GI Flashcards
What are the three major phases of swallowing?
The first phase has three
Normal swallowing in the dog: a cineradiographic study VRU 1979
Oropharyngeal, esophageal and gastroesophageal
Oropharyngeal: oral, pharyngeal, pharyngoesophageal phase.
Describe the three oropharyngeal stages in the oropharyngeal phase of swallowing.
Normal swallowing in the dog: a cineradiographic study VRU 1979
Oral: voluntary stage. Stripping action of tongue to organize a bolus in the oropharynx. Bolus formation at the oropharynx elicits the next 2 stages
Pharyngeal: Peristaltic cranial contraction of pharynx and propulsion of bolus from the tongue into the laryngopharynx. Blockage of egresses (tongue - plunger like action to roof of mouth to block oropharynx, pharyngeal arch - nasopharynx, and epiglottis - larynx). At time of pharynx contraction - cricopharyngeal sphincter opened and allowed passage of bolus into the esophagus.
Pharyngoesophageal stage - closure of cricopharyngeal sphincter and relaxation of pharynx, epiglottis, tongue and pharyngeal arch.
Describe the different types of esophageal peristalsis
Normal swallowing in the dog: a cineradiographic study VRU 1979
Primary: Triggered by oropharyngeal phase
1) Swallow reflex –> esophageal peristaltic wave
2) Swallow –> bolus accumulates in cranial esophagus for multiple swallows until second bolus pushes forward
Secondary: Triggered mechanically by luminal esophageal distension and tactile stimuli
1) Swallowed bolus resides in esophagus until esophagus is stimulated to move
2) Multiple boluses from several swallow accumulate in proximal esophagus and trigger peristaltic wave
How is a pharyngeal contraction judged as adequate?
Normal swallowing in the dog: a cineradiographic study VRU 1979
Takes approximately 2-4 frames at a rate of 60 frames per second, and results in the entire bolus moving past the cricopharyngeal sphincter
What muscles make up the cricopharyngeal sphincter?
Normal swallowing in the dog: a cineradiographic study VRU 1979
Quantitative valuation of pharyngeal function in the dog VRU 41.5
cricopharyngeous and thyropharyngeous
Morphologic vs functional causes of dysphagia?
Quantitative evaluation of pharyngeal function in the dog. VRU 41.5
Morphologic: foreign body, neoplasia, trauma
Functional: inability of muscles to relax, incoordination of ontraction, flaccidity of muscles
What are the most common neoplastic transformation of spirocerca? What are the most common radiographic findings?
TPDCT perfusion characteristics of spirocercosis induced esophageal nodules in non-neoplastic versus neoplastic canine cases.” VRU. 56.3 2015
Esophageal Osteosarcoma is most common. (fibrosarcoma and chondrosarcoma less likely). Radiographic findings: aortic aneurysm, caudal thoracic spondylitis, caudodorsal mediastinal mass
What are common characteristics of neoplastic vs non-neoplastic nodules in spirocerca esophageal lesions? (Comment on: contour, mineralization, necrosis, compare contrast enhancement between the two, and and the surrounding esophagus)
TPDCT perfusion characteristics of spirocercosis induced esophageal nodules in non-neoplastic versus neoplastic canine cases.” VRU. 56.3 2015
Non-neoplastic: smooth, no mineralization, necropurulent pockets (74% - 18% CSA), higher contrast enhancement when compared to neoplastic nodules (significant in all phases), higher enhancement of adjacent esophageal tissues (precontrast and early arterial phases) Neoplastic: irregular, mineralization (93%- 17% of CSA), necropurulent pockets (46% - 4% of CSA), contrast enhancement (lesser degree than non-neoplastic), esophagus had higher HU value than neopalstic nodule for all pahses
What nerves help govern swallowing?
Trigeminal, facial, glossopharyngeal, vagus and hypoglossal
In dogs with cricopharyngeal acahlasia - which portion of swallowing is significantly delayed?
