Final Exam - Septic/PAS Foals

Question 1

T/F: a foal is septic until proven otherwise

Answer 1

true

Question 2

what is bacteremia?

Answer 2

presence of viable bacteria in the blood stream

Question 3

what is SIRS?

Answer 3

malignant global activation of multiple proinflammatory pathways - nonspecific innante inflammatory response

Question 4

what is sepsis?

Answer 4

presence of a probable or documented infection together with systemic manifestations of infection

Question 5

to say a neonate has SIRS, the patient must have 2 or more of the following conditions?

Answer 5

1. fever or hypothermia
2. tachycardia
3. tachypnea or hypocapnia
4. leukocytosis or leukopenia
5. presence of bands on a blood smear

Question 6

what are 3 possible risk factors for a foal developing neonatal sepsis that would be important to gather during a history?

Answer 6

1. dystocia
2. maternal illness - placentitis, vulvar discharge
3. failure of passive transfer

Question 7

does a normal cardiothoracic auscultation on a neonatal foal rule out pulmonary disease?

Answer 7

no

Question 8

why is ultrasonographic evaluation of the urachus important?

Answer 8

need to know what structures are involved

Question 9

what are the 2 most commonly affected joints in septic arthritis in the neonatal foal?

Answer 9

1. tarsocrural
2. femoropatellar

Question 10

what are the pros & cons of blood culture when attempting to diagnose septicemia in a foal?

Answer 10

gold standard, definitive diagnosis

delayed results = delayed treatment, high false negatives due to low circulating bacterial load, low volume of blood collected, or variance in culture media & processing

Question 11

what information do you need to obtain a sepsis score?

Answer 11

CBC, blood glucose, lactate, IgG, creatinine, clinical exam (petechiae, diarrhea, swollen joints, respiratory distress, neuro signs), historical data, presence of SIRS

Question 12

what are some important considerations when choosing antimicrobials in a septic foal?

Answer 12

want broad spectrum, bactericidal, & IV antibiotics

FPT - has neutropenia & bad immune system
IV because gut & muscle perfusion are altered

ampicillin & amikacin

Question 13

what is the main underlying issue that leads to clinical manifestation of NE?

Answer 13

brain damage results from:

decrease in cerebral blood flow, oxygen, hypoxia, inflammatory cascade leading to ischemia, neuronal cell death, repurfusion injury/oxidative injury

excessive intracellular calcium has profound effects (swelling)
microglia (developmental) & elevated pregnanes

Question 14

what is the madigan squeeze? how does it work?

Answer 14

thoracic pressure is applied to a young foal in order to induce recumbency and a slow-wave sleep

believed to signal the foal to transition from sleeping in the womb to wakefulness - mimics birth canal, gives them a bit of a redo

Question 15

why are septic foals at a higher risk for developing pneumonia?

Answer 15

abnormal perinatal development, hypoxia & SIRS cause vascular leakage, & they are immunocompromised

Question 16

what are the most common pathogens of foal enterocolitis?

Answer 16

c. perfringens, c. difficile, salmonella, rotavirus

Question 17

whats the most common pathway for a foal to develop sepsis?

Answer 17

enterocolitis/pneumonia

Question 18

what agent is often associated with causing omphalitis?

Answer 18

e. coli

Question 19

what is a common complication of omphalitis?

Answer 19

patent urachus

Question 20

when may you use hyperimmune plasma?

Answer 20

foal that needs oncotic support, endotoxemia, or FPT

Question 21

what is the shock dose for a foal?

Answer 21

20 ml/kg then reassess mentation, pulses, & urine

Question 22

what nutritional treatment is needed for a septic foal?

Answer 22

enteral - indwelling NG tube needed to stimulate intestinal development at 50 kcal/kg/day

Question 23

what is the prognosis of septic foals?

Answer 23

50-60% survival short term

Question 24

what are some negative prognostic factors in septic foals?

Answer 24

gram negative or mixed infections, septic arthritis, significant elevations in bands or creatinine, concurrent meningitis

Question 25

what is NE?

Answer 25

neonatal encephalopathy

Question 26

what are some risk factors associated with NE?

Answer 26

maternal disease (hypotension), dystocia, placentitis, acute or chronic uteroplacental separation, twinning, congenital abnormalities, meconium aspiration, sepsis, prematurity/dysmaturity

Question 27

what are some clinical signs of NE?

Answer 27

weakness, inability to lie down, lack of interest in dam, recumbency, lack of suckle, seizures, inappropriate suckle, other organs affected

Question 28

what is category 1 NE?

Answer 28

born normal, develop signs after 48 hours, good prognosis for survival

Question 29

what is category 2 NE?

Answer 29

associated risk factors, born abnormal, decreased survival rate

Question 30

what are some differentials for NE?

Answer 30

sepsis, epilepsy, hypoglycemia

Question 31

how is NE treated?

Answer 31

generally refer for severe cases, supportive care, dummy foal cocktail, therapeutic hypothermia, free radical scavengers