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Y4 EQ - Gastrointestinal tract > Other conditions of the GIT and body wall > Flashcards

Other conditions of the GIT and body wall Flashcards

1
Q

‘Choke’ is the term used to describe?

A

Oesophageal obstruction

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2
Q

How does oesophageal obstruction occur?

A

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

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3
Q

How is oesophageal obstruction diagnosed?

A

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

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4
Q

How is oesophageal obstruction managed initially?

A
  • Most episodes will clear spontaneously
  • Where there is no improvement, veterinary assessment is required
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5
Q

What advice should be given to the owner when oesophageal obstruction initially presents?

A
  • 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
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6
Q

As a vet, how do you approach an oesophageal obstruction case that hasn’t spontaneously resolved?

A
  • Obtain a full history
  • Perform a full clinical examination
  • Palpate the left cervical region
  • Sedate the horse (α2 agonist / butorphanol)
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7
Q

How can you confirm there is an oesophageal obstruction?

A
  • Pass a nasogastric tube
  • Identify the level of the obstruction
  • Never force the tube (perforation is usually fatal)
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8
Q

How can you clear an oesophageal obstruction?

A

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

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9
Q

Describe the aftercare needed following oesophageal obstruction

A
  • 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
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10
Q

What should be done if the oesophageal obstruction cant be cleared?

A
  • 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
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11
Q

When do oesophageal tears occur?

A

Following trauma, secondary to oesophageal pathology (e.g. diverticulum) or be iatrogenic (stomach tubing)

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12
Q

How are oesophageal tears/perforations diagnosed and treated?

A
  • 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
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13
Q

Describe carbohydrate overload in horses

A

Ingestion of large quantities of grain / concentrate feed can be potentially fatal
Early and aggressive treatment is essential

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14
Q

Describe the pathogenesis of carbohydrate overload

A
  • Intestinal bacterial fermentation and absorption of endotoxins
  • Colic and severe abdominal distention
  • SIRS, laminitis, diarrhoea +/- death
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15
Q

In cases of carbohydrate overload what information needs to be gathered from the owner?

A
  • 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)
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16
Q

Describe the clinical exam for cases of carbohydrate overload

A

Assess vital signs & digital pulses
Check for evidence of colic / abdominal distension
Pass a stomach tube to check for reflux

17
Q

How should cases of carbohydrate overload be managed in the early stages?

A
  • 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
18
Q

How should cases of carbohydrate overload be managed in the later stages once signs of SIRS have developed?

A

Referral or intensive medical or occasionally surgical management indicated
Prognosis generally poor if signs of colic/ laminitis develop

19
Q

Define dysphagia

A

Difficulty swallowing but usually expanded to include difficulty eating

20
Q

What are the 3 main groups of causes of dysphagia?

A

Pain
Neurological
Obstructive

21
Q

List some painful causes of dysphagia

A
  • Abscess: buccal, lingual
  • Strep equi var equi: retropharyngeal abscess
  • Dental pathology
  • Mouth pain/trauma
  • Foreign body
  • Masseter myositis
  • Atypical myopathy
22
Q

List some neurological causes of dysphagia

A

Head trauma
Guttural pouch disease
Pharyngeal paralysis
Lead poisoning
Botulism
Hepatoencephalopathy

23
Q

How should you approach cases of dysphagia?

A
  • 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)
24
Q

How is dysphagia treated?

A

Depends on underlying cause
Referral may be warranted in some cases
NSAIDS
Slurry feed / nasogastric intubation
+/- IV fluids
General nursing care & ongoing careful observation

25
Q

Describe management of lip lacerations

A

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

26
Q

Describe how to manage tongue injuries

A
  • 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
27
Q

How should you approach mandibular fractures?

A
  • Can look alarming
  • Sedate the horse and perform careful examination of the mouth
  • Determine the fracture configuration
  • Sedation & nerve blocks
  • Intra-oral wiring
28
Q

Rectal prolapse occurs secondary to?

A

Prolonged straining

29
Q

List some possible causes of a rectal prolapse

A

Diarrhoea
Colic
Heavy parasite burden
Proctitis / mass in the rectum
Other causes of repeated straining – dystocia, retained foetal membranes

30
Q

How should a rectal prolapse be treated?

A

Grades I, II & III
- Reduce prolapsed tissue
- Address underlying cause
Grade IV
- Surgical management (poor prognosis)

31
Q

What consequences can occur as a result of trauma to the abdomen?

A
  • Rupture of abdominal viscus
  • Body wall tears / rupture
  • Diaphragmatic tears
  • Abdominal haemorrhage
  • Peritonitis
32
Q

How should causes of trauma to the abdomen be assessed and managed?

A
  • 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
33
Q

Haemoabdomen can occur as a result of?

A
  • Can be secondary to abdominal trauma
  • Splenic rupture / tear
  • Uterine tear (pregnant mare)
  • Can occur following parturition -> Rupture of the middle uterine artery
34
Q

Body wall hernias can result in … ?

A

Colic if intestine becomes entrapped

35
Q

Incisional hernias occur as a result of … ?

A

Relatively uncommon complication following colic surgery (laparotomy)

36
Q

How are incisional hernias treated?

A

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

37
Q

What are the potential consequences of thoracic wall injuries?

A
  • Penetration of the thoracic wall can cause pneumothorax and respiratory distress
  • Intra-thoracic haemorrhage
  • Pleuropneumonia
38
Q

How should thoracic wall injury cases be assessed?

A
  • 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

Y4 EQ - Gastrointestinal tract (9 decks)

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