Sx E 2 25 Esophageal Surgery
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81 terms
Terms | Definitions |
|---|---|
 What is the function of the esophagus? | Move large food boluses, water and saliva from pharynx to stomach. |
| How much can the esophagus expand during swallowing? | double or tripple |
| T/F the esophagus is constantly movign | True - from swalling and respiration |
| What are the 4 layers of the esophagus | Mucosa submucosa muscularis adventitia NO serosa |
| Which tissue layer does the esophagus not have? | No serosa |
| How would you describe the blood supply to the esophagus? | segmental - 3 portions |
| What are the 3 portions of blood supply? | Cervical esophagus Thoracic esophagus Terminal esophagus |
| The thyroid arteries well-vascularize which part of the esophagus? | Cervical |
| The bronchoesophageal artery less well supplies which part of the esophagus? | Thoracic esophagus |
| The branches of gastric arteries supply which part of the esophagus? | terminal |
| Is the esophagus easy to deal with surgically? | No - try to refer it |
| What makes the esophagus difficult? What are potential repercussions of surgery? | Dehiscense Stricture formation |
| When should surgery be performed on the esophagus? | Only if there is no better alternative |
| What is vital to maintain during surgery to the esophagus? | blood supply |
| What should be minimized during surgery to the esophagus? | Tension |
| The esophagus is a high ____ area. | Motion |
| Follow principles of _____ when operating on the esophagus. | Asepsis |
| Incision into the esophageal lumen = | esophagotomy |
| Will you ever remove the esophagus? | Esophagectomy Not all of it, but partial esophagectomy and anastomosis possible |
| What is a suture that is placed through tissue, then used to retract tissue called? What happens to the free ends of this suture? | Stay suture Free ends clamped with a hemostat |
| Where is surgical access for the cervical esophagus? | Ventral cervical midline approach |
| Where is surgical access to the cranial thoracic esophagus? | Left 3rd intercostal thoracotomy |
| Where is surgical access for the mid thoracic esophagus? | Right 5th intercostal thoracotomy |
| Where is surgical access for the caudal thoracic esophagus? | Left sided 8th intercostal thoracotomy |
| Before esophageal surgery is performed what 2 things help maintain asepsis? | Esophagus is suctioned transorally Surgical site is isolated/packed off |
| After closure of esophgeal surgery, what occurs before lavage? Why? | Change sterile gloves & instruments Surgical contents are contaminants. |
| For an esophagotomy, what is used to incise? | 11 blade to incise metzenbaum scisors to extend |
| What two types of closures are possible with an esophageotomy? Which is preferred? | double layer or single layer closure Single just as good. |
| Where are the knots in a double layer closure? | Deep laer - knots burried in lumen Superficial layer - knots on outside |
| What is the most important component of a single layer esophagotomy closure? | Get the submucosa in the suture or the incision will dehisss |
| What suture should be used for esophagotomy | Monofilament = pds |
| What suture pattern should be used ofr an esophagotomy and why? | Simple interrupted to obtain good apposition. |
| When resecting/anastomosing in a partial esophagectomy, which tissue should be resected? | Healthy! |
| What is key in closing a partial esophagectomy? | Submucosa |
| How many layers can be used to close a parital esophagectomy and what is the pattern/goal of sutures? | 1 or 2 layer simple approximating |
| How much of the esophagus cervical vs thoracic can be removed in an esophagectomy? What is the limiting factor ? | 20% cervical vs 50% thoracic No tension -may need tension-relieving technique |
| What are the 6 more common esophageal diseases? | 1. foreign body 2. stricture 3. neoplasia 4. vascular ring anomaly 5. hiatal hernia 6. cricopharyngeal achalasia |
| Which animals are more prone to esophageal foreign body? What may be seen? | -Young indiscriminate eaters, small breed dogs more common to bones & sharp objects |
| Which animals are less prone to esophageal foreign bodies? What may be seen? | cats - more discriminate Sgring, needles |
| What are the 4 most common sites for FB to be lodged? | 1. pharyngeal esophagus 2. thoracic inlet 3. base of heart 4. diaphragmatic hiatus |
| What are the c/s of esophageal fb? | Witness ingestion Dysphagia, regurgitation, gagging, ptaylism, retching |
| What are regurgitating animals at risk for and what should be done? | aspiration pneumonia Do thoracic radiographs - pharynx to stomach to not miss |
| What are 2 possible TX for esophageal foreign bodies and what % do they fix? | Endoscopy - 69% removed, 29% pushed to stomach Only 8% require esophageal surgery |
| What is the first line of defence for esophageal foreign body? | Endoscopy |
| Which surgery is preferable gastrotomy or esophagotomy? | gastrotomy |
