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BVM3 Alimentary > Esophageal Obstruction in the Horse > Flashcards

Esophageal Obstruction in the Horse Flashcards

1
Q

What is the common name for esophageal obstruction in the horse?

A

Choke

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2
Q

Which food is the most common cause of obstruction in the UK?

A

Sugar beet

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3
Q

Which horses are more at risk of esophageal obstruction?

A

Bold eaters
Old horses with poor dentition

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4
Q

Is esophageal obstruction an emergency? What should treatment be aimed at?

A

Yes - its an emergency
Treatment should be directed primarily at relieving the obstruction and preventing complications

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5
Q

What is the prognosis of esophageal obstruction?

A

Good

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6
Q

What is the anatomy of the horse esophagus?

A

120cm in length
Upper 2/3 striated muscle, lower 1/3 smooth muscle
Innervated by peripheral nervous system (vagus nerve)

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7
Q

What is important to consider when choosing drugs to target the esophagus?

A

Muscle type

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8
Q

What are the risk factors associated with esophageal obstruction in the horse?

A

Poor dentition
Bolt feeders
Type of feed
Horses with previous history of choke
Sedation, General Anesthesia
Exhaustion
Dehydration

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9
Q

What are the clinical signs of esophageal obstruction?

A

Anxiety
Ptyalism (hypersalivation)
Attempts to swallow
Bilateral nasal regurgitation of food
Intermittent neck extension and retching
Pain
Respiratory distress +/- coughing
Palpable swelling on left side of neck

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10
Q

Abnormalities in what levels will occur with longstanding choke?

A

Dehydration/Electrolyte abnormalities

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11
Q

What should you NEVER do with NG tube?

A

Force it against resistance

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12
Q

How do you diagnose esophageal obstruction in the horse?

A

History, Physical examination
Passage of NG tube (never force)
Observation of clinical signs (ptyalism, bilateral nasal regurgitation)
Endoscopy
Radiography +/- contrast

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13
Q

What is the treatment for esophageal obstruction in the horse?

A

Sedation - Xylazine, Detomidine, Romifidine
Buscopan “hyoscine butylbromide” - antispasmodic
Remove food and water

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14
Q

How long should you treat a horse with esophageal obstruction before deciding to refer?

A

Do not treat for longer than 12 hrs prior to considering different approach

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15
Q

What is this?

A
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16
Q

What is esophageal lavage? How is it properly performed?

A

Use sedation - detomidine, romifidine
Ensure head is below point of the shoulder (to prevent regurgitation)
Pass NG tube and lavage obstruction with WARM WATER while GENTLY advancing tube

17
Q

How are most obstructions freed up?

A

Most obstructions are made of food and will be broken up by warm water

18
Q

What should you NEVER USE to lavage the esophagus? Why?

A

Mineral oil - fatal if aspirated

19
Q

How is endoscopy properly performed?

A

2-3 m endoscope
Used to visualize obstruction
Direct pressurized flushing
Can also attempt removal of material with biopsy instrument
Bore small hole through obstruction

20
Q

What is the dietary aftercare for a patient recovering after esophageal obstruction? What should you not feed and why?

A

Restrict food for 12-72 hrs to promote healing of esophageal mucosa
Gradually re-feed over 48-72 hrs with low bulk minimally abrasive diet
NO HAY - too abrasive!

21
Q

What is typical aftercare after esophageal obstruction?

A

Restrict food, take time reintroducing non-abrasive feed
Broad spectrum abx (TMPS/Doxy)
NSAIDs - pain/inflammation control

22
Q

How is endoscopy useful as a tool in aftercare for a patient recovering from esophageal obstruction?

A

Endoscopy can be useful to assess degree of mucosal damage and to monitor for strictures

23
Q

What increases the risk of developing stricture? When are strictures more likely to occur after esophageal obstruction?

A

If damage is circumferential there is high risk for developing stricture - Affects prognosis and MUST be considered if obstruction has been there for a while!

24
Q

What is a stricture?

A

When tissue heals it shrinks down (scarring) which reduces lumen size of esophagus and increases risk of blockage/obstruction occurring again

25
Q

What are the after-complications associated with esophageal obstruction?

A

Aspiration pneumonia
Ulceration
Stricture
Diverticula
Perforation

26
Q

In how esophageal obstruction cases is apiration pneumonia also seen?

A

67%

27
Q

How do perforations most often occur with esophageal obstruction?

A

Usually iatrogenic (stomach tube)

28
Q

Prevention measures for esophageal obstruction?

A

Perform thorough dental exams often (especially in older horses)
ID horses that bolt food - use slow feeders/double hay nets
Ensure dry pelleted feeds are moistened
Consider complete pelleted feed for horses with recurrent choke

BVM3 Alimentary (24 decks)

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