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year 1/2 > Digestion & Metabolism 2: LA Esophageal Dz > Flashcards

Digestion & Metabolism 2: LA Esophageal Dz Flashcards

1
Q

3 PORTIONS of the esophagus?

esophagus also includes the ____ down to the ____

A

3 portions?
1. CERVICAL
2. THORACIC
3. ABDOMINAL

PHARYNX, CARDIA

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2
Q

how does CHEWING work for ruminants?

A

after chewing, goes down into rumen and COMES BACK UP A FEW TIMES before FINALLY GOING INTO OMASUM

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3
Q

esophageal anatomy…
lined by WHAT kind of epithelium?
are there SECRETIONS from the esophagus?
why is the esophagus EASILY DAMAGED?
4 layers?

A

esophagus lined by NON-KERATINIZED STRATIFIED SQ EPITHELIUM

NO SECRETIONS, so needs MOISTURE FROM SALIVA

easily damaged bc skin is NON-KERATINIZED

4 layers?
1. non-keratinized stratified squamous epithelium
2. submucosa
3. skeletal & smooth muscle
4. adventitia

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4
Q

HORSES vs. RUMINANT esophagus?

A

in HORSES, top is 2/3 SKELETAL muscle, then SMOOTH MUSCLE

in RUMINANTS, WHOLE THING IS SKELETAL MUSCLE due to need for REGURGITATION during rumination

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5
Q

diagnosis of LA esophageal dz…
MOST patients can be diagnosed with a really good what 2 things?
what other 2 diagnostics are most important for LA esophageal dz?

A

MOST patients can get dx via GOOD HISTORY & PE

2 other diagnostics?
1. ESOPHAGOSCOPY
2. PLAIN AND CONTRAST RADIOGRAPHY

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6
Q

what animals are PREDISPOSED to getting ESOPHAGEAL DZ? & include why (3)

which animal is NOT likely to get esophageal dz?

A
  1. GERIATRIC horses = teeth constantly erupting and GRINDING DOWN FOOD prior to swallowing, so OBSTRUCTION common
  2. FRESIAN BREED = likely to get MEGAESOPHAGUS or ESOPHAGEAL PERFORATION
  3. CAMELIDS = likely to get MEGAESOPHAGUS

RUMINANTS = RARELY get esophageal dz

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7
Q

DIET (2), DENTAL CARE (1) & VACCINE Hx (1) in ESOPHAGEAL Dz

A

DIET…
1. more likely to CHOKE ON ALFALFA CUBES and CARROTS
2. feeding an OLD HORSE HAY can cause PERFORATION/damage bc DOESN’T HAVE ENOUGH TEETH TO CHEW IT

DENTAL CARE…
1. history of QUIDDING = food DROPPING OUT OF MOUTH bc CHUNKS TOO BIG

VACCINE HISTORY…
1. DYSPHAGIA can be a SIGN OF RABIES

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8
Q

notable clinical signs in esophageal dz (5)

A
  1. DYSPHAGIA = difficulty or discomfort swallowing, and ESOPHAGUS IS THE LAST PHASE OF SWALLOWING
  2. SALIVA/FEED from NARES or MOUTH
  3. REGURGITATION (passive action)
  4. BRUXISM = GRINDING TEETH, manifestation of discomfort in esophagus/stomach
  5. PTYALISM = SALIVATION/FROTHING at mouth
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9
Q

four PE things we should do for ESOPHAGEAL DZ?

A
  1. RECTAL TEMP = for PERFORATION or ASPIRATION (if inc)
  2. RR/RE/HR
  3. MMs
  4. BORBORYGMI
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10
Q

when do we put in a NASOGASTRIC TUBE?

A

if we KNOW the horse has CHOKE (esophageal obstruction), then DO THIS IMMEDIATELY!!

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11
Q

ESOPHAGOSCOPY…
need to use WHAT SIZE endoscope for ADULT horses?
what 2 big causes of dz can we see?
how can this help with monitoring?
what is this tool NOT helpful for examining?

A

3 METER ENDOSCOPE for VIDEO

2 big causes…
1. ESOPHAGEAL OBSTRUCTION causing CHOKE
2. ESOPHAGEAL ULCERATION

can use this to MONITOR HEALING/TREATMENT EFFICACY

NOT HELPFUL FOR EXAMINING ESOPHAGEAL STRICTURES because we would need to DISTEND ESOPHAGUS, and this is not often done

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12
Q

ID LESION & DIAGNOSTIC TOOL

A

ULCERATIONS in ESOPHAGUS taken via VIDEO ESOPHAGOSCOPY

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13
Q

ID LESION & what TOOL we SHOULDN’T USE to visualize this

A

ESOPHAGEAL STRICTURE, ESOPHAGOSCOPY IS NOT GOOD FOR THIS

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14
Q

PLAIN & CONTRAST RADS for esophagus…
which one is BETTER for esophageal dz?
allows us to visualize WHAT lesion that esophagoscopy cannot?
what ELSE can it visualize?

