Basics of Foal Diseases Flashcards
Critical care for primary or secondary apnea
establish an airway stimulate the foal oxygen, ambu bag, coupage Drugs (doxapram) Maintain sternal recumbency!!!
Critical care for bradycardia or cardiac arrest
cardiac massage and chest compressions give a fluid bolus epinephrine and ADH Atropine Get an ECG
Some general observations to make with PE of a foal
eat/sleep/play cycles bonding to the mare weight gain urination and defecation distension
For hypoglycemia, what do we give?
1% dextrose in the fluids, 5-10% will cause neurological disease.
For recumbency of a sick foal, watch for
lung collapse from not keeping sternal
decubital (bed sores)
and corneal ulcers
What is a common cause of post-maturity?
fescue toxicosis
Prematurity causes
fetal placental maternal - disease iatrogenic - induction idiopathic
Major systems involved in Prematurity
Respiratory - distress, paradoxical breathing, fatigue
MSK - incomplete ossification causing angular limb deformities, crushing joint surfaces. Big deal***
GI - FTPI, poor glycemic control, nec enteritis, drug metabolism
Prematurity “other problems”
CV Renal Endocrine -= insulin resistance neuro - pernatal asphyxia syndrome, seizures Drug metabolism may be altered. Predisposed to sepsis
Prematurity treatment options
supportive
prevent sepsis
anticipate problems and be realistic about it the animal will live or not.
Causes of Congenital hypothyroidism and dysmaturity
prolonged gestation and abortions - the mother and the foal seem to be out of sync
Clinical signs of Congenital hypothyroidism and dysmaturity
mandibular prognathism forelimb contracture ruptured common/lateral extensor tendon delayed ossification \+/- enlarged thyroid
Congenital hypothyroidism and dysmaturity pathogenesis
not much. risk factors like mineral deficiencies (iodine?) and feeding greenfeed (nitrates) causing sporadic occurences
Congenital hypothyroidism and dysmaturity Dx
History (gestation length?), clinical signs
Low serum T4/T3 and low response to TSH
Congenital hypothyroidism and dysmaturity Tx
Supportive and T4 if needed
Congenital hypothyroidism and dysmaturity prognosis
guarded in ICU patients
risks orthopedic problems
What are the benchmarks of post-partum care
look at the placenta PE of the mare and foal Make sure there is colostrum in the foal disinfect the umbilicus enema to get meconium out Blood work Tetanus prophylaxis and AM Exercise Imprint them - differing opinions on this
What are all the parts of the PE?
History and general observations (eat/sleep/activity/weight, etc.)
CV for murmurs
Respiratory - lungs sounds, mm/oxygenation, rib fractures
GI - PALATE, feed intake, distention
Genit/Urinary - patent urachus, cryptorch, hernias
Umbilicus - infection/hernia
MSK - lax tendons, swollen joints,
Eye - uveitis, hypopyon, entropion, microphthalmia
Neuro - bonding, maladjustment, eating manure, sleep
COmmon organisms causing sepsis in foals
e coli actinobacillus kleb salmonella enterbacter strep
Routes of infection causing sepsis
through resp
intra-uterine
GI tract
What are the risk factors in causing sepsis?
FTPI *****
management, problems at birth, premature, congnital, etc. etc.
How do you Dx sepsis
With the systemic inflammatory response AND infection (localized infection/bacteremia) AND Cultures (Either blood or from the sites - TTW, CSF, etc)
What are the systemic inflammatory response signs in sepsis?
attitude/mentation are off body temp is messed HR weird RR weird MM are wonky CBC
Early clinical signs of sepsis
subtle lethargy, decreased suckle reflex don't gain weight more recumbent weird mm FEVER/HYPOTHERMIA Tachypnea Diarrhea
Later signs of sepsis
aural petechiation,
uveitis,
hypopyon
specific stuff like - diarrhea, resp signs, swollen joints, umbilicus, neurologic
Treatment of Sepsis
AM - broad - pen/amp + aminoglyc joint lavage maybe treat/prevent FTPI and maybe give plasma nutrition fluids - looking at DH, elect, acidosis, and glycemic state O2 if needed NSAIDs -
Prognosis of Sepsis
guarded, 25-50% die still in ICU
worst if joints and neuro signs
When is colostrum production started and when is it no longer
starts 2 weeks prior
24 hr after birth, it can’t be absorbed anymore. (but 72 hours is where people feel safe in cases of NI)
How do we make sure the foal gets enough Ig?
need adequate intake
good quality
absorption
normal rate of Ig metabolism
how do we evaluate colostrum quality?
