Internal Medicine: Gastroenterology: Oesophagus and Swallowing Disorders Flashcards
What are signs of oropharyngeal and oesophageal disease?
- Dysphagia
- Drooling saliva
- Halitosis
- Odynophagia- painful swallowing
Regurgitation- oesophageal disease
What are the different categories of causes of dysphagia?
Functional
* Abscence
* Spastiticty
* Incoordination
Morphological
* physical
* anatomical
How can dysphagia manifest?
- Difficulty lapping water or forming bolus
- Excessive mandibular or head motion
- Dropping food from mouth
- Persistent forceful but ineffective swallowing
- Nasal discharge
- Gagging
- Coughing
What can cause functional neuromuscular dysphagia?
- Cricopharyngeal chalasia/achalasia
- Myasthenia gravis
- Brainstem disease
- Peripheral neuropathy
- Hypothyroidism
- Botulism
What can cause morphological dysphagia?
- Oropharyngeal inflammation
- Oropharyngeal trauama
- Foreign bodies
- Neoplasia
- Congenital/developmental
What are potential sequalae of oral inflammation?
- Ulceration
- Necrosis
- Secondary infectoin
What are potential causes of morphological congenital dysphagia?
- Hare-lip
- Lip folds
- Cleft palate
- Malocclusion
- Craniomandibular osteopathy
- Temporomandibular dysphagia
What are ddxs of halitosis?
Oropharyngeal disease
* inflammation
* neoplasia
* foreign body
Oesophageal diease
Diet associated
Malabsorption
Dental disease
Nasal cavity/sinus disease
Uraemia
Liver disease
anal sac disease
What should be noted about regurgitation?
- Passive event- vomiting
- Undigested food?
- Mucus/saliva covered
- Immediate or delayed
- What is pseudoptyalism?
- What is ptyalism?
- Failure to swallow normal volume of saliva
- Increased saliva production
What are secondary signs of oesophageal or oropharyngeal disease?
- Malnutrition/dehydration
- Anorexia/polyphagia
- Aspiration pneumonia/tracheal compression
- Cough dyspnoea
How can swallowing problems be investigated?
- History- what is vomited, when, signs, concurrent signs
- physical examination- oral exam, head, palpation of neck, systemic, neurological
- Diagnosic imaging- head, neck, thorax, barium
- Endoscopy
- Lab investigations- haem, biochem
- FNA- mass, lymph nodes
- Biopsy
- Anti ACh receptor antibody
- 2-M abs
- ACTH stimulation test
What is cricopharyngeal dysphagia?
How is it treated?
Hypertension of cricopharyngeal sphincter
Cricopharyngeal myotomy
How is oropharyngeal eosinophilic granuloma treated in cats?
- Oral hygiene
- ABs
- Steroids
What are the differentials for primary salivary gland enlargment?
- Sialadenosis/hypersialosis
- Primary sialoadenosis
- What are the clinical signs of salivart gland infarction?
- How is it treated?
Acute salivary gland enlargment and drooling saliva
Tx- phenobarbitol, corticosteroids
What disease cause the following disorders?
1. Motlity
2. Obstruction
3. Inflammation
- Megaoesophagus, dysautonomia, hiatal hernia
- Vascular ring, stricture, FB, neoplasia
- Oesophagitis, reflux, hiatal hernia
Also- diverticulum, broncho-oesophageal fistula
What are the different causes of megaoeosphagus?
Primary- idiopathic
Secondary- acquired
* Myasthenia
* Oesophagitis
How is idiopathic megaoeosphagus treated?
- Treat from height
- Slurry/textured food
- Metoclopramide?
Prognosis guarded
Bailey chair
What can cause oesophagitis?
- Ingestion of caustics and irritants
- Foreign bodies
- Acute and persistent vomiting
- Gastric reflux
What are the clinical signs of oesophagitis?
- Anorexia
- Dysphagia
- Odynophagia
- Regurgitation
- Hypersalivation
How is oesophagitis treated?
Symptomatic
* Frequent small feeds
* ABs
* Liquid antacids
* Local anaesthetics
* Gastrostomy tube feeding
Specific
* Sucralfate
* Antacids
* Metoclopramide
What are different causes of oesophageal obstruction?
Intraluminal- FB
Intramural
* Neoplasm
* Stricture
* Granuloma
Extramural
* thyroid
* thymic/mediastinum
* vascular ring
What is the aetiology of oesophageal stricture?
Fibrosis and ulceration of mucosa by
* FB
* Caustic material
* Severe oesophagitis
* Gastric reflux
* Drugs- doxycycline in cats
How are oesophageal strictures dilated?
Bouggienage
* Increased risk of perforation
* Longitudinal shear
Balloon dilation- inflatable
* Radial stretch
* Stationary force
* less risk of perforation
Can inject steroid around the lesions- triamcinolone actonide
How are oesophageal foreign bodies treated?
What is required after removal?
Tx
* peroral approach- endoscope, pull FB to mouth or push to stomach for gastrotomy
* Surgical removal- last resort
After removal
* Radiographs
* PEG tube
* Omeprazole
* Sucralfate
