Podcast
Questions and Answers
What is a potential long-term complication of esophageal obstruction?
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?
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?
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?
What can lead to esophageal rupture in horses?
What is a diverticulum formation in the context of esophageal obstruction?
What is a diverticulum formation in the context of esophageal obstruction?
Which feeding modification is recommended to prevent oesophageal obstruction?
Which feeding modification is recommended to prevent oesophageal obstruction?
What are the primary components of glandular mucosal protection?
What are the primary components of glandular mucosal protection?
Which risk factor is NOT associated with Equine Squamous Gastric Disease (ESGD)?
Which risk factor is NOT associated with Equine Squamous Gastric Disease (ESGD)?
What is a common diagnostic procedure for evaluating oesophageal abnormalities?
What is a common diagnostic procedure for evaluating oesophageal abnormalities?
Which statement best describes the glandular mucosa's function?
Which statement best describes the glandular mucosa's function?
How prevalent is Equine Squamous Gastric Disease (ESGD) in Thoroughbred racehorses?
How prevalent is Equine Squamous Gastric Disease (ESGD) in Thoroughbred racehorses?
What is a characteristic of Equine Glandular Gastric Disease (EGGD)?
What is a characteristic of Equine Glandular Gastric Disease (EGGD)?
What is a recommended strategy to reduce excitement prior to feeding horses?
What is a recommended strategy to reduce excitement prior to feeding horses?
Which condition is a potential secondary cause of gastric ulcers?
Which condition is a potential secondary cause of gastric ulcers?
Which structure does the squamous mucosa NOT facilitate?
Which structure does the squamous mucosa NOT facilitate?
What is the most common cause of oesophageal obstruction in horses?
What is the most common cause of oesophageal obstruction in horses?
Which clinical sign is least likely associated with oesophageal obstruction in horses?
Which clinical sign is least likely associated with oesophageal obstruction in horses?
Which of the following treatment options for oesophageal obstruction is focused on muscle relaxation?
Which of the following treatment options for oesophageal obstruction is focused on muscle relaxation?
Where is oesophageal obstruction most commonly located in horses?
Where is oesophageal obstruction most commonly located in horses?
Which of the following is a potential consequence of untreated oesophageal obstruction?
Which of the following is a potential consequence of untreated oesophageal obstruction?
What symptom might indicate anxiety in a horse experiencing oesophageal obstruction?
What symptom might indicate anxiety in a horse experiencing oesophageal obstruction?
Which condition must be differentiated from squamous ulceration in equine gastric ulceration syndrome?
Which condition must be differentiated from squamous ulceration in equine gastric ulceration syndrome?
What approach is commonly recommended for handling cases of oesophageal obstruction that may self-resolve?
What approach is commonly recommended for handling cases of oesophageal obstruction that may self-resolve?
What is the primary purpose of lowering the head during the treatment of oesophageal obstruction?
What is the primary purpose of lowering the head during the treatment of oesophageal obstruction?
Which treatment option should only be performed with caution to avoid damage to the oesophagus?
Which treatment option should only be performed with caution to avoid damage to the oesophagus?
When should chronic cases of choke be referred for further investigation?
When should chronic cases of choke be referred for further investigation?
Which medication can cause colic signs when used in the treatment of oesophageal obstruction?
Which medication can cause colic signs when used in the treatment of oesophageal obstruction?
What is the purpose of using systemic antimicrobials in the treatment of oesophageal obstruction?
What is the purpose of using systemic antimicrobials in the treatment of oesophageal obstruction?
Which condition warrants the use of endotracheal intubation under general anaesthesia during oesophageal obstruction treatment?
Which condition warrants the use of endotracheal intubation under general anaesthesia during oesophageal obstruction treatment?
Which substance is commonly used for causing smooth muscle relaxation in the treatment of oesophageal issues?
Which substance is commonly used for causing smooth muscle relaxation in the treatment of oesophageal issues?
Which of the following statements about simple obstructions is true?
Which of the following statements about simple obstructions is true?
What is the primary aim of treatment for equine EGUS?
What is the primary aim of treatment for equine EGUS?
