Podcast
Questions and Answers
Which of the following cranial nerves is NOT directly involved in the process of mastication?
Which of the following cranial nerves is NOT directly involved in the process of mastication?
- Hypoglossal (CN XII)
- Facial (CN VII)
- Vagus (CN X) (correct)
- Trigeminal (CN V)
In a horse with dysphagia, what is the MOST critical immediate concern regarding saliva loss?
In a horse with dysphagia, what is the MOST critical immediate concern regarding saliva loss?
- Hypochloremic metabolic alkalosis (correct)
- Hypernatremia
- Hyperkalemia
- Metabolic acidosis
A horse is diagnosed with Equine Protozoal Myelitis (EPM) affecting the brainstem. Which combination of clinical signs would MOST strongly suggest involvement of cranial nerves associated with dysphagia?
A horse is diagnosed with Equine Protozoal Myelitis (EPM) affecting the brainstem. Which combination of clinical signs would MOST strongly suggest involvement of cranial nerves associated with dysphagia?
- Facial paralysis, circling, and absent gag reflex
- Lack of menace response, head tilt, and tongue weakness
- Seizures, blindness, and loss of balance
- Difficulty swallowing, nasal discharge, and coughing during eating (correct)
Which of the following conditions affecting prehension is MOST likely to present with an acute onset of clinical signs, including the inability to grasp food, and may be associated with recent exposure to specific neurotoxins?
Which of the following conditions affecting prehension is MOST likely to present with an acute onset of clinical signs, including the inability to grasp food, and may be associated with recent exposure to specific neurotoxins?
A horse presents with slow chewing, food falling from the mouth, and the formation of 'quids' of partially masticated feed. What underlying issue does this MOST strongly indicate?
A horse presents with slow chewing, food falling from the mouth, and the formation of 'quids' of partially masticated feed. What underlying issue does this MOST strongly indicate?
During an endoscopic examination of a horse with dysphagia, a lesion is observed affecting the guttural pouch. Which of the following is the MOST immediate life-threatening concern associated with guttural pouch mycosis that directly contributes to dysphagia?
During an endoscopic examination of a horse with dysphagia, a lesion is observed affecting the guttural pouch. Which of the following is the MOST immediate life-threatening concern associated with guttural pouch mycosis that directly contributes to dysphagia?
A horse is suspected of having an esophageal obstruction (choke). After initial assessment, what is the MOST crucial next step in confirming the diagnosis?
A horse is suspected of having an esophageal obstruction (choke). After initial assessment, what is the MOST crucial next step in confirming the diagnosis?
What is the PRIMARY rationale for administering sedatives, such as Buscopan, during the treatment of choke in horses?
What is the PRIMARY rationale for administering sedatives, such as Buscopan, during the treatment of choke in horses?
In managing a horse with chronic dysphagia and significant weight loss, which LONG-TERM nutritional strategy would be MOST appropriate to ensure adequate caloric intake and minimize complications?
In managing a horse with chronic dysphagia and significant weight loss, which LONG-TERM nutritional strategy would be MOST appropriate to ensure adequate caloric intake and minimize complications?
Which diagnostic finding would MOST strongly suggest that a horse's dysphagia is caused by a peripheral nerve disease affecting the pharynx, rather than a central nervous system (CNS) disorder?
Which diagnostic finding would MOST strongly suggest that a horse's dysphagia is caused by a peripheral nerve disease affecting the pharynx, rather than a central nervous system (CNS) disorder?
Which of the following steps is MOST important when first approaching a horse exhibiting clinical signs of difficulty eating?
Which of the following steps is MOST important when first approaching a horse exhibiting clinical signs of difficulty eating?
A horse with confirmed esophageal obstruction experiences a sudden onset of severe respiratory distress. What complication is MOST likely occurring?
A horse with confirmed esophageal obstruction experiences a sudden onset of severe respiratory distress. What complication is MOST likely occurring?
Which cranial nerve is primarily responsible for the motor function of the lips, and therefore MOST crucial for prehension?
Which cranial nerve is primarily responsible for the motor function of the lips, and therefore MOST crucial for prehension?
Following resolution of an esophageal obstruction, which diagnostic procedure is MOST critical to perform to assess the extent of damage and predict potential long-term complications?
