Esophageal Dz I

What nerves are involved in the pharyngeal stage?

CN V (5)

CN IX (9)

CN X (10)

CN XII (12)

-involuntary

What nerves are involved in the esophageal stage

CN IX (9)

CN X (10)

-primary wave to the stomach

The canine esophagus is entirely ___ muscle and the feline its 2/3 _____ and 1/3 ____ muscle?

Skeletal

Skeletal

Smooth

How do you dx a functional esophageal defect?

Dynamic imaging - fluoroscopy

-dx abnormalities w/ muscle/ nerve function

How can you dx megaesophagus?

Static thoracic rads

Dogs w/ Megaesophagus will often see what other issues?

Recurrent aspiration pneumonia

Malnutrition

Dehydration

Uncomfortable esophagitis

What is going to cause diffuse congenital idiopathic megaesophagus?

Defect in vagal innervation -> ineffective peristalsis

-can dx at 10 w. Large breed

How do you tx diffuse congenital idiopathic megaesophagus?

Symptomatic therapy

Sildenafil

How does sildenafil work in diffuse congenital idiopathic megaesophagus?

Relaxes the LES via NO synthesis by inhibiting PDE-5 (Prevents the degradation of cGMP)

What is Myasthenia gravis?

Lack of ACH or ACH receptors at neuromuscular junctions

Will acquired or congenital myasthenia gravis have a positive serum antibody titer?

Aquired - autoimmune - POSITIVE TITER

Congenital - deficiency - no positive antibody titer

Myasthenia gravis can sometimes be secondary to what?

Thymoma

Why should we always test dogs w/ MegaEsophagus for Myasthenia gravis?

Can have ME w/out generalized weakeness (It can be focal)

What is the Drug of choice for Myasthenia gravis?

Pyridostigmine

Can try steroids at immunosuppressive dose

What is the MOA of pyridostigmine?

AChE inhibitor

-Keeps ACh around longer so it can work on available receptors

What AE should we be cautious of w/ Pyridostigmine?

SLUDD

What is the prognosis for Myasthenia Gravis?

Good - spontaneous remission

How do you RO Megaesophagus that is secondary to hypoadrenocortism?

Resting cortisol - reversible if tx

When might we consider testing for hypothyroidism induced ME?

If concerent signs of Hypothyroidism are present - Relationship not proven exactly

What is lower esophageal achalasia like syndrome?

Loss of inhibitory neurons in the LES - inability to relax the sphincter and food gets stuck

Identify?

LES -AS - bird beak sign

How do you treat/ dx Megaesophagus induced by LES-AS?

Botox inj - lasts 40 days

-paralyzes it open

What is permanent tx for Megaesophagus induced by LES-AS?

Sx myotome and fundoplication

What is dysautonomia?

A generalized degeneration of the autonomic nervous system- unknown mechanisms - fatal

Does sildenafil tx aquired megaesophagus as well as idiopathic?

No - not as well

What is a congenital esophageal diverticulae?

Mucosa herniates through muscularis

What is an aquired esophageal diverticulae?

Dilation secondary to obstruction

OR

extra esophageal inflamation

What is a R vascular ring anomaly?

Persisten R aortic arch traps the esophagus between the aortic arch and ligament arteriosum

What breeds are predisposed to a R vascular ring anomaly?

GSD

Irish setters

When does a R vascular ring anomaly present?

Regurge post weaning

-aspiration pneumonia

-failure to thrive

What is dx of R vascular ring anomaly?

Rads w/ contrast

Esophagoscope - extraluminal compression w/ pulse

How is R vascular ring anomaly Tx?

Sx transection of ligaments arteriosum

Identify?

R vascular ring anomaly

What typically will cause an esophageal stricture?

Circumferential scar reducing luminal diameter usually due to previous esophagitis

-anesthesia

-FB

-chem injury

Name 3 medications that can cause strictures in a cat?

Doxy

Clindamycin

Bisphosphonates

What is tx for strictures?

Repeate balloon dilation

Inj intramucosal steroids

Stents

-Guarded prognosis

How can strictures be medically managed?

Slury diets

Elevated feedings

Gastrostomy tube