Gastroenterology Pt. 4 Flashcards
CONGENITAL ESOPHAGEAL DISORDERS (5)
¡ Vascular ring anomalies
¡ Esophageal diverticulum
¡ Sliding & paraesophageal hiatal hernias
¡ Congenital megaesophagus (motility disorder)
¡ Esophageal achalasia (lower esophageal sphincter does not relax)
congential esophageal disorders diagnosis
¡ Thoracic radiographs
¡ Barium swallow (Fluoroscopy best)
¡ Endoscopy
treatment for primary esophageal motility disorder
¡ Gravity feeding
¡ Bailey chair
¡ Small frequent meals
treatment for achalasia
¡ Sildenafil
¡ Surgery
treatment for congenital esophageal disorders aside from primary motility disorders and achalasia
surgery
causes of acquired megaesophagus
¡ Esophageal motility ± swallowing disorder
> Occasionally just swallowing disorder (dysphagia)
¡ Idiopathic
> Most common diagnosis
¡ Myasthenia gravis
> Focal or generalized ± thymoma in cranial
thorax
> Diagnosis - acetylcholine receptor antibody titre
¡ Previous GDV and gastropexy
¡ Classical and atypical Addisons
> ACTH stimulation test
¡ Hypothyroidism?
¡ Esophagitis?
¡ Dysautonomia – dysuria, dry mm, abnormal PLRs
¡ Other causes
main complication of acquired megaesophagus
high risk for aspiration pneumonia
diagnostics for acquired megaesophagus
¡ Radiograph
¡ Endoscopy
¡ Work-up for underlying disorder
consideration when using radiographs to diagnose acquired megaesophagus
avoid barium if possible (aspiration risk)
pros and cons of endoscopy to diagnose acquired megaesophagus
- Cannot judge motility
- Useful to identify FB, stricture, esophagitis
- Increased risk of aspiration after anesthesia
underlying disorder work-ups that we can do to investigate acquired megaesophagus
¡ Acetylcholine receptor antibody titer (Myasthenia gravis)
¡ Resting cortisol/ACTH stimulation test (Hypoadrenocorticism)
¡ Thyroid profile
acquired megaesophagus treatment
¡ Treat underlying cause if possible
> eg. myasthenia gravis > pyridostigmine
¡ Gastrotomy tube
¡ Metoclopramide/cisapride
> Increase smooth muscle tone of LES
> Promote gastric emptying
¡ Esophageal suctioning
¡ Sildenafil?
myasthenia gravis treatment? what not to use?
- Pyridostigmine (cholinergic drug)
- ± Immunosuppression
- Not prednisone
> Muscle weakness & aspiration pneumonia
acquired megaesophaus prognosis
¡ Idiopathic close to 0% survival
¡ Myasthenia gravis – 20-40% survival
¡ Addisons – 100% survival
¡ Post GDV and other?
causes of acute esophagitis
¡ Esophageal FB
¡ Regurgitation under anesthesia
¡ Caustic substance
¡ Severe protracted vomiting
¡ Small intestinal ileus
signs of acute esophagitis
¡ Regurgitation
¡ Depression (painful)
causes of chronic esophagitis
- Gastroesophageal reflux disease (GERD)
> Not as common a primary disorder as in humans
> Reduced LES tone
> R/O hiatal hernia - Persistent vomiting
medical treatments for chronic esophagitis
- Gastroprotectants (sucralfate, omeprazole…)
- Treat cause of vomiting
types of esophageal neoplasias
¡ Spirocerca lupi (nematode) sarcoma
¡ Primary esophageal carcinoma
¡ Invasive thyroid or pulmonary tumour
diagnosis for esophageal neoplasia
¡ Plain radiographs ± barium
¡ Endoscopy
> Cannot normally biopsy esophagus by endoscopy
> Sometimes can biopsy a mass
most common cause of esophageal stricture? when do we see clinical signs?
Most commonly caused by gastroesophageal reflux during general anesthesia
¡ Reported to have preceded stricture formation in up to 65% of cases
¡ Clinical signs typically reported 7-8 days post anesthesia
how often are esophageal strictures alone? how often are there multiple?
¡ Single strictures identified in 80%, 2 or 3 in remaining 20%
where are most esophageal strictures located?
¡ 80-90% located in intrathoracic esophagus
esophageal stricture treatment options; how do they work, pros and cons
¡ Balloon dilation
> Theoretical advantage: forces applied in
a radial stretch
> Balloon kept inflated for 60-90 seconds and then deflated
¡ Bougienage
> Longitudinal forces applied
> Dilation with mechanical dilators (bougies)
¡ With either treatment:
> Multiple treatments often required
> Risk of esophageal perforation
- Esophageal balloon dilation feeding tube
¡ Twice daily at home dilations for 6
weeks
¡ In one study, 92% had improvement
¡ Major complications in 17%
reasons for regurgitation in cats (5)
¡ Esophageal FB, occasionally large furballs
¡ Caustic - doxycycline
¡ Esophageal stricture
¡ Squamous cell carcinoma
¡ Megaesophagus – can affect:
> Proximal 2/3 striated muscle
> Distal 1/3 smooth muscle
> Whole esophagus
List 3 of the main factors in the gastric mucosal barrier:
¡ Bicarbonate-rich mucus
¡ Mucosal cells
¡ Blood supply
Which of the following is not a potential cause of secondary megaesophagus?
¡ A) Hyperadrenocorticism
¡ B) Hypothyroidism
¡ C) Myasthenia Gravis
¡ D) Hypoadrenocorticism
¡ A) Hyperadrenocorticism
Identify the true statement in regards to esophageal strictures
¡ A) Forces applied in balloon dilation are applied longitudinally and those with bougeniage are applied radially
¡ B) Patients that develop esophageal strictures subsequent to GER during anesthesia will usually show signs within 1- 2 days afterwards
¡ C) A single treatment (with either balloon dilation or bougenieage) is usually sufficient to treat esophageal strictures
¡ D) Esophageal perforation is a risk with treatment of esophageal strictures
D) Esophageal perforation is a risk with treatment of esophageal strictures
