Esophageal & Gastric Disorders in the Horse Flashcards
(116 cards)
1
Q
if the horse is not able to swallow what are the 3 categories of reasons why
A
- mechanical disorders
- anatomical abnormalities
- neurological
2
Q
what are mechanical disorders that would prevent the horse from swallowing (5)
A
- persistent entrapment of epiglottis
- pharyngeal mass
- tongue foreign body
- tongue base neoplasia
- severe temporohyoid osteoathropathy
3
Q
what are anatomical abnormalities that would prevent the horse from swallowing
A
palatoschisis
4
Q
what would neurological reasons be for not be able to swallow (2)
A
- loss of pharyngeal sensation
- loss of normal coordination –> guttural pouch mycosis, guttural pouch neoplasia
5
Q
what cranial nerve would cause pharyngeal paralysis
A
Glossopharyngeal
CN IX
6
Q
What are the clinical signs of dysphagia (4)
A
- gagging and neck stretching when attempting to swallow
- nasal regurgitation of feed, saliva
- slow feed consumption
- particularly slow to eat forage
7
Q
what could a diagnostic work up for dysphagia generally look like (8)
A
- oral exam: tongue base and ranula
- palpate retropharyngeal region (enlargement of lymph nodes?)
- palpate esophagus (left side, usually not palpable)
- can a stomach tube be passed?
- endoscopy of URT and guttural pouches
- endoscopic visualization of swallowing mechanism
- is pharyngeal sensation and response to stimulation normal
- radiographic investigation of pharynx
8
Q
what are ddx to glossitis (3)
A
- tongue foreign body
- tongue squamous cell carcinoma
- sialolith
9
Q
what is glossitis
A
inflammation/trauma of the tongue
due to foriegn body, tongue squamous cell carcinoma, sailolith
10
Q
what would the diagnostic workup of glossitis entail (3)
A
may need to place probe
rad/CT to determine expense
histopathology to rule out neoplasia
11
Q
how would you manage glossitis
A
debridement and lavage
topical, systemic metronidazole
12
Q
what are the signs of temporohyoid osteoarthropathy be
A
slow chewing and deglutition
13
Q
what nerve might be involved with temporohyoid osteoarthropathy
A
CN VIII
Vestibular nerve
14
Q
what are the diagnostic features of temporohyoid osteoarthropathy
A
- endoscopic appearance
- decreased joint movement
- rad/CT to determine extent
15
Q
how is temporohyoid osteoarthropathy managed
A
- conservative
- certahyoidectomy (disarticulating the affected side)
16
Q
what is palatoschisis
A
cleft palate
embryonic palatal folds fuse rostral to caudal
can affect both hard and soft palate
17
Q
what are the signs of palatoschisis
A
neonatal presentation or at weaning
difficulty nursing
aspiration pneumonia
18
Q
where is the most common site for palatoschisis
A
cleft of caudal 1/2 to 2/3 of soft palate is most common
margins of cleft run caudally into palatopharyngeal arches
19
Q
what would the symptoms of glossopharyngeal nerve (IX) damage be (3)
A
- chronic nasal discharge and slow ingestion
- possibly concurrent aspiration pneumonia
- intermittent epistaxis
20
Q
how would you diagnose glossophrayngeal nerve damage
A
endoscopy of URT and guttural pouches to assess pharyngeal sensation and coordination
21
Q
what are the reasons for glossopharyngeal nerve damage (2)
A
- guttural pouch mass (may need histopathology)
- guttural pouch mycosis
22
Q
what is the diagnosis of this
A
granulomatous mass in guttural pouch
glossopharyngeal nerve damage
23
Q
what is the prognosis of glossopharyngeal nerve damage due to mycosis
A
guarded
esophagotomy carries guarded prognosis due to risk of complications
24
Q
what is equine dysautonomia
A
neurological disorder
grass sickness
25
what can equine dysautonomia cause (3)
1. ptyalism
2. dysphagia
3. retrograde peristalsis
damage to enteric plexus plus cranial nerve nuclei
26
what is a linear esophageal ulceration
acute grass sickness
due to prolonged gastroesophageal reflux
may occur with gastric outflow obstruction
extreme pain on passage of NG tube
27
what is the clinical presentation of simple esophageal obstruction (4)
1. most commonly soon after feeding
2. bilateral nasal regurgitation of feed and saliva
3. gagging/retching/neck stretching behaviour
