Digestion & Metabolism 2: Neonate Foal Flashcards
6 common DDxs for COLIC in neonatal foals?
- MECONIUM IMPACTION
- ENTEROCOLITIS
- NECROTIZING ENTEROCOLITIS
- INTUSSUSCEPTION
- CONGENITAL ABNORMALITIES (intestinal atresia, ileocolonic agangliosis)
- GASTRODUODENAL ULCER SYNDROME
what should be your TOP ddx for a foal within 12-24 hours of age with COLIC?
MECONIUM IMPACTION
when is meconium formed?
what 4 things is it made of?
when does it FIRST APPEAR?
when is BILIRUBIN EXCRETED
when is meconium formed? = THROUGHOUT FETAL LIFE then GET RID OF UPON BIRTH
made of…
1. SWALLOWED AMNIOTIC FLUID
2. INTESTINAL SECRETIONS
3. CELLULAR DEBRIS
4. OTHER DEBRIS
first appears in FIRST TRIMESTER
bilirubin excreted by BEGINNING OF SECOND TRIMESTER
why would meconium look YELLOW upon birth?
if MECONIUM IS RETAINED/NOT PASSED WITHIN AN HOUR AFTER BIRTH, starts to ABSORB BILIRUBIN
ID what this is
this is MECONIUM, defined HYPOECHOIC SHAPE with HYPERECHOIC SPECKLES
ID LESION in foal 24 HOURS OLD
GAS DISTENTION around GUT from MECONIUM IMPACTION
STANDARD ENEMA vs. RETENTION ENEMA for MECONIUM
STANDARD = usually given to foals ONCE THEY’RE BORN, made with SOAPY WATER
RETENTION = for meconium HIGHER UP IN LARGE COLON or STANDARD ENEMA HASN’T WORKED, use SEDATION
if a STANDARD ENEMA doesn’t work for MECONIUM IMPACTION after a couple times, we should… (2)
STOP, do not want to cause RECTAL TEARS FROM STRAINING!
should do RETENTION ENEMA
2 steps for RETENTION ENEMA…
- put FOLEY IN LATERAL RECUMBENCY with HIND ELEVATION FOR 20 MINS
- GRAVITY-FEED IN ACETYL CYSTEINE to BREAK DOWN DISULFIDE BONDS in MECONIUM
ORAL Tx for MECONIUM IMPACTION? (2)
- ORAL LAXATIVES via MINERAL OIL (given NGT to avoid ASPIRATION PNEUMONIA)
- ONLY ALLOW NURSING if NOT PERSISTENTLY COLICKY/DISTENDED ABDOMEN, otherwise NPO
if NPO, neonates should receive… (2)
- IV FLUIDS
- DEXTROSE
NEONATAL GASTROENTEROPATHY
associated with what disease? (2 names) what does this mean clinically?
often associated with what 3 causes?
4 clinical signs? (hint, one is a disease!)
associated with NEONATAL ENCEPHALOPATHY/DUMMY FOAL SYNDROME = foals are NEUROLOGIC & DON’T NURSE PROPERLY
often associated with 3 causes…
1. DYSTOCIA
2. STRESSFUL BIRTH
3. LATE GESTATION
4 clinical signs?
1. ILEUS/DYSMOTILITY
2. COLIC/GAS DISTENTION
3. NECROTIZING ENTEROCOLITIS (NEC)
4. INTUSSUSCEPTION
trophic feeding definition?
= feeding SMALL volumes of ENTERAL FLUIDS to STIMULATE DEVELOPMENT OF IMMATURE GI TRACT in NEONATES
TREATMENT for NEONATAL GASTROENTEROPATHY (2)
- treat/manage OTHER PROBLEMS (perfusion, sepsis, etc)
- TROPHIC FEEDING
NECROTIZING ENTEROCOLITIS..
can be secondary to WHAT dz?
= definition
2 causes?
diagnosis via… & what 2 things do we see?
can be secondary to NEONATAL GASTROENTEROPATHY
= NECROSIS of MUCOSA & SUBMUCOSA of GI TRACT caused by BACTERIAL INVASION of INTESTINAL WALL
2 causes?
1. neonatal GI IMMATURITY
2. HYPOXIC/ISCHEMIC EVENT (ex = dystocia)
diagnosis via ABDOMINAL US
1. PNEUMATOSIS INTESTINALIS
2. SLOUGHING OF MUCOSA
TREATMENT for NECROTIZING ENTEROCOLITIS… (2)
why is RESECTION & ANASTOMOSIS not helpful here?
prognosis for ADVANCED lesions?