What other portions of swallowing phase are delayed, but not significant between normal and abnormal dogs?
Quantitative evaluation of pharyngeal function in the dog. VRU 41.5
Opening and closure of the cranial esophageal sphincter (cricopharyngeal sphincter) in both liquid and kibble swallows.
Liquid: (0.09 - N, vs 0.31s - Abnormal)
Kibble: 0.26s - N, vs 0.44s - Abnormal
Caudal contraction of pharynx and epitlottic reopening times. –> why it should be called dyssynchrony instead!
What is approximate timing (from onset of swallow - the closure of the epiglottis) until CES opening and closure in normal vs abnormal dog (dysphagic)
Quantitative evaluation of pharyngeal function in the dog. VRU 41.5
Normal dog:
Opening: 0.09-0.1
Closing: 0.26-0.33
Dysphagic dog
Opening: 0.31-0.37
Closing: 0.44-0.6
Which muscles make up the upper esophagela sphincter (the cricopharyngeal arch). What nerves innervate these muscles?
Oropharyngeal dysphagias in the dog – cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders. I. Oral stage and pharyngeal stage dysphagias.
Thyropharyngeus, and cricopharyngeus
Parts of glossopharyngeal/vagus – the pharyngoesophageal nerve
What are fluoroscopic findings consistent with dysfunction of the oral stage of the oropharyngeal phase of swallowing?
Oropharyngeal dysphagias in the dog – cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders. I. Oral stage and pharyngeal stage dysphagias.
Variable reduction in tongue movement.
Difficulty forming a bolus
Contrast retention at the base of tongue - due to poor plunger like action of the tongue during following phases.
NO difference in ability to handle kibble vs liquids (vs CP dysphagia)
What are fluoroscopic findings consistent with dysfunction of the pharyngeal stage of the oropharyngeal phase of swallowing?
Oropharyngeal dysphagias in the dog – cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders. I. Oral stage and pharyngeal stage dysphagias.
1) No problem with bolus formation
2) Incomplete pharyngeal contraction - residual gas and contrast medium after CP relaxation
3) Slow contraction (cranial to caudal motion)
4) Retention of contrast in piriform recesses, pharyngeal opening
5) CP still coordinates well with pharyngeal motion
How to differentiate between primary pharyngeal stage and cricopharyngeal stage dysphagias?
Oropharyngeal dysphagias in the dog – cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders. I. Oral stage and pharyngeal stage dysphagias.
Cricopharyngeal: transient pharyngeal outpouchings due to forceful contraction of pharynx against closed cricopharyngeal arch.
Pharyngeal dysphagia: no deformation of cricopharyngeal passage
What is definition of chalasia and achalasia? (In regards to cricopharyngeal dysphagias)
Chalasia: failure to close
Achalasia: failure to open
What are some findings that may be seen in cricopharyngeal sphincter malfuction? (3)
Oropharyngeal dysphagias in the dog: a cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders. II. Cricopharyngeal stage and mixed oropharyngeal dysphagias
1) premature opening of cricopharyngeal passage and closure before emptying
2) delayed opening - cricopharyngeal arch begins to relax when pharynx is receding
3) Total absence of coordination between cricopharyngeal passage and pharyngeal contraction
What are some findings that may be seen in mixd oropharyngeal dysphagia?
Oropharyngeal dysphagias in the dog: a cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders. II. Cricopharyngeal stage and mixed oropharyngeal dysphagias
Simultaneous poor pharyngeal contractility and cricopharyngeal non-relaxation
Weak pharyngeal contraction resulting in contrast retention
What is importance in distinguishing between mixed pharyngeal/cricopharyngeal and cricopharyngeal dysphagia?
Oropharyngeal dysphagias in the dog: a cinefluorographic analysis of experimentally induced and spontaneously occurring swallowing disorders. II. Cricopharyngeal stage and mixed oropharyngeal dysphagias
Cricopharyngeal dysphagia - can be surgically treated with myotomy
If mixed - will result in severe aspiration pneumonia due to retention of large amounts of food within the pharynx resulting in aspiration.
