Small Ani. Med 2- Eso Dzs

wilsbach's version from 2016-02-25 15:02


Question Answer
three main anatomical parts of esocranial sphincter (upper esophageal sphincter), esophageal body, caudal sphincter (lower esophageal sphincter)
the esophagus is made up of different proportions of sm and striated mm- what are the diff proportions for the diff animals?DOG: basically all striated (pig too). CAT: last 1/5 smooth. HORSE: last 1/3 smooth. RUMI: all striated. (chicken is all smooth, human is 2/3 smooth)
once again, the dysphagia vs regurg vs vomiting chart (read over again)
What IS regurgitation? and what WONT you see with regurg?Retrograde expulsion from pharynx, esophagus, (stomach<-she had this in parenthesis in notes). There will be no abdominal contraction, no introducing signs (such as nausea, salivation, restless)
what is vomiting, what will you see?vomiting is powerful & reflectory. There is Always with introducing clinical signs!! (regurg doesnt have intro. CSs) like smacking, swallowing, salivation, restlessness, EFFORT to expel stomach content, abddominal component
Differential diagnoses regurgitation--> pharynx?inflammation, obstruction, NM, cricopharyngeal achalasia
Differential diagnoses regurgitation--> eso?inflammation (reflux, fistula), obstruction (FB, vascular ring anomaly, hiatic hernia, neoplasia), motility (megaeso)
Differential diagnoses regurgitation--> stomach?Pyloric stenosis
what are the 4 most common places a FB can get lodged in the eso (and in her opinion, the 2 most common of those)Cr cervical eso, thoracic inlet, *heart base, *caudal eso (diaphragm)
Radiographic Contrast study for FB... risks? which mediums?Risks include: esophageal perforation, endoscopic damage from barium contrast, aspiration pneumonia from barium. iodinated contrast medium (nonionic) dec risks associated with barium specifically.
explain the way you take contrast rads in a suspected FB pt1:1 of non-ionic iodinated contrast medium + water. Put patient in lateral recumbency on xray table, orally administer 5-10 mL/cat, 10-15mL/dog--> immediate rads
explain why time counts when it comes to a eso FB (sequelae to chronic) Chronic foreign body (days)--> tissue necrosis--> Esophagitis/perforation/stricture
if you're going to pill a cat, what should you be sure to do and why?pill the cat with water!! helps prevent esophagitis
How can you treat esophagitis?(1) remove FB (2) Sucralfate (coating and protective agent, helps with ulcers) (3) Metoclopramide (antiemetic, inc lower eso sphincter tone) (4) Cisapride (gastroprokinetic agent, a drug that increases motility in the upper gastrointestinal tract) (5) Omeprazole (H+ blocker) (6) Famotidine (H2 receptor agonist, inhibits acid production)
what is a major complication of esophagitis?Esophageal stricture
how do you dx and tx a eso stricture?Diagnosis: endoscopy, Therapy: balloon dilation q 2-3 days
Differentiate external reasons for stricture--> PRAA vs Hiatal hernia!!!(1) PRAA: Clinical signs with weaning, Small statue, ravenous appetite, Surgery: Remove vascular band. PEG tube (percutaneous endoscopic gastrostomy, a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach.), Prognosis—fair if early enough (Cranial esophagus may remain dilated, motility may return ). HIATIC HERNIA: RARE! might see Aspiration pneumonia/regurgitation, Contrast radiography for diagnosis. therapy is sx.
