3 Equine Difficulty in Eating

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Questions and Answers

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?

  • 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?

  • 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?

<p>Nigropallidal encephalomalacia (B)</p> Signup and view all the answers

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?

<p>Dental abnormalities (D)</p> Signup and view all the answers

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?

<p>Damage to cranial nerves (B)</p> Signup and view all the answers

A horse is suspected of having an esophageal obstruction (choke). After initial assessment, what is the MOST crucial next step in confirming the diagnosis?

<p>Attempting to pass a nasogastric tube (A)</p> Signup and view all the answers

What is the PRIMARY rationale for administering sedatives, such as Buscopan, during the treatment of choke in horses?

<p>To relax the esophageal muscles and reduce spasm (D)</p> Signup and view all the answers

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?

<p>Providing a 'slurry' of easily digestible feed and supplementing with enteral fluids (B)</p> Signup and view all the answers

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?

<p>Presence of guttural pouch mycosis observed during an endoscopic examination. (D)</p> Signup and view all the answers

Which of the following steps is MOST important when first approaching a horse exhibiting clinical signs of difficulty eating?

<p>Obtain a thorough history and observe the horse attempting to eat (C)</p> Signup and view all the answers

A horse with confirmed esophageal obstruction experiences a sudden onset of severe respiratory distress. What complication is MOST likely occurring?

<p>Severe aspiration pneumonia (B)</p> Signup and view all the answers

Which cranial nerve is primarily responsible for the motor function of the lips, and therefore MOST crucial for prehension?

<p>Facial (CN VII) (D)</p> Signup and view all the answers

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?

<p>Esophagoscopy (D)</p> Signup and view all the answers

What is the MOST likely acid-base and electrolyte derangement observed in a horse with prolonged saliva loss due to dysphagia?

<p>Metabolic alkalosis with hypochloremia (A)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to directly cause a mechanical, non-neurological dysphagia in horses?

<p>Equine Protozoal Myelitis (EPM) (C)</p> Signup and view all the answers

Which of the following diagnostic tests would be MOST useful in differentiating between pharyngeal and esophageal dysphagia in a horse?

<p>Endoscopic examination (A)</p> Signup and view all the answers

Administration of which medication is CONTRAINDICATED during the treatment of choke in mares?

<p>Oxytocin (C)</p> Signup and view all the answers

A horse is diagnosed with Temporohyoid Osteoarthropathy (THO). Which cranial nerve is MOST likely affected, leading to difficulties in prehension or mastication?

<p>Facial nerve (CN VII) (B)</p> Signup and view all the answers

What is the MAIN objective of supportive care in a horse with difficulty in eating?

<p>To provide necessary nutrition and fluids (C)</p> Signup and view all the answers

Which of the following is an indication of prehension difficulties specifically, rather than mastication or swallowing problems?

<p>Difficulty grasping food and pulling it into the mouth (B)</p> Signup and view all the answers

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?

<p>Endoscopic evidence of fungal plaques within the guttural pouch (D)</p> Signup and view all the answers

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?

<p>Lidocaine (D)</p> Signup and view all the answers

A horse presents with dysphagia and is found to have a retropharyngeal abscess. What is the MOST significant immediate risk associated with this condition?

<p>Tracheal compression and upper respiratory obstruction (B)</p> Signup and view all the answers

When managing a horse with dysphagia, what is the PRIMARY concern related to saliva loss that should guide the fluid therapy plan?

<p>Hypochloremia and metabolic alkalosis (C)</p> Signup and view all the answers

You perform an oral exam on a horse and observe ulcers on the tongue. Which condition would be MOST likely to cause these ulcers?

<p>Vesicular Stomatitis (B)</p> Signup and view all the answers

Which of the following cranial nerves is MOST important for swallowing?

<p>Vagus (CN X) (D)</p> Signup and view all the answers

Which part of the process of eating are the pharyngeal and esophageal actions associated with?

<p>Swallowing (B)</p> Signup and view all the answers

What is the PRIMARY function of the upper esophageal sphincter?

<p>To prevent air aspiration and esophagopharyngeal reflux (A)</p> Signup and view all the answers

What is a major clinical sign of mastication problems?

