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Problems of the Esophagus

Problems of the Esophagus. Carla Sommardahl, DVM, PhD, DACVIM Assistant Professor. Normal Anatomy. Common and not so common problems. Choke – esophageal obstruction with feed material Foreign body obstruction/irritation Esophagitis Megaesophagus Congenital Disorders. Early Signs of Choke.

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Problems of the Esophagus

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  1. Problems of the Esophagus Carla Sommardahl, DVM, PhD,DACVIM Assistant Professor

  2. Normal Anatomy

  3. Common and not so common problems • Choke – esophageal obstruction with feed material • Foreign body obstruction/irritation • Esophagitis • Megaesophagus • Congenital Disorders

  4. Early Signs of Choke • Excess drooling of saliva and feed material or froth • Saliva and feed material from nostrils • Extend head and neck • Restless behavior • Attempt to drink • Cough, retching

  5. Other Signs of Choke • Partial choke – signs may occur on and off depending on diet • Long term or recurrent choke – depression, dehydration, weight loss

  6. Esophageal Obstruction • Common types of obstruction material: • Beet pulp, pelleted feed, corncobs, grain, hay, pieces of fruit, “crab apples”, boluses • Wood shavings and other foreign bodies

  7. Esophageal Obstruction • Sites of obstruction: • Esophageal opening (retropharyngeal LN) • Mid cervical region • Thoracic inlet • Terminal Esophagus

  8. Potential areasof obstruction!

  9. What can you do? • Not an immediate emergency, but can be life threatening due to complications • Call your veterinarian immediately • Remove all feed and water • Put in unbedded stall

  10. Initial Examination and Treatment • Complete physical exam • Sedation • Passage of a nasogastric tube to identify obstructed location • Lavage of esophagus with head down

  11. Further Examination • Endoscopy of the esophagus • Radiographs of the neck area with and without contrast • Ultrasound examination of neck region • Radiographs of the lungs

  12. Treatment • Tranquilization and relaxation of esophagus for lavaging • Intravenous fluids and electrolytes in more severe cases • No Oral Intake for 24 hours • NSAIDs • Antibiotics for aspiration pneumonia

  13. Treatment (cont) • Refractory cases may require general anesthesia • Pass cuffed endotracheal tube into esophagus then nasogastric tube • Lavage with water keeping horses head ventral to facilitate drainage • Gentle lavage to avoid esophageal rupture • Surgical Treatment (esophagostomy) • Only in severe case, stricture likely

  14. Prognosis • Good in most cases (< 24 hours duration) • Prognosis depends on length and duration time in which obstructing material remains in esophagus • Endoscopic evidence of esophageal ulcer • 24 hours is general concern

  15. Complications of Choke • Dehydration • Electrolyte imbalances • Aspiration pneumonia • Upper airway irritation and inflammation

  16. Complications of Choke • Esophagitis • Motility disorders = megaesophagus • Esophageal ulcers and stricture • Esophageal rupture or tear

  17. Prevention • Proper dental care • Good quality hay • Rapid eaters • Feed separately, place large object in grain bucket to slow down eating • Older horses or horses with previous choke • Avoid dry pelleted feeds and beet pulp – expand when wet. Moisten these prior to feeding. • Avoid hay cubes or large fibrous horse treats if new to horse

  18. Esophagitis • Inflammation of the esophagus with or without ulceration • Regurgitation of gastric fluid into the esophagus • Gastric ulcer disease • Increased stomach volume from motility disorders or outflow obstruction • Impaired lower esophagus sphincter function • Chemical Injury • Trauma from foreign bodies, choke, nasogastric tubes

  19. Signs of Esophagitis • Discomfort or gagging when swallowing • Signs similar to choke • Loss of appetite, weight loss • Signs of underlying disease • Colic • Depression

  20. Diagnosis of Esophagitis • Endoscopic examination • Contrast radiographs • Underlying disease process with high risk for esophagitis • Gastric ulcers • Enteritis • Gastric outflow obstruction

  21. Treatment of Esophagitis • Treat underlying problem • Decrease stomach acidity • Mucosal protectants • Dietary modifications • Frequent small meals of moistened pellets and fresh grass

  22. Motility Disorders of Esophagus (Megaesophagus) • Often secondary to choke or esophagitis • Extraesophageal tumors or abscesses causing obstruction • Pleuropneumonia • Neurological diseases • EPM, Equine Herpesvirus, Botulism, Idiopathic vagal neuropathy

  23. Congenital Disorders • Very rare • Stenosis • Persistant right aortic arch • Idiopathic megaesophagus

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