Equine Gastrointestinal Health Quiz

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Questions and Answers

What is a potential long-term complication of esophageal obstruction?

Inflammation of the stomach lining

Circular fibrous submucosal scarring (correct)

Gallbladder dysfunction

Increased salivation

What underlying pathology might contribute to recurrent choke episodes in horses?

Gastric ulcers

Diabetes mellitus

Chronic laminitis

Dental disease leading to incomplete mastication (correct)

Which diagnostic method is used to assess esophageal function in suspected cases of obstruction?

Liver function tests

Urinalysis

CT scan of the abdomen

Barium swallow study (Fluoroscopy) (correct)

What can lead to esophageal rupture in horses?

Iatrogenic causes from NG tube placement Signup and view all the answers

What is a diverticulum formation in the context of esophageal obstruction?

Defects in muscular layers of the esophagus Signup and view all the answers

Which feeding modification is recommended to prevent oesophageal obstruction?

Dampen high risk hard feeds Signup and view all the answers

What are the primary components of glandular mucosal protection?

Prostaglandin synthesis and bicarbonate secretion Signup and view all the answers

Which risk factor is NOT associated with Equine Squamous Gastric Disease (ESGD)?

Low carbohydrate high forage diet Signup and view all the answers

What is a common diagnostic procedure for evaluating oesophageal abnormalities?

Barium swallow study Signup and view all the answers

Which statement best describes the glandular mucosa's function?

It secretes bicarbonate and mucus. Signup and view all the answers

How prevalent is Equine Squamous Gastric Disease (ESGD) in Thoroughbred racehorses?

90-100% Signup and view all the answers

What is a characteristic of Equine Glandular Gastric Disease (EGGD)?

It results from a breakdown in mucosal defenses Signup and view all the answers

What is a recommended strategy to reduce excitement prior to feeding horses?

Provide access to hay before hard feed Signup and view all the answers

Which condition is a potential secondary cause of gastric ulcers?

Gastric impaction Signup and view all the answers

Which structure does the squamous mucosa NOT facilitate?

Digestion of food Signup and view all the answers

What is the most common cause of oesophageal obstruction in horses?

Rapid ingestion of food Signup and view all the answers

Which clinical sign is least likely associated with oesophageal obstruction in horses?

Excessive weight gain Signup and view all the answers

Which of the following treatment options for oesophageal obstruction is focused on muscle relaxation?

Intravenous sedation Signup and view all the answers

Where is oesophageal obstruction most commonly located in horses?

Proximal oesophagus Signup and view all the answers

Which of the following is a potential consequence of untreated oesophageal obstruction?

Gastric ulceration Signup and view all the answers

What symptom might indicate anxiety in a horse experiencing oesophageal obstruction?

Repeated spasm of neck muscles Signup and view all the answers

Which condition must be differentiated from squamous ulceration in equine gastric ulceration syndrome?

Glandular ulceration Signup and view all the answers

What approach is commonly recommended for handling cases of oesophageal obstruction that may self-resolve?

Give time and monitor the horse Signup and view all the answers

What is the primary purpose of lowering the head during the treatment of oesophageal obstruction?

To encourage drainage of food and saliva Signup and view all the answers

Which treatment option should only be performed with caution to avoid damage to the oesophagus?

Pass Nasogastric (NG) Tube Signup and view all the answers

When should chronic cases of choke be referred for further investigation?

If the obstruction persists for more than 24 hours Signup and view all the answers

Which medication can cause colic signs when used in the treatment of oesophageal obstruction?

Oxytocin Signup and view all the answers

What is the purpose of using systemic antimicrobials in the treatment of oesophageal obstruction?

To prevent or treat infections from impacted feed Signup and view all the answers

Which condition warrants the use of endotracheal intubation under general anaesthesia during oesophageal obstruction treatment?

When performing high volume lavage Signup and view all the answers

Which substance is commonly used for causing smooth muscle relaxation in the treatment of oesophageal issues?

Romifidine Signup and view all the answers

Which of the following statements about simple obstructions is true?

