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Equine Final Year > Approach To The Sick Equine Neonate > Flashcards

Approach To The Sick Equine Neonate Flashcards

1
Q

Barbera:

  • 24h old filly, BAR
  • 3rd foal from this mare No problems previous foals
  • Parturition flawless
  • Standing within 1h
  • Nursing 90 minutes from birth
  • Passed meconium, urinating frequently
  • Vital parameters: normal for filly this age
  • Measure IgG: between 400-800mg/dL
  • Navel: looks ok
  • Nursing well while you are there

What is your plan? (2)

A
  • Administer hyperimmune plasma
  • Disinfect navel
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2
Q

What should IgG levels be?

A

800+

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3
Q

What do we use to test the IgG levels?

A

IgG Snap Test

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4
Q

How do we administer plasma to a foal?

A

Commercial plasma is hyperimmune or form donor from same environment

Plasma administration kit (contains filter)

Thaw plasma in warm water (comfortable to hand)

  • Hot water/microwave denaturate IgG!

Start slowly (10 min) checking TPR (ever 3-5 mins) then increase speed if ok until bag done

Watch for anaphylaxis:

  • tachycardia, tachypnoea, fever, fasciculations, piloerection, colic, blanching of mucous membranes, collapse

RETEST IgG 24h LATER!!!

Still not okay? Need to give more. Keep going until adequate

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5
Q

How do we disinfect the naval?

A

Good practice in all foals, not only sick ones, for first few days

0.5% Chlorexedine solution superior to 2% iodine solution.

Iodine tincture of Lugol’s solution can cause necrosis and should be avoided

Care to avoid dampness or excessive dessiccation

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6
Q

What is this?

A

Patent uracus – didn’t obliterate; urine can drip and dirt go in

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7
Q

What is this?

A

Umbilical infection

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8
Q

Ziggy:

26 hour old colt

Quiet (still nursing), than up and down, flagging the tail, straining to defecate, some abdominal pain

Owner reports colt passed meconium at 4h

What do you do next, and in what order? (6)

A
  1. Physical exam
  2. Rectal (digital)
  3. Haematology and biochemistry
  4. Abdominal US
  5. Abdominocentesis
  6. Abdominal Rx+/- contrast
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9
Q

What best describes blood work results?.

A

FPT, hyperglycaemia

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10
Q

What would you see on bloods in sepsis which isn’t present here?

A

Sepsis you would have neutrophils, maybe lactate

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11
Q

Why is this animal not anaemic?

A

PCV is normal – not anaemia

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12
Q

What does this show?

A

1-2-3-4: small colon containing impacted meconium

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13
Q

What is this?

A

Diffuse gas-distended large intestine, with granular-appearing luminal contents in the caudoventral abdomen (meconium impaction).

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14
Q

How do you treat a meconium impaction?

A

ENEMA

Note:

Laxatives are pointless as the obstruction is very distal and by the time the laxative will reach the small colon you would have hoped to have cleared the impaction already.

Surgery – generally not indicated as vast majority of foals respond well to medical treatment with oenemas.

IV fluids don’t work well for impaction – just more urine

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15
Q

What are the 2 types of enema and how do you do them?

A

Oenema

  • By gravity (no pressure!)
  • Mix with lube/ acetylcysteine/paraffin/water

Retention oenema

•Use a ballooned catheter (Foley’s) to blockage exit of fluid introduced for 30-45minutes. When you inject in – prevents it coming out so can go further up

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16
Q

Do we need to give IV fluids for meconium impactions?

A

•IVF often not necessary as condition should resolve quickly, but if dehydration is present then appropriate

17
Q

Obi-wan-cannotbe

  • Full term colt
  • Uncomplicated birth
  • Nursing at 1h
  • At 48h foal is nursing less
  • HR 90bpm, RR 40bpm, Temp 39.2℃
  • Skin tent ~2sec, quiet borborygmi

How would you describe these mucous membranes?

A

Jaundiced

18
Q

Which three parameters do you think could be explain jaundice?

A
  • PCV
  • Liver enzymes
  • Bilirubin
19
Q

What are the two most likely diagnoses?

A
  • Neonatal isoerythrolysis
  • Sepsis

Note:

Anaemia (low pcv) from haemolysis (high bilirubin) is likely consequence of NI. Sepsis can not be discounted as foal is pyrexic and there is neutrophilia (with sepsis both neutropaenia or neutrophilia can ensue), though many with NI alone present with pyrexia and neutrophilia.