According to the article
Initial influence of right vs left lateral recumbency on radiographic findings of duodenal gas on subsequens.nt survey VD projections of canine abdomen. VRU 56.1
Which lateral should be performed first if you are concerned about pyloric/duodenal obstruction?
Left lateral - more likely to have duodenal gas on the VD projection
When performing left lateral projection first - resulted in increased gas within the duodenum on all projections
Why do they suspect that performing a left lateral first (in an abdominal sries) is more likely to result in more gas present within the duodenum?
Initial influence of right vs left lateral recumbency on radiographic findings of duodenal gas on subsequent survey VD projections of canine abdomen. VRU 56.1
When the left lateral is performed - gas goes to the pyloric region. In humans, when enough gas is present in the pylorus - it will open for short periods of time to allow passage of gas into the duodenum.
When comparing two groups (group 1 that had left lateral performed first and group 2 that had right lateral performed first) - which was more likely to have gas present within the duodenum on the right lateral projection?
Initial influence of right vs left lateral recumbency on radiographic findings of duodenal gas on subsequent survey VD projections of canine abdomen. VRU 56.1
Group 1 - left lateral performed first - 43% vs group 2 that had 4%
When performing left lateral projection first - resulted in increased gas within the duodenum on all projections
How likely are foreign bodies to be found in the duodenum?
How likely are linear foreign bodies found to include the duodenum?
Initial influence of right vs left lateral recumbency on radiographic findings of duodenal gas on subsequent survey VD projections of canine abdomen. VRU 56.1
1) - 4-24%
2) - 84%
Duodenal changes in cases of pancreatitis?
Initial influence of right vs left lateral recumbency on radiographic findings of duodenal gas on subsequent survey VD projections of canine abdomen. VRU 56.1
lateral displacement of the duodenum
widening of the pyloroduodenal junction
abnormal gas distention of the duodenum
What are primary and secondary causes of a mesenteric volvulus?
Imaging diagnosis: Use of multiphasic CE-CT for diagnosis of mesenteric volvulus in a dog. VRu 55.1
Primary: Altered Gi motility, high fiber diets
Secondary: adhesions, hernia, pregnancy, previous surgery, GDV, foreign body, IBD, intussusception.
What is the CT whirl sign? When is it seen?
Spiral appearance (barber pole) to vessels, intestines, and fat, secondary to a volvulus.
Imaging diagnosis: Use of multiphasic CE-CT for diagnosis of mesenteric volvulus in a dog. VRU 55.1
In humans, what are common CT findings that may lead to a diagnosis of volvulus?
Imaging diagnosis: Use of multiphasic CE-CT for diagnosis of mesenteric volvulus in a dog. VRU 55.1
Whirl sign Global dilation of the small intestines Bowel wall thickening Enlarged veins Alterations of mesenteric vessels Beak shape of the intestines at the site of the volvulus. Thrombi within the vessels
What are the US characteristics of primary GI carcinomas vs lymphoma?
Imaging diagnosis: US appearance of small bowel metastasis from canine mammary carcinoma VRU 55.2
Intestinal carcinomas: transmural thickening of intestinal wall with complete loss of normal intestinal layers, changes in normal wall echogenicity decreased motility with or without obstruction, lymphadenopathy.
Lymphoma: diffuse, or solitary hypoechoic intestinal mass with transural thickening and loss of wall layering. Can also appear as diffuse infiltrative disease with wall thickening.(Cats - muscularis layer, dogs - not specific layer)
What are most common GI tumor types in dogs?
Imaging diagnosis: US appearance of small bowel metastasis from canine mammary carcinoma VRU 55.2
Adenocarcinoma
Lymphoma
What is frequency of occurrence of mammary carcinoma in dogs?
