Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 16 > Esophagus: Regurgitation & Dysphagia > Flashcards

Esophagus: Regurgitation & Dysphagia Flashcards

1
Q

describe the anatomy of the esophagus from pharynx to the stomach

A

starts dorsal to larynx

runs of left side, dorsal to trachea in mediastinum

through esophageal hiatus in diaphragm

enters stomach at cardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the two sphincters of the esophagus (2)

A
  1. upper esophageal sphincter (UES): cricopharynx
  2. lower esophagus sphincter (LES): cardia of stomach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the layers of the esophagus (4)

A
  1. mucosa
  2. submucosa
  3. muscularis: striated in the dog and striated and smooth in cats
  4. adventitia (no serosa)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what innervates the esophagus

A

the vagus nerve (efferent and afferents)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how is normal swallowing occur

A

highly coordinated and largely involuntary

Upper esophageal sphincter relaxes and food moves into the proximal esophagus. Peristalsis than moves food down esophagus

Lower esophageal sphincter relaxes before the food gets there and food can empty into stomach. Then contracts to prevent reflex
If primary peristaltic wave fails to get food down a secondary wave will move the food down generated by esophageal distention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is dysphagia

A

difficulty swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is pharyngeal dysphagia

A

try and swallow repeatedly but gag, retch, struggle to drink and may eject food from mouth (immediately after eating)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the causes of pharyngeal dysphagia

A

failure of UES to relax (achalasia) OR

incoordination between pharyngeal contraction and UES relaxation (asynchrony)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the signs of esophageal dysphagia

A

usually only 1 swallowing attempt, may or may not be able to drink

may bring up food at any time after eating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is regurgitation

A

passive evacuation of food and/or fluid from esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what causes regurgitation

A

local events within esophagus

may be due to structural disease, obstruction or functional disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how do you distinguish between regurgitation and vomiting

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

is there prodromal nausea with vomiting or regurgitation

A

usually with vomiting

not with regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

is there retching/abdominal effort with vomiting or regurgitation

A

with vomiting yes

not with regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

is there food material produced with vomiting or regurgitation

A

sometimes food with both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the character of the food material produced with vomiting or regurgitation

A

usually digested with vomiting

usually undigested with regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

is there bile with vomiting or regurgitation

A

sometimes with vomiting

not with regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is the pH of vomit and regurgitation material

A

acidic/alkali with vomiting

alkali with regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is aspiration pneumonia

A

food or water inhaled into lungs

causes chemical injury followed by secondary infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the signs of aspiration pneumonia (6)

A
  1. soft cough
  2. dyspnea
  3. tachypnea
  4. pyrexia
  5. lung crackles
  6. +/- nasal discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are the signs of aspiration pneumonia on rads

A

radioopacity of the ventral lung fields with air bronchograms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what are risk factors of aspiration pneumonia

A

regurgitation or dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is the treatment for aspiration pneumonia

A
  1. oxygen therapy if needed
  2. fluid therapy if needed
  3. broad spectrum antibiotics
  4. nebuilization
  5. coupage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are signs of esophageal disease (9)

A
  1. regurgitation
  2. dysphagia
  3. +/- odynophagia
  4. +/- ptyalism
  5. +/- ravenous or reduced appetite
  6. +/- weight loss
  7. +/- dehydration
  8. +/- cervical swelling
  9. +/- respiratory signs due to secondary aspiration pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are obstructive esophageal diseases (8)

A
  1. vascular ring anomaly (VRA)
  2. foreign body
  3. stricture
  4. hiatal hernia
  5. diverticulum
  6. perioesophageal obstruction
  7. gastro esophageal intussception
  8. parasitic granuloma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are functional esophageal diseases (5)

A
  1. megaesophagus (MO) (congenital or acquired; primary or secondary)
  2. esophagitis
  3. gastroesophageal reflux
  4. lower esophageal sphincter achalasia-like syndrome (rare)
  5. cricopharyngeal achalasia or asynchrony (rare)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the clinical examination abnormalities that can be seen with esophageal diseases (5)

A
  1. hypersalivation
  2. poor body condition
  3. bulging in neck (food or air)
  4. muscle atrophy/weakness (neuromuscular disease)
  5. respiratory signs (aspiration pneumonia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what esophageal abnormalities can be seen on rads (6)

A
  1. radioopaque foreign body
  2. dilation of esophagus
  3. hiatal defects
  4. peri-esophageal massess
  5. pulmonary changes
  6. pneumomediastinum/mediastinitis/pleural effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is contrast radiography useful for

A
  1. luminal obstruction
  2. mucosal irregularity
  3. significant alterations in motility
  4. hiatal hernia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the risks for contrast rads

A

aspiration pneumonia –> severe problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what is fluoroscopy useful for

A

pharyngeal disorders

sublte esophageal motility disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what can you observe with fluoroscopy (5)

A
  1. oral phase
  2. esophageal transit time
  3. pooling contrast
  4. stalling of boluses
  5. gastroesophageal reflux
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what does esophagoscopy allow assessment of (4)

