Diseases of the equine proximal GI tract Flashcards
Dyspahgia
Difficulty with/inability to swallow
Why is dysphagia a problem
Lack of adequate nutritional intake
Secondary aspiration pneumonia
Welfare
Prepharyngeal dysphagia
Dropping feed, hypersalivation, cannot prehend feed
Pharyngeal and post-pharyngeal dysphagia
Coughing, nasal discharge (food/water), neck extension when swallowing
Potential painful causes of dysphagia
Dental abscesses
Temporohyoid osteoarthropathy
Foreign bodies, trauma
Potential obstructive causes of dysphagia
Oesophageal obstruction
Retropharyngeal abscess
Thyroid mass
Potential neurological causes of dysphagia
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
Media compartment of guttural pouch
Internal carotid artery
Fold containing CN IX, XI, XII; CN X ventrally
Cranial sympathetic ganglia
Lateral compartment of guttural pouch
External carotid and maxillary arteries
CN VII, VIII, and mandibular branch V near wall
Clinical signs of oesophageal obstruction
Head and neck outstretched
Food from nostrils
Coughing
Distressed or very quiet
§ Occasionally mistaken for colic
Some horses panic
Risk factors for oesophageal obstruction
Poor dentition
Rapid ingestion dry feed
Eating when heavily sedated
Underlying oesophageal disease
§ Diverticula
§ Abscesses
§ Neoplasia
§ Functional disease
DIagnosis of oesophageal disease
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
Treatment of oesophageal obstruction
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
Management of oesophageal obstruction
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
Sequellae to oesopahgeal obstruction
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
Presentation of equine gastric ulceration syndrome (EGUS)
Variable presentation
○ ‘fussy eating’
○ ‘girthy’
○ ‘grumpy’
○ Poor performance
○ Poor coat condition
○ Weight loss/poor condition
○ Bruxism
○ Low grade colic
Two types of EGUS
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
ESGD
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
EGGD
Equine glandular gastric disease
Pathophysiology unknown
Treat with omeprazole and sucralfate or misoprostol
Management of EGUS
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
Gastric impaction
Uncommon cause of colic
Feedstuff that swells
Dysmotility disorders
§ Consider liver disease
Outflow tract obstructions
Gastric neoplasia
Squamous cell carcinoma
§ Very poor prognosis, not very common
Adenomatous polyps
§ May cause outflow tract obstruction if large, or be associated with ‘ulceration’
Four recognised conditions of inflammatory bowel disease
Granulomatous enteropathy
Multisystemic eosinophilic epitheliotrophic syndrome
Lymphocytic plasmacytic enteropathy
Eosinophilic colitis
Clinical signs of IBD
May affect other body systems
Most common sign reported: weight loss in face of good appetite
Mild recurrent colic
Chronic or intermittent diarrhoea