Following resolution of an esophageal obstruction, which diagnostic procedure is MOST critical to perform to assess the extent of damage and predict potential long-term complications?
What is the MOST likely acid-base and electrolyte derangement observed in a horse with prolonged saliva loss due to dysphagia?
What is the MOST likely acid-base and electrolyte derangement observed in a horse with prolonged saliva loss due to dysphagia?
Which of the following conditions is LEAST likely to directly cause a mechanical, non-neurological dysphagia in horses?
Which of the following conditions is LEAST likely to directly cause a mechanical, non-neurological dysphagia in horses?
Which of the following diagnostic tests would be MOST useful in differentiating between pharyngeal and esophageal dysphagia in a horse?
Which of the following diagnostic tests would be MOST useful in differentiating between pharyngeal and esophageal dysphagia in a horse?
Administration of which medication is CONTRAINDICATED during the treatment of choke in mares?
Administration of which medication is CONTRAINDICATED during the treatment of choke in mares?
A horse is diagnosed with Temporohyoid Osteoarthropathy (THO). Which cranial nerve is MOST likely affected, leading to difficulties in prehension or mastication?
A horse is diagnosed with Temporohyoid Osteoarthropathy (THO). Which cranial nerve is MOST likely affected, leading to difficulties in prehension or mastication?
What is the MAIN objective of supportive care in a horse with difficulty in eating?
What is the MAIN objective of supportive care in a horse with difficulty in eating?
Which of the following is an indication of prehension difficulties specifically, rather than mastication or swallowing problems?
Which of the following is an indication of prehension difficulties specifically, rather than mastication or swallowing problems?
A horse showing signs of dysphagia is examined, and guttural pouch mycosis is suspected. Which of the following diagnostic findings would MOST strongly support this suspicion?
A horse showing signs of dysphagia is examined, and guttural pouch mycosis is suspected. Which of the following diagnostic findings would MOST strongly support this suspicion?
Following initial stabilization of a horse with choke, PRIOR to attempting to relieve the obstruction via a nasogastric tube, which medication is MOST appropriate to administer to reduce the risk of esophageal trauma?
Following initial stabilization of a horse with choke, PRIOR to attempting to relieve the obstruction via a nasogastric tube, which medication is MOST appropriate to administer to reduce the risk of esophageal trauma?
A horse presents with dysphagia and is found to have a retropharyngeal abscess. What is the MOST significant immediate risk associated with this condition?
A horse presents with dysphagia and is found to have a retropharyngeal abscess. What is the MOST significant immediate risk associated with this condition?
When managing a horse with dysphagia, what is the PRIMARY concern related to saliva loss that should guide the fluid therapy plan?
When managing a horse with dysphagia, what is the PRIMARY concern related to saliva loss that should guide the fluid therapy plan?
You perform an oral exam on a horse and observe ulcers on the tongue. Which condition would be MOST likely to cause these ulcers?
You perform an oral exam on a horse and observe ulcers on the tongue. Which condition would be MOST likely to cause these ulcers?
Which of the following cranial nerves is MOST important for swallowing?
Which of the following cranial nerves is MOST important for swallowing?
Which part of the process of eating are the pharyngeal and esophageal actions associated with?
Which part of the process of eating are the pharyngeal and esophageal actions associated with?
What is the PRIMARY function of the upper esophageal sphincter?
What is the PRIMARY function of the upper esophageal sphincter?
What is a major clinical sign of mastication problems?
What is a major clinical sign of mastication problems?
Which disease could affect any cranial nerve, potentially resulting in problems of eating?
Which disease could affect any cranial nerve, potentially resulting in problems of eating?
What does dysphagia refer to, used in the context of a lecture on difficulties in eating?
What does dysphagia refer to, used in the context of a lecture on difficulties in eating?
Which of the following steps is undertaken when treating a horse with choke?
Which of the following steps is undertaken when treating a horse with choke?
Which of these toxins cause prehension problems?
Which of these toxins cause prehension problems?
What is the initial treatment strategy for a horse diagnosed with choke due to esophageal obstruction?
What is the initial treatment strategy for a horse diagnosed with choke due to esophageal obstruction?
When a horse is diagnosed with dysphagia, what concerns warrant monitoring?
When a horse is diagnosed with dysphagia, what concerns warrant monitoring?