Imaging diagnosis: US appearance of small bowel metastasis from canine mammary carcinoma VRU 55.2
50% of tumors in intact females
Where does mammary carcinoma frequently metastasize to in dogs vs humans?
Imaging diagnosis: US appearance of small bowel metastasis from canine mammary carcinoma VRU 55.2
Lymphatic vessels to regional lymph nodes and to the lungs.
Dogs: Intestinal mets without specific layer being identified, skeletal and cardiac mets.
Women: lungs, liver, bones, soft tissue, brain and adrenal glands. GI mets are rare - involve diffuse mural thickening of the intestinal wall.
In the article: Imaging diagnosis: US appearance of small bowel metastasis from canine mammary carcinoma VRU 55.2. Where were the mets found, and which layer did they affect? How did they appear?
Multiple, oval to round well defined/marginated, hypoechoic nodules between 0.3-0.7cm.
Found in the muscularis layer of the small intestine (jejunum). The remaining wall layers were unaffected. The thickness of the jejunal wall was normal, except where nodules were found where they measured 0.6cm.
What is hyperechoic linear band paralleling colonic serosal layer in dogs represent?
Prevalence and significance of US colonic muscularis hyperechoic band paralleling serosal layer in dogs. VRU 56.6
Thickening of the fibrous tissue in the myenteric plexus of the muscularis
What are clinical signs of dogs with hyperechoic linear band paralleling the colonic serosal layer in dogs?
Prevalence and significance of US colonic muscularis hyperechoic band paralleling serosal layer in dogs. VRU 56.6
Usually NOT GI related.
What histology does a linear, hyperechoic structure in the mucosal layer of the GI represent in cats?’
sonographic appearance of intestinal mucosal fibrosis in cats. VRU 51.4
inflammatory cell infiltrates including eosinophils
What clinical significance did the linear, hyperechoic structure in mucosal layer of GI represent?
sonographic appearance of intestinal mucosal fibrosis in cats. VRU 51.4
All cats had some GI upset
What other changes did cats with linear hyperechoic structure in the mucosal layer have?
What clinical significance did the linear, hyperechoic structure in mucosal layer of GI represent?
Also had wall thickening, altered wall layering (increased echogenicity of mucosa, thick submucosa or muscularis layer).
No complete loss of wall layers.
What could US appearance of small bowel infarction appear like in a cat?
US diagnosis of small bowel infarction in a cat VRU 44.1
Progressive thickening of small intestinal loop (over 48 hours), with eventual loss of normal wall layers - diffusely hypoechoic
What are CT findings of bowel infarction?
US diagnosis of small bowel infarction in a cat VRU 44.1
diffuse/focal bowel wall thickening bowel dilation intramural gas intramural edema peritoneal fluid or gas
A proposed inflammatory condition in cats that mimics neoplasia, eosinophils are the most abundantly involved cell type.
JFMS 15.2
Feline gastrointestinal eosinophilic sclerosing fibroplasia.
Bacteria has been cultured from Feline gastrointestinal eosinophilic sclerosing fibroplasia in only about 56% of cases. What bacteria is most commonly isolated?
JFMS 15.2
Meth resistant Staph Aureus
This condition in cats has been known to mimic GI neoplasia in which there can be focal thickening of the GI tract with loss of wall layering. However this is not a neoplastic etiology.
JFMS 15.2
Feline gastrointestinal eosinophilic sclerosing fibroplasia
The most common solitary site for GI lymphoma in the cat?
JFMS 15.2
Ileocolic junction
What is the recommended protocol for computed tomography pneumocolongraphy?
CT Pneumocolonography in normal dogs VRU 56.3
Pre-insufflation scan
Insufflate to 15-20mmHg
Post-insufflation scan without contrast (2 minutes)
Post contrast scan (2 minutes after administration)
It was hypothesized that 25mmHg of insufflated air would be ideal in CT pneumocolon in dogs. Why was this deemed in aprpopriate?