<p>Slow chewing (C)</p> Signup and view all the answers

Which disease could affect any cranial nerve, potentially resulting in problems of eating?

<p>EPM (C)</p> Signup and view all the answers

What does dysphagia refer to, used in the context of a lecture on difficulties in eating?

<p>Difficulty in Swallowing (A)</p> Signup and view all the answers

Which of the following steps is undertaken when treating a horse with choke?

<p>A and B (A)</p> Signup and view all the answers

Which of these toxins cause prehension problems?

<p>Yellow star thistle and Russian knapweed (C)</p> Signup and view all the answers

What is the initial treatment strategy for a horse diagnosed with choke due to esophageal obstruction?

<p>Passing a nasogastric tube while sedating the horse (D)</p> Signup and view all the answers

When a horse is diagnosed with dysphagia, what concerns warrant monitoring?

<p>Saliva loss (C)</p> Signup and view all the answers

A horse exhibits difficulty in elevating its soft palate during swallowing. Which of the following phases of swallowing is MOST directly affected?

<p>Pharyngeal phase, as the soft palate's elevation is crucial for preventing nasal regurgitation. (C)</p> Signup and view all the answers

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?

<p>Difficulty initiating the swallowing reflex and reduced pharyngeal motility. (C)</p> Signup and view all the answers

A horse with temporohyoid osteoarthropathy (THO) is MOST likely to exhibit which of the following clinical signs related to eating?

<p>Pain during mastication, causing the horse to drop partially chewed food. (D)</p> Signup and view all the answers

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?

<p>Fluoroscopy (dynamic radiography) of the pharynx and esophagus during swallowing. (A)</p> Signup and view all the answers

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?

<p>Severe esophageal stricture formation, compromising the esophageal lumen. (C)</p> Signup and view all the answers

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?

<p>Contrast radiography revealing a dilated pharynx with delayed esophageal entry. (B)</p> Signup and view all the answers

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?

<p>Feeding frequent small meals from a ground-level feeder to slow down the rate of consumption. (C)</p> Signup and view all the answers

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?

<p>Difficulty swallowing, nasal regurgitation, and laryngeal paralysis. (D)</p> Signup and view all the answers

When managing a horse with chronic dysphagia, what is the MOST significant concern related to electrolyte imbalances resulting from saliva loss?

<p>Hypochloremic metabolic alkalosis causing decreased respiratory drive. (C)</p> Signup and view all the answers

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?

<p>Inability to protrude the tongue and manipulate food in the mouth. (B)</p> Signup and view all the answers

Which of the following scenarios presents the GREATEST risk of aspiration pneumonia as a complication of dysphagia in a horse?

<p>A horse with severe laryngeal paralysis and absent cough reflex. (D)</p> Signup and view all the answers

During an oral examination of a horse, ulcers are observed on the tongue. Which of the following etiologies is the MOST likely cause?

<p>Vesicular stomatitis virus. (C)</p> Signup and view all the answers

What is the MOST critical factor in differentiating between prehension and mastication problems in horses?

<p>Observing if the horse can successfully grasp food with its lips and incisors. (C)</p> Signup and view all the answers

Which of the following clinical signs is MOST indicative of difficulties in the esophageal phase of swallowing?

<p>Regurgitation of undigested food hours after eating. (A)</p> Signup and view all the answers

Which of the following is the MOST appropriate INITIAL treatment strategy for managing a horse diagnosed with choke due to esophageal obstruction?

<p>Light sedation, passing a nasogastric tube to attempt to dislodge the obstruction, and slow infusion of water. (A)</p> Signup and view all the answers

Which of the following clinical signs is the MOST specific indicator of prehension difficulty related to cranial nerve dysfunction?

<p>The horse struggles to grasp food with its lips. (A)</p> Signup and view all the answers

A horse with dysphagia secondary to guttural pouch mycosis is at GREATEST risk of developing which of the following complications?

<p>Severe hemorrhage from erosion of the internal carotid artery. (B)</p> Signup and view all the answers

Which of the following diagnostic approaches is MOST effective in differentiating between esophageal obstruction and pharyngeal dysfunction as the cause of dysphagia?

