Esophageal Dz Flashcards
Where does regurgitation help localize a lesion to?
Esophagus
What are 2 types of regurgitation?
Obstructive
Motility
What are 2 endocrinopathies often associated with motility regurg?
HypoT4
Addison’s
With regurgitation, what two types of achalasia might you see and what would be the clinical sign?
Cricopharyngeal achalasia - dysphagia
Esophageal achaasia - Odynophagia
What is esophageal achalasia?
Inability of lower esophageal sphincter to close
Animals that are regurgitating also have a ravenous appetite, why?
Because they are not getting enough nutrients
What 4 things do you need to diagnose regurgitation?
Hx
Clinical signs
Imaging
Biopsy
What type of imaging do you start with when looking at regurgitation?
Plan RADs
What is a contraindication to fluoroscopy?
Megaesophagus
What would you use endoscopy for with regurgitation?
To confirm a stricture
What findings make myasthenia gravis less likely?
a BIG megaesophagus (inversely proportional)
Why is it important to find out if your regurgitating patient has local myasthenia gravis?
Because it can progress to fulminant myasthenia gravis which results in respiratory failure
On plain radiographs of a regurgitating patient, what do you need to keep in mind if they’re sedated?
Can be an artifact of air sitting in esophagus
What is pretty pathognomonic for megaesophagus on thoracic RADs?
Tracheal stripe sign
What are 4 things you may see on thoracic RADs when you’re dealing with regurgitation due to Spirocerca lupi?
Caudodorsal thoracic cavity mass Aortic aneyurism (looks like knuckles) Space filling defect Spondylitis
When is barium contraindicated in a regurgitation contrast study?
Any suspicion of a fistula or worried about aspiration
What will you see if you have aspiration of contrast?
Bronchial pattern
What should you do if you have aspiration of contrast?
Don’t panic, broad spectrum abx for 14 days
What does a normal canine esophagus look like on esophagoscopy?
Pale pink with longitudinal folds and a closed cardia
What is different about a feline esophagus on esophagoscopy?
Annular folds (rings) from striated muscle in the distal 1/3rd
NOTE: Cats very rarely get megaesophagus
What is the most common cause of esophageal stricture in a cat?
Iatrogenic (dry swallowing pills)
When you encounter a stricture, what can help you determine if it is a vascular ring anomaly?
Pulsations
Why can we often only get superficial biopsies of the esophagus?
Because it’s very tough tissue
What neurovascular structure in the esophagus can degenerate/disappear with stress causing megaesophagus?
Myenteric plexus
What age group is affected by congenital idiopathic megaesophagus?
Clinical signs start at
If you have congenital idiopathic megaesophagus, what might you consider is the issue?
PRAA
T/F: animals with congenital idiopathic megaesophagus can grow out of it.
True
If a dog has acquired idiopathic megaesophagus, what do we see on RADs?
Generalised esophageal dilation
How can we help dogs with acquired idiopathic megaesophagus?
Postural feeding
What 3 breeds commonly get acquired idiopathic megaesophagus?
Collie
GSD
Miniature schnuazer
If the dog is suffering from lots of regurgitation, what else can we do to help them get nutrients?
Place a stoma in the stomach. Owner will be responsible for nutrients
What is the more common form of myasthenia gravis?
Acquired
What is the cause of acquired myasthenia gravis?
Ab production against acetylcholine receptors at motor end-plates
What is the underlying trigger of acquired myasthenia gravis?
Thymoma
NOTE: Most cats with megaesophagus have a thymoma
What is the gold standard test for myasthenia gravis?
Acetylcholine receptor antibody assay
NOTE: Monitor titers every 3-6 months because they can go into remission
How do you treat myasthenia gravis?
Pyridostigmine
Where would you see a thymoma on thoracic RADs?
Well defined soft tissue mass cranial to the heart
What are 2 ways you can manage megaesophagus?
Bailey chair
Low profile gastrostomy tube
What 4 breeds (2 dog, 2 cat) are predisposed to vascular ring anomalies?
GSD
Setters
Persians
Siamese
What are 4 vascular ring anomalies?
PRAA
Double aortic arch
Persistent right ligamentum arteriosum
Right subclavian artery
Why do you not see megaesophagus in suckling pups and kittens?
Because liquid has no problem passing through, but solid food gets stuck.
In a case of a vascular ring anomaly, where are the diverticula located?
Cranial to the constriction
Why do we need to correct the vascular ring anomaly asap?
Because the more distended the diverticula, the less likely it is to return to normal
What are 4 major causes of esophagitiss?
Gastroesophageal reflux under GA (fasted too long or not enough before surgery)
Chronic vomiting
FB
Structural anomaly
What is the best drug to manage esophagitis?
Sucralfate
Provides a diffusion barrier to peptic mucosal damage
What are 2 other drugs besides Sucralfate that you can use to manage esophagitits?
Metoclopramide (Improve tone of caudal esophageal sphincter)
H2 Blocker s and PPIs (Neutralize acid secretion)
NOTE: Metoclopramide only indicated if you suspect esophagitis
How are strictures acquired?
Secondary to esophageal inflammation
When do strictures occur?
2-3 weeks post-inflammation
When are strictures most commonly formed?
After GA when dog is placed in dorsal recumbency
What is the current recommended treatment for strictures?
Balloon dilation
NOTE: Needs to be repeated over time, give Abx, sucralfate and prednisolone (antifibrotic)
How do you remove an esophageal FB?
~90% can be removed per os
What should you not do with an esophageal FB and why?
Push it into the stomach, because can damage lower esophageal sphincter
If you DO end up having to push an esophageal FB into the stomach, what should you not treat with and why?
Don’t use H2 blockers because it will slow the disintegration of the bone
What is the most important consideration pre-op for patients that have an esophageal FB?
Pain control (opioids)
Post-op, how should you care for esophageal FB patients?
H2 blockers/PPIs (assuming not a bone pushed into the stomach)
Sucralfate
Analgesics (not NSAIDs)
Abx
Food and water
May need a PEG (percutaneous endoscopically placed gastrostomy) tube (if you think there’s lots of damage to esophagus)
What are 5 complications associated with esophageal FB removal?
Failure to remove FB Perforation Stricture/stenosis Fistulae Diverticula
What 2 breeds often get hiatal hernias?
Shar peis
English bulldogs
What are 3 clinical signs of a hiatal hernia?
Reflux esophagitis
Reguritation (soon after eating)
Body condition
How common are esophageal neoplasias?
Uncommon
When we DO see esophageal neoplasia, what are the 2 major types that we see?
Sarcoma (complication of Spirocerca)
SCC (femal cats especially)
What kind of prognosis do we expect with esophageal neoplasia?
Generally poor
What 3 things can you do to help a patient with esophageal neoplasia?
Pain control
Feed soft diet/gruel
Place an infinity stent to minimize stricture
