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Equine Medicine and Surgery > Lecture 2: Esophageal Obstruction and Equine Gastric Ulcer Syndrome > Flashcards

Lecture 2: Esophageal Obstruction and Equine Gastric Ulcer Syndrome Flashcards

1
Q

what is the most common cause of choke/esophageal obstruction

A

Inadequately soaked beet pulp

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2
Q

Describe the anatomy of the esophagus

A

2 muscle layers:
1. Muscularis mucosa: in cranial esophagus, becomes more substantial as it approaches cardia- composed of smooth muscle, longitudinal orientation

  1. Muscularis externa: present along entire length of esophagus. Composed of striated muscle in midthoracic region and smooth muscle in caudal 1/3
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3
Q

What are the 4 most common sites for choke

A
  1. Cervical esophagus
  2. Thoracic inlet
  3. Base of heart
  4. Cardia/terminal esophagus
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4
Q

What are the sedation options for treatment of choke and what do they do

A
  1. Xylazine: alpha 2 agonist with sedative and pain relieving properties ~10 minutes
  2. Butorphanol- partial kappa/sigma agonist opioid with pain relieving properties. Stops coughing and gagging (antitussive)
  3. Acepromazine: muscle relaxant and anti-anxiety, no pain relief
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5
Q

What muscle relaxants are used to tx choke and what do they do

A
  1. Buscopan/N-butylscopolammonium: anti-cholinergic, antispasmatic, smooth muscle relaxant
  2. Acepromazine
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6
Q

What is a side effect of Buscopan/ N-butylscopolammonium

A

Tachycardia! Important to check heart rate prior to use because can cause V-fib

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7
Q

What is a common NSAID used to tx choke

A

Banamine

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8
Q

What antibiotic is commonly used for choke

A

Excede- broad spectrum antibiotic- not administered orally

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9
Q

What mucosal protectant is commonly used to tx choke

A

Sucralfate

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10
Q

When passing an NG what two things should you do to prevent aspiration pneumonia

A
  1. Nastrotracheal tube with cuff
  2. Heavy sedation with head down
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11
Q

Once NG is passed what do you want to give

A

6-8 liters of water and electrolytes

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12
Q

T of F: you can feed a horse right after tx choke

A

F: hold off feed for 12 hours and slowly reintroduce wet, soft feed

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13
Q

What do you do if you are unsuccessful in relieving the choke

A
  1. Supportive care: night of IV fluids and muscle relaxants
  2. Refer to scope
  3. GA
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14
Q

What are some common life threatening complications of choke and which is the most common

A
  1. Aspiration pneumonia- most common
  2. Acid base and electrolyte abnormalities
  3. Dehydration
  4. Esophageal mucosal irritation
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15
Q

What is the MOST common life threatening complication of choke

A

Aspiration pneumonia

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16
Q

What are some less common life threatening complications of choke

A
  1. Stricture formation
  2. Esophageal perforation
  3. Pleuritis
  4. Laminitis
  5. Laryngeal paralysis
  6. Horners syndrome
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17
Q

What are some ways to prevent choke

A
  1. Dental care
  2. Slow feeders
  3. Elevated feeders
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18
Q

What are some signs of gastric ulcers

A

Poor appetite, dullness, attitude change, decreased performance, reluctance to train, poor body condition, mild colic, salivation when tacking, poor hair coat, weight loss, sour disposition, avoidining hard feed, prefer hay, bruxism, cribbing

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19
Q

What is wrong here

A

Multifiocal, diffuse, gastric ulcers near the pylorus. Grade 3-4

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20
Q

What is the pathophysiology of ESGD

A

Increased exposure of squamous mucosa to acid

21
Q

What is the pathophysiology of EGGD

A

Breakdown of normal defense mechanisms that protect the mucosa from acidic gastric contents

22
Q

What are some predispositions to ESGD

A

Racehorses, increase intensity and duration of exercise, high fiber, >6 hours between meals, feeding grain at 1% body weight

23
Q

What are some predispositions to EGGD

A

Warmbloods, exercised more than 5 days a week, stress

24
Q

Access to pasture may be protective in what gastric ulcer syndrome

A

EGGD

25
Q

What is the only antemortem diagnostic for ulcers

A

Gastroscopy

26
Q

What grade ulcer is this? What are the characteristics of this grade?

A

grade 4: extensive ulcers, often merge to give areas of deep ulceration, raw

27
Q

What grade ulcer is this? What are the characteristics of this grade?

A

grade 0: stomach lining intact, no reddening

28
Q

What grade ulcer is this? What are the characteristics of this grade?

A

Grade 2: stomach has small single or multiple ulcers

29
Q

What grade ulcer is this? What are characteristics of this grade

A

Grade 1: stomach lining intact, but there are some areas of reddening

30
Q

What grade ulcer is this? What are the characteristics of this grade

A

Grade 3: Stomach has large single or multiple ulcers

31
Q

What is the key for ESGD treatment

A

Acid suppression, pH >4 for 16-18 hours daily

32
Q

What are the main drugs used to treat ESGD

A

Proton pump inhibitors
1. Omeprazole
2. H2 antagonists

33
Q

What is the dose for omeprazole and how long is duration of tx

A

1-4mg/kg for 21 days

34
Q

Should omeprazole be given on full or empty stomach

A

Empty to improve absoprtion

Followed by food 30 minutes later

35
Q

What is the main H2 antagonist used to tx ESGD

A

Ranitidine

36
Q

What is the dose for ranitidine

A

6.6mg/kg PO q8

36
Q

What are some nutritional management strategies for ESGD

A

Avoid high starch grain, frequent feeding every 4-6 hours or free choice, vegetable oil

37
Q

How do we grade EGGD

A

Anatomic location, description (hyperemia, hemorrhagic, pseudomembranous), and size (% effected area)

38
Q

What are the drugs used to tx EGGD

A
  1. Sucralfate
  2. Misoprostal
  3. Omeprazole
39
Q

What is dose for Sucralfate in EGGD

A

20mg/kg PO q12 for 8 weeks

40
Q

How many hours after omeprazole can you administer sucralfate

A

2 hours

41
Q

What is the mechanism of action of sucralfate

A

Adheres to ulcerated mucosa, stimulates mucose secretion, prostaglandin E synthesis and enhanced blood flow

42
Q

What is the dose for Misoprostal

A

3-5 ug/lg PO q12

43
Q

What is the mechanism of action of Misoprostal

A
  1. Inhibits basal and nocturnal gastric acid secretion by stimulating prostaglandin E1 receptors on parietal cells
  2. Induces mucus and bicarbonate secretion, increase mucosal blood flow and epithelial repair
44
Q

What is the dose for omeprazole in tx EGGD

A

4-8mg/lg PO q12-24hrs for 8 weeks

45
Q

T of F: can use omeprazole as monotherapy in EGGD

A

False!

46
Q

Can you give Misoprostal with omeprazole

A

No because antacids decrease absoprtion

47
Q

What are some ways we can prevent gastric ulcers

A
  1. Provide minimum of 2 rest days/week
  2. Turn out when possible
  3. Feed prior to exercise so no empty stomach while at speed

Equine Medicine and Surgery (27 decks)

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