Other conditions of the gastrointestinal tract + body wall Flashcards
What is choke?
- Oesophageal obstruction
- feed becomes impacted within the oesophageal lumen
- occasionally due to ingestion of objects such as carrots, apples….
- sometimes associated with extra-luminal masses
What are clinical signs of choke?
– Coughing
– Ptyalism - too much saliva
– Dysphagia – food and saliva evident at the nostrils
– Repeated flexion & extension of neck
What is initial management of choke?
- Take all food + water away
- Monitor for 30mins - if no improvement call vet
- If resolved = provide water + wait 1-2hrs before feeding - feed wet food
- Ask about dental history / quidding
What should be done if no improvement with choke?
- Perform full exam
- Sedate horse (A2 agonist / butorphanol)
- +/- butylscopamine
- helps horse lower head = reduce fluid aspirated
- Pass nasogastric tube - identify level of obstruction (never force tube - perforation = fatal)
- Lavage oesophagus - warm water + stirrup pump (REPEAT until resolved)
What is aftercare of choke?
- Flunixin
- Antimicrobials? - risk of inhalational pneumonia
- Provide water + gradually reintroduce feed over 24-48hrs
- Rule out underlying cause - dental exam
- If 2 or more episodes = endoscopic evaluation
What should be done if obstruction cannot be cleared?
- If feed is known to have been involved it is sometimes appropriate to repeat lavage again in 4-8 hours
- Endoscopic evaluation required
– determine the underlying cause
– may be required to remove foreign bodies - Occasionally lavage under general anaesthesia may be indicated
- Rarely is oesophageal surgery required
How does oesophageal tears / perforation occur?
What should you do?
- Following trauma, secondary to oesophageal pathology (diverticulum) or iatrogenic (Stomach tubing)
- suspect if marked swelling + crepitus in left cervical region (Horse CV parameters will deteriorate rapidly)
- Further investigations required = endoscopy + radiography (REFERRAL)
- POOR PROGNOSIS
What occurs with carbohydrate overload?
- Ingestion of large quantities of grain / concentrate feed can be potentially fatal
– Horses / ponies breaking into a feed shed
– Sometimes feed may contain other additives (e.g. grain for poultry & other fowl) - Early and aggressive treatment is essential
If no Tx =
1. Intestinal bacterial fermentation and absorption of endotoxins
2. Colic and severe abdominal distension
3. SIRS, laminitis, diarrhoea +/- death
What should be done as initial exam after carbohydrate overload?
+ initial management?
– Assess vital signs & digital pulses
– Check for evidence of colic / abdominal distension
– Pass a stomach tube to check for reflux
- Lavage with warm water
- Activated charcoal
- Flunixin
- Ice therapy of feet
- Poor prognosis if signs of colic / laminitis (SIRS)
What is dysphagia? What are the causes?
- Difficulty swallowing
- Pain = abscess, strangles, dental path, mouth pain (trauma), foreign body, masseter myositis, atypical myopathy
- Neurogenic = head trauma, guttural pouch disease, pharyngeal paralysis, lead poisoning, botulism, hepatoencephalopathy, EGS, viral encephalomyelitis
- Obstructive = oesophageal obstruction / stricture, neoplasia
With dysphagia when would you not perform intra-oral examination for diagnosis?
- In rabies endemic areas - where rabies potential cause
How would you treat dysphagia?
– Referral may be warranted in some cases
– NSAIDS
– Slurry feed / nasogastric intubation
– +/- IV fluids
– General nursing care & ongoing careful observation
What should be done with lip lacerations?
- Check for other injuries to the head
- Sedate and assess if partial / full thickness
- Suturing – local anaesthetic nerve blocks
What should be done with tongue injuries?
- Sedate the horse
- Examine the tongue properly – gag and good light source
- Partial thickness lacerations – conservative management indicated
- Full thickness lacerations – suturing required (may need to be referred)
What should be done with mandibular fractures?
- Initial approach:
– Sedate the horse and perform careful examination of the mouth
– Determine the fracture configuration - Fractures of the incisive plate can be treated in the field
– Sedation & nerve blocks
– Intra-oral wiring
