GI1- Esophageal Dz

  1. What are types of pathophysiologies associated with the esophagus? (4)
    obstruction (intraluminal, mural lesions-stricture, external compression), inflammation, decreased motility, oropharyngeal dysphagia
  2. Clinical signs of esophageal disease. (7)
    regurgitation, hypersalivation, repeated swallowing, dysphagia, weight loss, anorexia or polyphagia, cough and fever (aspiration pneumonia)
  3. What esophageal diseases are GSDs predisposed to genetically? (3)
    idiopathic megaesophagus, persistent right aortic arch, myasthenia gravis
  4. What is an important extension of the physical exam for an animal with suspected esophageal disease?
    observation of eating and drinking (water, canned food, kibble)
  5. 6 disorders that present with regurgitation.
    esophageal foreign body, esophagitis, esophageal stricture, vascular ring anomaly, megaesophagus, oropharyngeal dysphagia
  6. Where is the most common location for an esophageal foreign body to get lodged?
    esophageal hiatus at the diaphragm
  7. How do you diagnose an esophageal foreign body?
    acute onset, regurgitation, dysphagia, gagging, radiographs, +/- contrast and endoscopy
  8. What are complications that can arise from esophageal foreign bodies? (4)
    esophagitis, perforation, stricture, secondary pneumonia
  9. What are exogenous causes of esophagitis? (4)
    foreign bodies, chemicals, drugs, infections (rare)
  10. What is an endogenous cause of esophagitis?
    gastroesophageal reflux
  11. What are predisposing causes to reflux esophagitis? (4)
    general anesthesia, hiatal hernia, gastric outflow obstruction, repeated vomiting
  12. Physiologic factors promoting reflux. (3)
    decreased GES pressure/tone, delayed gastric emptying, delayed esophageal clearance
  13. How does general anesthesia predispose to reflux esophagitis? (4)
    decreases GES pressure, impaired esophageal clearance under general anesthesia,body position, lack of ET tube (upper airway obstruction/increased inspiratory effort)
  14. How do you treat esophagitis? (5)
    H2 blocker or PPI, Sucralfate suspension (bandaid), Metaclopramide or Cisapride (increase GES tone), maybe steroids to prevent stricture, +/-nutritional support
  15. What are predisposing causes of esophageal stricture? (4)
    gastroesophageal reflux secondary to anesthesia, esophageal foreign body, oral doxycycline tabs (cats), other random (caustic agents, thermal or radiation injury, surgery)
  16. Clinical signs of esophageal stricture. (3)
    regurgitation (esp of solid foods), ravenous appetite (food not getting to stomach), weight loss
  17. How can you manage an esophageal stricture? (2)
    endoscopic/fluoroscopic balloon dilation, surgical resection
  18. How do vascular anomalies cause esophageal disease?
    In the developmental process, if the right aortic arch remains attached to the ligamentum arteriosum, it constricts the esophagus
  19. How do you diagnose persistent right aortic arch? (5)
    animals<6 months old, regurg of solids at weaning, thoracic radiographs,  contrast esophagram, CT angiogram
  20. How do you treat persistent right aortic arch?
  21. What type of neoplasia can obstruct the esophagus most commonly? (2)
    esophageal SCC, leiomyoma
  22. What is achalasia?
    failure of gastroesophageal sphincter to relax
  23. What kind of disorder is megaesophagus?
    hypomotility disorder
  24. What is the most common form of megaesophagus?
    idiopathic- either congenital (young animal) or acquired (older animal)
  25. What neuromuscular disorders can result in megaesophagus? (5)
    CNS disease, neuropathy, NMJ (myasthenia gravis), myopathy (botulism), myositis
  26. What breeds have congenital genetically inherited megaesophagus?
    autosomal in wire-haired fox terriers and miniature schnauzers
  27. What diseases can cause secondary megaesophagus? (6)
    NM disorders, CNS disease, hypothyroidism, Lead toxicity, addison's disease, esophagitis
  28. What clinical findings are associated with megaesophagus? (3)
    regurgitation (sometimes hours later since food can sit in the giant esophagus), weight loss, dyspnea/cough/fever (pneumonia)
  29. What tests should be done when diagnosing megaesophagus and underlying causes? (5)
    PE and neuro exam, routine bloodwork, thoracic radiographs, barium swallow (rule out obstruction), Acetylcholine receptor antibody titer (rule out MG)
  30. Describe focal MG.
    can be facial, pharyngeal, laryngeal, esophageal involvement with no appendicular muscle weakness; Ach receptor Ab titer >0.6nmol/L
  31. How do you diagnose idiopathic megaesophagus?
    diagnosis of exclusion
  32. How do you manage idiopathic megaesophagus? (3)
    monitor and treat for pneumonia, nutritional support (upright feeding, soft foods, small meals, +/- G tube), promotility drugs (none for dogs b/c all skeletal muscle, Cisapride for cats)
  33. What are structural disorders that can cause oropharyngeal dysphagia? (7)
    dental/periodontal disease, stomatitis, pharyngitis/tonsillitis, neoplasia, foreign body, cleft palate, TMJ (temporomandibular joint) disease
  34. What are functional disorders that can cause oropharyngeal dysphagia? (6)
    CNS disease, peripheral neuopathies, disorders of NMJ, muscle disorders, hypothyroidism, cricopharyngeal achalasia
  35. Clinical signs of oral dysphagia. (5)
    can't prehend food or water, excess chewing, dropping food, submerge muzzle to drink, pytalism [no pneumonia or weight loss]
  36. Clinical signs of pharyngeal/cricopharyngeal disorders. (8)
    normal food and water uptake, repeated attempts to swallow, spit up saliva covered food, ventral head tuck when eating, pharyngeal food retention, gag/retch/regurg, nasal d/c/cough/fever [high risk for aspiration pneumonia], weight loss
  37. What is a unique cause of esophagitis in cats?
    Doxycycline pills that aren't passed from the esophagus
  38. 2 pathophysiologic consequences of gastroesophageal reflux?
    esophagitis, esophageal stricture
  39. What is the most common cause of intraluminal esophageal obstruction?
    bones and rawhides
  40. What is the first step to characterize oropharyngeal dysphagia?
    watch the animal eat and drink
  41. What type of esophageal disease is NOT associated with aspiration pneumonia?
    oral dysphagia
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GI1- Esophageal Dz
vetmed GI1