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Horsies > Choking and Gastric Disease > Flashcards

Choking and Gastric Disease Flashcards

1
Q

You go to visit a horse in September which has suddenly developed hypersalivation. NAD on dental exam. You notice he also has some faecal staining on the hindquarters and frequently urinates. Whilst chatting to the owner about the horse’s history, you discover that he is fed on hay from a field which has a lot of red clover. What is your top differential?

A

Rhizoctonia leguminicola ingestion - fungus which grows on red clover

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2
Q

Other than a mouth gag, what other equipment do you need to do a dental exam on a horse?

A

Head torch
Dental mirror
Dental pick
Rasps x3

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3
Q

You are presented with a horse with hypersalivation. Which 2 broad differentials can you help rule in/out with focussed history questions?

A

Dietary issues
Dental issues

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4
Q

You are investigating the cause of a horse’s hypersalivation. You have ruled out dietary and dental issues on history and dental examination, and are now going to look for obstructive abnormalities. List 3 possible differential diagnoses.

A

Retropharyngeal lymphadenopathy (strangles - Streptococci equi var equi)
Malformation/Injury/Oedema of pharynx/larynx/oesophagus
Laryngeal disorders - epiglottic cysts
Palate disorders - cleft palate, dorsal displacement of the soft palate
Guttural pouch disorders - tympany, empyema
Oesophageal obstructions and diverticula

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5
Q

List 2 painful differential diagnoses for a horse with hypersalivation

A

Tooth - root abscess, broken, abnormal wear
Mandibule/Maxilla - fractures or trauma
Stomatitis/Glossitis
Temporohyoid osteoarthritis
Temporo-mandibular osteopathy

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6
Q

What are the 4 broad causes of stomatitis/glossitis?
Stomatits = inflammation of oral mucosa
Glossitits = inflammation of the tongue

A

Foreign body - plant material or metal/wire
Ulcerative stomatitis - phenylbutazone toxicity or Blester beetle poisoning
Vesicular stomatitis - poxvirus and Rhabdovirus
Bacterial - Actinobacillus lignicresi

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7
Q

Which bacteria is responsible for Wooden Tongue in horses?

A

Actinobacillus lignicresi

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8
Q

You are called out to see a horse with ptyalism. The horse has been on box rest for a musculoskeletal injury obtained a week ago. On questioning, the owner tells you they have been giving the horse Bute. You do a dental exam and find ulcers on the tongue and oral mucosa. What is your top differential?

A

Phenylbutazone toxicity
Can also cause diarrhoea, anaemia, low white blood cell count, ulcers or haemorrhages in the gastrointestinal and oesophagus tract, and intestinal, kidney and liver diseases.

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9
Q

You arrive at a yard to look at an 8 year old gelding. He presents with hypersalivation, ulcers and erosions of the mouth linings, shedding of the surface of the tongue and ulcers at the junctions of the lips. He also has slight inflammation and erosions at the coronary band of the hoof, and his owner mentions he’s been slightly lame for 2 days. What is your top differential diagnosis?

A

Vesicular stomatitis

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10
Q

You have made a presumptive diagnosis of vesicular stomatitis on a horse with hypersalivation and ulcers at the junction of his lips, tongue and oral mucosa. What is your next step?

A

Ring the APHA as this is a reportable disease. Don’t leave until APHA vets arrive.

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11
Q

What is temporomandibular osteoarthropathy?

A

Degenerative or inflammatory condition resulting in bony proliferation around the stylohyoid and temporal bone joint

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12
Q

Give 3 clinical signs of temporomandibular osteoarthropathy

A

Acute onset vestibular dysfunction - head tilt, nystagmus, circling, strabismus
Head shyness
Facial paralysis
Corneal ulceration
Dysphagia
Difficult prehension
Complete/Partial unilateral hearing loss
Ptyalism

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13
Q

A horse presents with a variety of clinical signs, one of which is hypersalivation. You have ruled out diet, dental, obstructive and painful conditions. What is your next step?

A

Complete neurological examination

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14
Q

You are working as a vet in Texas. A horse you are examining presents with ptyalism and dysphagia. Which condition should always be on your differential list?

A

Rabies - take precautions

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15
Q

Name 3 infectious causes of neurological disease in horses which could involve hypersalivation

A

Rabies - NOTIFIABLE
Viral encephalitis - NOTIFIABLE
Verminous encephalitis and Equine Protozoal Myeloencephalitis - not in UK
Meningitis
Botulism and Tetanus

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16
Q

True or False?
CNS trauma, including cerebral damage/oedema and brainstem haemorrhage, can result in hypersalivation

A

True
Also CNS masses, e.g. cholesteroloma

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17
Q

Lead poisoning can cause hypersalivation and other neurological signs, including impaired vision, ataxia, nystagmus and constipation, as well as colic, collapse and anaemia. What are 2 other toxic causes of hypersalivation and neurological signs?

