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Choke is a condition in horses in which the
esophagus The esophagus (American English) or oesophagus (British English; both ), non-technically known also as the food pipe or gullet, is an organ in vertebrates through which food passes, aided by peristaltic contractions, from the pharynx to the ...
is blocked, usually by food material. Although the horse is still able to breathe, it is unable to swallow, and may become severely
dehydrated In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
. A secondary condition,
aspiration pneumonia Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may inclu ...
, may also develop if food material and saliva accumulate in the pharynx, spilling into the
trachea The trachea, also known as the windpipe, is a Cartilage, cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends ...
and into the lungs. Choke is one of the "top 10" emergencies received by equine
veterinarian A veterinarian (vet), also known as a veterinary surgeon or veterinary physician, is a medical professional who practices veterinary medicine. They manage a wide range of health conditions and injuries in non-human animals. Along with this, vet ...
s.Mississippi State University, CARES programme
/ref> The condition is seen in other
Equidae Equidae (sometimes known as the horse family) is the taxonomic family of horses and related animals, including the extant horses, asses, and zebras, and many other species known only from fossils. All extant species are in the genus '' Equus'', ...
like
mule The mule is a domestic equine hybrid between a donkey and a horse. It is the offspring of a male donkey (a jack) and a female horse (a mare). The horse and the donkey are different species, with different numbers of chromosomes; of the two pos ...
s and
donkey The domestic donkey is a hoofed mammal in the family Equidae, the same family as the horse. It derives from the African wild ass, ''Equus africanus'', and may be classified either as a subspecies thereof, ''Equus africanus asinus'', or as a ...
s.


Causes

Chewing: Horses may develop choke if they do not chew their food properly. Therefore, horses with dental problems (e.g. acquired or congenital
malocclusion In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-1930), ...
, loose or missing teeth, or excessively sharp dental ridges) that do not allow them to completely grind their food are particularly at risk. In addition, horses that bolt their feed and do not take the time to chew properly are more likely to suffer from choke. Dry Food: Dry foods may cause choke, especially if the horse does not have free access to water, or if the horse has other risk factors linked to choking. While pelleted or cubed feeds in general fall in this category, horse owners sometimes express particular concerns about
beet pulp Beet pulp is a byproduct from the processing of sugar beet which is used as fodder for horses and other livestock. Beet pulp is the fibrous material left over after the sugar is extracted from sugar beets. It is supplied either as dried flakes o ...
. However, while horses have choked on beet pulp, a university study did not document that beet pulp is a particular problem. It is believed that choke related to beet pulp is linked to the particle size and the horse's aggressive feeding behaviour, rather than the actual feed itself. Research suggests that horses that bolt their feed without sufficient chewing, or who do not have adequate access to water, are far more likely to choke, regardless of the type of feed, compared to horses that eat at a more leisurely rate.Warren, Lori K. "Horse Feeding Myths and Misconceptions
" Horse Industry Section, Alberta Agriculture, Food and Rural Development. Web site accessed June 28, 2010
The risk of choke associated with any dry feed can be reduced by soaking the ration prior to feeding. Foreign Objects: Horse may ingest non-edible materials such as pieces of wood. Cribbers may be more prone to this type of choke, if they happen to swallow a piece of wood or other material while cribbing.


Signs of choke

* Difficulty swallowing (horse may try to swallow without success) * Lack of interest in food * Coughing * Extending the neck and head, usually in a downward direction * Discharge from the nostrils. usually green in color, although it may also be yellow or clear, often looks like
vomit Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenterit ...
* Increased
salivation Saliva (commonly referred to as spit) is an extracellular fluid produced and secreted by salivary glands in the mouth. In humans, saliva is around 99% water, plus electrolytes, mucus, white blood cells, epithelial cells (from which DNA can be e ...
, saliva drooling from the mouth * Heart rate may increase slightly, due to the distress of the animal * Occasionally, a lump on the side of the neck is visible or can be
palpated Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...
, where the esophagus is blocked. This is normally most obvious on the left.


Diagnosing choke

If a horse is suspected of choke, a
veterinarian A veterinarian (vet), also known as a veterinary surgeon or veterinary physician, is a medical professional who practices veterinary medicine. They manage a wide range of health conditions and injuries in non-human animals. Along with this, vet ...
will often pass a stomach tube down the animal's esophagus to determine if there is a blockage. Failure to access the
stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...
with the tube indicates a complete obstruction; difficulty passing the tube may represent a
stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' ...
, or narrowing; or a partial obstruction.
Radiography Radiography is an imaging technique using X-rays, gamma rays, or similar ionizing radiation and non-ionizing radiation to view the internal form of an object. Applications of radiography include medical radiography ("diagnostic" and "therapeut ...
and
endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...
are also used in refractory cases.