A horse exhibits difficulty in elevating its soft palate during swallowing. Which of the following phases of swallowing is MOST directly affected?
A horse exhibits difficulty in elevating its soft palate during swallowing. Which of the following phases of swallowing is MOST directly affected?
During an endoscopic examination of a horse with suspected dysphagia, the veterinarian observes a lesion affecting the glossopharyngeal nerve. Which specific functional deficit would be MOST anticipated based on this finding?
During an endoscopic examination of a horse with suspected dysphagia, the veterinarian observes a lesion affecting the glossopharyngeal nerve. Which specific functional deficit would be MOST anticipated based on this finding?
A horse with temporohyoid osteoarthropathy (THO) is MOST likely to exhibit which of the following clinical signs related to eating?
A horse with temporohyoid osteoarthropathy (THO) is MOST likely to exhibit which of the following clinical signs related to eating?
In a horse diagnosed with Equine Protozoal Myelitis (EPM) affecting the brainstem, which diagnostic test would be MOST useful to assess the specific cranial nerve deficits contributing to observed dysphagia?
In a horse diagnosed with Equine Protozoal Myelitis (EPM) affecting the brainstem, which diagnostic test would be MOST useful to assess the specific cranial nerve deficits contributing to observed dysphagia?
After diagnosing a horse with choke secondary to esophageal obstruction, which of the following complications would be MOST likely to lead to a guarded long-term prognosis?
After diagnosing a horse with choke secondary to esophageal obstruction, which of the following complications would be MOST likely to lead to a guarded long-term prognosis?
A horse presents with clinical signs of dysphagia, including nasal discharge, coughing during eating, and food material observed in the trachea upon endoscopic examination. Which of the following diagnostic findings would MOST strongly suggest a dysfunction of the upper esophageal sphincter?
A horse presents with clinical signs of dysphagia, including nasal discharge, coughing during eating, and food material observed in the trachea upon endoscopic examination. Which of the following diagnostic findings would MOST strongly suggest a dysfunction of the upper esophageal sphincter?
Following relief of an esophageal obstruction in a horse, which of the following management strategies is MOST critical to prevent recurrence, especially in a horse with a history of rapid eating?
Following relief of an esophageal obstruction in a horse, which of the following management strategies is MOST critical to prevent recurrence, especially in a horse with a history of rapid eating?
A horse is diagnosed with guttural pouch mycosis complicated by dysphagia. If the fungal plaque is localized near cranial nerves IX and X, which of the following combinations of clinical signs is MOST likely to be observed?
A horse is diagnosed with guttural pouch mycosis complicated by dysphagia. If the fungal plaque is localized near cranial nerves IX and X, which of the following combinations of clinical signs is MOST likely to be observed?
When managing a horse with chronic dysphagia, what is the MOST significant concern related to electrolyte imbalances resulting from saliva loss?
When managing a horse with chronic dysphagia, what is the MOST significant concern related to electrolyte imbalances resulting from saliva loss?
A horse presents with acute onset of prehension difficulties and is suspected of having nigropallidal encephalomalacia due to yellow star thistle toxicity. Which of the following neurological deficits would MOST specifically support this diagnosis?
A horse presents with acute onset of prehension difficulties and is suspected of having nigropallidal encephalomalacia due to yellow star thistle toxicity. Which of the following neurological deficits would MOST specifically support this diagnosis?
Which of the following scenarios presents the GREATEST risk of aspiration pneumonia as a complication of dysphagia in a horse?
Which of the following scenarios presents the GREATEST risk of aspiration pneumonia as a complication of dysphagia in a horse?
During an oral examination of a horse, ulcers are observed on the tongue. Which of the following etiologies is the MOST likely cause?
During an oral examination of a horse, ulcers are observed on the tongue. Which of the following etiologies is the MOST likely cause?
What is the MOST critical factor in differentiating between prehension and mastication problems in horses?
What is the MOST critical factor in differentiating between prehension and mastication problems in horses?
Which of the following clinical signs is MOST indicative of difficulties in the esophageal phase of swallowing?
Which of the following clinical signs is MOST indicative of difficulties in the esophageal phase of swallowing?
Which of the following is the MOST appropriate INITIAL treatment strategy for managing a horse diagnosed with choke due to esophageal obstruction?
