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Small Animal Surgery > Esophageal Surgery > Flashcards

Esophageal Surgery Flashcards

1
Q

How does the esophagus of dogs and cats compare?

A

DOGS - entirely skeletal muscle

CATS - skeletal muscle, then smooth muscle

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2
Q

What are the 5 most common clinical signs of esophageal disease?

A
  1. regurgitation
  2. dysphagia
  3. salivation
  4. coughing
  5. dyspnea
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3
Q

What is the difference between vomiting and regurgitation?

A

VOMITING = nausea and retching with the presence of digested food or bile, acidic/alkali, and within anytime after feeding

REGURGITATION = no nausea or retching with the present of undigested food and no bile, alkali, and often related to feeding

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4
Q

What makes dehiscence common in the esophagus?

A
  • lack of a serosal layer
  • thick mucosa
  • presence of saliva and continual motion
  • no omentum
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5
Q

What is the holding layer in the esophagus for surgery? What is the vascular supply?

A

submucosa

submucosal plexus and segmental extrnisic vasculature

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6
Q

What are the 2 ways of closing the esophagus following an incision? What suture is commonly used?

A

ONE LAYER CLOSURE - simple interrupted knots tied on the extraluminal surface

TWO LAYER CLOSURE - simple inverted interrupted in the mucosa and submucosa and simple interrupted in submucosa, muscularis and adventitia

typically prolene, but PDS can be used

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7
Q

What are the 3 approaches to esophageal surgery?

A
  1. cervical - ventral midline, displace esophagus to the right
  2. thoracic cranial to the heart - LEFT by the 3rd-5th interspace
  3. thoracic caudal to heart - right or LEFT by the 9th-11th interspace
  • right at heart base = right
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8
Q

Left vs right thoracotomy:

A
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9
Q

How can the esophagus be made more obvious for surgeries? What body part must be carefully avoided?

A

pass an orogastric tube

thyroid and recurrent laryngeal nerves

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10
Q

How can the esophagus be stabilized during esophagotomy? What should be done after the procedure?

A

place stay sutures

flush after removal and asses that there is no further damage

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11
Q

In what 3 situations are esophageal resections and anastomoses indicated?

A
  1. severe trauma or necrosis
  2. esophageal stricture > 3-5 cm in length that is not successfully treated by bouginage
  3. esophageal neoplasia (rare in dogs and cats)
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12
Q

How much of the thoracic esophagus can be resected? What should be done if more is required?

A

1/3 of the esophagus

resection more than 3-5 cm require tension relieving techniques

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13
Q

In what order is the esophagus closed for esophageal resection and anastomosis?

A

360 mucosa closure - adventitia and muscularis sutured first and then mucosa and submucosa

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14
Q

Esophageal resection and anastomosis:

A
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15
Q

In what 2 ways can tension be relieved during esophageal resection and anastomosis?

A
  1. partial myotomy where a circumferential incision through longitudinal muscle layer 2-3 cm cranial and caudal to the site
  2. cranial mobilization of stomach
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16
Q

When is esophageal patching indicated? What are 3 possible body parts that can be used?

A

reinforcement of esophagotomy or esophagectomy site

  1. muscle pedicle graft from sternohyoid, sternothyroid, or diaphragm
  2. omentum
  3. pericardium or gastric wall
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17
Q

How should patients be fed following esophageal surgery?

A

NPO for 24 hours to 10 days or a liquid diet for 3-5 days

  • may need to bypass esophagus
18
Q

How long should a thoracostomy tube be left following esophageal surgery? How long are antibiotics used?

A

24-48 hours, but longer if pleuritis/mediastinitis is present

until drains or removed, longer if infection is present

19
Q

What are the most common complications of esophageal surgery? What 3 factors predispose?

A

leakage or rupture at suture line or stricture

  1. lack of serosa and omentum
  2. pressure gradient across esophageal wall caused by changes in pleural pressure with breathing (constant motion)
  3. rapid dilatation associated with swallowing
20
Q

What are the 4 most common sites of esophageal foreign body obstruction?

A
  1. pharynx/esophagus
  2. thoracic inlet
  3. base of heart
  4. esophagus hiatus
21
Q

What are the 4 most common clinical signs of esophageal foreign bodies?