2 treatments?
1. treat UNDERLYING PROBLEMS
–> fluid resuscitation
–> RESPIRATORY function
–> OXYGENATION
- NPO and give TOTAL PARENTERAL NUTRITION
RESECTION & ANASTOMOSIS?
–> not helpful because usually DIFFUSE/MULTIFOCAL DZ, so this alone DOES NOT HELP
GUARDED prognosis for ADVANCED lesions
why should we give foals with NECROTIZING ENTEROCOLITIS nutrition via TOTAL PARENTERAL versus PO?
want to PREVENT BACTERIAL PROLIFERATION
Dx this lesion & define it!
what DISEASE is this typically associated with?
PNEUMATOSIS INTESTINALIS = HYPERECHOIC, GAS-CASTING LESIONS in INTESTINAL WALL indicating that GAS IS GOING THROUGH IT
usually associated with NECROTIZING ENTEROCOLITIS
INTUSSUSCEPTION in foals can be….
but once it is a problem, usually a ____ problem
can cause issues with…
INTUSSUSCEPTION in foals can be NORMAL and HAVE NO CLINICAL SIGNS
but once it is A PROBLEM, usually a SURGICAL problem
can cause issues with MOTILTIY
CONGENITAL INTESTINAL ATRESIA…
tend to see colic WHEN?
2 clinical signs?
tend to see colic WITHIN FIRST 24 HOURS OF AGE
2 clinical signs?
1. ABDOMINAL DISTENTION
2. NO FECES
OVERO LETHAL WHITE SYNDROME
aka?
occurs in WHAT breed with WHAT genetic mutation?
not ALL…
can be….
aka = CONGENITAL AGANGLIONOSIS
occurs in AMERICAN PAINT FOALS from OVERO-OVERO breedings that are HETEROZYGOUS FOR ENDOTHELIUM RECEPTOR GENE
not ALL OVERO-OVERO MATINGS are AFFECTED
can be FATAL
4 possible presentations of GASTRIC ulcers in FOALS? which one tends to occur in OLDER foals?
pathophysiology?
3 common locations for ulcers?
4 presentations?
1. SUBCLINICAL
2. CLINICAL ULCERATION with MILD COLIC SIGNS
3. PERFORATING ULCERATION
4. GASTRODUODENAL ULCER SYNDROME –> OLDER foals
pathophysiology?
–> FOALS have more ALKALINE GASTRIC pH than ADULTS, so LACK OF PROTECTIVE FACTORS present can CAUSE ulcers
3 common locations?
1. GASTRIC
2. DUODENAL
3. ESOPHAGEAL
3 RISK/PREDISPOSING factors for ULCERS in FOALS?
- PERINATAL HYPOXIA
- SYSTEMIC ILLNESS such as SEPSIS or D+ that affects CARDIOVASCULAR STABILITY
- use of ANTI-INFLAMMATORIES –> mucosal HYPOXIA & ISCHEMIA –> loss of PROTECTIVE FACTORS
GASTRIC ulcers…
3 clinical signs for SIMPLE ulceration?
3 additional clinical signs for PERFORATING ulceration?
depending on the SEVERITY of the ulceration, need to rule out….
diagnosis MAINLY via what 2 methods? what else can we do/why would we do it?
SIMPLE ulceration…
1. BRUXISM
2. PTYALISM
3. COLIC/lying in dorsal recumbency
PERFORATING ulceration… (includes all above signs +)
1. FEVER
2. D+
3. more SEVERE/PERSISTENT COLIC
depending on severity, need to rule out SURGICAL CAUSES OF COLIC
diagnosis MAINLY = GASTROSCOPY & ABDOMINAL US
–> can ALSO DO ABDOMINOCENTESIS if suspect PERFORATION
3 medications for TREATMENT of GASTRIC ulcers? which one should be used for PREVENTION?
why should we AVOID gastric suppression in foals <2 weeks of age?
prognosis in SIMPLE & PERFORATING ulcers?
3 medications?
1. PROTON PUMP INHIBITORS (dec HCl)
2. SUCRALFATE (protective) –> PREVENTION
3. H2 ANTAGONISTS
ACID HELPS PROTECT AGAINST BACTERIAL ENTEROCOLITIS so NO GASTRIC SUPPRESSION in young foals
prognosis in…
SIMPLE = OVERALL GOOD but RISK OF PERFORATION higher in FOALS
PERFORATING = GRAVE
GASTRODUODENAL ULCER SYNDROME…
common in WHAT AGE RANGE FOALS?