A

Yellow star thistle - not in the UK
Hepatoencephalopathy - liver damage, e.g. due to pyrrolizidine alkaloid toxicity or Theiler’s disease (viral hepatitis)

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18
Q

True or False?
Polyneuritis equi (immune mediated paralysis), Grass sickness (dysautonomia) and guttural pouch disease are all causes of hypersalivation along with neurological signs?

A

True
Also thyrohyoid osteoarthropathy and petrous temporal bone fracture/osteomyelitis

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19
Q

Give 3 differential diagnoses for hypersalivation caused by muscular disease/dysfunction

A

Hyperkalaemia Periodic Paralysis (genetic mutation in sodium ion channels)
Nutritional Muscular Dystrophy (selenium or Vitamin E deficiency)
Polysaccharide Storage Myopathy (genetic mutation in glycogen storage)
Hypocalcaemia
Myotonia (delayed muscle relaxation)
Megaoesophagus

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20
Q

A 3 year old mare presents with ptyalism, dysphagia, coughing, regurgitation and repeated head extensions and retching. What is your top differential diagnosis?

A

Oesophageal obstruction
Other clinical signs include distention of the left jugular furrow, crepitus, dehydration, pyrexia, etc.

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21
Q

You diagnose a horse with an oesophageal rupture. You can hear crepitus in the neck on auscultation. What has happened?

A

Oesophageal rupture - crepitus from subcutaneous gas in the oesophagus

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22
Q

What secondary disease can result from an oesophageal rupture?

A

Aspiration pneumonia

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23
Q

What diagnostic tests could you do on a horse with a suspected oesophageal obstruction after physical exam?

A

Radiography - plain or contrast with barium paste +/- liquid barium with a cuffed NG tube
Oesophageal endoscopy
Gives additional information about possible ruptures and aspiration pneumonia

24
Q

How can you medically manage an oesophageal obstruction in the hopes that it will spontaneously resolve?

A

Remove all feed and water (including bedding)
IV fluids
NSAIDs
Sedation to relax the oesophagus
Oxytocin if obstruction is proximal

25
Q

You decide that an oesophageal obstruction in a horse won’t resolve using IV fluids, sedation and NSAIDs. What other non-surgical options do you have?

A

Oesophageal lavage and drainage under sedation (ensure head remains below the thoracic inlet)
Aggressive oesophageal lavage using a cuffed nasotracheal and naso-oesophageal tube - sedation or GA (double lumen NG tube allows you to put water in one side and pump out the other)

26
Q

What are the advantages of doing oesophageal lavage under general anaesthesia as opposed to standing sedation?

A

Minimises risk of aspiration
Aids relaxation of the oesophagus

27
Q

After doing an oesophageal lavage to remove an obstruction, what should you do?

A

Repeat endoscopy to assess mucosal damage
Small quantities of soft feed 48 hours post op
Provide electrolytes and fresh water
NSAIDs IV
Broad spectrum antibiotics if there is systemic inflammation or abnormal thoracic exam/ultrasound

28
Q

How would you carry out a longitudinal oesophagostomy to resolve an oesophageal obstruction?

A

GA
10cm skin incision over the obstruction
Retract the left carotid sheath
Isolate oesophagus by packing with moist sponges
5cm incision into the oesophagus, distal to the lesion
Place an oesophagostomy tube into the stomach and secure with a purse string suture
Remove obstruction and close up
IV fluids, broad spectrum antibiotics, NSAIDs
Feed through the tube with slurry pellets for 7-10 days

29
Q

What is a common complication of doing a longitudinal oesophagostomy?

A

Laryngeal hemiplegia

30
Q

What are the complications of a oesophagostomy?

A

Aspiration pneumonia
Oesophageal ulcer
Oesophageal stricture
Megaoesophagus
Diverticula
Oesophageal rupture

31
Q

What is an oesophageal diverticula?

A

Outpouching of the oesophagus

32
Q

What is the name of the divide between the glandular and non-glandular parts of the stomach?

A

Margo plicatus

33
Q

Name the 4 areas of the glandular stomach

A

Pylorus
Antrum
Ventral Glandular Fundus
Cardia

34
Q

Name the 3 areas of the non-glandular stomach

A

Lesser curvature
Greater curvature
Dorsal squamous fundus

35
Q

What is the difference in function of the glandular and non-glandular areas of the stomach?

A

Non-glandular: storage of food
Glandular: secretion of hydrochloric acid, pepsin, electrolytes and water

36
Q

Other than colic signs and weight loss, what are 4 more clinical signs of gastric disease?

A

Bucking/Rearing under the saddle
Resentment of girthing and leg aid
Poor performance
Changes in temperament

37
Q

True or False?
Clinical signs of gastric disease correlate with disease severity

A

False

38
Q

A client is worried about her horse getting gastric ulcers. What risk factors for gastric disease will you discuss with her?