SG >1.060 or 3000 mg/dL IgG
Do this before suckling
How do we assess FTPI?
TP or T globs won’t tell us
It has no clinical signs
TEst IgG in serum at 18-24 hours and possibly repeat.
What are the testing methods for FTPI?
SRID - single radial Immunodiffusion
SNAP test (ELISA)
Zinc sulfate turbidity test
Foalcheck (latex agglutination)
Details about the SRID test
most accurate for FTPI
quantitative from 0-3000 mg/dL
but takes 24 hours
Details about the SNAP ELISA
easy, convenient but only semi-quant
Details about the zinc sulfate turbidity test
easy and cheap
Details about the FoalCheck
high false positives
If you decide to go with plasma in the fluids for a FTPI, how will you do it?
get from commercial (hyperimmune plasma) or healthy horse,
thaw slowly,
slowly infuse through a filter,
watch for a reaction - if there is, slow or stop temporarliy.
How much will 1L of plasma increase IgG?
50-200 mg/dL
What is SCID and who gets it?
failure to produce T and B lymphocytes
Arabians, mice, dogs and humans
Autosomal recessive
SCID clinical signs
normal at birth, but infections of start of unusual organisms at the 3 months mark
Will manifest itself anywhere
Dx of SCID
genetic testing absolute lymphopenia on CBC neutrophilia can happen still with infection No IgM (test the pre-suckle serum) IgG normal until the 3 week mark too.
Treatment of SCID
bone marrow transplants?
Prognosis of SCID
they usually only live 5 months
pathology of SCID
hypoplasic of spleen, LN, and thymus but still normal architecture
What is NI?
a reaction on the RBCs of the foal between blood group antigens and plasma antibodies (alloantibodies)
Pathogenesis of NI
sensitization from transplacental hemorrhage (prev pregnancy) –> foal with antigen from stallion + mare with Ig in colostrum –> Lysis of RBCs
How often does NI happen?
1% in TB, more commonly in mares with Aa and Qa blood type antibodies or the specific Donkey factor
But it also happens in 100% Stdbred with Qa- bloodtype
How do you Dx NI?
clinical signs – pallor icterus
Time - 12-72 hour to 1 week old
other weakness and subsequent signs from these
CLinical pathology - anemia
What gives us a tentative Dx of Icterus?
lethargy, anemia, and icterus
DDx for icterus and anemia in foals
internal bleeding
piroplasmosis
NI
DDx for anemia without icterus
NI Blood loss (trauma)
DDx for icterus without anemia
sepsis
meconium impaction (biliary stasis)
Liver failure (Tyzzer’s)
NI
Treatment for NI
If before they’ve drank, … get other source of colostrum and give them that. Then at 72 hours, give them regular stuff.
If not caught early,…give supportive care and oxygen, decrease stress.
Keep fluids on to keep the kidneys and consider AM for sepsis.
Blood transfusions are only as a life-sparing thing.
How do you do blood transfusions for NI?
wash RBCs from dam so there is NO serum
Make sure it is Aa/Qa negative and cross-match with the mare’s serum.
What about the prognosis of NI
better with late onset
neuro signs? poor
How should we educate our clients about NI?
if the mare had one, she will likely have another so act accordingly, Hold back the colostrum, watch the birth, give colostrum from somewhere else, etc.
Also, tell them to type the stallions and mares
Screen the mare for alloantibodies
DO the Jaundiced Foal Agglutination test
Neonatal Maladjustment Syndrome pathophysiologies (3)
- hypoxia/asphyxia –> causing loss of energy production –> reperfusion injury –> imbalance of NT
- Septic ECopathy - because of inflammatory mediators
- reversion to the fetal cortical state –> high neurosteroids in the foal
What is the most consistent clinical sign (because everything else is so variable)
normal at birth foals that show neurological abnormalities within 24-72 hours
Prognosis of Neonatal Maladjustment Syndrome
good if treated early.
50-80% lead normal lives
Conditions that make Neonatal Maladjustment Syndrome worse to treat (prognosis too)
sepsis
prematurity
seizures
treatment of Neonatal Maladjustment Syndrome
Seizure control - increase intracranial pressure with Ketamine/Xylazine, as well as preventing injuries and so on.
Supportive Care - Lohmann just goes with this
Cerebral support with all the wonky stuff - anti-ox, free radical scav(DMSO), edema controllers(Mann, DSMO), perfusion controllers (inotropes, vasopressors), thiamine
Madigan Squeeze***** sounds promising
What are the chatacteristics of Respiratory Distress Syndrome in Foals?
