Esophagus Flashcards
What are other names for the upper esophageal sphincter?
Cranial esophageal sphincter Cricopharyngeal sphincter
What muscles is the UES made from…2 of them?
Cricopharyngeus m Thropharyngeus m
The esophagus is to what side of the trachea?
left thus enters the diaphragm on the left
What are the four walls of the esophagus?
- Fibrous 2. Muscular 3. Submucosa 4. Mucosa
What percentage of the esophagus is straited in the dog? Cat?
Dog: 100% Cat: Cranial 2/3.. the caudal 1/3 is smooth muscle
What arteries supply the esophagus? Cervical vs cranial thorax vs caudal thorax.
Cervical - Thyroid arteries Cranial thorax - Bronchoesophageal a. Caudal thorax - Esohageal branches of the aorta
What veins drain the esophagus?
Azygos Left gastric
What nerves are involved in swallowing?
5 - Trigeminal 7 - Facial 9 - Glossopharyngeal 10 - Vagus 12 - Hypoglossal
Why does this look this way and what is it called?
This is a normal appearance of the caudal esophagus of a cat.
Herringbone look.
What is this? Is this a problem?
This is a redundant esophagus. It is commonly incidental though can have reduction of motility thus fluoroscopic evaluation is warranted.
Who commonly has redundant esophaguses?
Brachycephalic dogs
Young dogs
What is not recommended for contrast in patients with greater risks for aspiration?
Barium paste because it can cause plugging of the lower airways
Iodinated contrast due to edema
Where can you see barium after barium is aspirated?
Thoracic lymph nodes (mediastinal and tracheobronchial)
What are the three phases of swallowing before the esophagus?
- Oral
- Pharyngeal
- Cricopharyngeal
Each one can have problems causing dysphagia
What is the difference between cricopharyngeal achalasia and cricopharyngeal chalasia?
- Cricopharyngeal achalasia is the inability for the UES to open
- Cricopharyngeal chalasia is that the UES is open between swallows
Do cats get dysphagia?
Rarely… mostly esophageal problems.
Dyspagia secondary to cricopharyngeal dysfunction can cause what?
Misdirection of food bolus into the trachea
What is the normal time in seconds does it take for the cricopharyngeal phase?
0.1s
Delayed is considered 0.3s
What type of dysphagia is most rare and usually does not happen without other types of dysphagia?
Pharyngeal… it is rare.
What type of esophageal disease is LarPar associated with?
Esophageal dismotility. Geriatric onset laryngeal paralysis polyneuropathy (GOLPP)
What does laying a dog in lateral recumbancy do to esophageal transit time? Time for oral, pharyngeal and cricopharyngeal phases? and percentage of swallows that need a secondary perstalsis wave?
Increases them all.
How many seconds is considered a prolonged esophageal time?
>5 sec
What are three criteria for diagnosis of esophageal dismotility?
- Esophageal time >5
- Retrograde flow >10cm
- Bolus staying in the esophagus after two secondary peristaltic waves.
Esophageal dysmotility can normally be seen in younger dogs….T/F?
True… wait til 1 year of age and it may resolve.
What types of aortic anomolies cause external esophageal stricture?
All of them
What is normal development of the aorta?
Aorta comes from the left 4th aortic arch
The right 4th should regress
What is the difference in the clinical signs from the aberrant right subclavin artery and the aortic anomalies?
Aberrant right subclavin artery (coming from the aorta and not the brachycephalic trunk) usually has less compression and is sometimes more cranial.
Granulomas from spirocera lupi can turn into what type of neoplasia?
Osteosarcoma
Fibrosarcoma
What are the two early signs for spirocera lupi?
Aortic mineralization
Spondylitis
On CT… what is the way to tell if neoplastic transformation has occured in nodules created by spirocera lupi?
Granulomas will enhance
Neoplastic nodules will not!
What breed gets redundant esophagus?
Brachycephalic breeds
What frame rate should you look at a fluroscopic esophagram?
30-60fps
Bolus size can significantly alter what in a swallowing study?
Pharyngeal contraction
Opening of the UES
Thoracic esophageal transit time
Pharyngeal dysphagia can look like what with clinical signs and fluoroscopic findings?
Cricopharyngeal dysphagia
What are the fluoroscopic abnormalities seen with pharygneal dysphagia?
Slow contraction of the larynx
Incomplete enclosure of the bolus
Incomplete rostral and dorsal movement off the larynx
Absence of forceful contraction of the phargynx to propel bolus to UES
Why is it important to differentiate between cricopharyngeal disorders and pharyngeal disorders?
Cricopharyngeal disorders (achalaisa) can be helped with a myotomy while pharyngeal disorders with worsen with a myotomy.
What is the discerning factor between pharyngeal dysphagia and cricopharyngeal dysphagia?
Time of opening of the UES
Cricopharyngeal achalasia is associated with what breed type?
Toy breeds
How do you calculation pharyngeal constriction ratio?
Dividing pharyngeal area at max contraction by the pharyngeal area at rest
What is the normal time (avg) between beginning of swallow (closure of epiglottis) to opening of the UES? Achalasia of the UES average time?
- 1s Normal.
- 3-0.4s Achalasia
What disease process is cricopharyngeal chalasia commonly seen with?
Myasthenia gravis
What is the most common type of dysphagia in a cat?
Esophageal - hiatal hernia, dysmotility and stricture being the most common
What disease process is esophageal dysfunction commonly associated with?
Lar Par
The percentage of primary waves are affected how in sternal recumbancy vs lateral?
Sternal recumbancy has significantly greater primary waves than in lateral.
Fluoroscopic signs of esophageal dysfunction?
Abnormal primary wave moves bolus 5 cm and abnormal secondary waves allow bolus retention in the esophagus after two subsequent swallows
Retrograde flow of more than 10 cm
Prolonged esophageal transit time (>5s)
Can esphageal dysmotility be caused by delayed maturation?
Yes.. can spontaneously impove after 1 year of age
What breed of dogs is seen to have reduced pharyngeal contraction secondary to myopathy?
Boxers
What disease can look identical to esophageal and paraesophageal varices in dogs?
Bronchoesophageal artery hypertrophy secondary to chronic pulmonary disease or thromboembolic disease.
