GP- esophagus+stomach

to pass food from the pharynx to the stomach

the function of the esophagus is..

cervical, thoracic, abdominal

what are the 3 different parts of the esophagus?

striated

dogs have an esophagus composed of _______ muscle

smooth + striated

(cranial 2/3 striated, distal 1/3 smooth)

cats have an esophagus composed of _______ muscle

smooth + striated

(cranial 2/3 striated, distal 1/3 smooth)

horses have an esophagus composed of _______ muscle

two sphincters:

1.pharyngoesophagic/proximal/upper sphincter

2.gastroesophagic/caudal/lower sphincter

the esophagus has _____ sphincters.

closed (constricted)

when resting, how are sphincters?

the UES relaxes, opening to allow food to pass to the LES

when food arrives to the upper esophagic sphincter, what happens?

the LES relaxes, opening to allow food to pass to the stomach

when food arrives to the lower esophagic sphincter, what happens?

closed

in a resting position, are the esophagic sphincters open or closed?

vomiting

if the animal has abdominal contractions, it this vomiting or regurgitation?

vomiting

which, vomiting or regurgitation involves nausea and retching?

regurgitation

if the animal eats and immediately after, the food comes back up- do we think this is regurgitation or vomiting?

no- vomiting can occur any time, even without a link with food ingestion

does the animal vomit immediately after eating?

vomit- partially digested, bilious, acidic

regurgitation- undigested, tube-shaped, alkaline, mucous

how does the appearance of vomit versus regurgitated food appear?

vomit

a dog lets out a partially digested, irregularly shaped lump of food- do we assume this is regurgitated or vomit?

vomit

which has an acidic pH- regurgitated food or vomit?

regurgitated food

which has an alkaline pH- regurgitated food or vomit?

esophagic- because this is regurgitated food (tube-shaped, undigested, mucous)

a dog has released this from its mouth... do we assume this is an esophagic or gastric issue?

esophagus

regurgitation is a sign of a problem with the _____

regurgitation

what is the MAIN symptom of esophagic disease?

-repeated attempts to swallow

-dysphagia

-odynophagia (pain when swallowing)

-cough

-regurgitation

what are the signs of esophagic disease?

pain when swallowing

what is odynophagia?

painful:

esophagitis

esophagic stenosis

gastroesophagic reflux

neoplasia

foreign bodies

not painful:

megaesophagus

esophageal diverticulum

esophageal fistula

what are the most common esophageal disorders?

esophagitis

esophagic stenosis

gastroesophagic reflux

neoplasia

foreign bodies

which esophagic disorders are painful for the animal?

esophagitis

the MOST COMMON esophageal disorder is...

narrowing of the esophagus

what is esophageal stenosis?

intramural causes:

trauma, causing scar tissue to form

intraluminal causes:

foreign bodies or tumors blocking the lumen

extramural causes:

cardiomegaly, lymphadomegaly, neoplasia

what might be the cause of esophageal stenosis?

intramural esophageal stenosis

what is the name of this disorder?

the narrowing of the esophagus due to the thickening of the esophageal wall (ex: scar tissue)

what is intramural esophageal stenosis?

the narrowing of the esophagus due to an obstruction (ex: foreign body, neoplasia)

what is intraluminal esophageal stenosis?

the narrowing of the esophagus due to something externally compressing it (ex: cardiomegaly, lynphadomegaly, neoplasia, etc)

what is extramural esophageal stenosis?

cardiomegaly- this is an extramural cause

what is the cause of this esophageal stenosis?

-anorexia/hyporexia

-adipsia/hypodipsia

-lethargy

-ptyalism/sialorrhea

-can lead to esophagitis

what are the main symptoms of esophageal stenosis?

intraluminal esophageal stenosis (due to a foreign body)

what is the disorder we see here?

when gastric content passes to the esophagus

what is gastroesophagic reflux?

no- but if it is, it is with brachycephalic breeds

is gastroesophagic reflux commonly seen in dogs?

gastroesophagic reflux

the disorder where gastric content passes to the esophagus is called...