CT Pneumocolonography in normal dogs VRU 56.3
Retrograde passage of gas into the small intestine
What position is ideal for CT pneumocolon?
CT Pneumocolonography in normal dogs VRU 56.3
Position did not matter.
What happened to measurements of colon after pneumocolon?
CT Pneumocolonography in normal dogs VRU 56.3
Cross sectional area increased, bowel lumen diameter increased, wall layers got thinner.
Did pneumocolon improve bowel wall conspicuity? Contrast?
CT Pneumocolonography in normal dogs VRU 56.3
Pneumocolon improved bowel wall inconscpiuity
Contrast improved over just pneumocolon with insufflation.
What are risks associated with CT pneumocolon?
CT Pneumocolonography in normal dogs VRU 56.3
cramping, discomfort, systemic hypotension, hypercapnia, vasovagal response, colonic pneumatosis, colonic rupture/pneumoperitoneum
RIsk of rupture increases with obstruction, hernia, colon biopsy/surgery, underlying colonic disease
What were percent of serosa-serosa margins of GI segments could be evaluated?
Evaluation of the GI tract in (normal) dogs using CT VRU 54.1
63%
What were percent of serosa-mucosa margins of GI segments could be evaluated?
Evaluation of the GI tract in (normal) dogs using CT VRU 54.1
78%
Was CT evaluation of GI tract useful for identifying individual wall layers? which portion for GI tract was best visualized?
Evaluation of the GI tract in (normal) dogs using CT VRU 54.1
22% of gastrointestinal segments could see awll layers
Stomach was the best portion of stomach to be seen.
What is the ideal protocol for contrast CT enterography?
When is optimal time to perform the post-contrast scan?
Evaluation of CT enterography with an orally administered lactulose solution in clinically normal dogs. AJVR 77.4
Continuous administration of 60ml/kg of lactulose diluted 1:4 with warm water over 45 minutes via NE tube.
0-20 minutes allowed adequate distention to visualize walls.
What was difference between continuous and bolus CT enterography?
Evaluation of CT enterography with an orally administered lactulose solution in clinically normal dogs. AJVR 77.4
Continuous - better distention (>1 on their scale of 0-2).
Bolus - suboptimal distention (
What was major side effect of continuous CT enterography?
Evaluation of CT enterography with an orally administered lactulose solution in clinically normal dogs. AJVR 77.4
Mild GI signs (vomiting and diarrhea in continuous group).
What is gastric emphysema? What causes this?
Imaging diagnosis - gastric pneumatosis in a cat VRU 52.6
Gas in the stomach wall without infection by gas-forming organisms
Secondary to increased intraluminal pressure - gastroscopy, vomiting, gastric outflow obstruction
What does gastric emphysema look like radiographically?
Imaging diagnosis - gastric pneumatosis in a cat VRU 52.6
Well defined linear, radiolucent streaks parallel to the border of the stomach wall
What is emphysematous gastritis? What causes this?
Imaging diagnosis - gastric pneumatosis in a cat VRU 52.6
Predisposing factor that allows for invasion of bacterial organisms into the gastric wall.
Corrosive substances, gastroienteritis, GI surgery, DM, immunosuppression, , enterotoxemia, bone ingestion, GDV, gastric necrosis
Radiographically, what does emphysematous gastritis look like?
Imaging diagnosis - gastric pneumatosis in a cat VRU 52.6
mottled cystic radiolucencies in the wall of the stomach, as opposed to linear pattern that we see with gastric emphysema.
What are three main abnormalities that may lead to dysphagia?
What are examples of each?
Contrast videofluoroscopic assessment of dysphagic cats VRU 55.5
mechanical: foreign body, strictures
anatomical: vascular ring anomaly
functional: pharyngeal, cricopharyngeal, esophageal dysmotility
What was most common cause of dysphagia in cats?
