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Small Animal Medicine II > Esophageal Dz > Flashcards

Esophageal Dz Flashcards

1
Q

Where does regurgitation help localize a lesion to?

A

Esophagus

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2
Q

What are 2 types of regurgitation?

A

Obstructive

Motility

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3
Q

What are 2 endocrinopathies often associated with motility regurg?

A

HypoT4

Addison’s

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4
Q

With regurgitation, what two types of achalasia might you see and what would be the clinical sign?

A

Cricopharyngeal achalasia - dysphagia

Esophageal achaasia - Odynophagia

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5
Q

What is esophageal achalasia?

A

Inability of lower esophageal sphincter to close

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6
Q

Animals that are regurgitating also have a ravenous appetite, why?

A

Because they are not getting enough nutrients

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7
Q

What 4 things do you need to diagnose regurgitation?

A

Hx
Clinical signs
Imaging
Biopsy

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8
Q

What type of imaging do you start with when looking at regurgitation?

A

Plan RADs

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9
Q

What is a contraindication to fluoroscopy?

A

Megaesophagus

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10
Q

What would you use endoscopy for with regurgitation?

A

To confirm a stricture

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11
Q

What findings make myasthenia gravis less likely?

A

a BIG megaesophagus (inversely proportional)

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12
Q

Why is it important to find out if your regurgitating patient has local myasthenia gravis?

A

Because it can progress to fulminant myasthenia gravis which results in respiratory failure

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13
Q

On plain radiographs of a regurgitating patient, what do you need to keep in mind if they’re sedated?

A

Can be an artifact of air sitting in esophagus

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14
Q

What is pretty pathognomonic for megaesophagus on thoracic RADs?

A

Tracheal stripe sign

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15
Q

What are 4 things you may see on thoracic RADs when you’re dealing with regurgitation due to Spirocerca lupi?

A 
Caudodorsal thoracic cavity mass
Aortic aneyurism (looks like knuckles)
Space filling defect
Spondylitis
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16
Q

When is barium contraindicated in a regurgitation contrast study?

A

Any suspicion of a fistula or worried about aspiration

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17
Q

What will you see if you have aspiration of contrast?

A

Bronchial pattern

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18
Q

What should you do if you have aspiration of contrast?

A

Don’t panic, broad spectrum abx for 14 days

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19
Q

What does a normal canine esophagus look like on esophagoscopy?

A

Pale pink with longitudinal folds and a closed cardia

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20
Q

What is different about a feline esophagus on esophagoscopy?

A

Annular folds (rings) from striated muscle in the distal 1/3rd

NOTE: Cats very rarely get megaesophagus

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21
Q

What is the most common cause of esophageal stricture in a cat?

A

Iatrogenic (dry swallowing pills)

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22
Q

When you encounter a stricture, what can help you determine if it is a vascular ring anomaly?

A

Pulsations

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23
Q

Why can we often only get superficial biopsies of the esophagus?

A

Because it’s very tough tissue

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24
Q

What neurovascular structure in the esophagus can degenerate/disappear with stress causing megaesophagus?

A

Myenteric plexus

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25
Q

What age group is affected by congenital idiopathic megaesophagus?

A

Clinical signs start at

26
Q

If you have congenital idiopathic megaesophagus, what might you consider is the issue?

A

PRAA

27
Q

T/F: animals with congenital idiopathic megaesophagus can grow out of it.

A

True

28
Q

If a dog has acquired idiopathic megaesophagus, what do we see on RADs?

A

Generalised esophageal dilation

29
Q

How can we help dogs with acquired idiopathic megaesophagus?

A

Postural feeding

30
Q

What 3 breeds commonly get acquired idiopathic megaesophagus?

A

Collie
GSD
Miniature schnuazer

31
Q

If the dog is suffering from lots of regurgitation, what else can we do to help them get nutrients?

A

Place a stoma in the stomach. Owner will be responsible for nutrients

32
Q

What is the more common form of myasthenia gravis?

A

Acquired

33
Q

What is the cause of acquired myasthenia gravis?

