Regurgitation And Dysphagia

Question 1

What are the 4 basic causes of regurgitation? Give examples of each

Answer 1

1. Inflammatory dz - esophagitis, myositis
2. Extraluminal esophageal compression - vascular ring anomaly, thymoma, hilar lymphadenopathy
3. Intraluminal esophageal obstruction - stricture, FB (thoracic inlet, heart base, distal esophagus), tumor, esophageal diverticulum
4. Neuromuscular dysfunction - motility disorder, megaesophagus (congenital, acquired)

Question 2

What is the difference between primary and secondary peristaltic waves in the esophagus. What initiates each?

Answer 2

• Primary - wave of relaxation in front of, and contraction behind the bolus of food; initiated by esophagus being distended by a bolus of ingesta
• Secondary - residual material in the esophagus is cleared by these; initiated by distension of the esophagus by residual ingesta

Question 3

What are the causes of esophagitis?

Answer 3

• Ingestion of caustic material
• foreign body
• drugs
• reflux of gastric acid (all may progress to stricture)

Question 4

How do you diagnose esophagitis?

Answer 4

Survey rads, contrast rads (stricture), or endoscopy (only definitive diagnostic test)

Question 5

How does one manage a case of esophagitis?

Answer 5

• Sucralfate liquid
• incr LES tone - Cisapride
• reduce acid output - omeprazole (2x daily)
• pain medications
• +/- rest esophagus (PEG tube)

Question 6

Define dysphagia. What does it typically result from?

Answer 6

Difficult or painful swallowing; results from oral, pharyngeal, or cricopharyngeal dz

Question 7

What are the clinical signs of dysphagia?

Answer 7

• Difficulty prehending or swallowing solids and/or liquids (watch them eat!)
• gagging, coughing
• nasal d/c or aspiration pneumonia
• wt loss
• secondary pharyngitis/tonsillitis
• facial mm atrophy

Question 8

What are your differentials for dysphagia?

Answer 8

• Oral or pharyngeal dz
• cricopharyngeal achalasia
• neuromuscular dz (myositis, myasthenia, trauma)

Question 9

How do you diagnose dysphagia?

Answer 9

Survey rads (head/cervical, thoracic), fluoroscopy, EMG

Question 10

How do you treat dysphagia?

Answer 10

• Treat underlying dz if able (often no effective therapy)
• cricopharygeal achalasia (myotomy)
• feeding tube (PEG or E-tube)

Question 11

How does the anatomy of the feline esophagus differ from that of the dog?

Answer 11

• In cats, the proximal 1/2 to 2/3 is skeletal mm, while the remainder is smooth mm
• in dogs, the entire esophagus is skeletal mm

Question 12

The tone of the lower esophageal sphincter is controlled by the muscles of what organ?

Answer 12

Diaphragm