Dysphagia & disease of the oral cavity

Question 1

define dysphagia

Answer 1

Difficulty eating (many different things can cause this)
Describes a set of clinical signs rather than a mechanism or a location of the problem

Question 2

what are the 3 phases of eating

Answer 2

prehension
mastication
deglutition (swallowing)

Question 3

Prehension

Answer 3

Voluntary control: CN 7: facial nerve

muscles of the facial expression (how the horse actually picks up the food)

Question 4

what are the clinical signs of prehension

Answer 4

pytalsim ( increase salivation), dropping feed, head tossing, exaggerated head movements, submerging head in fee/water

Question 5

Mastication

Answer 5

CN5 trigeminal nerve
muscles of facial expression
Masticatory muscles: masseter, temporalis, digastricus

Question 6

clinical signs of mastication

Answer 6

Ptyalism, prehension with no chewing attempts, exaggerated chewing movements, reluctance to open mouth, holding or packing feed into the oral cavity, dropping feed

Question 7

Deglutition (swallowing) what are the two phases

Answer 7

Swallowing

Phase 1: pharyngeal phase - Cn9, 10, 11

Phase 2: oesophageal [phase - CM 10 - vagus

Question 8

what are the three types of oral tumours

Answer 8

teeth (odontogenic) 
bone ( osteogneic) 
soft tissue ( ossifying fibroma)

Question 9

what is the most common disorder in the equine oeseophagus

Answer 9

Obstruction (choke)

most common cause: ingested of abnormal consistency

Question 10

what are the predisposing factors to choke

Answer 10

fast eater, dental disease, shetland ponies

Question 11

what are the steps involve in the treatment of choke

Answer 11

1. heavy sedation
2. nasogastric intubation + gentle lavage
3. antimicrobial therapy
4. pharmacological assistance

Second satge medical treatement

Question 12

how much saliva is produced on average by a 500kg horse

Answer 12

12L/24h

Question 13

what are the main salivary glands

Answer 13

Parotid, submaillary & sublingual

Question 14

Salivary loss in horses will result in

Answer 14

inititial hyponatraemic metabolic acidosis

as disease progresses, metabolic alkalosis develops due to progressive hypochloraemia

Question 15

You are presented with a a foal that has milk at the nostrils, coughing after nursing, ill thrift and when listening to the lungs you are suspicious of aspiration pneumonia. On oral exam you see a ridge/hole structure on the mandibule what do you suspect. what are your treatment options

Answer 15

Cleft palate

Surgical repair; mandiBULAR SYMPHYSIOTOMY

Question 16

what are the CS associated with a choke patient

Answer 16

Acute signs after eating 
Marked signs of distress 
retching/gagging 
profuse salivation 
Coughing 
Green mucoid discharge from mares 
Palpable masses in the region of eosophagus 
Some horses will continue to eat or drink

Question 17

what is the first step in dealing with a choke patient

Answer 17

Tells the owners NPO until examiantion & dont use a hose

Question 18

what are the most common sites for a choke

Answer 18

Post pharynx
thoracic inlet
base of heart
Cardia of stomach

Question 19

what antimicrobial therapy can be used in a horse suffering from a choke

Answer 19

There is a high chance of aspiration pneumonia need to warn the owner
Want a broad spectrum AB
Gentamicin - gram neg
penicilin gram +

Question 20

How will pharmacologic assistance help in a choke patient

Answer 20

Oxytocin can be used to stimulate smooth muscle contraction distal 1/3 of the oesophagus
Skeletal muscle relaxant

Question 21

what is involved in the second stage of medical treatment for a patient that is now in hopistal after a choke episode

Answer 21

withold feed or water 
IV fluid therapy - attempt to rehydrate ingesta in oesophagus ==>repeat nasogastric intubation in 12 hours no earlier
Asses & correct acid bases status 
NSAIDS
Continue antimicrobial therapy

Question 22

what are the most common sites for a choke

Answer 22

Post pharynx
Thoracic inlet
Base of heart
Cardia of stomach