Small Animal Sx - Esophagus 2

drraythe's version from 2015-11-24 19:39

eso 2

Question Answer
what is the only type of dysphagia with 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 because of failure of relaxation of the cricopharyngeal muscle in coordination with 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 circopharyngeal achalasia?puppy at weaning
what is the history 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 treatment for cricopharangeal 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 thing) circopharyngeal mm
how do perform a Cricopharyngeal myectomy?paws pulled backwards, tie mandible to table with 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 and 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 pt is awake try to give him some water and see how he swallows [other notes say: dissect bluntly to free insertion of cricopharyngeal mm and cut slits on either side of raphe and remove small sections of mm on either side and then let heal by 2nd intention]
Congenital megaesophagus is due to..incomplete nerve development
5 possible causes of megaeso?(1) congenital is due to incomplete nerve development (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 with eating with a megaeso?the bailey chair (keep them in chair for 15 min after theyve eaten)
what parasite likes the wreck havoc on the eso? what probs can it cause?spirocerca lupi. Usually associated with sarcomas, *hypertrophic osteopathy, and sudden death (granulomatous rxn in the esophageal wall, may perf the esophagus and cause an adhesion)
what eso prob can cause hypertropic osteopathy, and what does HOP do?caused 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 and put long forceps down the eso, stab incision between jaws of forceps to get directly into the esophageal lumen. push the forceps through the little hole, and grab a catheter with the jaws of the forceps. Pull the catheter tube back through the hole and one end out the mouth with the forceps. loop around outside the mouth and 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 with finger trap and 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?odenophagia
Esophagotomy is?opening and then closing it again
what's some stuff you gotta do to access the eso from the neck?separate sternohyoidius and sternothyroidius mm. . trachea has a small vein here going ventrally. displace trachea laterally. becareful of thyroid glans and dorsally to trachea- recurrent laryngeal nn. carotid sheath-vagosympathetic trunk alar. and jug
where do FB USUALLY get stuck, whats the downside to this?at thoracic inlet- try not to open thorax at all or your pt 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 anesthesia lead to esophageal stricture?GERD bc cardia is relaxed esp during OHE and gastric sx. lavage and eliminate and contents and use antacids.(GERD= gastroesophageal reflx disease)
which breed did he mention is prone to circopharyngeal achalasia?cocker spaniels
ddxs for puppy at weaningPRAA, circopharyngeal achalasia, congenital pyloric hypertrophy/stenosis
how can spirocerca cause sudden death?granulomatous rxn w/i wall of esophagus- pierce through esophagus and 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 diseasec) 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 surgery- a) Simple apposition for 1 and 2 layer closure b) 2 layer closure: first layer knots outside lumen, second layer inside c) 1 layer closure: knots tied outside the lumen d) Simple interrupted for 1 and 2 layer closureb) is False - 2 layer closure is as follows... 1st layer - Knots inside 2nd layer - Knots outside
***Regarding Esophageal surgery - Which layers do you go through for the first layer of the “2 layer closure”?Mucosa and Submucosa
***What layers do you go through for the second layer of the “2 layer closure”?Submucosa, Muscularis and 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 and can not keep her food down. She will eat and 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 and can not keep her food down. She will eat and regurgitate immediately afterwards!) You notice the food moves into the esophagus but is stopped. Given the history and your fluoroscopy what is this condition?a) The food is stopped by the Cricopharyngeal muscle - it fails to relax in coordination of pharyngeal muscles (so, a) Cricopharyngeal Achalasia)
*** T/F: Cricopharyngeal myectomy can be helpful in other forms of pharyngeal dysphagiaF (Cricopharyngeal Myectomy is CONTRAINDICATED!! for other forms of pharyngeal dysphagia!!!)
***T/F Dogs with congenital megaesophagus are usually euthanizedT (no cure bc nerve problem)

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