2 common causes?
4 sequelae?
common in OLDER foals 2- 6 MONTHS
2 common causes…
1. IDIOPATHIC
2. SECONDARY TO OTHER CHRONIC CONDITIONS
4 sequelae?
1. ESOPHAGITIS
2. GASTRIC SQUAMOUS & GLANDULAR ULCERATION
3. PYLORIC ULCERATION
4. PYLORIC STRICTURE
GASTRODUODENAL ULCER SYNDROME…
5 clinical signs?
3 diagnostics?
5 treatment options?
OFTEN requires ___ intervention
5 clinical signs?
1. UNTHRIFTY
2. POT-BELLIED APPEARANCE
3. BRUXISM
4. PTYALISM
5. COLIC
3 diagnostics?
1. ABDOMINAL US
2. GASTROSCOPY
3. NASOGASTRIC INTUBATION
5 tx?
1. FREQUENT GASTRIC DECOMPRESSION
2. GASTROPROTECTANTS
3. IV FLUIDS
4. ANALGESICS
5. PROKINETICS
in GASTRODUODENAL ULCER SYNDROME, prognosis is ____ with MEDICAL management and ____ with SURGICAL intervention
POOR, GUARDED
usually by the time we DIAGNOSE GASTRODUODENAL SYNDROME, WHAT has formed?
A STRICTURE (likely at PYLORUS) has formed
FOAL HEAT DIARRHEA…
this is a ___-____ condition that lasts for ___-___ ____
common in foals aging (range)..?
fever?
2 possible causes?
this is a SELF-LIMITING condition that lasts for 3-4 DAYS
common in foals 5-15 DAYS OLD
AFEBRILE
2 possible causes?
1. CHANGE IN MARE’S MILK COMPOSITION with FOAL HEAT
2. change in FOAL’S INTESTINAL MICROBIOTA due to COPROPHAGY
NUTRITIONAL DIARRHEA in FOALS often caused by…
often caused by FOALS EATING WEIRD THINGS LIKE SAND, ESPECIALLY WHEN BORED
LUMINANT IRRITANT D+ can be caused by what 2 things?
- PICA –> irritation of intestinal mucosa –> D+ & COLIC
- SAND ENTEROPATHY
LACTOSE INTOLERANCE can be caused by WHAT 2 things?
pathophysiology?
caused by?
1. ROTAVIRUS
2. C DIFF
pathophysiology? = ELIMINATE LACTASE BRUSH BORDER ENZYME
5 INFECTIOUS causes of D+ in foals?
- BACTERIAL (clostridium, rhodococcus, lawsonia, salmonella)
- VIRAL (rotavirus, coronavirus)
- SEPSIS
- PROTOZOAL (crypto)
- PARASITICC (strongyloides westeri)
3 NON-INFECTIOUS cases of FOAL D+?
- FOAL HEAT D+
- DIETARY INTOLERANCE
- ANTIMICROBIAL ASSOCIATED
TRUE/FALSE = ONLY C. perfringens can INFECT FOALS and cause CLOSTRIDIAL ENTEROCOLITIS
NO, both C. DIFF AND PERFRINGENS possible but PERFRINGENS MORE COMMON IN FOALS
how does CLOSTRIDIUM PERFRINGENS cause D+/disease?
how is it treated?
PRODUCES TOXINS
treated with METRONIDAZOLE
SALMONELLOSIS…
can affect WHAT ages in horses? what age test CHRONIC infections?
salmonella is GRAM-____ _____
transmission?
diagnosis? (2)
treatment?
can affect ALL AGES, but ADULTS TEND TO GET CHRONIC INFECTIONS
salmonella is GRAM-NEGATIVE ENTEROBACTERIACAE
transmission via FECAL-ORAL
diagnosis…
1. FECAL PCR
2. FECAL CULTURE
treatment? = NO ANTIMICROBIALS, but because FOALS more prone to sepsis can use BROAD-SPECTRUM
RHODOCOCCUS EQUI INFECTION…
this is a GRAM-____ BACTERIA
usually associated with foal ___ between the ages of ___-____ _____
can also cause WHAT OTHER 3 DISORDERS?
what 3 GI presentations can it have? do they also need to have the foal ___?
3 diagnostics?