Which of the following is the MOST appropriate INITIAL treatment strategy for managing a horse diagnosed with choke due to esophageal obstruction?
Which of the following clinical signs is the MOST specific indicator of prehension difficulty related to cranial nerve dysfunction?
Which of the following clinical signs is the MOST specific indicator of prehension difficulty related to cranial nerve dysfunction?
A horse with dysphagia secondary to guttural pouch mycosis is at GREATEST risk of developing which of the following complications?
A horse with dysphagia secondary to guttural pouch mycosis is at GREATEST risk of developing which of the following complications?
Which of the following diagnostic approaches is MOST effective in differentiating between esophageal obstruction and pharyngeal dysfunction as the cause of dysphagia?
Which of the following diagnostic approaches is MOST effective in differentiating between esophageal obstruction and pharyngeal dysfunction as the cause of dysphagia?
Which of the following is the MOST important consideration when formulating a long-term nutritional plan for a horse with chronic dysphagia?
Which of the following is the MOST important consideration when formulating a long-term nutritional plan for a horse with chronic dysphagia?
What is the PRIMARY concern regarding saliva loss in a horse with dysphagia?
What is the PRIMARY concern regarding saliva loss in a horse with dysphagia?
Which of the following cranial nerves is LEAST directly associated with the physical act of prehension in horses?
Which of the following cranial nerves is LEAST directly associated with the physical act of prehension in horses?
What is the MOST significant long-term complication to monitor for after a horse recovers from an episode of choke?
What is the MOST significant long-term complication to monitor for after a horse recovers from an episode of choke?
In a horse with suspected esophageal obstruction (choke), which diagnostic finding would MOST definitively confirm the diagnosis?
In a horse with suspected esophageal obstruction (choke), which diagnostic finding would MOST definitively confirm the diagnosis?
A horse with a long history of mastication problems is likely to develop which of the following secondary complications?
A horse with a long history of mastication problems is likely to develop which of the following secondary complications?
Which cranial nerve is MOST crucial for the motor function of the tongue during mastication and swallowing?
Which cranial nerve is MOST crucial for the motor function of the tongue during mastication and swallowing?
During an episode of choke, a horse begins to exhibit significant respiratory distress. What is the MOST likely underlying cause of this distress?
During an episode of choke, a horse begins to exhibit significant respiratory distress. What is the MOST likely underlying cause of this distress?
In managing a horse with dysphagia, why is it important to differentiate between pharyngeal and esophageal dysfunction?
In managing a horse with dysphagia, why is it important to differentiate between pharyngeal and esophageal dysfunction?
A horse is suspected of having a pharyngeal foreign body causing acute dysphagia. What imaging modality would provide the MOST definitive diagnosis?
A horse is suspected of having a pharyngeal foreign body causing acute dysphagia. What imaging modality would provide the MOST definitive diagnosis?
Which of the following is the MOST likely acid-base and electrolyte derangement observed in a horse with prolonged saliva loss due to dysphagia?
Which of the following is the MOST likely acid-base and electrolyte derangement observed in a horse with prolonged saliva loss due to dysphagia?
Which anatomical structure is MOST crucial for preventing aspiration during the swallowing process?
Which anatomical structure is MOST crucial for preventing aspiration during the swallowing process?
A horse is diagnosed with HYPP and exhibits signs of dysphagia. What is the underlying mechanism by which HYPP can cause difficulty in swallowing?
A horse is diagnosed with HYPP and exhibits signs of dysphagia. What is the underlying mechanism by which HYPP can cause difficulty in swallowing?
Which diagnostic finding would MOST strongly suggest that a horse's dysphagia is caused by a peripheral nerve disease affecting the pharynx, RATHER than a muscle disorder like HYPP?
Which diagnostic finding would MOST strongly suggest that a horse's dysphagia is caused by a peripheral nerve disease affecting the pharynx, RATHER than a muscle disorder like HYPP?
What is the PRIMARY purpose of administering sedatives, such as detomidine, during the initial management of choke in horses?
What is the PRIMARY purpose of administering sedatives, such as detomidine, during the initial management of choke in horses?
A horse presents with dysphagia, and the veterinarian suspects botulism. Which clinical sign would be MOST consistent with this diagnosis?