Which treatment option is considered the only licensed treatment for EGUS?
Which treatment option is considered the only licensed treatment for EGUS?
What is the effect of proton pump inhibitors like Omeprazole?
What is the effect of proton pump inhibitors like Omeprazole?
What is a common clinical sign of equine EGUS?
What is a common clinical sign of equine EGUS?
What is the recommended dosage for Sucralfate when treating EGUS?
What is the recommended dosage for Sucralfate when treating EGUS?
Which of the following statements is true regarding the use of H2-antagonists like Ranitidine in EGUS treatment?
Which of the following statements is true regarding the use of H2-antagonists like Ranitidine in EGUS treatment?
What should follow-up therapy for EGUS treatment typically involve?
What should follow-up therapy for EGUS treatment typically involve?
Which of the following is NOT a characteristic of clinical signs in equine EGUS?
Which of the following is NOT a characteristic of clinical signs in equine EGUS?
Misoprostol is known to have which effect in the treatment of gastric issues?
Misoprostol is known to have which effect in the treatment of gastric issues?
How often should Proton Pump Inhibitors like Omeprazole be administered to be effective?
How often should Proton Pump Inhibitors like Omeprazole be administered to be effective?
Flashcards
Equine Esophageal Obstruction (Choke)
Equine Esophageal Obstruction (Choke)
A condition in horses where the esophagus becomes physically blocked, often by food.
Risk Factors for Choke
Risk Factors for Choke
Rapid ingestion of food, dry food sources, poor chewing, or dental issues can all contribute to choke.
Common Locations for Choke
Common Locations for Choke
The most common areas where choke occurs include the beginning of the esophagus, the point where it enters the chest, near the heart, and at the point where it joins the stomach.
Clinical Signs of Choke
Clinical Signs of Choke
Visible signs of choke include discharge from the nostrils with food, excessive drooling, neck spasms, anxiety, coughing, and a possible rapid heart rate.
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Palpable Mass in Choke
Palpable Mass in Choke
A palpable mass in the left side of the neck may be present, indicating a blockage within the esophagus.
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Treatment for Choke: Conservative Management
Treatment for Choke: Conservative Management
For many cases of choke, conservative management techniques can be effective, including giving the horse time to naturally pass the obstruction.
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Lowering the Head and Sedation for Choke
Lowering the Head and Sedation for Choke
Positioning the horse with its head lower than its body enables drainage of food and saliva, while sedation helps the horse relax and promotes the widening of the esophagus.
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Alpha-2 Agonists for Choke
Alpha-2 Agonists for Choke
The use of medications like alpha-2 agonists can further relax the esophageal muscle.
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Lowering the Head for Choke
Lowering the Head for Choke
This helps to drain food and saliva, widening the esophagus.
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Dehydration in Choke
Dehydration in Choke
This condition can lead to further complications, such as damage to the esophagus.
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Phenylbutazone/Flunixin in Cases of Choke
Phenylbutazone/Flunixin in Cases of Choke
This medication can worsen the blockage by making the horse less likely to move the food.
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Esophageal Obstruction
Esophageal Obstruction
A condition where a blockage occurs in the esophagus, preventing food or liquids from passing through.
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Conservative Treatment
Conservative Treatment
The initial approach to treating esophageal obstruction, involving simple techniques like lowering the horse's head and providing time for the obstruction to pass naturally.
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Esophageal Relaxants
Esophageal Relaxants
Medications that help relax the muscles of the esophagus, easing the blockage and promoting passage of food.
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Nasogastric (NG) Tube
Nasogastric (NG) Tube
A tube inserted through the nose and down the esophagus, allowing for delivery of fluids and lubricants to the obstruction.
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Cautious Use of NG Tube
Cautious Use of NG Tube
A careful approach to utilizing an NG tube, ensuring it doesn't cause further harm to the esophagus.
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Low Volume Lavage
Low Volume Lavage
A procedure where fluids are administered through an NG tube to help lubricate and potentially loosen the obstruction.
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High Volume Lavage/Endoscopic Removal
High Volume Lavage/Endoscopic Removal
A treatment for esophageal obstruction involving aggressive options like high-volume lavage or endoscopic removal, typically performed under anesthesia and requiring referral.