- hypoxemia and hypercapnia from not enough gas exchange
- atelectasis from collapse
- get paradoxical breathing because of compliance of the lung –> the floppy chest trying to move the stiff wall
DDx for seizures in foals
hpoxia/asphyxia cranial trauma hypoglyc hypocalc hyponatr infection/sepsis Hepatoenceph idiopathic (arabians) (Lavendar Foal Syndrome)
How to Dx seizures
HX, PH, CBC, Chem (first r/os) arterial BG CSF CT, rads EEG
What is the funny name for C. botulism in foals?
Shaker foals
Dx of botulism in foals
clinical signs
toxin in blood/feces
Treatment of botulism in foals
Penicillin, Anti-toxin?, Vaccinate
When we see colic in foals, what should we do?
consider congenitals
is it meconium or impactions?
instusseptions
adhesions
Think of colic similar to how you would
Treatment of meconium impactions
colostrum acts as a sedative Enemas (acetylcysteine) Oral fluids/IV too mineral oil restrict milk intake give pain control O2 if distension of abdomen much
What is Lethal white syndrome?
Endothelin receptor gene defect in overo-overo paint breeding
autosomal recessive
hits the ileum, cecum and colon
What are the 4 clinical forms of Gastric Ulcer?
Silent
Active - bruxism, lying on back, don’t thrive and diarrhea
Perforated
Stricture - gastro-duodenal ulceration and reflux
What are the causes of Gastric ulcer syndrome?
NSAIDs,
Hypoxic injury - PAS necrotizing enterocolitis
Low-Flow conditions - sepsis, shock, trauma
What is PAS?
Perinatal asphyxia syndrome
How to Dx Gastric ulcer syndrome?
endoscopy - squamous ulcers (non-glandular) are the most common but foals have proportionally more glandular than adults.
abdominocentesis
reflux/occult or fecal blood
Treatment of Gastric Ulcer syndrome
Omep
Ranit
Sucralfate
antacids
Prevention of gastric ulcers syndrome
The watch list is to minimize: prefusion abnormalities hypoxia enteral bleeding NSAIDs
On the DDx for diarrhea in foals
foal heat viral bacterial protozoal parasitic dietary diarrhea
diarrhea in foals is often a presenting sign of
sepsis
What on earth is foal heat?
when the foal gets diarrhea with the mare in her first heat after parturition.
Cause of foal heat diarrhea?
not known. maybe strong westeri?
When do you see foal heat diarrhea and what does it look liek?
mild, self-limiting at 5-14 days of age.
When do we dx foal heat diarrhea?
when all others are ruled out
Where do we see viral diarrheas in foals?
in larger groups
commmon viral diarrhea etiology
rotavirus
What does rota do in viral diarrheas?
high morb/low mort
denudes the microvilli and dehydrates the foals
POssible etiologies for bacterial
clostridia perfringens (C) C difficile Salmonella e coli a equuili lawsonia intracell (older) rhodocuccus equi (older)
In neonates with diarrhea, what is indicated?
blood culture and sepsis score
How to Dx the clost diarrheas?
gram stain feces, culture and do toxin assays
What are the protozoal etiologies of foal diarrhea/
cryptosporidium
eimeria leukarti
trichomonas equi
giardia equi
What is important about crypto diarrhea in foals? but…
zoonotic.
We will often see in healthy foals and is self-limiting
Which are the septic bacterial etiologies in foal diarrhea? and what do we do for them?
salmonella, e coli, and a equuili
Fecal culture
fecal PCR
parasites causingFoal diarrhea
small strongyles - cyathostomes, large strongyles - vulg, edent, and equinus ascarids strongyloides westeri pinworms botlfy larvae tapeworms
How to treat parasitic Foal diarrhea
avermectins milbemycins benzimidazoles pyrantel salts praziquantel
How to Dx parasitic Foal diarrhea
Hx, C/S
FEC - not always reliable because of the prepatent periods
Histopathology
Life cycle of Strongylus Vulgaris
9 month PPP –> migrates through the arterioles –> cecum, descneding colon –> causes TE Dz often
Typical life cycle of the strongyles (large and small)
usually eggs passed in feces, developing larvae outside host to infective stage, ingestion, tissue migration, mature adults in GI
TRansmission and characteristics of strongyloides westeri infection in foals
transmammary transmission
usually infected by 8-12 days
see mild signs
WHere does parascaris equorum head to? PPP?
hepatopulmonary migration
2-3 month PPP
What is the complication of parascaris equorum
the worms die and obstruct
What are some clinical signs of parascaris equorum?
colic, diarrhea, respiratory signs, chronic weight loss
failure to thrive