A
  1. lumen and mucosa (obstructions, inflammation, perforation, hiatal hernia, dilation)
  2. biopsy or cytology sampling (rare)
  3. foreign body removal
  4. balloon dilation of strictures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what can be seen on hematology with esophageal diseases

A

often normal

but if aspiration pneumonia –> leukocytosis, left shift neutrophilia, monocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what can be seen on biochemistry with esophageal diseases

A

often normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the difficulties with esophageal surgery (5)

A
  1. risk of AP on induction of GA
  2. thoracotomy for intrathoracic esophagus
  3. risk of contamination of thoracic cavity
  4. healing challenging
  5. fixed length
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is esophagotomy

A

incision into lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is esophagectomy

A

removal of portion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is esophagostomy

A

creation of opening for feeding tube

40
Q

how is esophagotomy done (7)

A
  1. stabilize patient
  2. longitudinal incision
  3. two layer closure
  4. submucosa is holding layer (always include in sutures)
  5. simple interrupted suture pattern (do not leave knots on the wall)
  6. check closure integrity
  7. treat esophagitis post-operatively
41
Q

what is a congenital vascular ring anomaly

A

causes significant narrowing and obstruction of esophagus

42
Q

what are the causes of congenital vascular anomaly

A

persistant right aortic arch (most common)

right aortic arch becomes functional aorta instead of left fourth arch

various other less common vascular anomalies can occur

43
Q

what are the breed dispositions of vascular ring anomaly

A

GSDs and irish setters

start regurgitating when eaned

often have weight loss and stunting

44
Q

how are congenital vascular ring anomalies treated

A

surgery to transect ligamentum arteriosum

treat AP and improve body condition before surgery

>90% have significant clinical improvement

some have ongoing problems with esophageal motility –> regurgitation

45
Q

what are common sites of obstruction of foreign bodies (3)

A
  1. thoracic inlet
  2. heart base
  3. just cranial to diaphgram (most common)
46
Q

what are the signs of acute onset foreign body obstruction (5)

A
  1. regurgitation
  2. dysphagia
  3. odynophagia
  4. gagging
  5. hypersalivation
47
Q

what can be seen on clinical examination with foreign body obstruction

A
  1. halitosis
  2. cervical FB may be palpable
  3. systemic signs suggest AP or perforation
48
Q

how are foreign bodies diagnosed

A

often made on plain radiography

always taken to look for evidence of aspiration pneumonia

49
Q

how are foreign bodies treated (6)

A
  1. stabilize patient
  2. GA
  3. endoscopic removal is method of choice (remove orally or pushed into stomach)
  4. evaluate mucosa (hemorrhage, lacerations, perforation)
  5. post-endoscopy radiography to look for perforation
  6. treat for esophagitis
50
Q

what are the potential sequelae following a foreign body removal (3)

A
  1. stricture: narrowing of esophageal lumen by fibrous tissue
  2. fistula: abnormal tract between esophagus and usually respiratory system
  3. diverticulum: pouch like sacculation of esophageal wall
51
Q

what is an esophageal stricture

A

circular band of scar tissue: secondary to severe esophagitis

52
Q

what are the signs of esophageal strictures

A

hungry but lose weight

better with liquids

53
Q

how are esophageal strictures diagnosed

A

difficult to see on plain radiographs

contrast radiography (number, length, location)

endoscopy (cause –> biopsy)

54
Q

how are esophageal strictures treated (3)

A
  1. endoscopic balloon dilation
  2. followed by medical therapy for esophagitis
  3. +/- steroids to reduce recurrence
55
Q

what are the types of hiatal hernia

A

congenital or acquired

56
Q

what are the breeds predispositions to hiatal hernia

A

shar pei

english/french bull dogs

57
Q

what are the two main types of hiatal hernias (2)

A
  1. sliding: distal esophagus and stomach move into mediastinum through esophageal hiatus
  2. perioesophageal: portion of stomach moves into mediastinum through defect adjacent to esophageal hiatus
58
Q

what are the effects of hiatal hernias (3)

A
  1. gastroesophageal reflux due to decrease LES pressure
  2. esophagitis
  3. hypomotility
59
Q

what are the clinical signs of hiatal hernias (7)

A
  1. congenital is seen soon after weaning
  2. regurgitation
  3. vomiting
  4. hypersalivation
  5. hematemesis
  6. poor body condition
  7. dyspnea
60
Q

how are small hernias treated

A

medical management for esophagitis

61
Q

how are large hernias treated

A

surgical: narrow esophageal hiatus, pexy esophagus, pexy fundus of stomach

62
Q

what are the primary esophageal neoplasias (4)

A
  1. fibrosarcoma/osteosacroma (dog)
  2. leiomyosarcoma (dog)
  3. leimyoma (dog)
  4. squamous cell carcinoma (cat)
63
Q

what are the neoplasias that can affect the esophagus (3)