They may clear through natural passage of tubes. Signup and view all the answers

What is the primary aim of treatment for equine EGUS?

Keep pH levels above 4 Signup and view all the answers

Which treatment option is considered the only licensed treatment for EGUS?

Omeprazole Signup and view all the answers

What is the effect of proton pump inhibitors like Omeprazole?

Irreversibly inhibit gastric acid secretion Signup and view all the answers

What is a common clinical sign of equine EGUS?

Epigastric pain or 'girthing' Signup and view all the answers

What is the recommended dosage for Sucralfate when treating EGUS?

12-25 mg/kg per os BID or TID Signup and view all the answers

Which of the following statements is true regarding the use of H2-antagonists like Ranitidine in EGUS treatment?

They may still offer some benefit in treatment Signup and view all the answers

What should follow-up therapy for EGUS treatment typically involve?

Follow-up gastroscopy to assess healing Signup and view all the answers

Which of the following is NOT a characteristic of clinical signs in equine EGUS?

Consistent weight gain Signup and view all the answers

Misoprostol is known to have which effect in the treatment of gastric issues?

Suppresses gastric acid secretion Signup and view all the answers

How often should Proton Pump Inhibitors like Omeprazole be administered to be effective?

Every 1-3 hours Signup and view all the answers

Study Notes

Equine Upper Gastrointestinal Tract Conditions

Learning Objectives:
- Describe risk factors, clinical presentations, treatment options, and consequences of esophageal obstruction (choke) in horses.
- Explain the pathophysiology of equine gastric ulcer syndrome (EGUS).
- Differentiate between squamous and glandular ulceration.
- Outline treatment options and appropriate management strategies for EGUS.

Esophageal Obstruction (Choke)

Cause: Physical obstruction of the esophagus, typically by organic matter (e.g., food).
Risk Factors:
- Rapid ingestion of food.
- Dry, coarse feedstuffs.
- Poor mastication (chewing).
- Dental disease.
- Primary esophageal abnormalities.
Location: Can occur at different levels within the esophagus: proximal esophagus, thoracic inlet, heart base, cardia.
Clinical Signs:
- Profuse salivary/food-stained nasal discharge.
- Drooling.
- Repeated neck muscle spasms.
- Anxiety/agitation.
- Coughing.
- Possibly mild tachycardia.
- Palpable mass in the left lateroventral aspect of the neck.

Esophageal Obstruction - Treatment

Conservative treatment: Time for spontaneous resolution is often effective.
Give time: Many cases resolve themselves, or with conservative treatment.
Sedation:
- Intravenous sedation with alpha-2 agonists (detomidine/romifidine).
- Potentially with butorphanol (opioid).
Intravenous sedation: Alpha-2 agonists relaxation of skeletal muscles/smooth muscle relaxation, and potentially butorphanol.
Massage the esophagus: Encourage food/saliva drainage.
Pass Nasogastric (NG) Tube: For simple obstructions, cautious use, to help clear material.
Low volume lavage (with NG tube): To hydrate, lubricate obstructions.
High volume lavage/endoscopic removal: For severe obstructions requiring removal under general anesthesia.

Esophageal Obstruction - Chronic Cases

Treatment Failure: For cases not resolving within 24 hours.
Further Investigation: Warrant further investigation.
More Aggressive Therapy: May require more aggressive therapy and/or referral to a hospital.
Fluid Therapy: In need of fluid therapy.
Antimicrobials: Should receive systemic antimicrobials (e.g., potentiated sulfonamides, penicillin).
Pain Management: NSAIDs (e.g., phenylbutazone/flunixin) are helpful for pain relief (use caution due to possible renal compromise in dehydrated horses).
Important Complications:
Dehydration
Fatigue
Aspiration
Pneumonia

Esophageal Obstruction - Recurrent Cases

Underlying Pathology: Secondary choke episodes associated with underlying conditions affecting the upper GI tract.
Dental Disease: Incomplete mastication of food due to dental disease.
Esophageal Abnormalities: Structural abnormalities or diverticulum.
Diagnostics
Closely assess eating and drinking habits
Complete dental examination
Endoscopy of larynx/pharynx and upper respiratory tract
Endoscopy of esophagus, and
Barium swallow study (fluoroscopy).

