SA Sx - Esophagus 2

drraythe's version from 2017-09-14 04:08

Eso 2

Question Answer
What is the only type of dysphagia w/ a Tx?Cricopharyngeal achalasia
What is cricopharyngeal achalasia?An uncommon, treatable type of pharyngeal dysphagia: bolus of food not passed from oropharynx to cranial esophagus bc of failure of relaxation of the cricopharyngeal muscle in coordination w/ contraction of pharyngeal muscles
What is the etiology of cricopharyngeal achalasia?Unknown etiology, possibly congenital (common in puppies)
What is the signalment of an animals suffering from cricopharyngeal achalasia?Puppy at weaning
What is the Hx like for a puppy suffering from cricopharyngeal achalasia?Normal until begin eating solid food (around weaning), Gagging, retching, forceful expulsion of bolus of food. Regurgitation immediately after swallowing (and coughing)
Best way to Dx circopharageal achalasia?Fluoroscopy during barium swallow!! Bolus of food moved into esophagus but stopped by cricopharyngeal muscle. Esophageal motility should also be evaluated
What is the Tx for cricopharyngeal achalasia? When should you not do this Tx?Cricopharyngeal myectomy → Cricopharyngeal myectomy is CONTRAINDICATED for other forms of pharyngeal dysphagia
Why is the Tx Cricopharyngeal myectomy instead of myotomy?If just cut it, itll grow back. The ectomy actually removes a strip of musculature along the median raphae to avoid it healing back
Wut dis? (Starred thingy) Cricopharyngeal mm
How do perform a Cricopharyngeal myectomy?Paws pulled backwards, tie mandible to table w/ adhesive tape. Palpate the edge of the thyroid cartilage, place stay suture, expose the dorsal aspect larynx where the crico - pharyngeal lives. With a blunt instrument where the raphe live, dissect the muscle & then separate it. Cut about a cm wide over the raphe in the immediate post op you can see if it works or not when the PTx is awake try to give him some water & see how he swallows [other notes say: dissect bluntly to free insertion of cricopharyngeal mm & cut slits on either side of raphe & remove small sections of mm on either side & then let heal by 2nd intention]
Congenital megaesophagus is due to..Incomplete nerve development
5 possible czs of megaeso?(1) Congenital is due to incomplete nerve
(2) Vascular Ring Anomaly (PRAA)
(3) Myasthenia gravis (adult dogs)
(4) Hypothyroidism (?)
(5) Addisons (?)
Megaeso is due to a lack of ___ (general)Contractility
What is a tool which uses gravity to help w/ eating w/ a megaeso?The bailey chair (keep them in chair for 15 min after theyve eaten)
What parasite likes the wreak havoc on the eso? What probs can it cz?Spirocerca lupi
Usually associated w/ sarcomas
*Hypertrophic osteopathy
Sudden death (granulomatous rxn in the esophageal wall, may perf the esophagus & cz an adhesion)
What eso prob can cz hypertrophic osteopathy & what does HOP do?Czd by SPIROCERCA LUPI, HOP leads to inflammation in the cortex of the bones - edema, pain
Explain how to place a Esophagostomy tubeNeed a very wide clipping, no fur in the area you're working in. Open up the jaw & put long forceps down the eso, stab incision btwn jaws of forceps to get directly into the esophageal lumen. Push the forceps through the little hole & grab a catheter w/ the jaws of the forceps. Pull the catheter tube back through the hole & 1 end out the mouth w/ the forceps. Loop around outside the mouth & then push the free end of the tube back through the eso, pushing it down (other end is still outside of incision). Once in place, tube should be secured w/ finger trap & bandaging
How do you know when a esophagostomy tube is placed well?When the catheter is well placed it faces cranially badly placed = faces caudally
Word for pain when swallowing?Odynophagia
Esophagotomy is?Opening & then closing it again
What’s some stuff you gotta do to access the eso from the neck?Separate sternohyoideus & sternothyroideus mm. Trachea has a small vein here going ventrally. Displace trachea laterally. Be careful of thyroid glans & dorsally to trachea - recurrent laryngeal nn. Carotid sheath-vagosympathetic trunk alar & jugular
Where do FB USUALLY get stuck, whats the downside to this?At thoracic inlet - try not to open thorax at all or your PTx will not be breathing
Do you usually do a water test in the eso?Not usually bc high pressure system, but can try
How might ANx lead to esophageal stricture?GERD bc cardia is relaxed esp during OHE & gastric Sx. lavage & eliminate & contents & use antacids. (GERD = gastroesophageal reflux Dz)
Which breed did he mention is prone to cricopharyngeal achalasia?Cocker spaniels
DDxs for puppy at weaningPRAA
Cricopharyngeal achalasia
Congenital pyloric hypertrophy/stenosis
How can Spirocerca cz sudden death?Granulomatous rxn w/i wall of esophagus - pierce through esophagus & can go into aorta-sudden death
***All of the following are true regarding the esophagus except?
a) Lack of Serosal layer
b) Mucosa is thick
c) Mucosa is the holding layer
d) Regurgitation is the paramount sign of Dz
c) is False - “Submucosa” is the holding layer
***True or False - Morbidity / Mortality rates are higher for surgical removal of foreign bodies via EsophagotomyTrue
***Which is False regarding Esophageal Sx
a) Simple apposition for 1 & 2 layer closure
b) 2 layer closure: 1st layer knots outside lumen, 2nd layer inside
c) 1 layer closure: knots tied outside the lumen
d) Simple interrupted for 1 & 2 layer closure
b) is False - 2 layer closure is as follows... 1st layer - Knots inside 2nd layer - Knots outside
***Regarding Esophageal Sx - Which layers do you go through for the 1st layer of the “2 layer closure”?Mucosa & Submucosa
***What layers do you go through for the 2nd layer of the “2 layer closure”?Submucosa
Adventitia (1st is SM, 2nd layer is SAM)
***What are the common sites of obstruction of Esophageal foreign bodiesPharyngeal esophagus
Thoracic inlet
Base of the Heart
Esophageal hiatus
***Client comes in claiming that the puppy has just been weaned & cannot keep her food down. She will eat & regurgitate immediately afterwards! What test would you like to perform as your best tool for diagnosing this problem?Fluoroscopy during Barium Swallow
*** (Client comes in claiming that the puppy has just been weaned & cannot keep her food down. She will eat & regurgitate immediately afterwards!) You notice the food moves into the esophagus but is stopped. Given the Hx & your fluoroscopy what is this condition?The food is stopped by the Cricopharyngeal muscle - it fails to relax in coordination of pharyngeal muscles Cricopharyngeal Achalasia
*** T/F: Cricopharyngeal myectomy can be helpful in other forms of pharyngeal dysphagiaFalse (Cricopharyngeal Myectomy is CONTRAINDICATED!! for other forms of pharyngeal dysphagia!!!)
***T/F Dogs w/ congenital megaesophagus are usually euthanizedTrue (No cure bc nerve problem)