Esophagus

Question 1

Esophageal layers

Answer 1

Submucosa layer of strength because of the layer of collagen

Question 2

Swallowing mechanism

Answer 2

Tongue pushes food and pharynx relaxes and contracts. Upper esophageal sphincter relaxes and contracts. Primary peristaltic contraction. Bolus. Second peristaltic contraction. Gastroesphageal sphincter relaxes then to the stomach. This sphincter prevents reflux. Can have gastro esophageal reflux disease.

Question 3

Neuromuscular disease

Answer 3

Circopharyngeal dysphagia, idiopathic megaesophagus, esophageal hiatal hernia

Question 4

Cricopharyngeal dysphagia (achalasia)

Answer 4

Achalasia- failure to relax
Asynchrony- uncoordinated relaxation- contraction
Chalasia- failure to close
Fail to relax

Usually congenital. Dysphagia of solid foods. Aspiration pneumonia.
Diagnose with contrast fluoroscopy. Treatment- cricopharyngeal myotomy.

Question 5

Cricopharyngeal myotomy

Answer 5

Ventral approach
Pull sternothyroideus- rotate pharynx
Find cricopharyngeal mm and transect

Question 6

Idiopathic megaesophagus

Answer 6

Decreased myenteric plexus, decreased vagal innervation, or decreased afferent innervation

Question 7

Esophageal foreign body

Answer 7

Heart base> diaphragm> thoracic inlet. 
Acute onset. Diagnose with radiographs or esophagoscopy. 
Approach: 	
        1. Retrieve
	2. Push into the stomach
	3. Esophagotomy

Question 8

Esophageal foreign body complications

Answer 8

Perforation, strictures, diverticuli, bronchoesophageal fistula

Question 9

Esophageal FB medical treatment

Answer 9

Atraumatic removal- soft food for 3-5 days
Mild mucosal laceration- NP, IV fluids 3-5 days
Severe laceration or perforation- gastrostomy tubes

Question 10

Surgical approaches to the esophagus

Answer 10

Cervical- ventral midline
Anterior thoracic- left 4th
Heart base- right 5th
Posterior thoracic- left 9th
transdiaphragmatic

Question 11

Esophageal surgery considerations

Answer 11

No serosa or omentum.

Constant motion, poor longitudinal distention, segmental blood supply, contaminated.

Question 12

Esophagotomy and anastomosis closure

Answer 12

Doubly layer:
Esophagotomy- mucosa/submucosa- continuous pattern
Muscularis- S.I. or lembert pattern

Anastomosis- mucosa/submucosa- SI with knots in the lumen
Muscularis- SI pattern

Question 13

Esophageal strictures (stenosis)

Answer 13

Anesthesia- reflux esophagitis in cats
Prestenotic dilation- regurgitation 
Treatment:
Esophageal dilation (2-3 applications)
Esophagoplasty
Resection and anastomosis

Question 14

Hiatal hernia

Answer 14

Franco esophageal hiatus stretches out.
Type 1 vs type 2
Gastric cardia in pleural space- reduced GES pressure.
Reflux esophagitis- HCL- hypersalivation, regurgitation

Question 15

Hiatal hernia surgery

Answer 15

Prevent reherniation- reduce hiatus, gastropexy

Stop gastroesphageal reflux- antireflux procedure, gastrostomy tube

Question 16

Epiphrenic Diverticulum

Answer 16

2-3cm of cardia. Signs of partial obstruction.
Traction-adhesion
Pulsion- mucosa protrudes through muscular rent
Etiology- perforation, stricture
Treatment- left 8 or 9 IC incision. Dissect, cross clamp, and excise stalk.
Postoperative gastrotomy tube.
Guarded prognosis

Question 17

Gastroesophageal Intussusception- invagination

Answer 17

Dogs 6-12 weeks old.
Gastric cardia invaginate into terminal esophagus.
Acute onset regurgitation, dyspnea, cardiovascular collapse.
Treatment- medical shock therapy. Reduce and gastropexy.
Grave prognosis

Question 18

Vascular Ring Anomalies

Answer 18

Heritable. German Shepards.
Regurge after weaning. Stricture at the base of the heart.
Dog- Persistent right aortic arch, double aortic arch, aberrant subclavian aa, persistent left vena cava, left aortic arch and right LA
Cat- Double aortic arch, persistent right aortic arch, persistent right ductus arteriosus

Question 19

PRAA surgery

Answer 19

Elevate and divide LA between ligatures, break down fibrous constriction, foley catheter, esophageal plication?