Contrast videofluoroscopic assessment of dysphagic cats VRU 55.5
Hiatal hernia (5) Esophageal stricture (3) esophageal dysmotility (7)
What were Proximal esophageal opening and closing times, and how did this compare to dogs?
Epiglottis opening?
Contrast videofluoroscopic assessment of dysphagic cats VRU 55.5
Dogs: Open: 0.09, Closed: 0.26, Epi: 0.28
Cats: Open: 0.07, Closed: 0.23, Epi: 0.27
Were any oropharyngeal or cricopharyngeal causes of dysphagia appreciated in cats?
Contrast videofluoroscopic assessment of dysphagic cats VRU 55.5
no
What is difference between primary and secondary peristalsis?
Contrast videofluoroscopic assessment of dysphagic cats VRU 55.5
Primary - wave that moves a bolus of food or liquid from proximal esophageal sphincter to the idstal esophageal sphincter
Secondary - not associated with a swallow, but moved a stationary bolus of food or liquid to the distal esophageal sphincter
What is the difference between a Gruntzig dilatation catheters and bougienage catheters?
Balloon catheter dilatation of alimentary tract strictures in the dog and cat VRU 28.4
Bougienage - shearing and longitudinal as well as transverse - resulting in a snowplow effect - force acts upon the narrowest point of the stricture and can lead to trauma or perforation
Gruntzig - Balloon positioning first fors an hourglass contour at the point of greatest luminal stricture - and increased pressure is used until indentation disappears
What pressure will cause esophageal rupture during stricture dilatation?
What pressures are acquired when using a bougienage catheter?
Balloon catheter dilatation of alimentary tract strictures in the dog and cat VRU 28.4
238mmHg
25-830mmHg
When it comes to gastric motility - what do cats lack that dogs have?
Gastric emtying in cats using foods varying in fiber content and kibble shapes. vRU 44.3
Lacks the migrating myoelectrical complexes that occur during the fasted state, begin in stomach and move down intestinal tract to clear stomach of non-digestible substances
Cats have a migrating spike complex
Which food shape took longer to empty the stomach, and why?
Gastric emtying in cats using foods varying in fiber content and kibble shapes. vRU 44.3
Triangular shaped took longer to empty
round shaped cleared much faster at Time to reduce total by 20 and 50%
Did high or low fiber take longer to clear the stomach in cats?
Gastric emtying in cats using foods varying in fiber content and kibble shapes. vRU 44.3
Low fiber, round shaped food took longer time to reach 90% of emptying
Normally, where do the aortic arch, MPA, ligament arteriosum all live?
Imaging diagnosis - CT angiography of a rare vascular ring anomaly in a dog. VRU 49.1
Aorta comes out centrally
Aortic arch turns towards the left (lives to the left of the esophagus)
Descending aorta is on the left side
The MPA originates to the left of the where the aorta emerges.
The ligament arteriosum connects the descending aorta to the lateral aspect of the MPA
What is the most common VRA?
Imaging diagnosis - CT angiography of a rare vascular ring anomaly in a dog. VRU 49.1
Persistent 4th right aortic arch with a left sided ligamentum arteriosum - makes up 95% of VRA
Describe a VRA associated with an aberrant left subclavian artery.
Imaging diagnosis - CT angiography of a rare vascular ring anomaly in a dog. VRU 49.1
Type 2 vascular ring anomaly
Aberrant left subclavian comes off the right sided aortic arch and has to cross over to the left side towards the left forelimb
Compression is seen further cranial (not at the heart base)
What are other forms of VRA?
Imaging diagnosis - CT angiography of a rare vascular ring anomaly in a dog. VRU 49.1
Aberrant left and right subclavian arteries, double aortic arch, right patent ductus arteriosus, right sided ligamentum arteriosum, persistent right drosal aorta, aberrant intercostal arteries
Which way is the trachea deviated on VD views with a persistent right aortic arch?
Imaging diagnosis - CT angiography of a rare vascular ring anomaly in a dog. VRU 49.1
To the left
What is a type 1 vascular ring anomaly?