Esophageal Obstruction - Prevention

Modify Feeding Regimen:
- Dampen "high-risk" hard feeds (e.g. sugar beet pulp, coarse chaff);
- Feed smaller volumes more regularly;
- Do not feed immediately after exercise or sedation;
- Reduce excitement prior to feeding;
- Provide obstacles to limit access within the food bowl to prevent issues from fast eating;
- Provide pre-chopped fine roughage for dental disease;
- Soaking pelleted feed for esophageal disease.

Equine Gastric Ulcer Syndrome (EGUS)

Gastric Anatomy and Physiology:
- Squamous mucosa: Lines the cardia and fundus, not involved in digestion.
- Glandular mucosa: Secrete hydrochloric acid (HCl) and mucus/bicarbonate to protect gastric tissues, with involvement of parietal cells and histamine.
Glandular Mucosal Protection:
- Mucus and bicarbonate secretion for buffering.
- Prostaglandin synthesis to improve blood flow (healing).

Equine Squamous Gastric Disease (ESGD)

Cause: Direct contact with gastric acid along the greater or lesser curvature dorsal to the margo plicatus.
Risk Factors:
- High carbohydrate, low forage diet.
- Intermittent feeding, fasting periods.
- Water restriction.
- Stress.
- Intense exercise.

Equine Glandular Gastric Disease (EGGD)

Cause: Breakdown in mucosal defenses leads to inflammation
Risk Factors: Similar to ESGD, plus NSAID administration (in theory).
Location: High-grade lesions and lesions associated with the pyloric region are usually clinically significant.
Specific complications: Inflammation, hyperemia,erosion, and ulceration.

EGUS - Clinical Signs

Signs can be variable and vague.
Performance issues.
Altered or erratic appetite/feeding preferences.
Weight loss/gain issues.
Behavioral changes.
Coat changes (ill thrift).
"Girthing" or epigastric pain.
Recurrent colic.

EGUS - Diagnosis

Clinical signs are not reliable.
Gastroscopy is required for definitive diagnosis

EGUS - Management/Prevention

Ensure continual grazing behavior (18 hours per day or close to this) (to reduce periods of stomach fasting and stress).
Regular access to pasture (reduce the likelihood of stress related issues).
Feed smaller volumes more regularly (to prevent stomach stress).
Provide good quality forage: Lucerne is a good option due to its high calcium content.
Reduce or avoid high-starch/soluble carbohydrate diets, if possible.
Utilize oil (e.g., corn oil) for weight gain as needed.
Minimize stress (reduce stress and anxiety).
Tailor exercise regimen: Reduce high-intensity exercise periods
Supplements: No proven efficacy, potential benefits to pectin-lecithin compounds.

EGUS - Treatment

Aim to keep stomach pH >4: To protect the lining of the stomach and reduce the likelihood of HCl damage.
Treatment Options:
- Antacids/buffers: CaCO3, Mg(OH)2, Al(OH)3 (given every 1-3 hours for effectiveness)
- Mucosal protectants: Sucralfate (12-25mg/kg, BID or TID, to bind to damaged areas and increase prostaglandin synthesis)
- Proton pump inhibitors (PPIs): Omeprazole (4mg/kg once daily, for 28 days or longer to manage ESGD).
Follow-up gastroscopy is essential to monitor treatment responses to make management and treatment more planned and effective.
Refractory Cases: Long-acting injectable omeprazole or esomeprazole can be considered, as well as misoprostol for resistant cases.

References

ECEIM Consensus Statement on Equine Gastric Ulcer Syndrome (Sykes et al., 2015).
UK Vet Equine information on EGUS.

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Description

Test your knowledge on equine gastrointestinal health, focusing specifically on esophageal complications and related pathology in horses. This quiz covers diagnostic methods, potential risks, and management strategies in preventing esophageal obstruction. Ideal for veterinary students and horse owners alike.