4. often coughing due to inhalation
28
how is esophageal obstruction diagnosis
feed material in green nasal discharge
resentment of cranial esophageal palpation
resistance to passage of NG tube
attempts to eat followed by coughing
29
how is a simple esophageal obstruction managed
heavy sedation and lavage via NG tube
sedation causes head to drop
gravity helps with drainage
30
what is the most common site of obstruction
dorsal esophagus, thoracic inlet and cardia
31
how would you lavage esophageal obstruction
under sedation
feed matieral exits via opposite nostril
if material is impacted at top of esophagus may be difficult to get horse to swallow
32
if its not possible to clear the esophageal obstruction completely what should you do
try again after few hours
remove feed and beeding and leave on water only
repeat procedure
33
what is the risk of simple esophageal obstructions
aspiration pneumonia at early stage
34
what else should you do to manage esophageal obstruction
NSAIDs to decrease pharyngeal pain
broad spectrum antibiotics necessary
maintain on soft diet for 7 days post relief of obstruction
consider thoracic rads to determine severity if choke of \>12h duration
35
what are complications of choke
deep ulceration of esophagus
linear ulceration can precede rupture
36
how do you manage ulceration due to choke (3)
1. sucralfate and omeprazole to minimize acidic gastroesophageal reflux
2. dietary management
3. complete hay replacement ration
37
what are secondary esophageal obstructions (4)
1. pulsion diverticulum
2. traction diverticulum
3. stricture formation
4. persistent right aortic arch
38
how would you manage a secondary esophageal obstruction
1. depends on cause: pulsion vs traction
2. surgery more likely to be required for full thickness mural cicatrix
39
what are the clinical signs of esophageal obstruction dilation (2)
1. recurrent bouts of choke depending on size diverticulum
2. tends to deteriorate with age in congenital cases due to poor wall tone
40
how could you diagnose recurrent esophageal obstruciton dilation (3)
1. endoscopy
2. double contrast esophagram
3. radiograph to investigate aspiration
41
how would you manage recurrent esophageal obstruction dilation
1. cervical pulsatile diverticuli can be repaired surgically
2. can empty manually
3. dietary management only for larger diverticuli
42
what are the clinical signs of esophgeal strictures (2)
1. regurgitation of ingesta + saliva
2. maybe history of neck trauma/bite
43
what is shown here
esophageal stricture
44
how are esophageal strictures managed
full thickness lesion requires esophagomyotomy to release mucosa
endoscopic assessment during surgery to determine success
45
how are esophageal strictures treated surgically
luminal diameter restored by longitudinal esophagomyotomy
separation of outer and inner layers of the esophageal wall
tube passed during surgery
46
what are the clinical signs of cervical esophageal rupture (4)
1. swelling and pain at site of rupture
2. may be draining tract
3. subcutaneous emphysema
4. cardiorespiratory compromise if mediastinitis
47
how would you diagnose cervical esophageal rupture (2)
1. constrast esophagram
2. may release feed material if debriding
48
how are cervical esophageal rupture managed (5)
1. immediate establishment of drainage to prevent mediastinitis
2. surgical debridement is essential
3. placement of tube orally or tube esophagostomy ventral to site (primary repair likely to dehisce)
4. monitor for sepsis
5. treatment of local cellulitis
49
what clinical challenges with cervical esophageal rupture (6)
1. maintenance of nutrient intake
2. electrolyte balance
3. concurrent aspiration pneumonia
4. management of cellulitis
5. possible endotoxemia, laminitis
6. severe emphysema
50
what are complications of cervical esophageal rupture (3)
1. may succumb to complications of endotoxemia
2. recurrent choke likely post recovery
3. may be laryngeal hemiplegia due to sympathetic trunk damage
51
what are clinical signs of thoracic/abdominal esophageal rupture (2)
1. elevated temperature and resp rate
2. progressive septic pleural effusion
52
