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Gastroenterology > Regurgitation and Dysphagia > Flashcards

Regurgitation and Dysphagia Flashcards

1
Q

difficulty or painful swallowing

A

dysphagia

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2
Q

What is the difference in musculature makeup of the esophagus in dogs vs. cats?

A

dog: all straited muscle
cat: cranial 2/3 striated, caudal 1/3 smooth m.

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3
Q

The pharyngoesophageal or upper esophageal sphincter (UES) is composed of fibers from the

and muscles.

A

cricopharyngeus and thyropharyngeus

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4
Q

What are the layers of the esophagus?

A

adventitia, muscularis, submucosa, and mucosa

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5
Q

Causes of regurgitation

A

(1) esophageal inflammatory disease (esophagitis)
(2) extraluminal esophageal compression
(3) intraluminal obstruction
(4) neuromuscular disease

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6
Q

How is the primary vs. secondary peristaltic waves initiated in the esophagus?

A

primary: distention by bolus in the pharynx
secondary: distention in the esophagus by residual ingesta

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7
Q

What are the causes of dysphagia with regards to UES?

A
  1. non-opening (achalasia) UES
  2. lack of coordination between opening or closing of the UES and pharyngeal contraction (asynchrony)
  3. failure of the sphincter to close (chalasia)
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8
Q

What types of conditions in general are associated with dysphagia?

A

(1) oral disease (difficulties in prehension or movement of the tongue)
(2) pharyngeal disease (inflammatory and neoplastic diseases of pharynx, tonsils, and retropharyngeal lymph nodes, foreign bodies, congenital abnormalities, and a variety of neuromuscular disorders)
(3) cricopharyngeal disease (neuromuscular disorders)

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9
Q

A puppy (<1 yr) presented with the complaint of repeated swallowing efforts with the head and neck tucked down after normal prehension of a bolus of food accompanied by gagging, retching, and expulsion of the bolus which may be immediately picked up again and the process repeated. Muscle wasting and aspiration pneumonia.

DDX?

A

Dysphagia d/t often pharyngitis or tonsilitis

weight loss may mask the muscle atrophy

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10
Q

What are the three types of diagnostics commonly performed for dysphagia?

A
  1. thoracic rads (check for aspiration pneumonia)
  2. Fluoroscopy (observe swallowing mechanism)
  3. EMG (check for denervation or myopathy)
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11
Q

What treatment can be done for cricopharyngeal achalasia?

When are the symptoms most often first observed?

A

myotomy

6-8wks when wean off milk and move to solid food

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12
Q

Why would a patient with esophageal disease have anorexia and a fever?

A

aspiration pneumonia

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13
Q

A adult dog presents with pytalism, regurgiation, dysphagia, inappetance, nasal discharge, muscle wasting weight loss, cough & fever.

DDX?

What are the general categories of this condition?

A

Esophageal disease

  1. inflammatory dz
  2. esophageal compression
  3. intraluminal obstruction
  4. neuromuscular disease
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14
Q

Causes of esophagitis?

Common sequelae of esophagitis?

A

ingestion of caustic material, foriegn body, drugs, reflux of gastric acid

Stricture

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15
Q

How is esophagitis mainly diagnosed?

A

endoscopy

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16
Q

A patient recovering from anesthetia is regurgitating and has dysphagia. DDX? Why?

A

reflux esophagitis

gastroesophageal sphincter is relaxed and normal esophageal motility is suppressed with anesthetia

17
Q

What is the tx for esophagitis?

A
  • sucralfate
  • omeprazole (PPI: decrease acid production)
  • cisapride (increase LES tone)
  • pain meds
  • rest esophagus (PEG tube) +/-
18
Q

What is the most common cause of an extraluminal esophageal compression? When does is most often present?

A

vascular ring anomalies (persistent right aortic arch aka PRAA)

6-8 wks age when wean off milk

19
Q

What are the two most common locations for an extraluminal esophageal constriction?

A

thoracic inlet & heartbase

20
Q

Causes of extraluminal esophageal compression?

A

vascular ring anomaly (PRAA)

thymoma

other intrathoracic tumors

hilar lymphadenopathy

21
Q

What two breeds are predisposed to PRAA?

A

GSH & irish setters

22
Q

Causes of intraluminal esophageal obstruction

A

stricture

FB

tumor (rare)- Fibrosarcoma associated with Spirocerca lupi infection has been reported in the southern United States.

esophageal diverticulum

23
Q

What are the causes of an esophageal stricture?

A

FB

tumor

anesthetia

drugs (doxy-cats & clindamycin)

esophagitis

24
Q

Foreign bodies usually lodge in one of three places where normal distension may be impaired by extraluminal structures: list them.

A

(1) the thoracic inlet
(2) the base of the heart
(3) cranial to the gastroesophageal junction

25
Q

What is the most common type of esophageal FB?

A

bones and rawhide

26
Q

What is the most widely accepted technique for treating esophageal strictures?

What other treatments are beneficial?

A

Dilation of the esophagus via balloon dilation or bougienage of the stricture

Mitomycin C, same tx as for esophagitis (if esophageal lining is damaged)

27
Q

What is the treatment for esophageal FB?

A
28
Q

What are common sequelae of an esophageal FB?

A

intraluminal stricture, pulsion diverticula or esophageal rupture

29
Q

Common cause of esophageal neuromuscular dysfunction?

A

megaesophagus (congenital or acquired)

30
Q

DDX for megaesophagus

A

1st: muscle dysfunction such as myasthenia gravis, lead poisoning, immune-mediated polymyositis and polyneuritis, myotonia, Addison’s disease, chronic organophosphate toxicity, and systemic lupus erythematosus (SLE)
2nd: neoplastic involvement of the esophagus, LES, or gastric fundus
3rd: Elimination of these disorders leads to the diagnosis of idiopathic megaesophagus.

31
Q

Which breeds of dogs are predisposed to megaesophagus?

A

German shepherd, Great Dane, Irish setter, Miniature Schnauzer, and wire-haired terrier breeds

32
Q

What structure can be used to help dogs with megaesophagus eat upright?

A

bailey chair

33
Q

What is the proposed genetic defect for congenital megaesophagus?

A

defect in vagal afferents to the esophagus

34
Q

DDX for Acquired megaesophagus

A

Toxins (lead, OP-flea preventative)

Endocrine (hypoadrenocorticism, hypothyroidism?)

neuromuscular (MG, polyneuritis/myositis)

idiopathic

35
Q

What is the best diagnostic test for megaesophagus?

Additional tests?

A

radiographs (aspiration pneumonia)

36
Q

What is the tx for a dog with megaesophagus as a result of myesthenia gravis?

A

pyridostigmine

37
Q

What is the tx for a dog with megaesophagus as a result of myositis?

A

prednisone

38
Q

What drugs can be used in dog vs. cat to increase esophageal motlity with megaesophagus?

A

cat= cisapride

dog= bethanecol

Gastroenterology (11 decks)

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