GRAM-POSITIVE bacteria
usually associated with FOAL PNEUMONA between 1-6 MONTHS
can also cause…
1. MUSCULOSKELETAL DISORDERS
2. UVEITIS
3. NEUROLOGICAL DZ
3 GI presentations?
1. ABDOMINAL LYMPHADENITIS
2. ABDOMINAL ABSCESSES
3. ENTEROTYPHLOCOLITIS
–> DO NOT NEED TO HAVE CONCURRENT FOAL PNEUMONIA
3 diagnostics?
1. ABDOMINAL US
2. ABDOMINAL RADS
3. CULTURE
what DIAGNOSTIC should we do in RHODOCOCCUS EQUI if we suspect respiratory component?
what is the DZ we’re looking for?
TRANS-TRACHEAL WASH & CULTURE!
looking for FOAL PNEUMONIA
3 TREATMENTS for RHODOCOCCUS EQUI D+?
when can we do SX in these cases?
what is the MOST IMPORTANT COMPONENT TO CONTROLLING THIS DZ?
- MACROLIDE & RIFAMPIN
- ANTI-INFLAMMATORIES
- SUPPORTIVE CARE
can only do SX if LARGE, DISCRETE ABSCESSES with ADHESIONS
PREVENTION IS KEY! give EQUINE PLASMA WITHIN FIRST 2 HOURS OF AGE
LAWSONIA INTRACELLULARIS…
common in WHAT 2 SPECIES?
causes WHAT 2 GI manifestations?
transmission via…
3 diagnostic options?
common in…
1. PIGS
2. WEANLING HORSES 4-9 MONTHS
causes…
1. PROLIFERATIVE ENTEROPATHY of DISTAL SI
2. PROTEIN-LOSING ENTEROPATHY
transmission via FECAL-ORAL
3 diagnostic options?
1. FECAL PCR
2. IMPA
3. ULTRASOUND
what US finding do we usually see for LAWSONIA INTRACELLULARIS?
why do we see this?
THICK SI that looks CORRUGATED
because it’s a CHRONIC PROLIFERATIVE DZ
what is the best TREATMENT option for LAWSONIA INTRACELLULARIS?
when should we AVOID oral medication? what should we do in this case?
what OTHER therapy can we provide for animals with this dz?
best TREATMENT = TETRACYCLINES PO
AVOID oral medication if animal has DIFFUSE MALABSORPTIVE GI DZ, instead can give TETRACYCLINE IV and eventually PO
should also get SUPPORTIVE CARE like FLUID w/ COLLOIDS for PROTEIN LOSS (enteropathy)
3 TETRACYCLINES?
- OXYTETRACYCLINES
- DOXYCYLINE
- MINOCYCLINE
what is the MOST FREQUENT INFECTIOUS CAUSE OF D+ IN FOALS?
ROTAVIRUS
ROTAVIRUS in foals…
contagion?
transmission?
incubation period?
this disease is usually ___-____
causes ____ D+
diagnosis?
treatment?
contagion? = VERY CONTAGIOUS, SHED IN HIGH CONCENTRATIONS IN FECES
transmission? = FECAL-ORAL
incubation period? = 1-4 DAYS
this disease is usually SELF-LIMITING
causes MALABSORPTIVE D+
diagnosis? = ROTALVIRUS FECAL PCR
treatment? = SUPPORTIVE
3 PREVENTATIVE measures for ROTAVIRUS?
why might one of them NOT work?
- VACCINATE PREGNANT MARES –> might not be effective bc SO MANY STRAINS OF ROTAVIRUS
- ISOLATE CASES
- DISINFECTION
CRYPTOSPORIDIUM more commonly causes D+ in ____ than ____
parasites need to be _____ in ____ to cause D+ in ____
CALVES > FOALS
parasites must be HIGH IN NUMBER to cause D+ in FOALS
what clinical sign is COMMON in septic foals?
DIARRHEA
E. COLI causes D+ in ____ (1) but NOT ___ (2)
in ____ (2), causes these 2 things…
ONLY CAUSES D+ IN CALVES, NOT FOALS
can cause in FOALS…
1. SEPSIS
2. BACTEREMIA
3 unique clinical signs in ENTEROCOLITIS in foals?
5 treatment options for ENTEROCOLITIS? which one is a MUST?
3 clinical signs?
1. FEVER
2. COOL EXTREMITIES
3. SIGNS OF ENDOTOXEMIA
5 treatments?
1. IV FLUIDS sometimes with ELECTROLYTES
2. BROAD-SPECTRUM ANTIBIOTICS –> MUST be done!
3. PLASMA
4. NUTRITIONAL SUPPORT
5. ANTI-DIARRHEAL MEDICATIONS
