Diseases of the Esophagus & Stomach Flashcards
What is the equine esophagus like?
- not covered by serosa
- left side of the neck, not typically palpable
- 2/3 skeletal muscle, 1/3 smooth muscle
What are the 3 most common situations which horses develop esophageal obstruction (choke)?
- ravenous eaters (grain, hay, beet pulp, carrots)
- geriatric and young horses where dental pain is more common = decreased chewing
- sedated or exhausted
What should be asked before treating esophageal obstruction (choke)?
- cause of the obstruction - normal feed given to horse, pellets vs grain vs apples/carrots
- prior history, other times this happened
- how often/long this has been happening
In what 3 situations is choke harder to treat?
- pieces of food (apples, carrots) > accumulated grain
- repeated obstructions resulting in repeated damage and stricture
- long duration leading to dehydration and aspiration
What are the most common clinical signs associated with choke?
- anxiety
- extended neck
- gagging, retching
- coughing, ptyalism, dysphagia
- (palpable) distended esophagus
How is choke most commonly diagnosed?
- clinical signs
- NG tube
- endoscopy in esophagus to observe lesions and trachea to evaluate for aspiration
What are the 3 steps to treating choke?
- remove all feed and water from stall
- make the patient comfortable and left the esophagus relax with alpha-agonists, like Acepromazine, Xylazine, and Detomidine (low head carriage = avoids aspiration)
- pass tube up to obstruction and gently lavage while tracking water intake and outflow
Other than alpha-agonists, what medications are used during NG tube placement for choke?
- oxytocin
- lidocaine
- buscopan
What after care is required after treating choke?
- restrict food for 48 hr and progressively re-feed with soft mashes
- endoscopy to observe possible damage in esophagus and trachea
- NSAIDs
- antibacterials
What are 6 complications associated with choke?
- ulceration
- aspiration pneumonia
- metabolic alkalosis
- stricture due to circumferential ulcer
- perforation
- stomach rupture
What is avoided when treating choke? Specific treatments?
- leave food or water in stall
- push aggressively
- flush without lowered head
- forget followups and risks
- refeed too soon (within 48 hr)
butorphanol (suppressed cough) and mineral oil (aspiration causes irreversible respiratory lesions)
What has increased the prevalence of equine gastric ulcer syndrome?
- intense exercise in sporting horses
- horses are easily stressed?
What are the 2 regions of the equine stomach? What are they separated by?
- non-glandular/squamous - pale, white; incoming food, microbial fermentation, saliva buffering acid
- glandular - pink; highly acidic, thick mucus layer
margo plicatus - common area for ulcers
What is the main etiology of equine squamous gastric ulcer syndrome? What 3 risk factors are associated?
acidic conditions
- intense exercise/training
- stress - fasting, transport, stabling, work
- NSAIDs
What are the 3 main etiologies of equine glandular gastric ulcer syndrome? What are 3 risk factors?
- acidic conditions
- NSAIDs
- Helicobacter
- gender
- training, exercise
- no grass turn out, no roughage, unprocessed grain
What is unique about a risk factor in equine glandular gastric ulcer syndrome compared to squamous?
time in work does not have as much of an effect in EGGUS compared to ESGUS
What are the overall 2 risk factors associated with EGGUS/ESGUS?
- stress
- nutrition
What are the most common clinical signs associated with EGUS?
- colic
- poor appetite, weight loss
- pain on tightening of girth
signs more commonly seen in foals, horses with ulcers may have no clinical signs
What are 2 ways to diagnose EGUS? Two other possible ways?
- endoscopy - withhold food for 16 hr and water for 1 hr
- therapeutic trial with Omeprazole
- fecal occult blood
- sucrose marker
Squamous ulcers:
pale, white
Glandular ulcers:
red, pink
What are the 2 major ways to treat EGUS?
- suppression of acid production + protectants
- change in management practices
What 2 families of drugs are used to suppress gastric acid secretion?
- PPI - Omeprazole (Gastrogard, Ulcergard) for one month, Esomeprazole, Pantoprazole
- H2R antagonists - Cimetidine, Ranitidine, Famotidine
What 2 families of drugs are used to protect ulcerated mucosa?
- protection/repair - Sucralfate, Misoprostol
- antacids - Mg(OH)2, Al(OH)3, Lidocaine