A
  1. dysphagia, choking, coughing
  2. regurgitation
  3. refusal to eat
  4. depression and pyrexia
22
Q

What are the 5 most common radiographic findings on survey radiographs with esophageal foreign bodies?

A
  1. abnormal intraluminal density
  2. esophageal distention (dilated)
  3. tracheal displacement
  4. abnormalities of mediastinum
  5. abnormalities of lung fields +/- pleura
23
Q

What is the treatment for esophageal foreign bodies? What must be done after?

A

removal

assess integrity of esophagus by endoscopy and contrast radiography and surgically repair if necessary

24
Q

How does morbidity and mortality rate for esophageal foreign bodies removal by esophagotomy vs endoscopy compare?

A

morbidity and mortality rates are higher via esophagotomy, so non-surgical means of removal should be used whenever possible

(however, large or heavy FBs may be impossible to remove with endoscope or balloon catheter)

25
Q

What is cricopharyngeal achalasia? What is the most common signalment?

A

pharyngeal dysphagia where a bolus of food is not passed from the oropharynx to the cranial esophagus due to failure of the relaxation of the cricopharyngeal muscle in coordination with contraction of the pharyngeal muscles

puppy at weaning is normal until it begins eating solid food, where it will being gagging, retching, and regurgitating food immediately after swallowing

26
Q

How is cricopharyngeal achalasia diagnosed?

A

fluoroscopy during a barium swallow shows a bolus of food moved into the esophagus, but stopped by the cricopharyngeal muscle

27
Q

What is the treatment of cricopharyngeal achalasia? When is this contraindicated?

A

cricopharyngeal myectomy (cricopharyngeal cartilage is c-shaped)

other forms of pharyngeal dysphagia

28
Q

Cricopharyngeal myectomy, ventral approach:

A

must elevate cricopharyngeal muscle to separate from esophagus

(place an orogastric tube to make the esophagus more obvious)

29
Q

Cricopharyngeal myectomy:

A
30
Q

What are the 2 most common causes of megaesophagus in young patients? 3 causes in older patients?

A
  1. congenital due to incomplete nerve development
  2. vascular ring anomaly
  • myasthenia gravis
  • hypothyroidism
  • Addison’s
31
Q

Why are barium studies not done as commonly to diagnose megaesophagus?

A

barium will remain for a long time and regurgitation can lead to movement into the lungs

32
Q

In what 3 ways can megaesophagus be diagnosed?

A
  1. UNSEDATED radiography
  2. endoscopy
  3. blood testing (hypothyroidism, Addison’s in older animals)
33
Q

How is megaesophagus managed?

A
  • elevated feeding chairs (Bailey chair) keep esophagus from dilating
  • gastric feeding tubes bypass esophagus
34
Q

What are vascular ring anomalies? In what animals are they mostly diagnosed?

A

congenital malformation of the great vessels mechanically interfering with function of the esophagus and trachea

German Shepherds
(95% are persistent 4th right aortic arch)

35
Q

How must young patients with vascular ring anomalies be prepared for surgery? How is this surgery done?

A

pneumonia is treated and body condition must be improved so that anesthesis does not pose a risk

identify, isolate, occlude, and divide offending vessels

36
Q

How are thoracoscopic ligations performed with vascular ring anomalies? Why must this be done carefully?

A

ligmentum arteriosum is dissected and a vascular clip is placed

vagus nerve is present on the ventrolateral surface of the esophagus

37
Q

When is Spirocerca lupi most commonly found? What 3 conditions are they associated with?

A

necropsy

  1. sarcomas
  2. hypertrophic osteopathy
  3. sudden death
38
Q

How is a feeding tube placed?

A
  • a Carmalt is fed into the pharynx and elevates the esophagus close to the skin
  • the skin is nicked and the Carmalt is pulled through
  • the esophagostomy tube is clamped and fed rostral through the pharynx and then turned around and directed down the esohagus
39
Q

How far is a feeding tube allowed to go?

A

no further than the 8th intercostal space —> wanted in the distal esophagus, not in the stomach

40
Q

Improperly placed feeding tubes:

A

in the trachea

41
Q

Where on the neck should the feeding tube be placed?

A

dorsal aspect —> doesn’t interfere with E collar

(+ it should be wrapped in to ensure it does not move too much)

42
Q
A

Small Animal Surgery (34 decks)

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