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Lecture 11: esophageal disease Flashcards

1
Q

what are the 3 stages of swallowing

A
  1. Voluntary/oral stage: chewing
  2. Pharyngeal stage (involuntary)
  3. Esophageal stage (involuntary)
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2
Q

what CN are involved in pharyngeal stage of swallowing

A

CN V, IX, X, XII

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3
Q

what occurs during pharyngeal stage of swallowing

A
  1. Food bolus reaches oropharynx
  2. Sensory impulses to brainstem swallowing center
  3. Pharyngeal muscles contract
  4. Larynx moves cranially, glottis closes, food moves caudally
  5. UES relaxes
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4
Q

what CN are involved in esophageal stage of swallowing

A

CN IX and X

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5
Q

what occurs in esophageal stage of swallowing

A
  1. Primary peristalsis- continuation of pharyngeal contraction—> wave all the way to stomach
  2. Secondary peristalsis: reflexive response to retained food
  3. LES, stomach relax to receive bolus and then contract to prevent reflex
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6
Q

what causes relaxation of LES during swallowing

A

esophageal stretch—> activation of vagal afferent sensory fibers—> nitric oxide in LES—> relaxation

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7
Q

Which species: cat vs dog: have entirely skeletal muscle vs skeletal and smooth muscle esophagus

A

dogs: entirely skeletal muscle

Cats: proximal 2/3 skeletal, distal 1/3 smooth muscle

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8
Q

Why differentiate between vomiting and regurgitation

A

tells you location of issue
Regurgitation: cranial to diaphragm, thoracic cavity and cranial

Vomiting- abdominal cavity

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9
Q

what makes something a structural esophageal disease

A
  1. Abnormality of luminal diameter
    2, identifiable anatomic defect
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10
Q

what type of imaging do you do for structural esophgeal disease

A

static imaging- chest rads, esophagoscopy, CT

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11
Q

what makes something a functional esophgeal disease

A

abnormality of muscle/nerve function, no identifiable anatomic defect

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12
Q

how do you dx functional esophageal disease

A

dynamic imaging- fluoroscopy

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13
Q

what is this and is it a structural or functional esophageal disease

A

megaesophagus- structural

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14
Q

define megaesophagus

A

focal or diffuse dilation and dysmotility

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15
Q

how do you dx megaesophagus

A

static chest rads

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16
Q

what are the adverse effects/ complications of megaesophagus

A

aspiration pneumonia, malnutrition, dehydration, esophagitis

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17
Q

if not reversed what is mean survival time for megaesophagus

A

1-3 months

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18
Q

what is the cause of diffuse congenital idiopathic ME

A

defect in afferent vagal innervation—> ineffective peristalsis

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19
Q

what is tx for diffuse congenital idiopathic ME

A

symptomatic therapy, sidenafil

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20
Q

how does sidenfail help in congenital idiopathic ME

A

normally LES should relax with NO synthesis and that generates cGMP which is then degraded by PDE-5

Sidenafil inhibits PDE-5–> potentiation of NO-mediated relaxation

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21
Q

what are the causes of acquired, diffuse ME

A

nerve, muscle, NMJ defect of distal obstruction—> lack of peristalsis—> diffuse dilation

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22
Q

What is the cause of acquired focal megaesophagus

A

intra or extraluminal obstruction—> focal dilation

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23
Q

what are the major underlying causes of diffuse acquired ME

A
  1. Idiopathic
  2. Myasthenia gravis **
  3. LES achalasia like syndrome
  4. Addisons
  5. Hypothyroidism
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24
Q

what is myasthenia gravis and what is cause of acquired MG

A

lack of ACh or ACh receptors at NMJ due to autoimmune attack against nACH receptors