A

CONTRAST rads are better for ESOPHAGUS

can VISUALIZE ESOPHAGEAL STRICTURES

can also visualize ESOPHAGEAL DIVERTICULUM, usually associated with STRICTURES

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15
Q

ID LESION on this CONTRAST RADIOGRAPHY

A

ESOPHAGEAL STRICTURE

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16
Q

ID LESION on this CONTRAST RADIOGRAPHY

A

ESOPHAGEAL DIVERTICULUM, there’s an obstruction so ESOPHAGUS IS DILATED

17
Q

what is the BEST METHOD to diagnose MEGAESOPHAGUS?

A

CONTRAST RADIOGRAPHY

18
Q

ID LESION on CONTRAST RAD

A

MEGAESOPHAGUS

19
Q

THORACIC US/RADS…
if we suspect a horse has an ____ _____, we ALWAYS DO AN ____
AUSCULTATION in HORSES is NOT…

A

ESOPHAGEAL OBSTRUCTION, US (on the thorax)

NOT VERY SENSITIVE IN HORSES, better to visualize

20
Q

what happens when the ESOPHAGUS RUPTURES?

A

PLEURAL EFFUSION & PLEURAL PNEUMONIA

21
Q

ID LESION ON US

A

ESOPHAGEAL PERFORATION

22
Q

2 CBC findings for esophageal dz? only done if we’re concerned about WHAT dz/see WHAT value?

2 things we can assess with CHEM?

what do they help DO for dz?

A

CBC = can see ELEVATED…
1. SAA
2. FIBRINOGEN
–> done mostly if concerned about ASPIRATION PNEUMONIA (fibrinogen >1,000)

CHEM =
1. check ELECTROLYTES to ASSESS DEHYDRATION
2. CREATININE CONCENTRATION should be checked to confirm KIDNEY FUNCTION

CBC/CHEM only help MONITOR dz, NOT DIAGNOSE!

23
Q

ESOPHAGEAL OBSTRUCTION, “CHOKE”…
commonality?
what 2 equines are PREDISPOSED?
3 COMMON etiologies?
1 UNCOMMON etiology?
frequency/what it can cause?
the obstruction could POTENTIALLY…

A

VERY common in horses, SEEN OFTEN IN PRIMARY CARE

predisposed?
1. GERIATRIC horses
2. PONIES

COMMON etiologies?
1. POOR DENTITION
2. behavior –> if greedy/eat too fast, have PROBLEMS SWALLOWING
3. from EATING after SEDATION

RARE etiology?
1. FOREIGN BODY

frequency? = this can become a RECURRENT PROBLEM and cause STRICTURE

obstruction could POTENTIALLY RESOLVE SPONTANEOUSLY

24
Q

WHERE can esophageal obstruction/choke OCCUR? (3 locations)

A
  1. JUST PAST THE PHARYNX –> WORRY ABOUT ASPIRATION
  2. THORACIC INLET
  3. AT BASE OF HEART (just before entering stomach)
25
Q

in CHOKE, nasogastric intubation is both ___ & ____

how do we know when NG tube is IN STOMACH? (2)

A

DIAGNOSTIC & THERAPEUTIC

NG tube in stomach?
1. SMELL
2. GAS can be heard over DIAPHRAGM

26
Q

TREATMENT for esophageal obstruction/choke…
if it RESOLVES? (4)
if UNRESOLVED? (4)
if UNRESOLVED but NOW RESOLVED? (3)
if UNRESOLVED and PERSISTENT? (1)

A

if it RESOLVES…
1. SOFT FEED for a few days
2. SUCRALFATE (protective barrier over GI mucosa)
3. NSAIDs for 24 hours
4. MONITOR

if UNRESOLVED…
1. ESOPHAGOSCOPY
2. IV FLUIDS/ANTIMICROBIALS/NSAIDS
3. PERIODICALLY LAVAGE esophagus with horse SEDATED
4. NPO (no food)

if UNRESOLVED but NOW RESOLVED…
1. ASSESS INJURY/ASPIRATION PNEUMONIA
2. transition from SOFT FEED to NORMAL FEED SLOWLY
3. NSAIDs/SUCRALFATE

if UNRESOLVED & PERSISTENT…
1. GA to REMOVE OBSTRUCTION

27
Q

why should we MONITOR for ESOPHAGEAL STRICTURES?

how QUICKLY does the esophagus remodel?