Imaging diagnosis - CT angiography of a rare vascular ring anomaly in a dog. VRU 49.1
Most common VRA
Persistent right aortic arch, left sided ligamentum arteriosum connecting the aorta and MPA across the esophagus
What radiographic features may differentiate a PRAA from a persistent left cranial vena cava (PLCVC)?
Persistent left cranial vena cava (PLCVC) causing esophageal obstruction and consequential megaesophagus in a dog. J Comp Path 2006
Lack of left sided displacement of the trachea on the DV/VD view
What is embryologic development of the CV system?
Persistent left cranial vena cava (PLCVC) causing esophageal obstruction and consequential megaesophagus in a dog. J Comp Path 2006
Paired cranial and caudal cardinal veins that join to form the common cardinal veins (ducts of Cuvier)
Left and right common cardinal vein dump into the sinus venosus –> right atrium
Left and right cranial cardinal veins are joined cranial to the heart by direct fusion.
Remainder of left cranial cardinal vein atrophies caudal to fusion, while right side vessel enlarges to become part of the distal part of cranial vena cava
Right common cardinal vein –> right cranial vena cava
Most of the left cardinal system atrophies, except for left common cardinal vein that forms the coronary sinus
What are two forms of persistent left cranial vena cava (PLCVC)?
Persistent left cranial vena cava (PLCVC) causing esophageal obstruction and consequential megaesophagus in a dog. J Comp Path 2006
Complete - non-atrophied left cranial cardinal vein retains embryological connection with coronary sinus
Incomplete type - distal portion of left cranial vein atrophies, proximal portion persists and receives the hemiazygos vein
What are 2 forms of esophageal hiatal hernias?
Congenital esophageal hiatal hernia in the Chinese Shar-pei dog JVIM 1993
1) sliding hiatal hernia - abdominal segment of the esophagus and parts of hte stomach are displaced cranially through the esophageal hiatus
2) paraesophageal hiatal hernia - abdominal segment of the esophagus and lower esophageal sphincter remain in a fixed position but a portion of stomach herniates into the mediastinum alongside the thoracic esophagus
What are the clinical signs associated with a hernia?
Congenital esophageal hiatal hernia in the Chinese Shar-pei dog JVIM 1993
anorexia, hypersalivation, regurgitation, vomiting, hematemesis, dyspnea, cardiac arrest when large hernias interfere with cardiopulmonary function
What were radiographic findings found in congenital esophageal hiatal hernias?
Congenital esophageal hiatal hernia in the Chinese Shar-pei dog JVIM 1993
Caudodorsal gas-filled intrathoracic soft-tissue opacity
Suspected megaesophagus
Dependent alveolar consolidation consistent with aspiration pneumonia
Why should barium series be performed in the cases of hiatal hernias in Shar-Peis?
Congenital esophageal hiatal hernia in the Chinese Shar-pei dog JVIM 1993
Shar-peis are also predisposed to congenital, idiopathic megaesophagus
Were clinical signs of the dogs in the paper:
Congenital esophageal hiatal hernia in the Chinese Shar-pei dog JVIM 1993
due to reflux esophagitis?
No - all dogs that were necropsied/euthanized or died had no gross or histologic evidence of esophagitis
What was most common compliation of the sliding hiatal hernia in Shar-Pei?
Congenital esophageal hiatal hernia in the Chinese Shar-pei dog JVIM 1993
Aspiration pneumonia
What was success of medical management for sliding hiatal hernia?
Congenital esophageal hiatal hernia in the Chinese Shar-pei dog JVIM 1993
Medical management did not make a big difference - animals continued to regurgitate.
However - most animals were started on antibiotics for multipel days prior to surgery
What are the most common causes of esophageal strictures?
Benign esophageal stricture in the dog and cat: a retrospective study of 20 caes Canadian JVR 2002
chemical, thermal, traumatic, infectious agents, persistent vomiting, esophageal foreign bodies, gastroesophageal reflux - secondary to anesthetic events
What is the most common inciting event leading to development of esophageal strictures?
Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases Canadian JVR 2002
Anesthetic events with secondary gastroesophageal reflux
What were most common clinical signs of dogs with esophageal strictures?
Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases Canadian JVR 2002
hypersalivation, dysphagia, esophagodynia (pain in the esophagus), progressively worsening regurgitation
Is there a sex predilection for esophageal stricture?
Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases Canadian JVR 2002
Yes - females are more common
Females are more likely to have OHE –> gastroesphageal reflux –> stricture formation
Where are common locations that strictures occur?
Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases Canadian JVR 2002
Distal portion of the thoracic esophagus (caudal to the heart)
Cervical esophagus
Proximal portion of hte thoracic esophagus
Where was most common location for esophageal strictures in these dogs?
Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases Canadian JVR 2002
Distal portion of the thoracic esophagus (75%) - b/c most are due to GE reflux
What are fluoroscopic features are seen in the oral phase of dysphagia?
Bolus not formed or delaye dformation Bolus not propelled to pharynx weak plungerlike movement of tongue weak pharyngeal contractions subsequent phases are normal
What are fluoroscopic features are seen in the pharyngeal phase of dysphagia?
normal oral stage
remains synchronous with cricopharyngeal phase
retention of contrast medium int eh pharynx
no change im time to cricopharyngeal sphicnter opening
inadequate pharyngeal contraction
mis-direction of bolus into larynx or nasopharynx
What are fluoroscopic features are seen in the cricopharyngeal chalasia?
Relaxation of incompetence of cricopharyngeal sphincter
Prolonged opening time of scphincter
Weak pharyngeal contractions may be present
aspiration of contrast into lraynx or trachea
What are fluoroscopic features are seen in the cricopharyngeal achalasia?
incomplete or lack of opening of the cricopharyngeal sphincter
vigorous attempts to pass bolus to cricopharyngeal sphincter
synchrony/timing with pharyngeal contraction is off
delayed opening time of sphincter
barium tention
aspiration of contrast
What are causes of cricopharyngeal achalasia?
idiopathic
Causes for cricopharyngeal chaslaia
cricopharyngeus myotomy
radiation therapy
myasthenia gravis
Causes for pharyngeal dysphagia?
myositis/myopathy cricopharyngeus myectomy NM disease inflammation trauma idiopathic
Causes for oral dysphagia
NM disease
inflammation
oral foreign body
tongue abscess
Common presenting signs for cats with pyloroduodenal adenomatous polyps?
US and clinicopathologic features of pyloroduodenal adenomatous polyps in cats. JFMS pre-published 2016
Acute vomiting and lethargy are most common
Severe anemia was seen in 2/6 cats due to ulceration
On US - what did the pyloroduodenal adneomatous polyps appear as?
What were characteristics of the surrounding GI?
US and clinicopathologic features of pyloroduodenal adenomatous polyps in cats. JFMS pre-published 2016
discrete, small, round to oval shaped moderately echogenic and homogeneous nodule filing the proximal duodenum or pylorudodenal lumen
Can be effaced by fluid within the duodenum
Surrounding GI appeared normal in 5/6 cases. one cat had asymmetric thickening that ended up being a large ulcer at surgery.
What was prevalence of ulceration on the cats with pyloroduodenal adenoamtous polyps?
US and clinicopathologic features of pyloroduodenal adenomatous polyps in cats. JFMS pre-published 2016
5/5 cases had evidence of hemorrhage if not grossly, then microscopically
DDx for pyloroduodenal nodules in cats?
US and clinicopathologic features of pyloroduodenal adenomatous polyps in cats. JFMS pre-published 2016
Neoplasia: adenocarcinoma, lymphoma, mast cell tumor, smooth muscle tumor, granulomatous disease, feline gastrointestinal eosinophilic sclerosing fibroplasia
