Clin Med - GI Intro 1

drraythe's version from 2016-03-14 20:10

GI intro, Mouth, Esophagus

Question Answer
Explain the difference btwn SEGMENTAL contractions & PERISTALTIC contractions (what purpose do they serve? What happens if the type of motility ↓?)SEGMENTAL: This is for MIXING & if this motility slows, you can get Diarrhea
PERISTALTIC: This is for PROPELLING along the GI. A ↓ in the movement of this will result in ileus (a disruption of the normal propulsive ability of the gastrointestinal tract)
What kinda movements will the GI have during a fasted state?There will be minor contractile activity & the MMC (migrating motor complex) which works as a "housekeeping" fxn
List 9 CS which may indicate DYSPHAGIA(1) Abnormal swallowing (think about how complex this actually is)
(2) Halitosis
(3) Ptyalism
(4) Gagging & multiple swallowing attempts
(5) Abnormal
(6) Weight loss
(7) Painful mouth
(8) Coughing
(9) Hematemesis
What is Hematemesis?Vomiting blood
(What is hemoptysis?)Coughing blood
8 major dysphagia rule outs?Foreign bodies
Dental dz
Neuromuscular dzs
Neurological dysfxn
Dysphagia R/Os → Ulceration, inflammation or infxn → how might Renal Dz relate to dysphagia?The uremia can cz ulcerations in the mouth - you can confirm this by smelling their breath, it should reek like pee
Dysphagia R/Os → Ulceration, inflammation or infxn → what are some (2) FELINE specific things in this category which would cz dysphagia?(1) EOSINOPHILIC GRANULOMA! No parasite or anything.... they are prolly allergic to the plaque on their teeth. Fix? Take out the teeth
(2) Lymphocytic/plasmacytic Gingivitis/Pharyngitis
What virus can cz ulceration/inflammation/infxn of the mouth leading to dysphagia?Calicivirus (think this is just cats but she didnt specify)
What is Sialoadenitis?Inflammation of salivary glands
What 4 neuromuscular dzs can result in dysphagia? (Dont confused neuromuscular dz w/ neurological dysfxn)Masticatory Muscle Myositis
Oropharyngeal Dysphagia
Cricopharyngeal Achalasia & Asynchrony (this is incredibly rare)
Oropharyngeal dysphagia comes in what 3 stages?Oral phase
Pharyngeal phase
Cricopharyngeal phase
Dysphagia R/Os → neurological dysfxn → which nerves can be affected to cz dysphagia? (5 of them)*Remember nerve dysfxn can result in paralysis OR paresis* CNs V, VII,IX, X, XII
What are the most commonly mentioned neoplasias of the mouth which can cz dysphagia? (6)SCC (squamous cell carcinoma)
Multiple myeloma (cancer of plasma cells)
FSA (fibrosarcoma)
OSA (osteosarcoma)
epulis (aka acanthomatous ameloblastoma, AA)
When would you want to do bloodwork for a dysphagia? What specific blood tests would you want to do?You’d want to do blood work if a Complete if PE & CS indicate systemic involvement, OR if anesthesia is necessary. Some specific tests you might want to perform would be FeLV/FIV & a 2M antibody titer (masticatory muscle myositis)
Why would you only need 1 view to get radiographs of the neck & what is that view?Only need a lateral view, bc on the VD the spinal column is going to be too much in the way anyway
*(NAVLE): What is the muscle composition of the cat vs the dog esophagus?Dog is all striated mm, cat is all striated up to the distal portion, all of which is sm mm
What kinda motions can the esophagus make? Explain a little1° peristalsis (for regular food bolus) & 2° peristalsis (for remnant food)
How excited should you be about doing esophageal Sx?VERY UNENTHUSED - even touching the esophagus (or looking at it) wrong can cz it to STRICTURE → this is bad news
If an animal is regurgitating, you should get a Hx. What kinda things should you ask about?Chronicity?
Recent anesthesia?
Foreign body ingestion/removal?
If you have regurgitation (the clinical manifestation of esophageal dz) what are some additional CS you might see?Dysphagia
Weight loss (can be severe weight loss)
Maybe coughing & dyspnea
Maybe depression & anorexia
How do you tell the difference btwn regurgitation or vomiting?Regurg is PASSIVE, vomiting is ACTIVE (there will be abdominal effort)
What properties of vomiting are there that regurg doesnt have?Vomiting is an ACTIVE process w/ an abdominal component (retching) & there will be bile & nausea
Megaesophagus/ Esophageal weakness → idiopathic/primary megaesophagus is common in who & not common in who?RARE in cats. COMMON in any breed, but esp in:
Irish setters
*From homework, unrelated but SUPER IMPORTANT TO KNOW! What are the main lab findings on a dog w/ Addison’s?LOOKS LIKE RENAL FAILURE! But there is↓Na, ↑ K-& LACK OF STRESS LEUKOGRAM, EVEN IF TRYING TO DIE
Megaesophagus → 2° acquired can be bc of a LOT of things. I'm just going to list them bc the list is huge. Read it over a few timesMG (Myasthenia Gravis)—Systemic or Focal
