SA Sx, E1, Esophagus
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What are common clinical signs of esophageal disease?
- regurgitation, dysphagia, salivation
- coughing, dyspnea
What is the holding layer in the esophagus? Which layer is thickest?
- holding = submucosa
- mucosa is thick (missing serosal layer)
What makes up the vascular supply to the esophagus?
submucosal plexus + segmental extrinsic vasculature
What type of tension should be on suture line?
minimal tension (and gentle tissue handling)
How do you close esophageal incision?
- 1 layer closure: simple interrupted on extraluminal surface
- OR 2 layer closure: 1st layer simple interrupted in mucosa/submuc. w/knots in lumen; 2nd simple interrupted in submucosa/muscularis/adventitia w/knots external
What suture material is often used?
- PDS can also be used
It is necessary to tie the forelimbs down and out of the way of which surgical approach to the esophagus? which important nerve should you avoid with this approach?
- cervical approach on ventral midline
- recurrent laryngeal nerve
For lateral thoracotomy approach to the esophagus that is to be CRANIAL to the heart, which ribs are landmarks? right or left?
3rd, 4th, or 5th interspace on the RIGHT
For lateral thoracotomy that is CAUDAL to the heart, which ribs are landmarks? right or left?
10th, 11th, or 12th interspace on RIGHT OR LEFT
Is it ok to use stay sutures to help you handle the esophagus?
When is esophageal resection and anastomosis indicated?
- severe trauma/necrosis
- stricture >3-5 cm in length (thats not succesfully tx w/bouginage)
- neoplasia (rare)
How much of the thoracic esophagus can be resected?
up to 1/3 but more than 3-5cm may require tension relieving techniques
How do you close the esophagus after resection?
simple interrupted (two sets of 180 degree suturing)
what are two options for tension relieving?
- partial myotomy (circumferential incision through longitudinal m. layer that's 2-3cm cranial/caud to anastomosis)
- cranial mobilization of stomach
Which muscle layer is incised for tension relieving partial myotomy?
longitudinal muscle layer
What can be used for esophageal patching?
- muscle pedicle graft (sternohyoid, sternothyroid, or diaphragm)
- pericardium or gastric wall (less common)
How do you approach feeding post-op?
- NPO for 24hr - 10d, depending on condition of esophagus
- if feeding per os, liquid diet 3-5 d
What factors predispose the esophagus to rupture post op?
- lack of serosa
- pressure gradient across esoph.wall caused by changes in pleural pressure w/breathing
- rapid dilatation associated with swallowing
What are 4 common sites for esophageal foreign body?
- thoracic inlet
- base of heart
- esophageal hiatus
What are radiographic signs of esophageal foreign body?
- abnormal luminal density
- esoph. distension
- tracheal displacement
- abnormalities in mediastinum
- abnormalities of lung fields +/- pleura
What type of contrast should be used if perforation is likely?
water soluble iodinated contrast
What are non-sx options for removing foreign body in esophagus per os?
- balloon catheter retrieval
Morbidity/mortality rates are higher for sx removal by esophagotomy, esp. for which region of the esophagus?
After retrieving foreign body, what is protocol for diet and antibiotics if there is no perforation suspected? What if its minor perf? significant perforation?
- none: soft diet, ab's probably not needed
- minor: gastrostomy tube feed, antibiotics
- major: thoracotomy/thoracostomy tube + gastrostomy tube feeding + Abs
What are 3 common etiology of strictures in esoph?
- 2nd to inflammation/trauma
- complication of sx
- 2nd to gastro-esophageal reflux
What are tx options for esophageal stricture?
- resection/anastamosis if short area
- long strictures require reconstruction
True or False: Bouginage often requires multiple procedures, stricture is likely to recur, and soft diet may be needed for life.
What is term for uncommon pharyngeal dysphagia in which food bolus can't pass from oropharynx to esophagus due to failure of cricopharyngeal m. to relax? Is this treatable?
- cricopharyngeal achalasia (failed coordination when swallow)
- yes, treatable
What is etiology of cricopharyngeal achalasia? What is common signalment?
- unknown/congenital etiology
- puppy at weaning
There are several problems that present w/ similar signs when puppy starts weaning. How does presentation of puppy with cricopharyngeal achalasia, PRAA, and congenital pyloric stenosis differ?
- achalasia: regurgitate IMMEDIATELY when try to swallow
- PRAA: regurg can happen later after eating
- pyloric stenosis: VOMIT w/in 24hr of eating
what is best way to diagnose cricopharyngeal achalasia? how is it treated?
- fluoroscopy during barium swallow
- cricopharyngeal myectomy (this procedure is CONTRAINDICATED for all other conditions)
What are 2 reasons for megaesophagus that present in young dog? what could cause this in adult?
- congenital - incomplete nerve development
- vascular ring anomaly
- adult - myasthenia gravis
What is major concern with megaesophagus that could be demise of the patient? how are these patients managed at home?
- aspiration pneumonia
- feed upright and stay upright after eating for some time
What parasite is often seen at necropsy in the esophagus and is associated w/sarcomas?
spirocerca lupi (good prognosis if removed but can present w/sudden death if go undetected)
How else can spirocerca lupi present in the patient besides in esophagus?
hypertrophic osteopathy (long bones deformed/thick/painful)
When placing esophogostomy feeding tube, what major vessel is landmark? Left or right?
- ventral to external jugular vein; caudal to maxillary/lingofacial bifurcation
How far should esophagostomy feeding tube extend in the body? why?
mark tube so it stops mid-thoracic (7-8th rib) so tube does not contact cardia of stomach which could cause esophageal reflux
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