Gastrostomy tube with severe esophagitis
Same therapy as esophagitis
Esophageal strictures
Circular band of scar tissue leading to abnormal narrowing of esoph.
Muscularis layer damaged → inflamm. → fibroplasia
Pilled induced esophageal chemical injury (cats)
Oral admin of doxy or clindamycin (acidic properties)
↓ esophageal lubrication
Prevent by using liquid preps
Which medications cause anesthesia related GI reflux?
Atropine, iso, morphine, acepromazine, thiopental
Additional causes of esophageal strictures
FB injury
Esoph. sx
Intraluminal and extraluminal mass lesions (abscess, neoplasia, granuloma)
Esophageal stricture CS
Progressive regurg.
Swallowing impairment (↑ effort, hard to swallow)
Pytalism, anorexia, WL, coughing
Differentials to esophageal stricture
Esophagitis, megaesophagus, FB, mass lesions
Esophageal stricture tx
Mechanical dilation
Balloon dilation via endoscopic guidance (repeat in 5-7d)
Bougienage
Indwelling balloon dilation esophagostomy tube (BE-tube)
Post dilation tx for esophageal strictures
H2 blockers, proton pump inhibtors
Metoclopramide, sucralfate, pred, pain meds
Intraluminal stents if CS persist
Megaesophagus
Most common cause of regurg in dogs
Focal or diffuse esoph. dilation
Esoph. dysmotility
Secondary to NM dz (acquired)
Primary megaesophagus
Congential (idiopathic)
Acquired (idiopathic)
MG (congenital, focal, concurrent skeletal m.)
Congenital megaesophagus
Hypomotility and dilation of esoph.
Regurg and failure to thrive after weaning to solid food
Familial predisposition, prevalence in siamese cats
Pathophysiology of Congenital megaesophagus
Defect in afferent vagal nerve
↓ esophageal motility
Signalment of acquired megaesophagus
Dogs or cat middle ages
Rare in cats
Causes of acquired megaesophagus
MG, hypoadrenocorticism, hypothyroidism, etc
CS of megaesophagus
Regurg.
Aspiration pneumonia (acute/ chronic cough, fever, dyspnea)
Malnutrition/ WL/ emaciation
M. weakness, GI signs, m. pain, stiff gait
Ancillary tests for megaesophagus
ANA titer, Thyroid profile, blood lead level, esophagoscopy, electromyography, nerve conduction studies
Prognosis of megaesophagus
Guarded to poor with primary
Congenital may improve with time
Better prog with secondary
Medical management for megaesphagus (regurg and achalasia)
↓ acidity with omepraxol or pantoprazole
Prokinetics (cats) with cisapride
Sienafil (congential)
Injection of botulism toxin into LES
Pneumatic dilation via endoscopy (temporary)
Sx for megaesophagus (regurg and achalasia)
Heller myotomy with partial fundoplication (permanent)
Megaesophagus tx for aspiration pneumonia)
Abx broad spectrum, correct dehydration and coupage
Prevention: gastrostomy tube for feeding and intermittent fenestrated esophagoscopy tube
Myasthenia Gravis
Autoantibodies against AcH receptors
Skeletal m. weakness
Generalized MG
Tetraparesis
Dx with AcH ab titer: > 0.6 in dogs and > 0.3 in cats
Focal MG
Regurg.
Dx with tensilon test (exercise → give endrophonium chloride)
Tx for MG
Pyridostigmine
Glucocorticoids immunosupproessive dose
Tx megaesphagus