Dysautonomia (dysfxn of autonomic NS)
Polymyopathy/Myositis, Polyneuropathy/Neuritis
SLE (Systemic lupus erythematosus)
Toxins (Lead, OP(organophosphates), thallium)
Polyradiculoneuritis (Coonhound paralysis)
Familial canine Dermatomyositis (VERY rare, collies get this)
Familial Reflex Myoclonus
Glycogen Storage Dz
CNS Dz (infxn, neoplasia)
What are 3 toxins which can cz a 2° acquired megaesophagusLead
What is a Vascular Ring anomaly which can cz regurgitation & who is it most common in?Persistent Right Aortic Arch, most common in GSD
What are some things that can cz esophagitis? What can esophagitis lead to?Esophagitis can be czd by Post anesthesia, GERD (gastroesophageal reflux dz aka gastric reflux), excessive acidity.....all of the irritation to the esophagus can lead to STRICTURES
What is LES achalasia? What can this cz?Lower esophageal achalasia (which is a failure of smooth muscle fibers to relax)...this can lead to REGURGITATION (not vomiting)
What are the 2 main types of esophageal masses & what are the main czs? What can masses cz?Can cz REGURG!!!
(1) Neoplasia (can be Esophageal or Extraesophageal & still cz regurg)
(2) Granuloma (SPIROCERCA LUPI)
What is going on w/ a Hiatal Hernia? What problems might it present?The top of the stomach begins to stick through the hiatus of the diaphragm
What dog virus can cz regurg?Canine Distemper
What respiratory complication can you get from megaesophagus?Aspiration pneumonia
If you see a radio-opacity over the heart, what might you think? What if I told you it was related to megaesophagus?Megaesophagus predisposes to ASPIRATION PNEUMONIA! & the most LIKELY place for an inspired object is in the RIGHT MIDDLE LUNG LOBE (which lies right over the heart). Why? Bc it's the 1st 2° bronchi that the inspired material has a chance to fall into (earliest on the way down that is on the floor of the bronchi so it drops right in)
If you want to diagnose a problem w/ the esophagus what radiographs should you take?Thoracic & cervical
Pneumomediastinum can be related to the esophagus how?Pneumomediastinum might indicate a perforation of the esophagus
What are 2 major risks you are taking when you decide you want to do a contrast barium study? How might you try to reduce these risks?(1) ASPIRATION (can lead to Inflammation to severe fluid accumulation) (adding the barium to food might help reduce this risk)
(2) PERFORATION (it can leak into the mediastinum/ pleura)
If you are worried about a perforation but want to do a contrast study of the esophagus, what can you use?Iodinated agent if you suspect perforation
What’s the difference btwn a contrast study & fluoroscopy?A contrast study is where you give contrast & then take a radiograph & you have a picture to look at. In fluoroscopy, it is a "real time radiograph" where you are seeing a sort of video w/ the contrast where you can watch the animal swallow
What’s some stuff you'd be able to find w/ endoscopy & what is the benefit of endoscopy?Can VISUALIZE things DIRECTLY! Can see strictures & diverticulums & such.
What are 2 therapeutic interventions you can perform w/ the endoscope?(1) FB removal
(2) Balloon dilation (to open strictures)
If you are concerned about the esophagus, why would you look at CBC/CHEM/UA?Allow for systemic evaluation
Why would you go a fecal evaluation if you are concerned about the esophagus?To look for Spirocerca lupi egs
Why would you check Acetylcholine antibody titers if you were concerned about the esophagus?To check if there is MYESTHENIA GRAVIS which can cz megaesophagus
Tensilon test-what is this test for? Why would you do it if you were concerned about the esophagus?To check if there is MYESTHENIA GRAVIS which can cz megaesophagus
If you were concerned about the esophagus, why might you test for Creatinine Kinase?To check for Myositis, myopathies of the mms of the esophagus
Why would you perform a ACTH stimulation test if you're concerned about the esophagus?Addison’s can cz megaesophagus (rare) & this test tests for Addison’s (to see if that is the possible cz)
What tests might you perform if you want to do a Neuromuscular evaluation of the esophagus? (4)EMG (electromyography-an electrodiagnostic medicine technique for evaluating & recording the electrical activity produced by skeletal muscles)
Tensilon test (check for myasthenia gravis-this is a muscle & a nerve problem)
Peripheral muscle/nerve biopsy
Dysautonomia evaluation
How might you be able to differentiate a megaesophagus from a PRAA at a glance of a contrast radiographIf it doesnt stop at the base of the heart, it aint a PRAA (Persistent Right Aortic Arch)

Recent badges