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Chronic Esophageal Obstruction
Chronic Esophageal Obstruction
Cases of esophageal obstruction that persist for 24 hours despite conservative treatment, usually requiring further investigation and referral to a specialized facility.
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What is the cardia?
What is the cardia?
The part of the stomach connecting the esophagus to the body of the stomach, lined with tough, protective cells. This area is less prone to ulcers.
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What is the glandular mucosa?
What is the glandular mucosa?
The main part of the stomach that secretes acid and digestive enzymes. This area is where most stomach ulcers occur.
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What is glandular mucosal protection?
What is glandular mucosal protection?
The lining of the stomach that produces mucus and bicarbonate to protect it from acid. It also helps with healing.
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What is the Margo Plicatus?
What is the Margo Plicatus?
A line separating the cardia from the glandular mucosa in the stomach. It's important for understanding the location of ulcers.
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What is Equine Squamous Gastric Disease (ESGD)?
What is Equine Squamous Gastric Disease (ESGD)?
A condition caused by direct contact with gastric acid in the stomach. It is common in performance horses.
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What is Equine Glandular Gastric Disease (EGGD)?
What is Equine Glandular Gastric Disease (EGGD)?
A type of stomach ulcer linked to a breakdown in the stomach's natural defenses. It can occur alongside or without squamous ulcers.
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What is a high-carbohydrate, low-forage diet?
What is a high-carbohydrate, low-forage diet?
A common risk factor for EGUS, characterized by reduced forage in the diet.
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What is intermittent feeding or fasting?
What is intermittent feeding or fasting?
A risk factor for EGUS caused by periods of no food intake.
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What is water restriction?
What is water restriction?
A risk factor for EGUS that involves a lack of access to water.
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What is intense exercise?
What is intense exercise?
A risk factor for EGUS, often caused by intensive training and competition.
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What is EGUS?
What is EGUS?
Equine Gastric Ulcer Syndrome, a common condition in horses affecting the stomach lining. Most often affects the squamous and glandular regions of the stomach.
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What is the primary cause of EGUS?
What is the primary cause of EGUS?
While no singular pathogen has been directly linked to EGUS, Helicobacter pylori, known to cause ulcers in humans, is not a primary cause in horses.
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What are the signs of EGUS?
What are the signs of EGUS?
Signs of EGUS can be subtle and variable, making diagnosis challenging. Common symptoms include poor performance, changes in appetite, weight loss, and behavioral changes.
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How is EGUS definitively diagnosed?
How is EGUS definitively diagnosed?
Gastroscopy is the gold standard for diagnosing EGUS. It allows direct visualization of the stomach lining and confirmation of ulcers.
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What is the main aim of EGUS treatment?
What is the main aim of EGUS treatment?
The primary goal of EGUS treatment is to raise the stomach pH above 4. This helps neutralize acid and promote healing of the ulcers.
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What is the main drug for EGUS treatment?
What is the main drug for EGUS treatment?
Omeprazole is a proton pump inhibitor used to suppress acid production in the stomach. It's the only licensed treatment for EGUS and highly effective with a good safety profile.
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What is another key treatment for EGUS?
What is another key treatment for EGUS?
Sucralfate is a mucosal protectant that forms a protective barrier over ulcers and promotes healing. It's often used in conjunction with Omeprazole.
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What's another class of medication for EGUS?
What's another class of medication for EGUS?
H2 antagonists like ranitidine help reduce acid production but are less effective than Omeprazole. Their use in treating EGUS is now limited.
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How long does EGUS treatment last?
How long does EGUS treatment last?
The duration of treatment for EGUS depends on the severity and type of ulcers. Omeprazole is typically used for 3 weeks for squamous ulcers and 4-8 weeks for glandular ulcers.
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What are treatment options for resistant EGUS?
What are treatment options for resistant EGUS?
Refractory cases of EGUS may require long-acting injectable omeprazole or other off-label medications like esomeprazole. Prostaglandin analogues may be considered for glandular ulcers.
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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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