Dysphagia & disease of the oral cavity Flashcards
(22 cards)
define dysphagia
Difficulty eating (many different things can cause this) Describes a set of clinical signs rather than a mechanism or a location of the problem
what are the 3 phases of eating
prehension
mastication
deglutition (swallowing)
Prehension
Voluntary control: CN 7: facial nerve
muscles of the facial expression (how the horse actually picks up the food)
what are the clinical signs of prehension
pytalsim ( increase salivation), dropping feed, head tossing, exaggerated head movements, submerging head in fee/water
Mastication
CN5 trigeminal nerve
muscles of facial expression
Masticatory muscles: masseter, temporalis, digastricus
clinical signs of mastication
Ptyalism, prehension with no chewing attempts, exaggerated chewing movements, reluctance to open mouth, holding or packing feed into the oral cavity, dropping feed
Deglutition (swallowing) what are the two phases
Swallowing
Phase 1: pharyngeal phase - Cn9, 10, 11
Phase 2: oesophageal [phase - CM 10 - vagus
what are the three types of oral tumours
teeth (odontogenic) bone ( osteogneic) soft tissue ( ossifying fibroma)
what is the most common disorder in the equine oeseophagus
Obstruction (choke)
most common cause: ingested of abnormal consistency
what are the predisposing factors to choke
fast eater, dental disease, shetland ponies
what are the steps involve in the treatment of choke
- heavy sedation
- nasogastric intubation + gentle lavage
- antimicrobial therapy
- pharmacological assistance
Second satge medical treatement
how much saliva is produced on average by a 500kg horse
12L/24h
what are the main salivary glands
Parotid, submaillary & sublingual
Salivary loss in horses will result in
inititial hyponatraemic metabolic acidosis
as disease progresses, metabolic alkalosis develops due to progressive hypochloraemia
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
Cleft palate
Surgical repair; mandiBULAR SYMPHYSIOTOMY
what are the CS associated with a choke patient
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
what is the first step in dealing with a choke patient
Tells the owners NPO until examiantion & dont use a hose
what are the most common sites for a choke
Post pharynx
thoracic inlet
base of heart
Cardia of stomach
what antimicrobial therapy can be used in a horse suffering from a choke
There is a high chance of aspiration pneumonia need to warn the owner
Want a broad spectrum AB
Gentamicin - gram neg
penicilin gram +
How will pharmacologic assistance help in a choke patient
Oxytocin can be used to stimulate smooth muscle contraction distal 1/3 of the oesophagus
Skeletal muscle relaxant
what is involved in the second stage of medical treatment for a patient that is now in hopistal after a choke episode
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
what are the most common sites for a choke
Post pharynx
Thoracic inlet
Base of heart
Cardia of stomach