how would you diagnose thoracic/abdominal esophgeal rupture (3)
1. esophageal endoscopy in unexplained pleural effusions
2. thoracic ultrasound
3. thoracocentesis & cytology
53
how would manage thoracic/abdominal esophageal rupture
hopeless prognosis
rapid diagnosis most essential feature
liked to idiopathic muscular hypertrophy of esophagus in some cases
54
where is the stomach located
left side
caudal to diaphragm and liver
55
what side is the pylorus and duodenum
to the right
56
what are the omental and ligament attachments of the stomach
to the liver, duodenum, pancreas, diaphragm and spleen
57
how do you ultrasound the stomach
find the cranioventral border
follow dorsocaudally to determine size and filling
58
what correltates with grastric volume when ultrasounding the stomach
height at ICS 12 correlates to gastric volume
59
how thick should the stomach wall be
wall thickness ~9mm
60
what is shown here
stomach
61
where are the pyloric outflow and duodenum landmark when US the stomach
right ICS 10-11
duodenum cranial to pole of right kidney
ultrasound window between right liver and right dorsal colon
62
what is the wall thickness of the duodenum
\<4mm
63
what are clinical signs with acute gastric distention (4)
1. acute colic
2. possible rupture
3. peritonitis
4. endotoxemia
64
what are the clinical signs with chronic gastric distention (4)
1. weight loss and reduced rate of feed intake
2. increased water intake
3. recurrent mild colic
4. pendulous abdomen +/- ventral edema
65
what are clincal signs of chronic gastric inflammation (2)
1. may be symptom free, progressing to acute colic
2. change in dietary preference
66
what are the clinical signs of chronic gastric ulceration (2)
1. loss of performance; decreased forward movement
2. anterior abdominal pain
67
what are parasitic infections of the gastric
gasterophilus larvae
68
what are dysmotility gastric disorders (4)
1. equine dysautonomia
2. acute gastric dilation
3. gastric impaction
4. chronic gastric dilation
69
what are ulcerative gastric disorders
equine gastric ulceration syndrome
perforation and rupture
70
what are gastric neoplastic disorders
squamous cell carcinoma
71
what are inflammatory equine gastric disorders (2)
1. inflammatory polyps
2. glandular ulceration and gastritis
72
what are risk factors for acute gastric dialtion (2)
1. excess or fermentable feed
2. incorrect management
73
what are clinical signs of acute gastric dilation (4)
1. acute abdominal pain
2. spotaneous nasogastric reflux
3. progressive acidosis
4. endotoxemia
74
how is acute gastric dilation diagnosed
based on presentation
75
how is acute gastric dilation treated (4)
1. gastric decompression and lavage
2. IV fluid support
3. correction of acidosis
4. management of endotoxemia
76
what are sequelae to endotoxemia in acute gastric dilation (2)
1. laminitis
2. acute renal failure
77
what are gastric complications that can occur during acute gastric dilation (3)
1. transient loss of motility
2. delayed emptying
3. serosal tear
78
how do you manage the complications of acute gastric dilation (4)
1. gastroscopic assessment
2. risk fo secondary impaction
3. complete pelleted ration
4. altered feeding freq
79
what are risk factors for acute gastric impactions (5)
1. poor dentition
2. old age
3. trichobezoars (hair ball)
4. persimmon seeds
5. inappropriate feeding
80
what are the clinical signs of acute gastric impactions (3)
1. acute colic presentation
2. endotoxemia
3. possible rupture
81
how are acute gastric impactions diagnosed (3)
1. resistance to stomach tube
2. ultrasonography
3. gastroscopy
82
how are gastric impactions managed (2)
1. gastric lavage: remove soluble material
2. continuous lavage
83
how would you do continuous lavage to treat gastric impactions
5L/hour as continuous infusion via indwelling tube
position in terminal esophagus
alterante electrolytes with water to prevent Na+ overload
daily mineral oil
84
how long might it take for a gastric impaction to resolve
may take 3-6 days
85
what are the risk factors of chronic gastric impactions
not known
increased in warmbloods
86
what are the clinical signs of chronic gastric impaction (5)