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25
how do you dx acquired MG
positive serum for anti-nACH receptor antibodies
26
what causes congenital myasthenia
deficiency in nACH receptors
27
t or f: can dx congenital myasthenia with antibody titer
false- won’t have positive titer
28
how do you dx congenital myasthenia gravis
1. Acetylcholinesterase trial 2. Electromyelogram
29
what other condition can cause myasthenia gravis and therefore lead to ME
thymoma
30
myasthenia can be systemic or focal- what do you not see in focal MG
no generalized weakness
31
what is tx for acquired Myasthenia gravis
pyridostigmine: acetylcholinesterase inhibitor
32
what are adverse effects of prydiostigmine
SLUDD—salivation, lacrimation, urination, defecation, and dyspnea
33
in addition to pyridostigmine what other medications can you give for MG and in what scenario would you not give this additional medication
steroids- not for aspiration pneumonia
34
what is prognosis for ME and MG
good- spontaneous remission of MG in 88% of cases
35
what is the mechanism of hypoadrenocorticism/ additions causing ME
1. Glucocorticoid deficiency—> impaired muscle CHO metabolism—> glycogen depletion 2. Mineralocorticoid deficiency—> altered membrane potentials—> reduced contraction
36
What test can you do to rule out addisons as a cause of ME and what are results for + and -
resting cortisol > or =2ug/dl no addisons < 2ug/dl- do ACTH stimulation test to dx
37
patient presents with difficulty breathing and X-ray shows ME, other PE signs include weight gain, hypothermic, and loss of hair. What other disease do you want to test for
hypothyroidism
38
what is the cause of Lower esophageal achalasia like syndrome
loss of inhibitory neurons in LES enteric nervous system—> failure of LES to relax in response to incoming food bolus
39
what is tx for ME and LES-AS
mechanical dilation with balloon and the botulinum toxin A injection (botox)
40
what is ME and dyaustonomia
generalized degeneration of ANS nerves, both SNS and PNS
41
where in US is ME and dysautonomia common
Midwest
42
what is cause of congenital esophageal diverticula
developmental disorder—> mucosa herniates through muscularis
43
what is the cause of acquired esophageal diverticula
1. Pulsion: dilation secondary to esophageal obstruction 2. Traction: extra-esophageal inflammation—> adhesion to adjacent tissue
44
What is the vascular ring anomaly
persistent right aortic arch and traps esophagus between aortic arch and ligament I’m arteriosum
45
what breeds are predisposed to vascular ring anomalies
GSD, Irish setter
46
how do puppies with vascular ring anomalies typically present
regurgitation of solid food, aspiration pneumonia, failure to thrive
47
how do you dx vascular ring anomaly
1. TXR +/- contrast- esophageal diverticulum cranial to heart base. 2. Esophagoscopy- extraluminal compression with a pulse
48
what do you see on VD/DV views for vascular ring anomaly
focal deviation of trachea to the left
49
what is tx for vascular ring anomalies
surgical ligation and transaction of ligamentum arteriosum
50
Puppy presents with regurgitation. Following rad was taken- what’s wrong
Vascular ring anomaly
51
what are the causes of esophageal stricture
1. Anesthesia 2. Esophageal FB 3. Chemical injury 4. Post esophageal surgery
52
what chemicals cause esophageal stricture in cats
doxycycline, clindamycin, biphosphates
53
what wrong
Esophageal stricture
54
what are the results of chronic stricture
focal ME or diverticula
55
how do you dx esophageal strictures
contrast radiograph, fluoroscopic swallow study, esophagoscopy
56
what is tx for esophageal stricture
1. Repeated balloon dilation 2. Repeated bougienage 3. Steroid injections 4. Stents
57
what is prognosis for esophageal stricture
guarded
58
what is medical management for esophageal stricture
slurry diet, elevated feedings, gastronomy tube
59
what is the most common location for esophageal FB
LES
60
what are some signs of esophageal FB
severe regurgitation, hypersalivation, gagging, odynophagia
61
what is the sequela to esophageal FB
necrosis, ulceration, perforation, stricture
62
how do you dx esophageal FB
1. TXR
63
when taking rads for suspected esophageal FB, when can you not use barium contrast
if perforation suspected
64
what is the result of esophageal perforation
pneumomediastinum, mediastinitis, SQ emphysema
65
dog presents with regurgitation, hard swallowing, and hypersalivation. What wrong
esophageal FB—> perforation—> SQ emphysema and pneumomediastinum
66
what is spirocerca lupi and what does it cause
esophageal worm—> granuloma
67
how do you dx spirocerca lupi
fecal float, sugar float, Teleman’s sedimentation
68
what is tx for spirocerca lupi
doramectin, milbemycin, moxidectin/imidacloprid
69
what adverse transformation can spirocerca lupi undergo
neoplasia transformation Granulomas transform to fibrosarcoma, osteosarcoma, or undifferentiated sarcoma
70
what is the most common esophageal neoplasia in dogs
spirocerca lupi transformed neoplasia
71
what is the most common esophageal neoplasia in cats
SCC
72
what is a hiatal hernia
abdominal esophagus and cranial stomach intermittently herniate through esophageal hiatus
73
what causes hiatal hernia to occur
1. Reduce LES pressure 2. Reflux, esophagitis, hypomotility, regurgitation
74
what breeds are pre-disposed to hiatal hernias
brachycephalics
75
what causes acquired hiatal hernia
secondary to chronic airway obstruction (BOAS, lar par)
76
what wrong
left: normal Right: hiatal hernia
77
what is medical management for hiatal hernia
1. Reflux: pro kinetics, PPI’s sucralfate 2. Elevated feedings, frequent, small meals
78
what is sx tx for hiatal hernia
1. Airway corrective sx 2. Surgical reconstruction of diaphragm/hiatus
79
what muscle controls upper esophgeal sphincter
cricopharyngeus
80
what is achalasia
failure to relax
81
What is asynchrony in cricopharyngeal diseases
lack of coordination between UES relaxation and laryngeal contraction
82
what is tx for cricopharyngeal diseases
sx: cricopharyngeal myotomy Botox
83
what is gastroesophgeal reflux disease
gastric or intestinal fluid/ingesta moves backwards into esophagus
84
GERD secondary to loss of __function or tone or excessive negative ___
LES, intrathoracic pressure
85
what are some causes of GERD
hiatal hernia, GA, chronic vomiting, gastroparesis/ileus
86
what is tx for GERD
1. Pro kinetics 2. Acid suppression: PPIs 3. Sucralfate
87
no proknetic agent can act on __muscle in esophagus
skeletal muscle
88
Esophagus- what wrong
esophagitis
89
what are some causes of esophagitis
anesthesia, GERD, chronci vomiting, esophageal FB, caustic agents
90
what is tx for esophagitis
PPI, sucralfate, pro kinetic with action on LES
91
why is hypomotility
ineffective peristalsis without megaesophagus
92
how do you dx hypomotility
fluoroscopy
93
what is the result of geriatric onset laryngeal paralysis/polyneuropathy
1. Laryngeal paralysis 2. Dysphagia 3. Esophageal dysmotility—> ME 4. CP deficits
94
fluorscopy is better than rads for swallowing test, but what do you do if you don’t have
Inject barium into mouth slowly and immediately take lateral and VD rads
95
what are some feeding symptomatic therapy options for regurgitation
1. Elevated food 2. Bailey chair 3. Gastronomy tube 4. Slurry diet
96
gastronomy tube may or may not improve __ and __, will help prevent __
regurgitation, aspiration, malnutrition
97
what drugs are good for GERD and/or esophagitis
PPI’s, sucralfate
98
what drugs are good for megaesophagus
sidenafil
99
What drug is good for GERD to contract the LESD
cisapride

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