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52 Cards in this Set
- Front
- Back
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What is the most important esophageal disease in Large Animals? |
"Choke"
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What is the definition of choke? |
intraluminal esophageal obstruction
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What type of obstruction do horses and sheep get in choke? |
"Pack" - bits of shaving, grains. Lots of little things that get packed together into a mass |
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What type of obstruction do cows and goats get in choke? |
Bolus/mass -- one piece of something that wedges. |
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What predisposes an animal to choke? |
Poor chewing - exhaustion, sedation, bad teeth, N-M condition, weakness. Obstructive disease (Stricture) |
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What are the clinical signs of choke? |
**Feed tinged saliva (from mouth or mouth + nose - BAD)*** +/- a bulge in the throat. May have some "chewing" behavior if it is not in the thorax. BLOAT in ruminants, depression, metabolic acidosis. |
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What is always a risk with choke? |
Aspiration pneumonia
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What might you see on a CBC from a patient with choke |
A stress leukogram. IT is a very bad if they have toxic changes in the PMN or a L shift -- indicates aspiration pneumonia. |
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What might be seen on a chemistry panel from a Pt with choke? |
Ruminant -- metabolic acidosis (Hyponatremia, low HCO3); dehydration. There may be renal value elevation and hemoconcentration if the episode has been going on for a few days (becoming dehydrated) |
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What type of dx is choke? |
a stall side. Based on hx, Cxs, palpation of neck, ability to pass a stomach tube |
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What kind of imaging can you do for a choke case? |
Contrast radiographs (can assess lungs at the same time), endoscopy (assess mucosa, maybe see the offending object)
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What are the steps in dx of choke |
1. Palpate the throat - you probably will not be able to feel it. 2. Attempt to pass a stomach tube (NG -eq or OG for rum) -- most common way 3. Endoscope -- get location and what you are dealing w/ (not done in field) 4. Radiographs -- be careful, you do not want contrast material in the lungs!! |
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How do you treat choke? |
1. Prevent eating (feed or shavings), no water. KEEP THE HEAD DOWN so the saliva does not run into the lungs. 2. Sedation (alpha 2 > ace, buscopan (relaxant) > ace) 3. Gently pass the stomach tube -- tap, fluid, tap - to break up material (horses) 4 Cuffed stomach tube 5. General anes 6. Trochar/fistulization of rumen due to bloat. 7. Retreival! use a snare. 8. Rumenotomy 9. Do no harm!!!! |
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What should you do after you relieve the choke? |
1 Assess esophageal mucosa. 2. Gradually reintroduce foods (start with softened feed) and water 3. NSAIDS and abx prn (if there was aspiration pneumonia - treat that as well) 4. Fluid correction and correction of acid/base derrangements. |
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What pathology is seen as a sequel and as a pre-disposing factor for recurrent choke? |
Esophageal stricture. |
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How do esophageal strictures form? |
From circumferential erosions of the mucosa/submucosa. Form within 4-8 weeks of the primary lesion |
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How do you dx an esophageal stricture? |
Endoscopy, contrast rads. Especially if they are being seen for recurrent choke. |
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What is the treatment for esophageal strictures? |
Manage with soft feed; bougienage (must have concurrent NSAIDS) and last resort of sx. |
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Which cranial nerve serves the masseter muscle and facial sensation? |
CN V |
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What does dysfunction of CNV cause |
dropped jaw, facial anesthesia (inability to chew) |
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What innervates the superficial facial muscles? |
CN VII
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Can CNVII cause dysphagia |
VERY RARELY |
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Which CN are involved with swallowing and esophageal motility? |
IX, X, XI. Only X does esophageal motility |
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Dysfunction in CN IX, X, XI will lead to what? |
cough, aspiration and difficulty swallowing. If IX, or XI then can be semi silent if only one side is affected. |
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What innervates the tongue? |
IX, XII. |
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What happens if there is dysfunction in CN IX or XII? |
poor prehension, limp tongue. |
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Where do the CN come from? |
Brain stem nuclei |
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Where is the most common site of injury leading to CN dysfunction in the ruminant? |
the brain stem.
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Where is the most common site of injury leading to CN dysfunction in the horse? |
The Guttural pouches -- VII, IX, X, XI, XII all pass through here. |
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Which CN is very superficial and is easily damaged by halters? |
CN VII |
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Where can X be damaged? |
It runs down the neck, so venipuncture or trauma or head gates can cause damage. |
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What is so special about the equid esophagus? |
The last 6 inches are smooth muscle, so horses have no control over that -- they cannot vomit (easily). You see a horse that is vomiting, they are circling the drain. |
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What does the LES of the horse want to be? |
a one way door (keeps stomach pH at 2)
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What is the rumen pH? |
about 6.5 |
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What is esophagitis? |
irritation of the esophagus. This will inhibit peristalsis and open the LES (bringing in more acid contents) |
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What are some clinical signs of esophagitis? |
Pseudoptylaism, odynophagia, regurgitation/vomition in ruminant. |
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What can cause esophagitis |
Caustic feeds (rhododendron), medications (bute, amprolium), gastric acids (or worse, gastroduodenal acid and bile) , reflux in horses, hard feed (batteries in cattle) choke, intubation, viral diseases, 2º necrobacilosis. |
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How do you dx esophagitis? |
Hx; endoscopy (red streaks or plaques), fluid analysis (lower esophagus) -- look at the pH < 5 is consistent w/ reflux. Radiographs |
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What do you need to r/o in horses w/ esophagitis? |
REGURGITATION -- this is really erosive, and includes bile which is REALLY erosive- take that fluid sample and compare to saliva (if less than 5 it is reflux) |
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How do you treat that animal with esophagitis? |
remove cause, either NPO or a soft pelleted diet only. |
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What drugs can you use in a horse with esophagitis (reflux)? |
Bethanecol (LES tone) and metoclopromide (esophageal motility); Sucralfate, H2 blockers, PPI's |
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What do you need to be careful about with metoclopromide? |
IV in high doses will make horses CrAZY aggressive. SQ in LOW doses is effective and not crazy making. |
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Do we deal with a lot of megaesophagus in LA? |
NOPE!!! Except in camelids. |
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What is so special about Friesens? |
they have a congenital (genetic) MegaEsophagus. They can grow out of it. |
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How does ME progress? |
There is usually a defect in one spot, as food accumulates -- leads to choke and then further the area of poor muscular contractility onto generalized. |
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When would you notice a congenital ME? |
At weaning |
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How do adults "acquire" ME? |
1. Obstuction - chronic - choke, stricture, hernia, vascular anomaly 2. Disruption of nerve supply (VAGUS) - neck lesions/trauma, neuro disease -- Rickets, wobblers, EPM. 3. Myopathy - (unlikely WMD), RARE Myasthenia gravis, E- and ac/base imbalance, sarcocystis |
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What are the signs of ME? |
ptyalism, bulge in throat, fluid wave in neck, nasal reflux, regurgitation, poor growth/wt loss. Choke signs. Signs of underlying disease (esp in horses) |
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How do you definitively dx ME |
esophagram -- dilation and decreased clearance. Could also do manometry (measure peristaltic pressure) -- make sure to do bw, titers etc for underlying diseases. |
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What is the treatment for ME? |
Cure underlying disorder (ME may regress). Congential - may go away on own (more so than in adult acquired). Feed soft feed from a height, in small, frequent meals. |
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What do you need to do for ruminants w/ ME? |
Feed food stuff that does not have to be rechewed. |
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Can you give any drugs for ME? |
In horses - bethanecol (and be careful) - metoclopromide. |