<p>Endoscopic examination of the pharynx and esophagus. (C)</p> Signup and view all the answers

Which of the following is the MOST important consideration when formulating a long-term nutritional plan for a horse with chronic dysphagia?

<p>Ensuring adequate protein intake to support muscle mass and healing. (A)</p> Signup and view all the answers

What is the PRIMARY concern regarding saliva loss in a horse with dysphagia?

<p>Dehydration and electrolyte imbalance. (B)</p> Signup and view all the answers

Which of the following cranial nerves is LEAST directly associated with the physical act of prehension in horses?

<p>Olfactory nerve (I). (B)</p> Signup and view all the answers

What is the MOST significant long-term complication to monitor for after a horse recovers from an episode of choke?

<p>Esophageal stricture formation. (A)</p> Signup and view all the answers

In a horse with suspected esophageal obstruction (choke), which diagnostic finding would MOST definitively confirm the diagnosis?

<p>Inability to pass a nasogastric tube into the stomach. (D)</p> Signup and view all the answers

A horse with a long history of mastication problems is likely to develop which of the following secondary complications?

<p>Weight loss and poor body condition. (B)</p> Signup and view all the answers

Which cranial nerve is MOST crucial for the motor function of the tongue during mastication and swallowing?

<p>Hypoglossal nerve (XII). (D)</p> Signup and view all the answers

During an episode of choke, a horse begins to exhibit significant respiratory distress. What is the MOST likely underlying cause of this distress?

<p>Aspiration pneumonia from regurgitation. (B)</p> Signup and view all the answers

In managing a horse with dysphagia, why is it important to differentiate between pharyngeal and esophageal dysfunction?

<p>Specific diagnostic tests and treatments target different anatomical regions. (C)</p> Signup and view all the answers

A horse is suspected of having a pharyngeal foreign body causing acute dysphagia. What imaging modality would provide the MOST definitive diagnosis?

<p>Endoscopic examination of the pharynx. (C)</p> Signup and view all the answers

Which of the following is the MOST likely acid-base and electrolyte derangement observed in a horse with prolonged saliva loss due to dysphagia?

<p>Metabolic alkalosis with hypochloremia. (C)</p> Signup and view all the answers

Which anatomical structure is MOST crucial for preventing aspiration during the swallowing process?

<p>The epiglottis. (D)</p> Signup and view all the answers

A horse is diagnosed with HYPP and exhibits signs of dysphagia. What is the underlying mechanism by which HYPP can cause difficulty in swallowing?

<p>Muscular weakness affecting the tongue and pharyngeal muscles. (A)</p> Signup and view all the answers

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?

<p>Asymmetric muscle atrophy of the pharyngeal muscles, identified during endoscopy. (A)</p> Signup and view all the answers

What is the PRIMARY purpose of administering sedatives, such as detomidine, during the initial management of choke in horses?

<p>To relieve anxiety and allow for easier passage of a nasogastric tube. (B)</p> Signup and view all the answers

A horse presents with dysphagia, and the veterinarian suspects botulism. Which clinical sign would be MOST consistent with this diagnosis?

<p>Generalized muscle weakness and tongue paralysis. (D)</p> Signup and view all the answers

What is the MOST important factor in providing supportive care to a horse with difficulty in eating?

<p>Providing nutritional support tailored to the horse's ability to prehend, masticate, and swallow. (C)</p> Signup and view all the answers

Which of the following clinical signs is MOST indicative of a mastication problem, rather than an issue with prehension or swallowing?

<p>Dropping whole grains from the mouth while chewing. (A)</p> Signup and view all the answers

A horse is suspected of having Temporohyoid Osteoarthropathy (THO). Which diagnostic findings would BEST confirm this suspicion?

<p>Radiographic evidence of temporohyoid bone proliferation and fusion. (B)</p> Signup and view all the answers

In a horse experiencing choke, what is the PRIMARY rationale for using Buscopan (N-butylscopolammonium bromide) as part of the treatment protocol?

<p>To relieve esophageal spasm and facilitate passage of the obstruction. (C)</p> Signup and view all the answers

Flashcards

What is Dysphagia?