A horse presents with dysphagia, and the veterinarian suspects botulism. Which clinical sign would be MOST consistent with this diagnosis?
What is the MOST important factor in providing supportive care to a horse with difficulty in eating?
What is the MOST important factor in providing supportive care to a horse with difficulty in eating?
Which of the following clinical signs is MOST indicative of a mastication problem, rather than an issue with prehension or swallowing?
Which of the following clinical signs is MOST indicative of a mastication problem, rather than an issue with prehension or swallowing?
A horse is suspected of having Temporohyoid Osteoarthropathy (THO). Which diagnostic findings would BEST confirm this suspicion?
A horse is suspected of having Temporohyoid Osteoarthropathy (THO). Which diagnostic findings would BEST confirm this suspicion?
In a horse experiencing choke, what is the PRIMARY rationale for using Buscopan (N-butylscopolammonium bromide) as part of the treatment protocol?
In a horse experiencing choke, what is the PRIMARY rationale for using Buscopan (N-butylscopolammonium bromide) as part of the treatment protocol?
Flashcards
What is Dysphagia?
What is Dysphagia?
Difficulty in eating. Can involve prehension, mastication, or swallowing.
What is Prehension?
What is Prehension?
Grasping food with lips, incisors.
What is Mastication?
What is Mastication?
Chewing food
What is Swallowing?
What is Swallowing?
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What is needed for Prehension?
What is needed for Prehension?
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What is mastication?
What is mastication?
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What is the function of Trigeminal?
What is the function of Trigeminal?
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What is the function of Facial 7 in mastication?
What is the function of Facial 7 in mastication?
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What is the function of Hypoglossal?
What is the function of Hypoglossal?
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Swallowing: Tongue action?
Swallowing: Tongue action?
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Key swallowing actions?
Key swallowing actions?
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Nerves for Swallowing?
Nerves for Swallowing?
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Esophagus position?
Esophagus position?
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Clinical signs of Prehension?
Clinical signs of Prehension?
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Causes of Prehension Problems?
Causes of Prehension Problems?
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Nigropallidal encephalomalacia?
Nigropallidal encephalomalacia?
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What is Equine Protozoal Myelitis?
What is Equine Protozoal Myelitis?
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Signs of Prehension Issues?
Signs of Prehension Issues?
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Neuromuscular issues that affect eating?
Neuromuscular issues that affect eating?
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Mastication clinical signs?
Mastication clinical signs?
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Main cause of Mastication issues?
Main cause of Mastication issues?
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Neurologic diseases related to mastication?
Neurologic diseases related to mastication?
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What is Dysphagia?
What is Dysphagia?
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Clinical signs of Dysphagia?
Clinical signs of Dysphagia?
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Endoscopic Pharynx exam shows the...
Endoscopic Pharynx exam shows the...
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Causes of Peripheral nerve disease(Pharynx)?
Causes of Peripheral nerve disease(Pharynx)?
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Guttural pouch mycosis?
Guttural pouch mycosis?
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Causes of trauma-peripheral nerve disease?
Causes of trauma-peripheral nerve disease?
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Muscle diseases related to Pharyngeal Dysphagia?
Muscle diseases related to Pharyngeal Dysphagia?
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CNS diseases and relation to pharyngeal dysphagia?
CNS diseases and relation to pharyngeal dysphagia?
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Most common esophageal problem?
Most common esophageal problem?
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Clinical signs of Choke?
Clinical signs of Choke?
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Treatment of Choke?
Treatment of Choke?
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Smooth muscle relaxation?
Smooth muscle relaxation?
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Treatment for Choke?
Treatment for Choke?
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What is the #1 Rule of treating eating problems?
What is the #1 Rule of treating eating problems?
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What is Supportive Care?
What is Supportive Care?
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Management of Dysphagia?
Management of Dysphagia?
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Management concerns for Dysphagia?
Management concerns for Dysphagia?
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Management of Aspiration Pneumonia
Management of Aspiration Pneumonia
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Dysphagia
Dysphagia
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Prehension
Prehension
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Mastification
Mastification
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Swallowing
Swallowing
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Prehension Requirements
Prehension Requirements
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Clinical Signs of Mastication Problems
Clinical Signs of Mastication Problems
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Choke
Choke
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Study Notes
Objective of Lecture
- The lecture defines dysphagia as used in the context of the presentation.
