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Equine michaelmas 23 > Diseases of the equine proximal GI tract > Flashcards

Diseases of the equine proximal GI tract Flashcards

1
Q

Dyspahgia

A

Difficulty with/inability to swallow

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2
Q

Why is dysphagia a problem

A

Lack of adequate nutritional intake

Secondary aspiration pneumonia

Welfare

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3
Q

Prepharyngeal dysphagia

A

Dropping feed, hypersalivation, cannot prehend feed

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4
Q

Pharyngeal and post-pharyngeal dysphagia

A

Coughing, nasal discharge (food/water), neck extension when swallowing

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5
Q

Potential painful causes of dysphagia

A

Dental abscesses

Temporohyoid osteoarthropathy

Foreign bodies, trauma

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6
Q

Potential obstructive causes of dysphagia

A

Oesophageal obstruction

Retropharyngeal abscess

Thyroid mass

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7
Q

Potential neurological causes of dysphagia

A

Forebrain or brainstem disease

Prehension: CN V, VII, XII

Transfer of bolus to pharynx: CN V, XII

Swallowing: CN X (and IX? Disproven?)

Neuro/muscular disease e.g.:
* Guttural pouch disease (strangles, mycosis, etc.)
* Grass sickness
* Botulism
* Megaoesophagus
* Hyperkalaemic periodic paralysis

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8
Q

Media compartment of guttural pouch

A

Internal carotid artery

Fold containing CN IX, XI, XII; CN X ventrally

Cranial sympathetic ganglia

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9
Q

Lateral compartment of guttural pouch

A

External carotid and maxillary arteries

CN VII, VIII, and mandibular branch V near wall

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10
Q

Clinical signs of oesophageal obstruction

A

Head and neck outstretched

Food from nostrils

Coughing

Distressed or very quiet
§ Occasionally mistaken for colic

Some horses panic

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11
Q

Risk factors for oesophageal obstruction

A

Poor dentition

Rapid ingestion dry feed

Eating when heavily sedated

Underlying oesophageal disease
§ Diverticula
§ Abscesses
§ Neoplasia
§ Functional disease

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12
Q

DIagnosis of oesophageal disease

A

Palpate neck (left)
§ May feel impacted bolus of food

Pass nasogastric tube (carefully)

Endoscopy
§ Likely to be performed in complicated cases that are not resolving
§ Not expected on first opinion initial visit

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13
Q

Treatment of oesophageal obstruction

A

Tell owner to take feed away

Sedate (heavily)
§ Head must be low

Buscopan?
§ Smooth muscle relaxant – distal oesophagus

Oxytocin?
§ Smooth muscle relaxant – proximal oesophagus

Pass nasogastric tube

Gentle lavage with plain water
§ This tends to work best for feed matter

Endoscopy if not resolving, may require referral

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14
Q

Management of oesophageal obstruction

A

Warn owner regarding aspiration pneumonia risk
§ Antimicrobials – I would select doxycycline (on cascade)

Check teeth

Check diet

Sloppy feed for 48 hours – easily palatable and swallowed. Start to reintroduce longer fibre length after this if the horse is managing well

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15
Q

Sequellae to oesopahgeal obstruction

A

Secondary aspiration pneumonia
§ Can be severe/fatal
§ Prophylactic antimicrobials

Oesophageal ulceration
§ Some vets will give sucralfate to cases with moderate-severe ulceration

Oesophageal diverticula

Oesophageal rupture
§ Very bad prognosis, esp. if in thorax

Stricture formation

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16
Q

Presentation of equine gastric ulceration syndrome (EGUS)

A

Variable presentation
○ ‘fussy eating’
○ ‘girthy’
○ ‘grumpy’
○ Poor performance
○ Poor coat condition
○ Weight loss/poor condition
○ Bruxism
○ Low grade colic

17
Q

Two types of EGUS

A

Categorised according to which anatomic portion of the stomach affected

Equine squamous gastric disease (ESGD)

Equine glandular gastric disease (EGGD)

May have ESGD, or EGGD, or both.

No correlation.

Diagnosis: Gastroscopy

18
Q

ESGD

A

Equine squamous gastric disease

Commonly at margo plicatus, lesser curvature

RIsk factors: exposure of squamous mucosa to acid, starchy diet, stress, fasting

Treat with omeprazole

19
Q

EGGD

A

Equine glandular gastric disease

Pathophysiology unknown

Treat with omeprazole and sucralfate or misoprostol

20
Q

Management of EGUS

A

Diet

Low starch

High fibre, access to forage

Add oil

Calories if required

Reduces gastric acid production??

Alfalfa

Turnout as much as possible

EGGD: at least two rest days/week

21
Q

Gastric impaction

A

Uncommon cause of colic

Feedstuff that swells

Dysmotility disorders
§ Consider liver disease

Outflow tract obstructions

22
Q

Gastric neoplasia

A

Squamous cell carcinoma
§ Very poor prognosis, not very common

Adenomatous polyps
§ May cause outflow tract obstruction if large, or be associated with ‘ulceration’

23
Q

Four recognised conditions of inflammatory bowel disease

A

Granulomatous enteropathy

Multisystemic eosinophilic epitheliotrophic syndrome

Lymphocytic plasmacytic enteropathy

Eosinophilic colitis

24
Q

Clinical signs of IBD

A

May affect other body systems

Most common sign reported: weight loss in face of good appetite

Mild recurrent colic

Chronic or intermittent diarrhoea

25
Q

IBD diagnosis

A

Check diet, exclude dental disease, parasitism etc., routine blood work

Abdominal ultrasound, abdominocentesis

Glucose absorption test

Biopsies
§ Duodenal
§ Rectal

Laparotomy/laparoscopy?

26
Q

Oral glucose absorption test for IBD

A

Easy to do in first opinion practice
○ Starve 12 h
○ Baseline blood sample for glucose
○ 1g/kg glucose as 20% via nasogastric tube
○ Blood sample at 0, 30, 60, 90, 120, 150, 180, 210, and 240 min

Normal: >85% increase

Partial failure: 15-85% increase

Total failure: <15% increase

27
Q

Treatment of IBD

A

Corticosteroids

Limited evidence for other treatments such as azathioprine

Ensure good parasite control
○ Concern RE trigger for inflammation

Diet
○ Highly digestible, high fibre
○ Oil
○ Feed smaller meals more frequently

28
Q

Lymphoma - GI disease in horses

A

Young horses
○ Although any age may be affected

Similar diagnostic approach as IBD

Rectal biopsy and peritoneal fluid analysis may aid diagnosis, but can be challenging

Guarded prognosis

29
Q

Duodenitis-proximal jejunitis

A

Clinical signs mimic small intestinal obstructive diseases

We do not understand aetiopathogenesis

Increased secretion -> small intestinal distension/reflux

May have secondary hepatic changes

Peritoneal fluid analysis: lower TNCC than strangulating SI lesions

Equine michaelmas 23 (17 decks)

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