| When should surgery be done for esophageal fb (3) | If endoscopy unsuccessful If FB pushed into tomach - gastrotomy If perforation is present. |
| Should you do esophageal surgery in private practice? | If you're a surgeon. It's good to refer it. |
| What post-fb-removal management should you consider? What is tx based on? | H2 blocker Sucralfate slurry Gastrostomy tube Endoscopic re-evaluation Tx aspiration pneumonia if present Depends on severity of damage |
| Bands of intraluminal or intramural fibrous tissue in the esophagus which lead to an obstruction are called: | Esophageal stricture |
| What do strictures occur secondary to (5)? | Foreign body Surgery Esophagitis Trauma Gastroesophageal reflux under anesthesia |
| Is esophageal neoplasia common? | no, its rare |
| What are the types of esophageal neoplasia? | Primary: Sarcoma, SCC, Leiomyoma Metastatic: Thyroid, pulmonary, gastric |
| What parasite may lead to esophageal neoplasia? | Spirocerca lupi? |
| What congenital malformations (of great vessels) can lead to constriction of the esophagus? How does it present? | Vascular ring anomalies (VRA) -presents as regurgitation. |
| All vascular ring anomalies result from abnormal development of the ___ ____ # __ ___ & __. There are #___ different malformations reported. | aortic arch 3,4 & 6 7 dif types reported |
| 90% of animals diagnosed with vascular ring anomalies have ____ | PRAA persistent right aortic arch |
| 45% of animals with PRAA have a __ __ ___ __. What is the surgical significance? | Persistent left vena cava Runs over location of transection - may need to retract |
| 10% of animals with PRAA have a __ __ ___ | PDA |
| How is VRA diagnosed? | Survey thoracic rads -look for apsiration pneumonia Barium esophagram ideally with fluroscopy Echocardiogram/angiogram |
| On survey thoracic rads there will be a focal ____ curvature of the trachea nearthe cranial boarder of the heart in __ /___ views. | Leftward DV/VD |
| Both VRA and congenital VRA have what on rads? How can they be differentiated? | Both = esophageal distension cranial to heart Congential - huge all the way down |
| What must be considered when operating on PRAA? | TX secondary problems -Aspiration pneumonia -Severe malnutrition If no aspiration pneumonia/severe malnutrition, do not need to delay sx |
| In SX for PRAA Entry is by the ___ ___ ___ ___ Transect the ___ ___ & ___ ___ ___ Pass __ ___ or ___ ___ And what? | Entry: Left 4th intercostal thoracotomy 95% Transect ligamentum arteriosum & periesophageal fibrous bands Pass stomach tube or balloon catheter through constricted area Elevated feedings of a slurry. |
| How often is PRAA surgery successful? What is the most common complication? | 70-92% Failure to resolve signs of megaesophagus |
| T/F Most VRA can be repaired via the same approach as PRAA. | T - left 4th intercostal thoracotomy except persistent right LA w/left aortic arch |
| Protrusion of the abdominal esophagus or stomach through the esophageal hiatus is called what? | Hiatal hernia |
| What causes hiatal hernia? What are the signs? | Caused by congenital abnormality of the hiatus --> Gastroesophageal reflux, esophagitis, regurtitation, vomiting |
| What passes with the esophagus through the hiatus? | The vagus nerve |
| What passes through the aortic hiatus? | aortia & azygus |
| What is the most common type of hiatal hernia? | Type 1: Sliding/axial, loose connection, herniates as part of stomach/esophagus |
| What are the other 2 types of hiatal hernia? | Type 2: paraesophageal - pouch off stomach Type 3: sliding + paraesophageal - slide through & pouch |
| Cranial displacement of the stomach through the hiatus = hiatal hernia present with what c/s? | reflux and regurgitation |
| How do you dx hiatal hernia? | Rads of thorax, abdomen, pos contrast esophagram |
| If a hiatal hernia is sliding, what do you need to dx it? | Multiple radiographs or fluroscopy |
| What medical management is used for hiatal hernia? | Elevated feedings H2 antagonists Proton pump inhibitors Metoclopramide |
| What surgical tx can be used for hiatal hernia? | Hiatal plication - close down hernia Esophagopexy - tack esophagus Gastropexy - tack stomach to body wall |
| What is the cause of hiatal hernia? | phrenico-esophageal ligament congenitally weakened or incomplete |
| hiatal hernia type ? Gastresophageal sphincter is cranial to the esophageal hiatus? | 1 = axial or sliding |
| Hiatal hernia type? The gastroesphageal sphincter occupies a normal position while the fundus or other abdominal viscus herniates through the phrenico-esophageal ligament | 2 - para-esophageal |
| Hiatal hernia type? Both gastroesophageal sphincter and other abdominal viscus lie cranial to the hiatus | 3 - combined |
| What happens in type 1 & 3 when the resting pressure falls? What results? | The gastroesphageal sphincter moves into the thorax results in gastro-esophageal reflux - hypersalivate, dysphagia, vomit, regurg, esophaguitis or gastroesophageal sphincter obstruction |
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