PATHOLOGY - Oesophageal Disease Flashcards
(132 cards)
What are the three phases of swallowing?
Oral phase
Pharyngeal phase
Oesophageal phase
Describe the oral phase of swallowing
The oral phase of swallowing involves the prehension of food, mastication and the tongues caudal movement of the bolus towards the pharynx
Describe the pharyngeal phase of swallowing
During the pharyngeal phase of swallowing, the bolus stimulates pressure sensitive sensory receptors at the palatoglossal arches which stimulate the rostral movement of the hyoid apparatus to hold the epiglottis over the larynx, as well as the coordinated contraction of the pharyngeal muscles to push the bolus towards the oesophagus and relaxation of the upper oesophageal sphincter
Describe the oesophageal phase of swallowing
During the oesophageal phase of swallowing, oesophageal periastalsis moves the bolus towards the cardiac sphincter
Describe the anatomical topography of the oesophagus
The oesophagus begins at the pharynx and runs on the left side of the body, dorsal to the trachea in the mediastinum and enters the abdomen through the oesophageal hiatus at the diaphragm and into the cardia of the stomach
How does the structure of the oesophagus differ between dogs and cats?
In dogs, the muscularis layer of the oesophagus is made up of skeletal muscle, whereas in cats the first third of the muscularis layer of the oesophagus is made up of the skeletal muscle, however the remaining two thirds are made up of smooth muscle
Which muscles make up the upper oesophageal sphincter?
Cricopharyngeal muscle
Thyropharyngeal muscle
Which structure makes up the lower oesophageal sphincter?
Cardia of the stomach
Which nerve innervates the oesophagus?
Vagus nerve
What is dysphagia?
Dysphagia is difficulty swallowing
What is the difference between mechanical and functional dysphagia?
Mechanical dysphagia refers to physical obstructions or structural abnormalities whereas functional dysphagia refers to abnormal functionality of the normal swallowing apparatus
What are the three classifications of dysphagia?
Oral dysphagia
Pharyngeal dysphagia
Oesophageal dysphagia
What are the clinical signs of oral dysphagia?
Abnormal prehension of food
Dropping food
Halitosis
Hypersalivation
Coughing
What are some of the possible causes of mechanical oral dysphagia?
Periodontal disease
Oral foreign body
Oral mass
Cleft palate
Temporomandibular joint (TMJ) disease
Trauma
What are some of the possible causes of functional oral dysphagia?
CN V, VII and XII dysfunction
Myopathy
Glossitis
What are the clinical signs of pharyngeal dysphagia?
Hard, repetitive swallowing whilst eating or drinking (hallmark clinical signs)
Halitosis
Hypersalivation
Coughing
Gagging
What are some of the possible causes of mechanical pharyngeal dysphagia?
Pharyngeal foreign body
Pharyngeal mass
Nasopharyngeal polyp
Tonsilitis
Retropharyngeal lymphadenopathy
Trauma
What are some of the possible causes of functional pharyngeal dysphagia?
CN IX, X and XI dysfunction
Cricopharyngeal achalasia
Cricopharyngeal asynchrony
Myasthenia gravis
Hypothyroidism
Hypoadrenocorticism
Hypocalcaemia
What is cricopharyngeal achalasia?
Cricopharyngeal achalasia is where the upper oesophageal sphincter fails to relax during swallowing
What is cricopharyngeal asynchrony?
Cricopharyngeal asynchrony is where the contraction of the pharyngeal muscles and relaxtion of the upper oesophageal sphincter is not coordinated during swallowing
How can cricopharyngeal achalasia and asynchrony be treated?
Surgical correction
Botox (relaxes the upper oesophageal sphincter)
Why is botox not ideal for long term treatment of cricopharyngeal achalasia and asynchrony?
Botox is not ideal for long term treatment of cricopharyngeal achalasia and asynchrony as it only lasts up to 3 - 4 months before having to be redone
How do you approach investigating oesophageal dysphagia/disease?
- Assess history, signalement and clinical signs
- Clinical examination
- Diagnostic tests and diagnostic imaging
- Treatment plan
What are the possible clinical signs of oesophageal dysphagia?
Regurgitation (hallmark clinical sign)
Clinical signs of aspiration pneumonia
Halitosis
Hypersalivation
Coughing
Gagging
Odynophagia
Ravenous appetite or decreased appetite
Weight loss