- It covers prehension, mastication, and dysphagia, including their clinical signs, differential diagnoses (DDx), and diagnostic approaches.
- Also covered are methods to treat choke and management strategies for each eating problem.
The Process of Eating
- Eating involves prehension, mastication, and swallowing.
- Swallowing is further divided into pharyngeal and esophageal phases.
Prehension
- This involves proper use of the lips, normal incisors, and a normal maxilla and mandible.
- Cranial nerves involved include Facial nerve 7 responsible for motor function of the lips, and Trigeminal nerve 5 responsible for sensory function of the face.
- Sight and smell via cranial nerves 1 and 2 are also important for prehension.
Mastication
- Mastication is the chewing of food and requires teeth, tongue and muscles of mastication.
Cranial Nerves Needed for Mastication
- Trigeminal nerve (5): controls motor function to muscles of mastication and sensory function to mucosa and teeth.
- Facial nerve (7): controls motor function to lips and cheeks, sensory to 2/3 of tongue, and parasympathetic function to the salivary gland.
- Hypoglossal nerve (12): controls motor function to the tongue.
Swallowing
- Swallowing is divided into pharyngeal and esophageal phases and it requires a healthy neurological system, neuromuscular junction, muscle function, and normal anatomy.
The Normal Swallowing Process
- Food bolus is positioned by the tongue.
- The soft palate elevates.
- The larynx moves forward, and the epiglottis is tipped caudally.
- Pharyngeal contractions occur, along with cranial esophageal sphincter function.
Cranial Nerves Involved in Swallowing
- Glossopharyngeal nerve (9).
- Vagus nerve (10).
- Accessory nerve (11).
- Hypoglossal nerve (12).
Esophagus
- It is located initially dorsal to the trachea.
- Cervically, it's to the left of the trachea, and then in the thorax, it's located dorsal to the trachea, passing through the diaphragm.
Esophageal Sphincters
- The Upper sphincter prevents air aspiration and esophagopharyngeal reflux.
- The Lower sphincter, located at the gastroesophageal junction, prevents reflux.
Diseases/Problems with Eating
- Can occur in prehension, mastication, or swallowing phases.
Difficulties in Eating: Dysphagia
- Dysphagia means difficulty in eating, or difficulty in swallowing
- Proper definition of the problem is key; is it prehension, mastication, or swallowing?
- Different diseases affect each stage.
- Some clinicians/textbooks will use dysphagia as a term for problems with eating.
Basic Approach to Difficulties in Eating
- Take a history and a precise description of the complaint.
- Do a physical examination.
- Distinguish between anorexia and difficulty in eating.
- Determine if there is difficulty in eating versus not wanting to eat.
- Remember rabies.
Observe The Horse Eating
- Try different feeds like hay, grain, and grass and observe the time is takes to eat.
- Determine what the horse does when it tries to eat.
- Determine if the horse can drink.
- Do not do this in emergencies like choke or esophageal obstruction.
Difficulties of Prehension - Clinical Signs
- Difficulty grasping food and pulling it into the mouth.
- Absence of food from the nostrils or down the trachea.
- Absence of masticated food coming out of the mouth.
Prehension Problems Affecting the Central Nervous System
- Nigropallidal encephalomalacia.
- Yellow star thistle poisoning.
- Russian knapweed poisoning.
Nigropallidal Encephalomalacia
- Affected animals have problems with prehension.
- Some can still swallow if food/water is put in the back of pharynx.
Equine Protozoal Myelitis (EPM)
- A protozoal disease can affect the central nervous system in horses, specifically the spinal cord and brain stem.
- EPM can affect any cranial nerve that results in eating problems.
- Manifestations can include: Prehension (7), Mastication (5), or Dysphagia (9-12).
Temporohyoid Osteopathy (THO)
- This is another potential cause of eating difficulties.
Other Diseases
- Botulism (neuromuscular disease), HYPP (muscle disease), and tetanus (central neurological disease) can all result in abnormalities of prehension, mastication, and swallowing.
- Dysphagia is more "classic" for some of these diseases.
Tumors and Fractures
- These structural abnormalities are potential causes of eating difficulty
Oral Ulcers
- Vesicular Stomatitis can cause this conditions
Mastication Problems - Clinical Signs
- Slow chewing.
