Esophagus Disorders

These flashcards cover the anatomy and evaluation of esophageal diseases, focusing on key concepts such as layers of the esophagus, innervation, clinical signs, diagnostic methods, and complications.

What are the four layers that compose the wall of the esophagus?

1. Tunica mucosa

2. Tunica submucosa

3. Tunica muscularis

4. Tunica adventitia/serosa

Important anatomical structures in the neck

12. jugular vein 

13. trachea 

14. common carotid artery 

15. vago-sympathetic trunk 

16. recurrent laryngeal nerve 

Which cranial nerves are involved in the innervation of the esophagus? blood supply? 

Cranial nerves IX and X, sympathetic trunk. mesenteric ganglion cells 

Cervical corotid a, thoracic/abdominal part of bronchoesophageal and gastric a

What clinical sign indicates the potential for esophageal disease during a physical examination?

Ptyalism, dysphagia, coughing, or regurgitation of food.

Normal imaging of the neck

What is the purpose of performing a positive contrast esophagram?

To evaluate for esophageal obstructions, strictures, and other lesions.

Double contrast study

Negative contrast study

What is the primary clinical sign of impaction or choke in horses?

Ptyalism or excessive salivation.

Where do we start the endoscopy procedure? 

Start all the way down in the stomach and look cranially

What part of the esophagus is this?

Proximal

What part of the esophagus is this?

Cervical

What is choke in horses? 

Food becomes lodged in the esophagus, causing obstruction and discomfort leads to ptyalism, dysphagia, coughing, regurge of food, water and saliva from mouth and nostrils

• odynohphagis → painful swallowing

• repeated extension of the head and neck

• distress, agitation

• can lead to anorexia, electrolyte imbalance, dehydration, aspiration pneumonia (clinical signs occur 1 day after the choke)

Treatment for choke in horses

often involves sedation to keep head down, passing a nasogastric tube to relieve the obstruction DO NOT PUSH, and providing supportive care such as fluids and monitoring for complications

• others

  • cuffed endotracheal rube → lavage under pressure → external massage → endoscopic basket

  • muzzle the horse → stall without bedding → off feed/water

  • surgical treatment with esophagotomy 

  • ace, oxytocin, n-butylscopolammonium bromide, esophageal instillation of lidocaine for esophageal relaxation

Treatments for issues that arise from choke: Dehydration, Hyponatremia, Hypochloremia, Hypopotassemia, Metabolic alkalosis

• polyionic fluids

• broad spectrum antibiotics 

• NSAIDs be careful 

• Sucralfate 

• keep off food for 24-48h → slowly introduce pelleted mash food, hay can be given after 21 days

Prognosis for choke

Rate of reobstruction – 37%

Prognosis for survival – 78-88%

- Horses may require permanent diet changes

What damages can we see from chronic choke? 

• pharyngeal inflammation

• mucosal bruising

• mucosa stripped off submucosa

• stricture

• ruptured esophagus

• periesophageal abscess

• fistula

• esophageal diverticulum

What are the three types of esophageal strictures based on anatomical location?

Type I - mural lesions → adventitia and muscularis

Type II - esophageal rings or webs → mucosa and submucosa

Type III - annular stenosis → all layers

Medical management for esophageal stricture

Balloon dilation → not so common in LA

Surgical treatment for esophageal stricture

- Esophagomyotomy → for type 1

- Partial/complete resection and anastomosis

- Creation of a traction diverticulum

- Patch grafting

- Esophagostomy

What is one complication that can follow esophageal obstruction?

Aspiration pneumonia → make sure to sedate the horse so they drop their head to prevent further aspiration 

Clinical signs of esophageal rupture

- Discomfort, depressed

- Head/Cervical swelling

- Subcutaneous emphysema – swallowed air escapes

- Cellulitis

Treatment for esophageal rupture

• establish drainage 

• surgical repair within 12 hrs

• drain needs to be place

• second intension healing

• antibiotics, anti-inflammatories, fluid therapy

What can esophageal lead to?

- Mediastinitis, pleuritis, septicemia

- Horner’s syndrome, laryngeal hemiplegia

- Jugular thrombosis, carotid rupture

What are the two types of diverticula mentioned in the notes?

A. Traction (true) diverticulum → acquired from contraction of the periesophageal scar tissue, causes outward rotation and tenting of all layers. develops from esophagostomy, second intention healing sites. thicker neck 

B. Pulsion (false) diverticulum → protrusion of mucosa and submucosa through a defect in the esophageal muscularis. has a thinner neck. poorer prognosis and will require surgery 

What is the recommended treatment in cases of pulsing diverticulum?

Surgery is indicated due to the risk of obstruction and rupture → diverticulectomy, mucosa inversion preferred