Case Study - Choke
In this case study we encounter a senior aged mare who presented for acute onset of coughing and nasal discharge, shortly after eating a mixed feed of pelleted concentrate and chaff.
Clinical Signs
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Acutely distressed.
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Coughing.
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Neck extended abnormally.
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Green foam-like discharge from nostrils + mouth. This is typical of a choke reflux caused by mixed saliva and feed.
Physical exam
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Cervical oesophagus distended with palpable mass in oesophageal lumen.
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Nasogastric tube unable to be passed beyond the pharynx.
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Not performed in this case, but endoscopy may be used to visualise blockage if clinical exam does not confirm diagnosis — material and size of bolus forming obstruction.
Treatment
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Horse sedated — intravenous detomidine and acepromazine combination.
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Anti-inflammatory (flunixin)and smooth muscle relaxant (buscopan) also administered intravenously.
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Nasogastric tube used to push food bolus down the oesophagus toward stomach.
Ongoing Management
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No food to be given for 12-24 hours as some degree of oesophagitis, and decreased motility will likely be present. Soft food (e.g. bran mash) + fresh grass to be fed from 24-72 hours post-choke episode to reduce risk of recurrence, or oesophageal stricture formation.
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Rectal temperature to be taken once daily for the following 5-7 days. Fever may indicate aspiration pneumonia.
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If aspiration pneumonia is suspected, broad-spectrum antimicrobials may be indicated. Recheck with vet required.
Prognosis
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Good but recurrence is possible.
Risk Factors
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Commonly associated with sugar-beet pulp, chaff or hay. The dry material expands when mixed with saliva, causing obstruction in the oesophageal lumen.