- Food coming out of the mouth ("quidding").
- Clumps of hay dropping from the mouth.
- Absence of food out of the nostrils.
- Absence of aspiration (no coughing).
Abnormal Dentition
- It's the number one problem associated with mastication issues.
Mastication Problems
- These can stem from neurologic disease. Conditions like EPM, Rabies, and tetanus can cause CN 5,7, or 12 to not function properly.
- Muscular and neuromuscular diseases such as HYPP and Botulism may also cause mastication difficulty
- All of the diseases may also affect prehension and swallowing.
Dysphagia: Clinical Signs
- Food coming out of the mouth or nose.
- Coughing during eating, indicating aspiration.
Dysphagia
- It is difficulty in swallowing.
- It can be divided into Upper (Pharynx/Larynx) and Lower (Esophageal function).
- To diagnose, the next step is to determine if the problem is pharyngeal or esophageal.
Passing a Nasogastric (NG) Tube
- Passing an NG tube can help determine the location of the issue
- If an NG tube can pass into the esophagus but not into the stomach, an esophageal obstruction (choke) is likely.
- If the NG tube can pass into the stomach, choke can be ruled out.
Endoscopic Exam - Pharynx
- An endoscopic exam can reveal abnormalities with pharynx, neurological function, neuromuscular function or muscle problems
Peripheral Nerve Disease-Pharynx
- Guttural pouch diseases (common) - Mycosis or Strep equi
- Trauma
- Botulism (neuromuscular)
- Lead toxicity (rare)
Guttural Pouch Mycosis
- This can cause hemorrhage and dysphagia and is difficult to treat.
Trauma – Peripheral Nerve Disease
- Can be caused by Rupture of the Longus Capitus or Basisphenoid Fractures.
Muscle Disease - Dysphagia
- Hyperkalemic Periodic Paralysis (HYPP).
- White Muscle Disease in foals which stems from a selenium deficiency.
CNS Diseases
- Tetanus.
- Rabies.
- EPM.
- Herpes.
- Viral encephalitis.
Anatomical Problems-Pharynx
- Cleft Palate
- Chondritis
- Epiglottic entrapment
- Retropharyngeal abscess
- Tumor
- These also result in URT Obstruction.
Esophageal Problems
- Choke is esophageal obstruction and not a tracheal obstruction.
- Risk factors include poor mastication (teeth) and eating too fast.
- Secondary issues to choke include stricture, diverticulum and esophageal rupture, and aspiration pneumonia.
Choke - Clinical Signs
- Dysphagia
- Food coming out of the nose, mouth, and trachea.
- Retching, distressed state.
- Palpable mass in the esophagus may be present.
- Diagnosis is confirmed when unable to pass an NG tube into the stomach.
Treatment of Choke
- Place an NG tube in the esophagus against the obstruction.
- Sedate the animal to relax the esophagus and keep its head down to prevent aspiration pneumonia.
- Gently apply pressure with the NG tube.
- Slowly pump water into the esophagus to try to push the obstruction into the stomach (Food/water may come out of the nose).
- Medications -Buscopan (N-butylscopolammonium bromide) to relax smooth muscle or Oxytocin+/- (careful in mares)
- Intraluminal lidocaine
- Administer IV fluids if dehydrated and Antibiotics if aspiration pneumonia is present.
- Administer NSAIDs to decrease inflammation.
- Perform an endoscopy to assess damage.
Management of Problems of Eating
- Treat the primary problem.
- Provide supportive care, including nutrition and fluids.
Goals & Concerns of Dysphagia
- The main goal is to meet nutrition and fluid requirements.
- Saliva loss is a significant concern and horses are different than cattle
- Equine saliva has higher Cl and lower HCO3 compared to ruminants causing a loss of Na and Cl and Hypochloremic metabolic alkalosis
- Aspiration pneumonia is a concern.
Management of Dysphagia
- Enteral fluids & nutrition through home-made means (ground up complete feed pellets).
- Commercial products like Platinum Performance, Purina (Well-Gel), and Human – Ensure.
- Parental nutrition is an option
- Monitor electrolytes & BG frequently.
- Supplement NaCl or NaHCO3.
- Supplement K, as needed.
- Antibiotics for aspiration pneumonia.
- Completely remove feed and water from the animal.
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