Read over "Point the Pointer" caseesophagitis
how do you wanna dx the cause of esophagitis, and what are your DDxs?TAKE BIOPSY!! DDx: Reflux (anesthesia is a big risk of this), Persistent vomiting, Foreign body, Spirocerca lupi, Toxic substances, burns, neoplasia (sarcoma, carcinoma, melanoma, leiomyoma)
how do you want to change the diet of a dog with esophagitis?REDUCE the fat in the diet, bc high fat reduces motility and we want the eso to clear out bad things
4 main ways we treat esophagitis? which did she emphasize?(1) Ulcogant (Sucralfate) (coats and protects) (2) Stomach acid inhibitors (H+ inhibitors, H2 blockers) (3) Prokinetic medications (4) fat reduced diet (inc fat dec motility)
what is Spirocerca lupi? where do you find this dz? what are the clinical signs and major sequelae?Rare parasitic disease of eso. Gulf coast states, Israel, Caribbean. May lead to sarcoma and aortic aneurysms!! CSs usually Regurgitation, vomiting and dyspnea
how do you dx and tx spirocerca lupi?Dx: Zinc sulfate floatation/fecal sedimentation. Tx: Doramectin (look out for collie types!!), +/- Selamectin, +/- fenbendazole
3 categories of eso neoplasia?(1) Primary Esophageal (2) Periesophageal (3) Metastatic
what are the 3 main neoplasia DOGS get in their esophagus?fibrosarcoma, osteosarcoma, (secondary to spirocerca lupi granuloma....sarcomas!)
what is the neoplasia that cats get in their eso? squamous cell carcinoma
what are we looking at here? radiograph of MEGAESOPHAGUS-- note tracheal stripe sign
which endocrine disorder can cause megaeso? Hypoadrenocorticism (Addison’s) ( electrolyte imbalances and a cortisol deficiency. Electrolyte imbalances cause altered membrane potentials, which result in decreased neuromuscular functions. Muscle weakness is a symptom of deficient cortisol. )
9 possible causes of megaesophagus (7 she bolded are highlighted)(1) Idiopathic (2) Air swallowing (not real mega eso but just sequelae from aerophagia) (3) Obstructive: Vascular ring anomaly, stricture, neoplasia, foreign body (4) Hypoadrenocorticism (Addison’s) (5) neuromuscular: myesthenia gravis, systemic Lupus erythematosus, Polymyositis/Polymyopathy, Dysautonomia / Glycogen storage disease, distemper / tetanus (6) Lead toxicity, organophosphate toxicity (7) Esophagitis (8) Thymoma (9) Hypothyroidism
which toxicity can lead to megao eso?lead tox (also organophosphate poisoning) (lead=causes mm weakness))
how can you dx an IDIOPATHIC megaeso?exclusion of other differentials
if you think Hypoadrenocorticism is causing megaeso, what test do you do?ACTH Stim
if you think myesthenia gravis is causing your megaeso, how do you dx this as the cause?Acetylcholine rec ab titer, Tesilon test, EMG
workup Megaesophagus--> systemic Lupus erythematosus as possible cause--> dx?ANA, skin biopsy
workup Megaesophagus--> Polymyositis/Polymyopathy as possible cause--> dx?CK, muscle biopsy EMG
workup Megaesophagus--> Dysautonomia / Glycogen storage disease as possible cause--> dx?skin/muscle biopsy, urine
workup Megaesophagus--> distemper / tetanus as possible cause--> dx?CSF tap, distemper titer, toxin assay, EMG
workup Megaesophagus--> desophagitis --> dx?endoscopy
workup Megaesophagus--> Lead toxicity, organophosphate toxicity --> dx?CBC, lead, Cholineseterase act
what can you use to examine motility of Pharynx/Esophagus? how about stomach/intestine?Pharynx/Esophagus: Fluoroscopy. Stomach/intestines: U/S or contract study
read over Bikkel caseaww
once again... ddx for regurg?Megaesophagus, Esophagitis, Obstruction, Hiatic hernia, Pyloric stenosis, Neuropathie
3 main places vomiting can happen because of?central/GI/extra GI
big crappy sequelae to megaesophagus is?ASPIRATION PNEUMONIA!!! look for resp signs/systemic signs
if the dog has megaeo on rads, what should you look for on the rads also?cranial mediasteinal mass-- thymoma! (thymoma--> MG--> mm weakness--> megaeso)
if you suspect addison's, look at what lab values?Na/K (low Na high K in blood)
how do you wanna tx/manage megaeso?Frequent small meals, Vertical position for meal & 15-20mins after eating (want a setup where they can't get down for 15-20 min!!), No dry diet without water (sticks to esophagus). And then make sure to prevent/tx possible pneumonia from aspiration
how long must megoeso pt stay vertical after eating?20 min!!! (and no dry food, it sticks!)