A

Lack of access to forage
Lack of access to water
High carbohydrate diets
High stress environments/individuals
Other sources of pain (non-responsive cases)

39
Q

You have a horse booked in for a gastroscopy. How will you tell the owner to manage the horse in the 24 hours before the procedure?

A

Withhold food for at least 12 hours before
Remove water around 4 hours before (possibly)
Put a grazing muzzle on horses which eat bedding

40
Q

What sedation will you choose to sedate a 470kg horse for a gastroscopy?

A

Alpha-2 agonist and an opiate = detomidine and butorphanol

Nose twitching is also a useful additional restraint for some horses - often only needed for the first 20 seconds as you pass through the nasal passages

41
Q

You arrive at a yard to do an endoscopy on a horse. How many people do you need to assist you, and what jobs will you give them?

A

One person to restrain the horse
One person to pass the endoscope
One person to control the endoscope

42
Q

How many minutes should you wait after sedation before passing the endoscope through for gastroscopy?

A

At least 5 minutes

43
Q

Which anatomical area should you try to avoid whilst passing the endoscope through the nasal passages?

A

The ethmoturbinates - damage causes epistaxis

44
Q

How can you locate the oesophagus on endoscopy?

A

Collapsible tube about 1cm above the arytenoid cartilages

45
Q

How can you tell the difference between glandular and non-glandular stomach on endoscopy?

A

Pale pink = squamous/non-glandular mucosa
Dark pink = glandular mucosa

46
Q

You need to visualise all parts of the stomach when doing a gastroscopy. What can you do to enable this if the stomach contains food matter?

A

Jet water down the scope to lavage the stomach if needed

47
Q

Where is the most common place for glandular lesions?

A

Pyloric antrum

48
Q

How can you inflate the oesophagus when doing a gastroscopy?

A

Inflate it using pumped air

49
Q

Put the following levels of gastric squamous ulceration in order:
- Large single or extensive superficial lesions
- Intact mucosa with areas of hyperkeratosis
- Small, single or multifocal lesions
- Extensive lesions with areas of deep ulceration
- Intact epithelium with no hyperkeratosis

A
  1. Intact epithelium with no hyperkeratosis
  2. Intact mucosa with areas of hyperkeratosis
  3. Small, single or multifocal lesions
  4. Large single or extensive superficial lesions
  5. Extensive lesions with areas of deep ulceration
50
Q

What words/phrases might be used to describe lesions seen in glandular disease?

A

Mild/Moderate/Severe
Focal/Multifocal/Diffuse
Raised/Flat/Depresses
Hyperaemic (engorged blood vessels)
Haemorrhagic
Fibrinosupprative

51
Q

You diagnose a horse with squamous ulceration of the stomach. What are your 2 first line treatment options?

A

Oral omeprazole (4mg/kg)
Long acting, injectable omeprazole (4mg/kg once a week IM)
+/- oral sucralfate 10-40mg/kg (mucosal barrier) if glandular disease also present

52
Q

A new grad vet at your practice has a horse with glandular disease in the stomach. What first line treatment will you advise?

A

Oral misoprostol (5mcg/kg - prostaglandin analogue)
Long acting injectable omeprazole (4mg/kg once a week IM)
+/- oral sucralfate (mucosal barrier) if squamous ulceration also present

53
Q

How long does it take for squamous ulcers to heal compared to glandular disease?

A

Squamous ulcers: within 3 weeks
Glandular disease: about 3 months

54
Q

Why isn’t there a licensed product to treat glandular disease in horses?

A

Not an ulcerative condition (according to lecture notes) so if there is only glandular disease then can use oral misoprostol, which is licensed for this in humans

55
Q

What 4 options do you have if your initial treatment for glandular disease doesn’t seem to have cured it?

A
  1. Continue on current therapy for another period of time or reduce interval between treatment
  2. Long acting injectable omeprazole and oral misoprostol
  3. Further diagnostics - transendoscopic mucosal biopsies
  4. Switch to corticosteroids - dexamethasone or prednisolone if diffuse inflammation
56
Q

You have a client who has a horse with glandular disease. As well as treating with misoprostol, he has taken your advice to feed his horse ad lib roughage, reduce stress and eliminate carbohydrates from the horse’s diet. He has now asked whether he should add feed supplements into the diet. What advice will you give?

A

Limited evidence for many feed supplements
Buffers are of little use clinically
Pectin and lecithin have some evidence of bolstering the mucous barrier - pectin is in sugar beet

57
Q

Would you ever look at long term medication for horses prone to glandular disease? If so, what?

A

Oral omeprazole is licensed for long term use at 1mg/kg orally once daily, but don’t know how long term acid suppression affects the stomach
Can target omeprazole use to high risk periods, but consider competition legally - prohibited by the BHA

Horsies (8 decks)

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