Other conditions of the GIT and body wall Flashcards
‘Choke’ is the term used to describe?
Oesophageal obstruction
How does oesophageal obstruction occur?
Feed becomes impacted within the oesophageal lumen:
- Proximal cervical region
- Distal cervical (thoracic inlet) region
Occasionally due to ingestion of objects such as carrots, apples, etc
Sometimes associated with extra- luminal masses / functional abnormalities of the oesophagus
How is oesophageal obstruction diagnosed?
Usually clinical signs are sudden in onset and associated with eating
- Coughing
- Ptyalism (excess saliva)
- Dysphagia – food and saliva evident at the nostrils
- Repeated flexion & extension of neck
Can be quite distressing for the horse and owner
How is oesophageal obstruction managed initially?
- Most episodes will clear spontaneously
- Where there is no improvement, veterinary assessment is required
What advice should be given to the owner when oesophageal obstruction initially presents?
- Take all feed and water away
- Monitor for 30 minutes
- If there is no improvement veterinary examination will be required
- If it does resolve spontaneously, provide water but wait 1-2h until feeding (and start with sloppy feeds / grass)
- Ask about the dental history / any evidence of quidding behaviour as dental problems should be ruled out
As a vet, how do you approach an oesophageal obstruction case that hasn’t spontaneously resolved?
- Obtain a full history
- Perform a full clinical examination
- Palpate the left cervical region
- Sedate the horse (α2 agonist / butorphanol)
How can you confirm there is an oesophageal obstruction?
- Pass a nasogastric tube
- Identify the level of the obstruction
- Never force the tube (perforation is usually fatal)
How can you clear an oesophageal obstruction?
Perform lavage of the oesophagus
- Warm (not hot) water
- Stirrup pump is better than using gravity flow
- *single ended stomach tube
- Repeat lavage until obstructed material all removed and the stomach tube can be passed into the stomach
Describe the aftercare needed following oesophageal obstruction
- Decide if antimicrobials are needed
- Provide water and gradually reintroduce feed over 24-48 hours
- Owner should monitor carefully for nasal discharge / coughing / dullness
- Dental examination to rule out any dental pathology
- Endoscopic evaluation should be performed if 2 or more episodes of choke occur
What should be done if the oesophageal obstruction cant 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
When do oesophageal tears occur?
Following trauma, secondary to oesophageal pathology (e.g. diverticulum) or be iatrogenic (stomach tubing)
How are oesophageal tears/perforations diagnosed and treated?
- Suspect if there is marked swelling and crepitus in the left cervical region
- Horses CV parameters will deteriorate rapidly
- Further investigations using endoscopy & radiography required (referral may be appropriate)
- Prognosis usually hopeless / guarded
Describe carbohydrate overload in horses
Ingestion of large quantities of grain / concentrate feed can be potentially fatal
Early and aggressive treatment is essential
Describe the pathogenesis of carbohydrate overload
- Intestinal bacterial fermentation and absorption of endotoxins
- Colic and severe abdominal distention
- SIRS, laminitis, diarrhoea +/- death
In cases of carbohydrate overload what information needs to be gathered from the owner?
- How much and what type of feed they think has been ingested
- When this occurred
- If other horses could have accessed this
- If there are other additives in the feed (feed for other species -may need them to get feed label)
Describe the clinical exam for cases of carbohydrate overload
Assess vital signs & digital pulses
Check for evidence of colic / abdominal distension
Pass a stomach tube to check for reflux
How should cases of carbohydrate overload be managed in the early stages?
- Lavage gastric contents with warm water (within 1-2h of ingestion) and continue until only water is retrieved
- +/- administer activated charcoal (1- 3g/kg as slurry)
- Administer Flunixin
- Perform cryotherapy (ice therapy) of the feet
How should cases of carbohydrate overload be managed in the later stages once signs of SIRS have developed?
Referral or intensive medical or occasionally surgical management indicated
Prognosis generally poor if signs of colic/ laminitis develop
Define dysphagia
Difficulty swallowing but usually expanded to include difficulty eating
What are the 3 main groups of causes of dysphagia?
Pain
Neurological
Obstructive
List some painful causes of dysphagia
- Abscess: buccal, lingual
- Strep equi var equi: retropharyngeal abscess
- Dental pathology
- Mouth pain/trauma
- Foreign body
- Masseter myositis
- Atypical myopathy
List some neurological causes of dysphagia
Head trauma
Guttural pouch disease
Pharyngeal paralysis
Lead poisoning
Botulism
Hepatoencephalopathy
How should you approach cases of dysphagia?
- Obtain a full history
- Watch the horse trying to eat to determine what phase the problem appears to be in: Oral, Pharyngeal, Oesophageal
- Perform a full clinical examination
- Perform a neurological assessment
- +/- imagine
- +/- intra-oral examination
- Haematology / biochemistry or other laboratory tests (based on suspected cause)
How is dysphagia treated?
Depends on underlying cause
Referral may be warranted in some cases
NSAIDS
Slurry feed / nasogastric intubation
+/- IV fluids
General nursing care & ongoing careful observation
Describe management of lip lacerations
Relatively common
Good blood supply
Check for other injuries to the head
Sedate and assess if partial / full thickness
Suturing – local anaesthetic nerve blocks. At least 2 layers of closure.
Important to get a good cosmetic and functional outcome
Describe how to manage 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
How should you approach mandibular fractures?
- Can look alarming
- Sedate the horse and perform careful examination of the mouth
- Determine the fracture configuration
- Sedation & nerve blocks
- Intra-oral wiring
Rectal prolapse occurs secondary to?
Prolonged straining
List some possible causes of a rectal prolapse
Diarrhoea
Colic
Heavy parasite burden
Proctitis / mass in the rectum
Other causes of repeated straining – dystocia, retained foetal membranes
How should a rectal prolapse be treated?
Grades I, II & III
- Reduce prolapsed tissue
- Address underlying cause
Grade IV
- Surgical management (poor prognosis)
What consequences can occur as a result of trauma to the abdomen?
- Rupture of abdominal viscus
- Body wall tears / rupture
- Diaphragmatic tears
- Abdominal haemorrhage
- Peritonitis
How should causes of trauma to the abdomen be assessed and managed?
- Obtain a full history: when and how trauma occurred
- Perform a full clinical exam: vital signs, check for other traumatic injuries
- +/- perform abdominocentesis
- Treatment based on assessment of degree of trauma / repair of wounds / suspicion of internal organ damage
Haemoabdomen can occur as a result of?
- Can be secondary to abdominal trauma
- Splenic rupture / tear
- Uterine tear (pregnant mare)
- Can occur following parturition -> Rupture of the middle uterine artery
Body wall hernias can result in … ?
Colic if intestine becomes entrapped
Incisional hernias occur as a result of … ?
Relatively uncommon complication following colic surgery (laparotomy)
How are incisional hernias treated?
Conservative treatment initially:
- Prolonged box rest in some cases
- Use of a commercial hernia belt (e.g. CM belly band)
Surgical repair may be required in some:
- Repair not performed until 4-6 months after initial surgery
- Prosthetic mesh placement
What are the potential consequences of thoracic wall injuries?
- Penetration of the thoracic wall can cause pneumothorax and respiratory distress
- Intra-thoracic haemorrhage
- Pleuropneumonia
How should thoracic wall injury cases be assessed?
- Assess for respiratory distress
- Evaluate the thorax for any wounds / crepitus
- Determine what structures are affected & depth / extent of injuries
- If there is a wound that you suspect has penetrated the body wall wrap cling film around it - wound management can be performed once the horse is stabilised