A

ESOPHAGUS REMODELS in 30-60 DAYS

if STRICTURES FORM, CAN CAUSE OBSTRUCTION –> CHOKE

28
Q

esophageal perforation is often…

A

FATAL

29
Q

VASCULAR RING ANOMALY = ???

it can cause WHAT?

A

occurs when the AORTA ENCIRCLES & CONSTRICTS around both TRACHEA & ESOPHAGUS

can POTENTIALLY cause ESOPHAGEAL OBSTRUCTION/CHOKE

30
Q

if esophageal obstruction is RECURRENT, what UNDERLYING DZs should we consider? (8, including ONE RARE ONE)

A
  1. VASCULAR RING ANOMALY
  2. GRANULATION TISSUE
  3. NEOPLASIA
  4. STRICTURE
  5. MEGAESOPHAGUS
  6. DIVERTICULUM
  7. GASTRIC IMPACTION
  8. OTHER diseases causing PHARYNGEAL/LARYNGEAL dysfunction, but RARE
31
Q

TREATMENT for esophageal strictures… (4)

A
  1. DIET MANAGEMENT until REMODELING occurs
  2. BOUGIENAGE = difficult & usually UNSUCCESSFUL
  3. MYOTOMY = cut muscles so esophagus can EXPAND, only done if EXTERNAL trauma caused injury to muscle
  4. ESOPHAGOSTOMY = put a tube down esophagus that exits through SKIN
32
Q

ID PROCEDURE & WHY IT’S BEING DONE

what DIRECTION do we enter the INCISION from?

A

ESOPHAGOSTOMY for ESOPHAGEAL STRICTURE

VENTRAL incision

33
Q

ESOPHAGEAL DIVERTICULUM…
2 lesions w/ commonality & what they are

A
  1. PULSION = RARE
    –> occurs when there’s DAMAGE TO THE MUSCLE LAYER OF ESOPHAGUS, so OTHER LAYERS BULGE OUT
  2. TRACTION = MUCOSA & SUBMUCOSA PULLED OUT
34
Q

TRACTION esophageal diverticulum…

is usually secondary to WHAT 2 THINGS?

how is it DIAGNOSED?

how does it PRESENT/what is it USED FOR?

A

secondary to…
1. CERVICAL TRAUMA
2. ESOPHAGOSTOMY

diagnosis? = CONTRAST RADS

presentation/use?
1. SUBCLINICAL
2. used usually for ESOPHAGEAL STRICTURES

35
Q

MEGAESOPHAGUS…
what 2 species are predisposed?
give one reason for one, 2 for another
6 clinical signs?
diagnosed via…

A

2 species?
1. CAMELIDS
2. FRESIAN HORSE BREED

CAMELID = mostly UNKNOWN

FRESIAN =
1. GENETIC CT DISORDER
2. CHRONIC ESOPHAGEAL DILATION

6 clinical signs?
1. WEIGHT LOSS
2. DYSPHAGIA
3. POSTPRANDIAL REGURGITATION
4. PTYALISM
5. FROTHING at mouth
6. ABNORMAL RUMINATION (camelids)

diagnosed via CONTRAST RADS

36
Q

TREATMENT of megaesophagus…
is MOSTLY ___ ____
and if not, likely ____ is the next best option
prognosis?

A

is MOSTLY DIETARY MANAGEMENT!

EUTHANASIA is likely the next best option

POOR PROGNOSIS

37
Q

ESOPHAGEAL PERFORATION…
history/causes? (5, first 2 common, last is uncommon)
5 clinical signs?
treatment? (trick question)

A

history/causes?
1. ESOPHAGEAL OBSTRUCTION = COMMON
2. NG TUBE PASSAGE = COMMON
3. FOREIGN BODY
4. MEGAESOPHAGUS
5. TRAUMA = NOT COMMON

clinical sings?
1. DULL DEMEANOR
2. FEVER
3. TACHYCARDIA/TACHYPNEA
4. INJECTED MMs
5. RELUCTANCE to eat/swallow

THIS DISEASE CANNOT BE TREATED!! but SOMETIMES can do ESOPHAGOSTOMY

year 1/2 (139 decks)

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