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Diagnosis and Treatment of Dysphagia
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Dysphagia is defined as difficulties in swallowing but is often used more broadly to describe problems with eating (i.e. prehension, mastication, swallowing and esophageal transport). A horse with dysphagia has as a consequence the inability but not the unwillingness to eat. Dysphagia can be either congenital or aquired, the main problem or part of a multi-systemic condition, and dysphagia may be associated with muscular or neurological diseases. There are more than 109 possible causes of dysphagia recognised in horses that be broken down to disorders involving the oral cavity, pharynx and/or esophagus. Sometimes painful conditions involving these structures can present like dysphagia (e.g. fractured tooth, thrush, vesicular stomatitis, mandibular trauma). Obstructive lesions in the stomach or small intestine can result in reflux of ingesta which can be difficult to distinguish from dysphagia. Material from the esophagus is usually slightly alkaline and ingesta from the stomach are more acidic. Therefore a thorough clinical examination is a must, but sometimes it can be very difficult to find the reason for dysphagia.
Clinical signs
Clinical signs of dysphagia can vary depending on the source of the problem, but may include ptyalism (excessive salivation), gagging, quidding, nasal discharge and coughing as some of the material may be aspirated into lungs resulting in acute aspiration pneumonia. The nasal discharge will be more apparent with the head lowered, usually within a minute after the ingestion of food or liquids. A horse with dysphagia will in some cases show forceful attempts to swallow accompanied by extension of the head, followed by a forceful flexion and contractions of the muscles at the ventral part of the neck. The basic approach for dysphagia is to assess whether it is due to a functional or morphologic abnormality. Thus, basic requirements include a thorough history, physical examination and additional tests (e.g. endoscopy, radiographs, ultrasonography). For example, a history of acute dysphagia is often consistent with trauma, whereas a slow onset is more likely due to a neurologic problem. Toxic substances exposure should also be considered (e.g. lead, yellow star thistle). Clinical signs of oral cavity involvement include quidding or dropping water from the mouth, reluctance to chew, ptyalism or abnormalities in prehension. Pharyngeal and esophageal dysphagias are characterised by coughing, nasal discharge (containing water, saliva or food material), gagging, anxiousness and neck extension with swallowing attempts. [...]
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