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LAM > Test 2 - Choke > Flashcards

Test 2 - Choke Flashcards

1
Q

Define Choke.

A

Esophageal obstruction

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2
Q

The cranial 2/3 of the esophagus are composed of ____ muscle, the caudal 1/3 is composed of ______.

A

The cranial 2/3 of the esophagus are composed of skeletal muscle, the caudal 1/3 is composed of smooth.

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3
Q

The ________ is the most common site for esophageal obstruction.

A

The thoracic inlet is the most common site for esophageal obstruction.

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4
Q

What is the most common etiological agent for primary esophageal obstruction?

A

• Most common: roughage, particularly leafy alfalfa hay

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5
Q

What are some predisposing diets?

A

Predisposing diets: hay cubes, large pellets, beet pulp

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6
Q

What are predisposing factors to primary esophageal obstruction?

A

Predisposing factors: poor mastication, gulping food, exhaustion, weakened/chronic debilitation

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7
Q

What are the 2 types of secondary esophageal obstruction?

A
  • Intramural abnormalities → tumors (SCC), strictures, diverticula, cysts and vascular ring anomalies
  • Extramural abnormalities → mediastinal or cervical masses → tumor abscesses
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8
Q

What kind of tumor is associated with secondary intramural abnormalities?

A

SCC

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9
Q

TRUE/FALSE

Ataxia is associated with choke.

A

FALSE

Staggering is but ataxia is a neurological problem.RULE IT OUT

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10
Q

What are the first signs of choke?

A

Ptyalism and dysphagia

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11
Q

Describe the relationship of the esophagus and the trachea through the neck of the horse.

A
  • Cranial aspect located medial plan dorsal to trachea
  • Midcervical region (C4-C5) esophagus shift to let left side of the trachea → when obstructions or tube can be visualized
  • The thoracic esophagus lies ventral to the tracheal until it reaches the tracheal bifurcation where it resumes a dorsal position
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12
Q

TRUE/FALSE

An animal with choke will present with following signs?

  • Gagging or retching
  • Usually first signs are ptyalism & dysphagia
  • Anxiety with neck extension
  • Pawing
  • Bilateral frothy nasal discharge (saliva/food material)
  • coughing
  • distention of the cervical esophagus may be evident
  • Staggering: not ataxia (rule out)
  • Colic
A

TRUE

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13
Q

______ can be associated with esophageal rupture if felt on palpation.

A

Crepitus can be associated with esophageal rupture if felt on palpation.

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14
Q

What landmark is used when measuing the NG tube?

A

13th ICS

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15
Q

______ should never be used when inserting a NG tube during a choke case.

A

Mineral oil or DSS should never be used when inserting a NG tube during a choke case.

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16
Q

What are the uses of ultrasound in a choke case?

A
  • Cervical region very useful to confirm the obstruction
  • Location and extent of the obstruction
  • Evaluate aspiration pneumonia
17
Q

What is the use of Radiographs during a choke case?

A
  • Contrast study with air or barium
  • Assess an esophageal impaction
  • More useful after relief of the impaction → demonstrate strictures, diverticula, esophageal rupture or masses, esophageal dilatation
18
Q

What is the treatment approach for choke?

A
  1. Relieve obstruction
  2. Reduce Esophageal tone & pain
  3. Physical Dispersion
  4. Post-obstruction monitoring
19
Q

What are some drugs to reduce esophageal tone & pain?

A
  • Acepromazine
  • Xylazine & Butorphanol: combination had greatest effect on esophageal motility
  • Detomedine
  • Oxytocin: can reduce esophageal muscle tone suggesting it may be useful for relief of the obstruction
  • Buscopan
20
Q

Describe some methods to physically disperse the impacted material.

A

Nasogastric intubation
• Carefully lavage the esophagus
• External manipulation of the esophagus
• Head must be lowered to ground
• Dual tube method
• Supportive therapy → IV fluids (NaCl + KCl). Correct electrolyte imbalance & acid-base deficits.
• Maintain adequate oxygenation.
• With hold food for 24-48 hrs and reassess.
• General anesthesia (tilted table) → don’t want to anesthetize compromised horse already
• Surgery to massage the obstruction without cutting esophagus
• Time NPO w/ supportive care

21
Q

TRUE/FALSE

Esophagostomy should be used once NG intubation fails

A

FALSE.

It is a LAST RESORT.

22
Q

List the antimicrobials for each type of microbe:

  • Gram +
  • Gram -
  • Anaerobe
A
  • Gram + : K Penicillin
  • Gram - : Gentamycin
  • Anaerobe : Metronidazole
23
Q

What gasatric drugs can be used post-obstruction?

A

Sucralfate / omeprazole

24
Q

What is the purpose of performing an endoscopic exam immediately after relief of impaction?

A

to determine whether any complications are expected.

Also to investigate possible inciting cause of obstruction

25
Q

A neurological exam is performed to R/O _______.

A

A neurological exam is performed to R/O dysphagia.

26
Q

TRUE/FALSE:

A power float is associated with dental abnormalities that may lead to choke.

A

TRUE

27
Q

TRUE/FALSE

A Metabolic acidosis is seen d/t prolonged loss of salivary Cl, Na

A

FALSE

Alkalosis!

28
Q

TRUE/FALSE

Esophageal ulceration, stricture, perforation, aspiration pneumonia and megaesophagus are some complications asociated with choke.

A

TRUE

29
Q

List the prognostic factors in choke case.

A

• Damage dependent
• Severity of 1° condition → strictures, diverticula, megaesophagus,
ruptured esophagus
• Geriatric horses

LAM (5 decks)

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