A
  1. primary esophageal
  2. peri esophageal
  3. metastatic
64
Q

what are the signs of esophageal neoplasia (5)

A
  1. progressive esophageal obstruction
  2. odynophagia
  3. anorexia
  4. weight loss
  5. depression
65
Q

how are esophageal neoplasia diagnosed

A
  1. plain/contrast films
  2. esophagoscopy (biopsy/cytology)
66
Q

what is the prognosis of esophageal neoplasia

A

often poor

67
Q

what can cause parasitic granulomas

A

spirocerca lupi

nematode

beetle is intermediate host

68
Q

what are the types of megaesophagus

A
69
Q

what is megaesophagus

A

diffuse esophageal dilation and aperistalsis

70
Q

what breed predispositions to congenital megaesophagus

A
  1. irish setter
  2. GSD
  3. great danes
71
Q

what are secondary megaesophagus (7)

A
  1. myasthenia gravis
  2. severe esophagitis
  3. hypoadrenocorticism
  4. generalized myopathies
  5. generalized neuropathies
  6. toxins
  7. hypothyroidism
72
Q

what are the clinical signs of megaesophagus (6)

A
  1. regurgitation
  2. dysphagia
  3. +/- hypersalivation
  4. weight loss
  5. +/- respiratory signs
  6. +/- signs of underlying disease
73
Q

what can be seen on rads in megaesophagus

A

dilated with air, fluid or ingesta

look for signs of aspiration pneumonia

74
Q

what is shown here

A

megaesophagus

75
Q

what is shown here

A

megaesophagus

76
Q

how is megaesophagus treated (5)

A
  1. treat underlying cause if secondary
  2. postural feeding
  3. ideal food consistency varies
  4. sildenafil
  5. treat aspiration pneumonia
77
Q

how do you look for secondary causes of megaesophagus (3)

A
  1. hematology/biochemistry
  2. acetly choline receptor antibodies (myasthenia gravis)
  3. ACTH stimulation test (neuor exam –> evidence for myopathies or neuropathies)
78
Q

why does metoclopramide not help dogs

A

acts on smooth muscle rather than skeletal muscoe and tends to close the lower sphincter

may be helpful in cats where there is more smooth muscle

79
Q

how do you diagnose esophageal dysmotility

A

need fluoroscopy

80
Q

how is esophageal dysmotility treated

A

same as megaesophagus

81
Q

what is myasthenia gravis

A

end of motor nerves acetylcholine is released to stimulate the skeletal muscle via the acetylcholine receptor across the neuromuscular junction

82
Q

what is the most common secondary cause of megaesophagus

A

myasthenia gravis

83
Q

what are the types of myasthenia gravis

A
  1. congenital
  2. acquired
84
Q

what is acquired myasthenia gravis

A

due to antibody production against acetly choline receptors at motor end plates

85
Q

how is myasthenia gravis diagnosed (2)

A
  1. tensilon test: generalized only, non-specific
  2. acetyl choline receptor antibody assay: acquired only
86
Q

how is myasthenia gravis treated (2)

A
  1. pyridostigmine
  2. consider injectable: needs to get to stomach
87
Q

what is the prognosis of myasthenia gravis

A

esophageal function may improve with treatment

about 50% respond

88
Q

what are the side effects of pyridostigmine (6)

A

muscarinic:

  1. salivation
  2. micturition
  3. bradycardia
  4. arrhythmias
  5. hypotensions
  6. weakness
89
Q

what are causes of esophagitis (5)

A
  1. chronic vomiting
  2. gastroesophageal reflux (can be secondary due to GA)
  3. ingestion of caustic agents
  4. capsule retention (doxycycline)
  5. foreign bodies
90
Q

what are the clinical signs of esophagitis (7)

A
  1. variable (asymptomatic to severe)
  2. dysphagia
  3. regurgitation
  4. odynophagia
  5. hypersalivation
  6. food avoidance
  7. weight loss
91
Q

how is esophagitis diagnosed

A

inflammation seen endoscopically

biopsy usually necessary

likely under diagnosed

92
Q

how is esophagitis treated (5)

A
  1. small low fat high protein meals
  2. +/- withold food PO
  3. sucralfate liquid
  4. metoclopramide
  5. gastric acid secretory inhibitors (PP inhibitors)
93
Q

what are the causes of gastroesophageal reflux

A

disorder of LES allowing reflux of fluids/ingesta into esophagus

leads to esophagitis

94
Q

what is gastroesophageal reflux due to (5)

A
  1. chronic vomiting
  2. gastric emptying disorder
  3. hiatal hernia
  4. upper airway obstruction
  5. anesthesia
95
Q

how is gastroesophageal reflux treated (5)

A
  1. avoid high fat diets (to encourage rapid gastric emptying)
  2. sucralfate suspension
  3. gastric acid secretory inhibitors
  4. metoclopramide (help close the lower esophageal sphincter)
  5. surgery for upper airways in brachycephalic dogs helps

Module 16 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions