Esophageal Diseases

Question 1

What is the difference between the canine and feline esophagus?

Answer 1

Canines have striated mm. the entire length of the esophagus

Felines have smooth muscle in the distal portion

Question 2

This is the outermost layer of the esophagus

Answer 2

Adventitia

Question 3

The lower esophageal sphincter (LES) is also known as the

Answer 3

cardia

Question 4

Vomiting or Regurgitation?

Abdominal contractions are present

Answer 4

Vomiting

Question 5

Vomiting or Regurgitation?

Sphincters actively open and relax

Answer 5

Vomiting

Question 6

What is the MOA of vomiting?

Answer 6

Reverse peristalsis from the stomach or duodenum

Question 7

What is the MOA of regurgitation?

Answer 7

Backflow from the esphagus or pharynx

Question 8

Vomiting or Regurgitation?

Which one is esophageal disease associated with?

Answer 8

REGURGITATION

Question 9

If esophageal disease is suspected, what is the location

of the radiographs you would take?

Answer 9

Neck and thorax (with contrast)

Question 10

When taking rads for suspected esophageal disease,

you’re evaluating for compressive lesions in these 2 locations

Answer 10

Intrathoracic

or

Cervical

Question 11

The best method to evaluate peristalsis and swallowing

Answer 11

Fluoroscopy

Question 12

Inflammation of the esophageal mucosa

Answer 12

Esophagitis

Question 13

How is esophagitis diagnosed and what are the findings?

Answer 13

Endoscopy- erythemic and edematous mucosa

Question 14

How is esophagitis treated?

Answer 14

Pain meds- Buprenorphine, Tramadol, Fentanyl Patch

Sucralfate or Carafate

Antacid (PPI- Omeprazole)

Question 15

What are 3 risks associated with esophageal foreign bodies?

Answer 15

perforation

stricture

fistulae/diverticulae

Question 16

If an esophageal foreign body is pushed into the stomach,

what medicine is contraindicated?

Answer 16

H2 blockers (Famotidine, Ranitidine, Cimetidine)

Question 17

What is the tx for esophageal stricture?

Answer 17

Balloon dilation

Question 18

an outpouching of mucosa through the muscular layer of the esophagus

is known as

Answer 18

Esophageal diverticulae

Question 19

How is esophageal diverticulae diagnosed?

Answer 19

Rads or Fluoroscopy with contrast

Question 20

The formation of esophageal diverticulae is secondary to

________ or congenital

Answer 20

trauma

Question 21

Larger esophageal diverticulae are associated with

what 4 conditions?

Answer 21

impactions

esophagitis

rupture

pyothorax

Question 22

Severe generalized dilation with

severely decreased or absent peristalsis of the esophagus

Answer 22

Megaesophagus

Question 23

Thin linear soft tissue lines on a thoracic radiograph

is indicative of this esophageal condition

Answer 23

Megaesophagus

Question 24

Congenital megaesophagus is due to

abnormal ________

Answer 24

neuromuscular innervation

Question 25

What breeds are predisposed to congenital megaesophagus?

Answer 25

Sharpei, Fox Terrier, GSD, Labs, Danes, Irish Setters, Mini Schnauzers, Newfies Siamese Cats

Question 26

T/F: Congenital megaesophagus may improve with time

Answer 26

TRUE

Question 27

What are the causes of acquired megaesophagus?

Answer 27

Idiopathic Primary CNS (brainstem lesion, Myasthenia Gravis) Endocrine (Hypothyroid, Addison's) Lead Toxicity

Question 28

What esophageal condition is associated with lead toxicity?

Answer 28

Acquired Megaesophagus

Question 29

What are some methods of treating megaesophagus?

Answer 29

``` Nutritional support (smaller frequent meals, thick-it, elevated food bowls) Feeding tubes ``` Treatment of the underlying disease

Question 30

What is the prognosis for megaesophagus?

Answer 30

**Fair to good** when interventions work **Guarded to poor** in MG crisis or aspiration pneumonia

Question 31

A developmental abnormality in which an abnormal vessel entraps the thoracic esophagus

Answer 31

Vascular ring anomaly

Question 32

What is the most common vascular ring anomaly?

Answer 32

PRAA persistent right aortic arch

Question 33

T/F: Vascular ring anomalies like PRAA are much more common in cats

Answer 33

FALSE! More common in dogs

Question 34

What breeds are predisposed to vascular ring anomalies (like PRAA)?

Answer 34

Boston terrier, Irish setter, GSD Persians, Siamese

Question 35

A young irish setter presents with intermittent regurgitation, unthriftiness, poor hair coat, and signs of aspiration pneumonia. What is your primary ddx and what would you do to confirm?

Answer 35

Vascular ring anomaly (PRAA) Imaging! Rads, Fluoroscopy, CT

Question 36

What is the treatment for PRAA?

Answer 36

Surgical correction

Question 37

Cystic nodules in the esophageal wall are seen as dense masses on radiographs of a dog from Mississippi. What is your primary ddx?

Answer 37

Spirocerca Lupi

Question 38

T/F: Fecal evaluation is a good way to diagnose spirocerca lupi infection

Answer 38

FALSE! If there is no fistula allowing larva to pass into the alimentary tract, S. lupi will not be detected in fecal! Use **rads** instead!

Question 39

What is a complication seen sometimes in Hounds with Spirocerca lupi infections?

Answer 39

Cyst→Granuloma→**Sarcoma with Mets**

Question 40

This is a potentially fatal complication associated with Spirocerca lupi infection

Answer 40

Aortic aneurysm (fatal bleeds)

Question 41

A complication sometimes seen with Spirocerca lupi infections includes **hypertrophic osteopathy** associated with neoplasia. **Exostosis** can be seen on rads in this location

Answer 41

Between thoracic vertebrae

Question 42

This intermediate host is necessary in the life cycle of spirocerca lupi

Answer 42

Dung beetle

Question 43

Spirocerca lupi larvae mature into adult worms in the \_\_\_\_\_\_\_

Answer 43

aorta

Question 44

What preventatives are used in endemic regions against spirocerca lupi?

Answer 44

Moxidectin/Imidacloprid

Question 45

Spirocerca lupi is often too advanced to treat, but can try these drugs

Answer 45

Doramectin or Ivermectin + Prednisolone

Question 46

Which breeds are predisposed to esophageal hiatal hernias?

Answer 46

Sharpei, English bulldog, French bulldog

Question 47

A Type 1 Esophageal Hiatal Hernia is also known as a \_\_\_\_\_\_\_ hernia

Answer 47

sliding

Question 48

What is the difference between a Type 1 and Type 2 Esophageal Hiatal Hernia?

Answer 48

In type 1 - LES and gastric fundus are displaced In type 2- only the gastric fundus is displaced

Question 49

T/F: The best way to dx an esophageal hiatal hernia is endoscopy

Answer 49

FALSE! Rads + Contrast + Fluoroscopy

Question 50

T/F: Neoplasia of the esophagus is very rare

Answer 50

TRUE

Question 51

What are the 3 types of primary neoplasias that can occur in the esophagus?

Answer 51

SCC Leiomyosarcoma Sarcoma

Question 52

Which cancers can metastasize to the esophagus?

Answer 52

Thyroid Mammary Lymphoma

Question 53

How is esophageal neoplasia diagnosed and what is the prognosis?

Answer 53

Endoscopy and biopsy VERY POOR PROGNOSIS with esophageal neoplasia :(