A

Ab production against acetylcholine receptors at motor end-plates

34
Q

What is the underlying trigger of acquired myasthenia gravis?

A

Thymoma

NOTE: Most cats with megaesophagus have a thymoma

35
Q

What is the gold standard test for myasthenia gravis?

A

Acetylcholine receptor antibody assay

NOTE: Monitor titers every 3-6 months because they can go into remission

36
Q

How do you treat myasthenia gravis?

A

Pyridostigmine

37
Q

Where would you see a thymoma on thoracic RADs?

A

Well defined soft tissue mass cranial to the heart

38
Q

What are 2 ways you can manage megaesophagus?

A

Bailey chair

Low profile gastrostomy tube

39
Q

What 4 breeds (2 dog, 2 cat) are predisposed to vascular ring anomalies?

A

GSD
Setters
Persians
Siamese

40
Q

What are 4 vascular ring anomalies?

A

PRAA
Double aortic arch
Persistent right ligamentum arteriosum
Right subclavian artery

41
Q

Why do you not see megaesophagus in suckling pups and kittens?

A

Because liquid has no problem passing through, but solid food gets stuck.

42
Q

In a case of a vascular ring anomaly, where are the diverticula located?

A

Cranial to the constriction

43
Q

Why do we need to correct the vascular ring anomaly asap?

A

Because the more distended the diverticula, the less likely it is to return to normal

44
Q

What are 4 major causes of esophagitiss?

A

Gastroesophageal reflux under GA (fasted too long or not enough before surgery)
Chronic vomiting
FB
Structural anomaly

45
Q

What is the best drug to manage esophagitis?

A

Sucralfate

Provides a diffusion barrier to peptic mucosal damage

46
Q

What are 2 other drugs besides Sucralfate that you can use to manage esophagitits?

A

Metoclopramide (Improve tone of caudal esophageal sphincter)
H2 Blocker s and PPIs (Neutralize acid secretion)

NOTE: Metoclopramide only indicated if you suspect esophagitis

47
Q

How are strictures acquired?

A

Secondary to esophageal inflammation

48
Q

When do strictures occur?

A

2-3 weeks post-inflammation

49
Q

When are strictures most commonly formed?

A

After GA when dog is placed in dorsal recumbency

50
Q

What is the current recommended treatment for strictures?

A

Balloon dilation

NOTE: Needs to be repeated over time, give Abx, sucralfate and prednisolone (antifibrotic)

51
Q

How do you remove an esophageal FB?

A

~90% can be removed per os

52
Q

What should you not do with an esophageal FB and why?

A

Push it into the stomach, because can damage lower esophageal sphincter

53
Q

If you DO end up having to push an esophageal FB into the stomach, what should you not treat with and why?

A

Don’t use H2 blockers because it will slow the disintegration of the bone

54
Q

What is the most important consideration pre-op for patients that have an esophageal FB?

A

Pain control (opioids)

55
Q

Post-op, how should you care for esophageal FB patients?

A

H2 blockers/PPIs (assuming not a bone pushed into the stomach)
Sucralfate
Analgesics (not NSAIDs)
Abx
Food and water
May need a PEG (percutaneous endoscopically placed gastrostomy) tube (if you think there’s lots of damage to esophagus)

56
Q

What are 5 complications associated with esophageal FB removal?

A 
Failure to remove FB
Perforation
Stricture/stenosis
Fistulae
Diverticula
57
Q

What 2 breeds often get hiatal hernias?

A

Shar peis

English bulldogs

58
Q

What are 3 clinical signs of a hiatal hernia?

A

Reflux esophagitis
Reguritation (soon after eating)
Body condition

59
Q

How common are esophageal neoplasias?

A

Uncommon

60
Q

When we DO see esophageal neoplasia, what are the 2 major types that we see?

A

Sarcoma (complication of Spirocerca)

SCC (femal cats especially)

61
Q

What kind of prognosis do we expect with esophageal neoplasia?

A

Generally poor

62
Q

What 3 things can you do to help a patient with esophageal neoplasia?

A

Pain control
Feed soft diet/gruel
Place an infinity stent to minimize stricture

Small Animal Medicine II (8 decks)

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