Difficulty in eating. Can involve prehension, mastication, or swallowing.

What is Prehension?

Grasping food with lips, incisors.

What is Mastication?

Chewing food

What is Swallowing?

Moving food from mouth to stomach

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What is needed for Prehension?

Lips, incisors, maxilla, mandible, facial nerves, trigeminal

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What is mastication?

Chewing of food

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What is the function of Trigeminal?

Motor to muscles of mastication; sensory to mucosa and teeth.

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What is the function of Facial 7 in mastication?

Motor to lips/cheeks, sensory to 2/3 tongue, parasympathetic to salivary gland.

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What is the function of Hypoglossal?

Motor to Tongue

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Swallowing: Tongue action?

Food bolus moves from the tongue to the back of the throat

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Key swallowing actions?

Soft palate elevates, epiglottis tips caudally, pharyngeal contractions, esophageal sphincter opens

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Nerves for Swallowing?

Glossopharyngeal (9), Vagus (10), Accessory (11), Hypoglossal (12)

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Esophagus position?

Initially dorsal, cervical to left, thoracic dorsal, through diaphragm

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Clinical signs of Prehension?

Difficulty grasping food, pulling into mouth

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Causes of Prehension Problems?

Nigropallidal Encephalomalacia, EPM, Cranial Nerve damage

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Nigropallidal encephalomalacia?

Problems with prehension, can still swallow if food placed in pharynx.

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What is Equine Protozoal Myelitis?

Protozoal disease affecting the CNS in horses

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Signs of Prehension Issues?

Difficulties grasping food and pulling food into the mouth

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Neuromuscular issues that affect eating?

Botulism, HYPP, Tetanus can result in abnormalities

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Mastication clinical signs?

Slow Chewing, food coming out of mouth

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Main cause of Mastication issues?

Abnormal dentition are #1 Problem

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Neurologic diseases related to mastication?

EPM, Rabies and Tetanus

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What is Dysphagia?

Difficulty in Swallowing divided into upper and lower issues

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Clinical signs of Dysphagia?

Food coming out of mouth or nose, cough during eating

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Endoscopic Pharynx exam shows the...

Nasopharynx and oropharynx

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Causes of Peripheral nerve disease(Pharynx)?

Trauma, Guttural Pouch diseases, Lead toxicity, Botulism

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Guttural pouch mycosis?

Hemorrhage and dysphagia (difficult to treat)

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Causes of trauma-peripheral nerve disease?

Rupture Longus Capitus, Basisphenoid Fractures

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Muscle diseases related to Pharyngeal Dysphagia?

Hyperkalemic Periodic Paralysis (HYPP), White Muscle Disease

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CNS diseases and relation to pharyngeal dysphagia?

Tetanus, Rabies, EPM, Viral Encephalitis, and Herpes

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Most common esophageal problem?

Choke

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Clinical signs of Choke?

Unable to pass NG into stomach, food out of nose/mouth, retching/distress

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Treatment of Choke?

Sedation, Relax Esophagus

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Smooth muscle relaxation?

Buscopan

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Treatment for Choke?

IV fluids if dehydrated, Antibiotics (aspiration pneumonia), NSAID (decrease inflammation)

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What is the #1 Rule of treating eating problems?

Treat primary problem!

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What is Supportive Care?

Provide necessary nutrition and fluid

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Management of Dysphagia?

Enteral fluids & nutrition

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Management concerns for Dysphagia?

Monitor electrolytes, supplement NaCl, Equine saliva different from horses

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Management of Aspiration Pneumonia

Antibiotics, completely remove feed and water

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Dysphagia

Difficulty in Eating or Swallowing

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Prehension

Grasping or gathering food into the mouth.

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Mastification

Chewing and grinding food to reduce particle size

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Swallowing

Moving food from the mouth to the stomach

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Prehension Requirements

Proper lip use, normal teeth maxilla and mandible, cranial nerves 1, 2, 5 and 7

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Clinical Signs of Mastication Problems

Slows Eating, food out of mouth, clumps of hay

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Choke

Esophageal Obstruction

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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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