-LES disorders

-chronic vomiting

-hiatal hernia

-delayed gastric emptying

what are the possible etiologies of gastroesophagic reflux?

gastroesophagic reflux

an LES disorder will most likely lead to what problem in the esophagus?

-odynophagia

-hypersalivation/ptyalism

-extension of the head and neck when swallowing

-hyporexia/anorexia- weightloss

-cough

-regurgitation

what are the symptoms of gastroesophagic reflux?

regurgitation

will a gastroesophagic reflux cause vomiting or regurgitation?

gastroesophagic reflux

what type of disorder is characterized here?

leiomyoma- smooth muscle tumor

carcinoma- epithelial tissue tumor

sarcoma- bone/soft tissue tumor

what are the possible types of neoplasia we might see in the esophagus?

neoplasia in the esophagus

what is the problem we see here?

parasite in the esophagus (Spirocerca lupi)

what is the problem we see here?

Spirocerca lupi

what is the most common parasite we will find in the esophagus of a dog?

very slow onset (the clinical signs appear very slowly)

how fast is the onset of clinical signs of an esophagic neoplasia?

the diffuse dilation of the esophagus

what is megaesophagus?

megaesophagus

the most common cause of regurgitation in dog is...

megaesophagus

the diffuse dilation of the esophagus is medically called...

congenital (after weaning, vagal nerve disorder)

acquired

idiopathic muscular or neural disorder

or secondary to another disease

what are the possible reasons that an animal might have megaesophagus?

german shepherd, great dane, labrador, siamese

what small animal breeds are predisposed to congenital megaesophagus?

-CNS disorders (distemper, brainstem lesion)

-peripheral neuropathy (polyneuritis, dysautonomy)

-neuromuscular junction disease (myasthenia gravis, botulism, tetanus)

-piloric stenosis

-esophagic muscle disturbances (esophagitis, endocrine disease)

-mediastinitis

an acquired megaesophagus can be secondary to what diseases?

-regurgitation

-dyphagia

-anorexia/hyporexia

-pain (if caused by esophagitis)

-ptyalism

-halitosis

-aspiration pneumonia

what are the symptoms of an animal with megaesophagus?

-megaesophagus

-esophageal stenosis

-gastroesophagic reflux

-esophageal diverticulum

-neoplasia

-foreign body

-esophageal fistula

-esophagitis

if an animal comes in to the clinic because it is regurgitating, what disorders would we add to our differential diagnosis?

megaesophagus

after performing tests on this animal, we receive this image- what is the diagnosis?

a pouch-like dilation of the esophageal wall

what is an esophageal diverticulum?

esophageal diverticulum

a pouch-like dilation of the esophageal wall is called a...

no

are esophageal diverticulums common in small animals?

esophageal diverticulum

an endoscopy and xray of this animal reveals these findings- what is the diagnosis?

-regurgitation

-retching

-anorexia

(usually unpainful)

what are the symptoms of an animal with an esophageal diverticulum?

-control the size and frequency of food passing to the intestines

-start protein and fat digestion

-vitamin and mineral absorption

what are the functions of the stomach?

-vomiting

-abdominal pain

what are the 2 main symptoms of a gastric disorder?

prayer position

abdominal pain due to gastric dysfunction

this position is called _______, and it is a sign of what?

false- vomiting does not indicate that the problem is ONLY in the stomach, it can be secondary to another disorder

true or false- vomiting always is due to a primary gastric disorder

the active ejection of the contents of the stomach and upper intestine

define vomit

common- dogs, pigs, cats

uncommon- horses

vomiting is common in what animals? it is uncommon in what animals?

no, it is a symptom

is vomiting a disease?

1. sickness/nausea

2. retching

3. vomit

what are the phases of vomiting?

rhythmic inspirations with a closed glottis

-intrathoracic pressure decreases while intraabdominal pressure increases

-inhibition of gastric motility

-retrograde contraction of the small intestine and pylorus

-cardia and LES dilation- content is transferred to the esophagus

what is retching?

small intestine and pylorus (they contract in a retrograde manner)

what structures contract in order to retch?

abdominal muscles and diaphragm

during vomiting, what muscles are mainly contracting?

