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RUSVM LAM I > E2: Choke > Flashcards

E2: Choke Flashcards

1
Q

What side of the horse is the esophagus usually on?

A

Left

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2
Q

T/F: Similar to cats, the cranial two thirds of the esophageal wall is composed of skeltal muscle while the distal third is composed of smooth muscles. The muscles also get thicker as you move aborally.

A

True

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3
Q

What muscle forms the cranial esophageal sphincter?

A

Cricopharyngeus

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4
Q

What is the most common cause of primary esophageal obstruction?

A

Roughage (alfalfa)

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5
Q

What are the earliest signs of esophageal obstruction?

A

Anxiety

Ptyalorrhea

Dysphagia

Coughing

Gagging or retching

Nasal discharge (bilateral, frothy)

Neck extension

Pawing

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6
Q

Feeling what upon palpation of the jugular furrow suggests esophageal rupture?

A

Crepitus

Cellulitis

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7
Q

T/F: Gagging and retching can cause esophageal rupture.

A

True

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8
Q

What landmark do you use for measuring the NG tube length?

A

13th ICS

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9
Q

T/F: Mineral oil or DSS can be used to resolve an esophageal obstruction

A

FALSE, never use these (can result in asipration - pneumonia)

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10
Q

What modality is used to definitively evaulate an esophageal obstruction?

A

Endoscope

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11
Q

Why is acepromazine not the ideal drug choice for reducing esophageal tone and pain in male horses?

A

Penile prolapse

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12
Q

Which drug or combintion of drugs has the greatest effect on esophageal motlity? What other drugs can be used?

A

Best: Xylazine and Butorphanol

Oxytocin

Buscopan (antispasmotic)

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13
Q

What is the post-esophageal obstruction treatment prototcol?

A

Anti-microbials (Potassium penicillin (gr +) + Aminoglycoside (gr-) + Metronidazole (anaerobes))

NSAIDs

Nebulization

Sucralfate (binds to negatively chagred structures, like ulcers)

Omeprazole (gastroprotectant)

Withhold food 24-48 hrs then reassess

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14
Q

What acid-base abnormality often accompanies choke?

A

Metabolic alkalosis (prolonged salivary loff of Cl and Na)

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15
Q

T/F: Megasophagus following an esophageal obstruction is a progressive, chronic problem.

A

False, not always can resolve

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16
Q

T/F: Problems with dentition can predispose a horse to choke.

A

True

That’s why it’s important to check the teeth

17
Q

What are the 2 types of secondary esophageal obstruction? Give an example of each.

A

Intramural: tumors (SCC), strictures, diverticula, cysts, vascular ring anomalies

Extramural: mediastinal or cervical mass or abcesses

18
Q

What secondary clinical signs are seen with choke?

A

Dehydration

Tachypnea

Aspiration pneumonia

Impaired gas exchange

Bicarb loss and e-lyte imbalance

19
Q

When placing in esophgeal tube, how should you position youself and in what orientation do you insert the NG tube?

A

Stand beside, not in front of horse

Push NG tube medially and ventrally (into ventral meatus) in the nasal passage

20
Q

What must you consider when using drugs such as xylazine or metomidine to reduce esophageal tone and for analgesia?

A

These drugs cause renal vessel dilation and thus diuresis, whihc is a problem because choke horses tend to be dehydrated and this would execerbate this.

21
Q

After you resolve a choke, what could you do to figure out whether the obstruction was caused by a stricture, dilation, or diverticulum?

A

Contrast rads with air or barium

22
Q

Describe how you would physically disperse the material that is causing the obstriction when treating choke.

A

NG intubation

Carefully lavage esophagus

External manipulations/massage

Head must be lowered to the ground

23
Q

What are the options if you cannot resolve the obstruction using an NG tube?

A

Tilted table under anesthesia

Surgery to massage obstruction without cutting esophagus

Wait a while, NPO + supportive therapy, and try again

Last resort: Esophagostomy

24
Q

What should be performed immediately after the impaciton is relieved to determine whether any complications are expected? What else should you do before sending the horse home?

When should you re-evaluate your patient after discharging them?

A

Immediately: Endoscopic exam

Ultrasound exam (for lung damage due to aspiration)

Neuro exam (rule out dysphagia)

Maybe chest rads

Recheck in 2-4 weeks

RUSVM LAM I (19 decks)

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