1. failure to gain weight/weight loss
2. change in abdominal silhouette
3. change in demeanour
4. ventral edema
5. acute colic +/- prior recurrent colic
87
how are chronic gastric impactions diagnosed (5)
1. resistance to stomach tube
2. enlarged gastric outline
3. stomach may be palpable
4. gastroscopy: impaction often vertically stacked
5. may be up to esophageal cardia
88
how do you treat chronic gastric impactions
prolonged continuous gastric lavage
aim to empty stomach
89
how do you manage chronic gastric impactions (3)
1. permanent turnout
2. no forage other than grass
3. complete pelleted ration if required
90
what is the prognosis of chronic gastric impactions
progressive further dilation of stomach, spontaneous rupture possible
2-4 years from presentation
dependent on speed of initial diagnosis
lifelong diligent management
91
what are the risk factors of equine gastric ulceration syndrome (EGUS) (8)
1. decreased access to grazing
2. high intake of concentrate rations
3. prolonged periods without forage
4. intesive training at \>70% VO2max
5. other GI disorders
6. NSAIDs
7. crib biting
8. pregnancy
92
what are the clinical signs of equine gastric ulceration syndrome (EGUS) (3)
1. loss of performance
2. decreased feed intake
3. colic as severity increases
93
how is equine gastric ulceration syndrome (EGUS) diagnosed (2)
1. gastroscopy
2. sucrose absorption may be herd screening tool
94
what are stratified squamous ulceration scores
scored from 0-1 with lesions \> 3 of clinical significance
95
what is stratified squamous ulceration based on
surface area is primary determinant of score
96
grade these ulcerations
grade 0
grade 1
grade 2
97
what grade is this ulcer
grade 3
98
what grade is this ulcer
grade 4
99
what is grandular ulceration
mostly scored from 0-4
gross appearance of lesions very variable
erythema to ulceration
100
what grade is this glandular ulcer
grade 0
101
what grade is this glandular ulcer
grade 1
102
what grade is this glandular ulcer
grade 2
103
what grade is this glandular ulcer
grade 3
104
what grade is this glandular ulcer
grade 4
105
what lesions are more siginficant in glandular ulceration (think location)
lesions affecting pyloric motility
106
what are the gross appearance of glandular inflammatory lesions (6)
1. erythema
2. flat, hemorrhagic
3. raised, hemorrhagic
4. flat, diptheritic
5. raised diptheritic
6. combination
107
what are the presenting signs of equine glandular polyps (3)
1. recurrent colic
2. weight loss
3. short episodes of acute pain
108
what is prognosis of equine glandular polyps based on
1. size
2. response to treatment
109
how are squamous erosion and ulceration treated with EGUS
omeprazole 4mg/kg SID 4-6 weeks
tapered dose for 2 weeks
sucralfate 20mg/kg 3-4 x daily
110
how can squamous erosion and ucleration in EGUS be managed (5)
1. increased access to forage and grazing
2. decreasd or stop concentrate feed
3. decreased intesity of exercise
4. chaff feeds prior to exercise
5. reduce other stressors
111
how are squamous erosion and ulceration in EGUS prevented
improved management to reduce risk factors
gastroguard 1mg/kg at start of training
112
how are glandular ulceration and inflammation in EGUS treated
longer term depending on type of lesion
omeprazole 4mg/kg SID 4-6 weeks + reassessment prior to reducing
sucralfate 20mg/kg x3 daily
113
how are refractory glandular ulcerative lesions of EGUS treated
diphtheritic membrane or inflammation
addition of doxycycline 10mg/kg BID in sucralfate carrier (muco-adhesive)
further 4wk course of omeprazole
114
what additional therapies can be used to treat glandular ulcertive EGUS lesions
1. pectin-lecithin complex may be beneficial
2. antacids? multiple unproven supplements
115
how are inflammatory polyps treated in EGUS
similar treatment initially
longer treatment course
lifelong management to prevent obstruction of pyloric canal
strict dietary control
116
what further investigations are needed if you diagnose inflammatory polyps in EGUS
histopathological investigation
freq and significance of lesions
assessment of risks
rational approach to management and prevention
