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
