Esophageal Disease

Question 1

Clinical findings associate with esophageal disease

Answer 1

Regurgitation, WL and anorexia/ polyphagia
Poor BCS, halitosis, drooling, coughing, nasal discharge, pyrexia, wet lungs sounds
Dilated, cervical esophagus, food slopping in esophagus, mass/ FB

Question 2

Diagnostics to assess regurgitation

Answer 2

Routine + rads (contrast- barium), endoscopy
Special tests: thyroid, ACTH stimulation, ACHR, Ab serology, ANA titer and lead levels

Question 3

What is the next best step after radiology?

Answer 3

Endoscopy: direct visualization of mucosal lesion and luminal content
Determines the extent of injury

Question 4

Esophagitis

Answer 4

Inflammation of the esophagus
Mild to severe
Mucosa to muscularis layer

Question 4

Anatomic differentials of regurgitation

Answer 4

Megaesophagus
esophagitis
Esophageal obstruction, diverticulum
Vascular ring anomaly
Pyloric outflow obstruction
Hiatal hernia

Question 5

What is esophagitis secondary to?

Answer 5

Chemical injury
GERD,
Chr. vomit,
Oral abx (doxycycline and clindamycin)
Heat injury
Direct mucosal damage (FBs, masses)

Question 6

CS of esophagitis

Answer 6

Asymptomatic
Anorexia, dysphagia, odynophagia and hypersalivation
Cachexia, WL, cough, dyspnea and pyrexia

Question 7

________ + _________ is a definitive dx for esophagitis

Answer 7

Endoscopy and biopsy
endoscopic changes alone may indicate presence of esophagitis

Question 8

Based on location in the esophagus, what could cause esophagitis?

Answer 8

Upper esoph (past upper sphincter): oral doxy/ clindamycin
Dist. esoph. (cr. to lower sphincter): anesthesia related or GI reflux

Question 9

Esophagitis tx

Answer 9

Remove cause and prevent exposure to acidic substance
Soft diet, small frequent meals, easily digestible diet, fat restricted

Question 10

Medical esophagitis tx

Answer 10

Oral sucralfate (protects from reflux)
Parenteral followed by oral prokinetic agent (↑ gastric emptying)
Parenteral followed by oral H2 blocker or proton pump inhibitor (reduce acidity, helps with GERD)

Question 11

Esophagitis medication duration

Answer 11

Mild: 5-7d
Moderate- severe: 2-3w
Recheck 1w after discharge and 1w after meds stopped
severe if strictures occur

Question 12

Types of esophageal FBs

Answer 12

Bones (76.5%)
Fishhooks, rawhides chews, greenies, hairballs
Play toys (cats)

Question 13

CS associated with FBs

Answer 13

Salivation, regurg, anorexia, odynophagia, halitosis

Question 14

Tx of FBs

Answer 14

Remove immediately (sharps, large, metal, obstructive)
Rigid sigmoidoscope with grasping forceps (cr. esoph FBs only)
Flexible endoscope
Sx (dist. esoph or pushed into stomach)

Question 15

Esophageal FB post removal therapy

Answer 15

Fast 24-48 hrs
Fluid therapy with dehydration
Gastrostomy tube with severe esophagitis
Same therapy as esophagitis

Question 16

Esophageal strictures

Answer 16

Circular band of scar tissue leading to abnormal narrowing of esoph.
Muscularis layer damaged → inflamm. → fibroplasia

Question 17

Pilled induced esophageal chemical injury (cats)

Answer 17

Oral admin of doxy or clindamycin (acidic properties)
↓ esophageal lubrication
Prevent by using liquid preps

Question 18

Which medications cause anesthesia related GI reflux?

Answer 18

Atropine, iso, morphine, acepromazine, thiopental

Question 19

Additional causes of esophageal strictures

Answer 19

FB injury
Esoph. sx
Intraluminal and extraluminal mass lesions (abscess, neoplasia, granuloma)

Question 20

Esophageal stricture CS

Answer 20

Progressive regurg.
Swallowing impairment (↑ effort, hard to swallow)
Pytalism, anorexia, WL, coughing

Question 21

Differentials to esophageal stricture

Answer 21

Esophagitis, megaesophagus, FB, mass lesions

Question 22

Esophageal stricture tx

Answer 22

Mechanical dilation
Balloon dilation via endoscopic guidance (repeat in 5-7d)
Bougienage
Indwelling balloon dilation esophagostomy tube (BE-tube)

Question 23

Post dilation tx for esophageal strictures

Answer 23

H2 blockers, proton pump inhibtors
Metoclopramide, sucralfate, pred, pain meds
Intraluminal stents if CS persist

Question 24

Megaesophagus

Answer 24

Most common cause of regurg in dogs Focal or diffuse esoph. dilation Esoph. dysmotility Secondary to NM dz (acquired)

Question 25

Primary megaesophagus

Answer 25

Congential (idiopathic) Acquired (idiopathic) MG (congenital, focal, concurrent skeletal m.)

Question 26

Congenital megaesophagus

Answer 26

Hypomotility and dilation of esoph. Regurg and failure to thrive after weaning to solid food Familial predisposition, prevalence in siamese cats

Question 27

Pathophysiology of Congenital megaesophagus

Answer 27

Defect in afferent vagal nerve ↓ esophageal motility

Question 28

Signalment of acquired megaesophagus

Answer 28

Dogs or cat middle ages Rare in cats

Question 29

Causes of acquired megaesophagus

Answer 29

MG, hypoadrenocorticism, hypothyroidism, etc

Question 30

CS of megaesophagus

Answer 30

Regurg. Aspiration pneumonia (acute/ chronic cough, fever, dyspnea) Malnutrition/ WL/ emaciation M. weakness, GI signs, m. pain, stiff gait

Question 31

Ancillary tests for megaesophagus

Answer 31

ANA titer, Thyroid profile, blood lead level, esophagoscopy, electromyography, nerve conduction studies

Question 32

Prognosis of megaesophagus

Answer 32

Guarded to poor with primary Congenital may improve with time Better prog with secondary

Question 33

Medical management for megaesphagus (regurg and achalasia)

Answer 33

↓ acidity with omepraxol or pantoprazole Prokinetics (cats) with cisapride Sienafil (congential) Injection of botulism toxin into LES Pneumatic dilation via endoscopy (temporary)

Question 34

Sx for megaesophagus (regurg and achalasia)

Answer 34

Heller myotomy with partial fundoplication (permanent)

Question 35

Megaesophagus tx for aspiration pneumonia)

Answer 35

Abx broad spectrum, correct dehydration and coupage Prevention: gastrostomy tube for feeding and intermittent fenestrated esophagoscopy tube

Question 36

Myasthenia Gravis

Answer 36

Autoantibodies against AcH receptors Skeletal m. weakness

Question 37

Generalized MG

Answer 37

Tetraparesis Dx with AcH ab titer: > 0.6 in dogs and > 0.3 in cats

Question 38

Focal MG

Answer 38

Regurg. Dx with tensilon test (exercise → give endrophonium chloride)

Question 39

Tx for MG

Answer 39

Pyridostigmine Glucocorticoids immunosupproessive dose Tx megaesphagus