Treatment

Choking horses should be deprived of food and drink pending
veterinary Veterinary medicine is the branch of medicine that deals with the prevention, management, diagnosis, and treatment of disease, disorder, and injury in animals. Along with this, it deals with animal rearing, husbandry, breeding, research on nutri ...
attention, so as not to increase the obstructive load within the esophagus. The veterinarian will often
sedate Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...
the horse and administer
spasmolytics A muscle relaxant is a drug that affects skeletal muscle function and decreases the muscle tone. It may be used to alleviate symptoms such as muscle spasms, pain, and hyperreflexia. The term "muscle relaxant" is used to refer to two major therapeu ...
, such as
butylscopolamine Hyoscine butylbromide, also known as scopolamine butylbromide and sold under the brandname Buscopan among others, is an anticholinergic medication used to treat crampy abdominal pain, esophageal spasms, renal colic, and bladder spasms. It is a ...
, to help the esophagus to relax. Once the muscles of the esophagus no longer force the food down the throat (active
peristalsis Peristalsis ( , ) is a radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an anterograde direction. Peristalsis is progression of coordinated contraction of involuntary circular muscles, which ...
), it may slip down on its own accord. If spasmolytics do not solve the problem, the veterinarian will usually pass a stomach tube through one of the nostrils and direct it into the esophagus until the material is reached, at which point ''gentle'' pressure is applied to manually push the material down. Gentle warm water lavage (water sent through the stomach tube, to soften the food material) may be required to help the obstructing matter pass more easily, but caution should be exercised to prevent further aspiration of fluid into the trachea. Refractory cases are sometimes anesthetised, with an orotracheal tube placed to prevent further aspiration and to allow for more vigorous lavage. Disruption of the impacted material can sometimes be achieved via endoscopy. If these methods still do not lead to results, the horse may require
surgery Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...
to remove the material. Some workers have advocated the use of
oxytocin Oxytocin (Oxt or OT) is a peptide hormone and neuropeptide normally produced in the hypothalamus and released by the posterior pituitary. It plays a role in social bonding, reproduction, childbirth, and the period after childbirth. Oxytocin ...
in choke, on the grounds that it decreases the esophageal muscular tone. However, this technique is not suitable in pregnant mares, as it may lead to
abortion Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of pregn ...
.


Following up

After the material has passed, a veterinarian may try to prevent the onset of
aspiration pneumonia Aspiration pneumonia is a type of lung infection that is due to a relatively large amount of material from the stomach or mouth entering the lungs. Signs and symptoms often include fever and cough of relatively rapid onset. Complications may inclu ...
by placing the horse on
broad-spectrum antibiotic A broad-spectrum antibiotic is an antibiotic that acts on the two major bacterial groups, Gram-positive and Gram-negative, or any antibiotic that acts against a wide range of disease-causing bacteria. These medications are used when a bacterial inf ...
s. The animal should be monitored for several days to ensure that it does not develop pneumonia, caused by inhalation of
bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
-rich food material into the
lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...
s. The material caught in a horse's throat usually causes
inflammation Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
, which may later lead to
scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...
ring. Scarring reduces the diameter of the esophagus (a
stenosis A stenosis (from Ancient Greek στενός, "narrow") is an abnormal narrowing in a blood vessel or other tubular organ or structure such as foramina and canals. It is also sometimes called a stricture (as in urethral stricture). ''Stricture'' ...
or stricture), which increases the chance that the horse may choke again. The veterinarian may therefore place the horse on a course of
NSAID Non-steroidal anti-inflammatory drugs (NSAID) are members of a therapeutic drug class which reduces pain, decreases inflammation, decreases fever, and prevents blood clots. Side effects depend on the specific drug, its dose and duration of ...
s, to help to control the inflammation of the esophagus. Often the horse will only be fed softened food for a few days, allowing the esophagus to heal, before it is allowed to gradually resume its normal diet (e.g. hay and unsoaked grain). Horses with re-occurring chokes may require their diet to be changed.


Prevention

* Always provide water for the horse * Soak dry foods before feeding to horses prone to choke * Change feeds gradually * Discourage the bolting of food: spread out feed, place large, flat stones (large enough so that the horse can not swallow it) or salt blocks in the feed bin so that the horse must slow down, or feed smaller meals more often * Cut apples, carrots, or other treats into small pieces * Withhold feed material for one hour following sedation


References

* * {{Commons category, Choke in Equidae Horse diseases