NI – mare builds AB agsinst RBC of foal. After colostrum the foal ingests the AB against the RBC. Related to ingesting IgG – get over this and the foal should be okay

Foals relying on IgG to work – IMHA needs immune function

Sepsis – anaemia and neutrophils.

20
Q

How would you treat a foal where you have narrowed the differentials to NI or sepsis? (2)

A
  • ANtimicrobial
  • IVF (2x maintenance)
21
Q

Why do we not give dexamethasone in NI?

A

Dexamethasone – although this is indicated in IMHA, in NI this is useless as the antibodies came form the colostrum and are not being actively produced. So Dex is not indicated. One may use it if the foal is in SIRS to limit the exagerated inflammatory response, however this foal does not appear in SIRS (e.g. neutrophilia and not neutropaenia)

22
Q

When would we use blood transfusion in a foal?

A

can be used but generally only if PCV <12-15% - this foal is coping still, is more 48h old (so not absorbing more colostrum and likely as bad as it is going to get.

23
Q

Why do we not use omeprazole in foals?

A

antacids are currently not recommended in foals as they abolish the acid barrier in the stomach and may increase the risk of infection through the GI tract

24
Q

When might we use fureosemide?

A

may be helpful to preserve diuresis and limit kidney damage, however the effect of IVF should be sufficient for this. One might consider using furosemide generally to counteract fluid overload (not present in this foal and unlikely to develop overload if kidneys are working) but one must monitor electrolyte concentration if using furosemide.

25
Q

How would we give a blood transfusion?

A

Needed if PCV <12-15%

Identify suitable donor (NOT THE MARE!!!)

Cross-matching if possible (using mare’s serum!)

Alternatively use a gelding if x-m not available

PCV increases for 24h the gradually decreases

26
Q

Al-Coholica

36h old filly

BAR, suckling, getting-up with assistance

Moving freely but trembling of forelimbs when standing

L carpus straightened by pushing on carpus backward, but not the R carpus

What is you diagnosis? (2)

A

Flexural deformity

Tendon contracture

–Tendons contracted and so the leg cannot extend

–Needs physio

27
Q

How can we treat flexural deformity?

A

Attempting to straighten the carpus helps determining the severity of the flexural contracture

Can splint

Foals with fetlock joint flexural deformity appear to knuckle over at the fetlock as they Walk on tips

Can result in uneven hoof growth and clubfooted hoof shape

28
Q

36h old filly

BAR, suckling, getting-up with assistance

Moving freely but trembling of forelimbs when standing

L carpus straightened by pushing on carpus backward, but not the R carpus

What test would you perform?

A

IgG - they foal can’t stand somust rule this out first

29
Q

Which are suitable solutions to manage contracted tendons? (6)

A
  • Bandaging
  • Splinting
  • Casting
  • Controlled exercise (box rest)
  • Check ligaments desmotomy
  • Oxytetracycline
30
Q

Why do we need controlled exercsie for contracted tendons?

A

Mild contractures often improve within just a few days as the foal becomes stronger with exercise. Exercise should be restricted to firm footing to encourage tendon stretching and to a small paddock for frequent but short amounts of time. With extended periods of exercise, deformities may worsen due to fatigue of the muscles and tendons and the pain associated with their stretching.

31
Q

When is heel extension used?

A

Tendon laxity

32
Q

Why may we use oxytetracycline for contracted tendons?

A

mechanism not completely understood, may have to do with chelation of Calcium or neuromuscular blockade but none of these has been confirmed. 94% success outcome.

33
Q

When must we take care when using oxytetracylcines?

A

CAN ADVERSELY AFFECT RENAL FUNCTION so suitable only in well hydrated, non-sick foals (avoid with neonatal sepsis!)

34
Q

What is tendon laxity?

A

Walk on fetlock

35
Q

How can we treat tendon laxity? (3)

A
  • Controlled exercise
  • No bandaging (other than light dressing to prevent sores)
  • Corrective farriery (heel extensions)
36
Q

What is this?

A
37
Q

What is this?

A

VaLgus

38
Q

What is the treatment for varus/valgus?

A

Screw through – other side catches up (L pic)

R pic – old days and putting wire through

39
Q

Willyitlive

  • Born 6h ago
  • Born 330 days gestation
  • Owner calls you as it nursed little and then struggled to stand
  • Now foal is semi-comatous

What’s most likely?

A
  • Neonatal sepsis
  • HIE
  • Prematurity
  • White muscle disease
  • Kidney failure
  • SIRS
  • It does not matter, I am going to refer anyway!

Equine Final Year (102 decks)

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