Esophagus

Question 1

What are other names for the upper esophageal sphincter?

Answer 1

Cranial esophageal sphincter Cricopharyngeal sphincter

Question 2

What muscles is the UES made from…2 of them?

Answer 2

Cricopharyngeus m Thropharyngeus m

Question 3

The esophagus is to what side of the trachea?

Answer 3

left thus enters the diaphragm on the left

Question 4

What are the four walls of the esophagus?

Answer 4

1. Fibrous 2. Muscular 3. Submucosa 4. Mucosa

Question 5

What percentage of the esophagus is straited in the dog? Cat?

Answer 5

Dog: 100% Cat: Cranial 2/3.. the caudal 1/3 is smooth muscle

Question 6

What arteries supply the esophagus? Cervical vs cranial thorax vs caudal thorax.

Answer 6

Cervical - Thyroid arteries Cranial thorax - Bronchoesophageal a. Caudal thorax - Esohageal branches of the aorta

Question 7

What veins drain the esophagus?

Answer 7

Azygos Left gastric

Question 8

What nerves are involved in swallowing?

Answer 8

5 - Trigeminal 7 - Facial 9 - Glossopharyngeal 10 - Vagus 12 - Hypoglossal

Question 9

Why does this look this way and what is it called?

Answer 9

This is a normal appearance of the caudal esophagus of a cat.

Herringbone look.

Question 10

What is this? Is this a problem?

Answer 10

This is a redundant esophagus. It is commonly incidental though can have reduction of motility thus fluoroscopic evaluation is warranted.

Question 11

Who commonly has redundant esophaguses?

Answer 11

Brachycephalic dogs

Young dogs

Question 12

What is not recommended for contrast in patients with greater risks for aspiration?

Answer 12

Barium paste because it can cause plugging of the lower airways

Iodinated contrast due to edema

Question 13

Where can you see barium after barium is aspirated?

Answer 13

Thoracic lymph nodes (mediastinal and tracheobronchial)

Question 14

What are the three phases of swallowing before the esophagus?

Answer 14

1. Oral
2. Pharyngeal
3. Cricopharyngeal

Each one can have problems causing dysphagia

Question 15

What is the difference between cricopharyngeal achalasia and cricopharyngeal chalasia?

Answer 15

1. Cricopharyngeal achalasia is the inability for the UES to open
2. Cricopharyngeal chalasia is that the UES is open between swallows

Question 16

Do cats get dysphagia?

Answer 16

Rarely… mostly esophageal problems.

Question 17

Dyspagia secondary to cricopharyngeal dysfunction can cause what?

Answer 17

Misdirection of food bolus into the trachea

Question 18

What is the normal time in seconds does it take for the cricopharyngeal phase?

Answer 18

0.1s

Delayed is considered 0.3s

Question 19

What type of dysphagia is most rare and usually does not happen without other types of dysphagia?

Answer 19

Pharyngeal… it is rare.

Question 20

What type of esophageal disease is LarPar associated with?

Answer 20

Esophageal dismotility. Geriatric onset laryngeal paralysis polyneuropathy (GOLPP)

Question 21

What does laying a dog in lateral recumbancy do to esophageal transit time? Time for oral, pharyngeal and cricopharyngeal phases? and percentage of swallows that need a secondary perstalsis wave?

Answer 21

Increases them all.

Question 22

How many seconds is considered a prolonged esophageal time?

Answer 22

>5 sec

Question 23

What are three criteria for diagnosis of esophageal dismotility?

Answer 23

1. Esophageal time >5
2. Retrograde flow >10cm
3. Bolus staying in the esophagus after two secondary peristaltic waves.

Question 24

Esophageal dysmotility can normally be seen in younger dogs….T/F?

Answer 24

True… wait til 1 year of age and it may resolve.

Question 25

What types of aortic anomolies cause external esophageal stricture?

Answer 25

All of them

Question 26

What is normal development of the aorta?

Answer 26

Aorta comes from the left 4th aortic arch The right 4th should regress

Question 27

What is the difference in the clinical signs from the aberrant right subclavin artery and the aortic anomalies?

Answer 27

Aberrant right subclavin artery (coming from the aorta and not the brachycephalic trunk) usually has less compression and is sometimes more cranial.

Question 28

Granulomas from spirocera lupi can turn into what type of neoplasia?

Answer 28

Osteosarcoma Fibrosarcoma

Question 29

What are the two early signs for spirocera lupi?

Answer 29

Aortic mineralization Spondylitis

Question 30

On CT... what is the way to tell if neoplastic transformation has occured in nodules created by spirocera lupi?

Answer 30

Granulomas will enhance Neoplastic nodules will not!

Question 31

What breed gets redundant esophagus?

Answer 31

Brachycephalic breeds

Question 32

What frame rate should you look at a fluroscopic esophagram?

Answer 32

30-60fps

Question 33

Bolus size can significantly alter what in a swallowing study?

Answer 33

Pharyngeal contraction Opening of the UES Thoracic esophageal transit time

Question 34

Pharyngeal dysphagia can look like what with clinical signs and fluoroscopic findings?

Answer 34

Cricopharyngeal dysphagia

Question 35

What are the fluoroscopic abnormalities seen with pharygneal dysphagia?

Answer 35

Slow contraction of the larynx Incomplete enclosure of the bolus Incomplete rostral and dorsal movement off the larynx Absence of forceful contraction of the phargynx to propel bolus to UES

Question 36

Why is it important to differentiate between cricopharyngeal disorders and pharyngeal disorders?

Answer 36

Cricopharyngeal disorders (achalaisa) can be helped with a myotomy while pharyngeal disorders with worsen with a myotomy.

Question 37

What is the discerning factor between pharyngeal dysphagia and cricopharyngeal dysphagia?

Answer 37

Time of opening of the UES

Question 38

Cricopharyngeal achalasia is associated with what breed type?

Answer 38

Toy breeds

Question 39

How do you calculation pharyngeal constriction ratio?

Answer 39

Dividing pharyngeal area at max contraction by the pharyngeal area at rest

Question 40

What is the normal time (avg) between beginning of swallow (closure of epiglottis) to opening of the UES? Achalasia of the UES average time?

Answer 40

0. 1s Normal. 0. 3-0.4s Achalasia

Question 41

What disease process is cricopharyngeal chalasia commonly seen with?

Answer 41

Myasthenia gravis

Question 42

What is the most common type of dysphagia in a cat?

Answer 42

Esophageal - hiatal hernia, dysmotility and stricture being the most common

Question 43

What disease process is esophageal dysfunction commonly associated with?

Answer 43

Lar Par

Question 44

The percentage of primary waves are affected how in sternal recumbancy vs lateral?

Answer 44

Sternal recumbancy has significantly greater primary waves than in lateral.

Question 45

Fluoroscopic signs of esophageal dysfunction?

Answer 45

Abnormal primary wave moves bolus 5 cm and abnormal secondary waves allow bolus retention in the esophagus after two subsequent swallows Retrograde flow of more than 10 cm Prolonged esophageal transit time (\>5s)

Question 46

Can esphageal dysmotility be caused by delayed maturation?

Answer 46

Yes.. can spontaneously impove after 1 year of age

Question 47

What breed of dogs is seen to have reduced pharyngeal contraction secondary to myopathy?

Answer 47

Boxers

Question 48

What disease can look identical to esophageal and paraesophageal varices in dogs?

Answer 48

Bronchoesophageal artery hypertrophy secondary to chronic pulmonary disease or thromboembolic disease.