CNS centers

peripheric receptors

chemoreceptors- by emetic substances

what 3 different categories can stimulate the vomit center in the brainstem?

-trauma

-hydrocephalus

-vestibular system

-psychological reasons

-acute pain

what problems can stimulate the CNS to stimulate the vomiting center?

-abdominal musculature

-salivary glands

-sphincters, stomach, esophagus, duodenum

when the vomit center in the brainstem is stimulated, what structures are then stimulated?

-duodenum

-pancreas

-liver

-kidney

-genitals

peripheric pain receptors located in the ___________, when stimulated, trigger the vomit center.

vagus nerve

vomit center in the brainstem

when peripheric pain receptors located in the duodenum, pancreas, liver, kidney, or genitals are stimulated, the ______ nerve stimulates the ______

because the vestibular system can stimulate the vomit center- they are very close to eachother

how can motion cause vomiting?

by triggering the CTZ (chemoreceptor trigger zone)

how can drugs induce vomiting?

-gastritis

-ulcers

-neoplasia

-flow obstruction

-foreign bodies

what gastric issues can cause vomiting?

-IBD (inflammatory bowel disease)

-neoplasia

-foreign bodies

-intussusception

-functional disorders

what intestinal issues can cause vomiting?

anything that causes pain in the kidneys, liver, pancreas, spleen, or urogenital tract

-genitourinary disease

-peritonitis

-pancreatitis, pancreatic neoplasia

-hepatitis, colangiohepatitis, bile obstruction

-splenic torsion

-nephritis, pielonephritis, nephrolithiasis, urinary obstruction, prostatitis, pyometra

what intraabonimal but unrelated to the GI tract issues can cause vomiting?

-uremia

-hypoadrenocorticism

-diabetic ketoacidosis

-hyperthyroidism

-hypercalcemia

-septicemia

what endocrine/metabolic disorders cause vomiting?

-strychnine

-ethylene glycol

-lead

what are the most common toxins that cause vomiting?

-vestibular disease

-encephalitis

-neoplasia

-increased intracraneal pressure

what neurological disorders commonly cause vomiting?

-fluid loss (causing dehydration and hypovolemia)

-electrolyte disturbances (hypokalemia, hypochloremia)

-metabolic alkalosis

-aspiration pneumonia

-reflux esophagitis

the consequences of vomiting are...

alkalosis

can vomiting cause metabolic acidosis or alkalosis?

-gastritis

-gastric ulcer

-gastric neoplasia

-foreign bodies

-gastric retention

-gastric dilation/torsion

the main monogastric stomach disorders are....

the inflammation of the gastric mucosa

gastritis is...

acute- sudden onset, short duration

chronic- persistent, prolonged, slowly evolving lesions

different etiologies!

what is the difference between acute and chronic gastritis?

-nutrition (greediness)

-coprophagia

-drugs

-chemicals

-foreign bodies

-secondary to acute nephropathy or hepatophaty, virus, bacteria, or parasites

acute gastritis might be caused by...

-long term injury

-chronic irritation due to foreign bodies

-virus (distemper, parvovirus)

-chronic nephropathy and hepatopathy

-food allergy

-chemical substances (fertilizers, pesticides)

what might cause chronic gastritis?

distemper, parvovirus

what viruses commonly cause chronic gastritis in dogs?

NSAIDs

what drug type commonly causes acute gastritis?

-abdominal pain

-vomit (severe and frequent in acute gastritis)

-appetite loss

-diarrhea (leads to dehydration)

-lethargy, weakness

-pale/yellow mucosa

the symptoms of gastritis include...

no, they are not common in dogs

are gastric ulcers a common cause of vomit in dogs?

gastritis

stomach endoscopy. what disorder do we see here?

gastric ulcer

stomach endoscopy. what disorder do we see here?

-mucosa

-prostaglandins

-high blood flow

-HCO3- secretion

-inhibition of gastrin release in the antrum

how does the stomach naturally defend itself against acid to prevent ulcers?