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Equine Medicine Final > GI disorders in the foal > Flashcards

GI disorders in the foal Flashcards

1
Q

What is the toxic principle in box elder tree seed pods?

A
  • Hyperglycine A
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2
Q

Differentials for nasal regurgitation of milk

A
  • Cleft palate
  • Pharyngeal dysfunction
  • Megaesophagus
  • Botulism - usually older foals
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3
Q

Cleft palate in foals diagnosis

A
  • Should be a part of the neonatal exam - digital palpation of the hard palate
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4
Q

Which is more common: cleft soft palate or cleft hard palate?

A
  • Soft palate
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5
Q

Common consequence of cleft palate

A
  • Aspiration pneumonia
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6
Q

Treatment of cleft palate

A
  • Surgical repair or euthanasia
  • If they live long enough to consume
  • Solid feed may survive
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7
Q

Dfdx for colic in neonates that are infectious

A
  • Enteritis/sepsis
  • Neonatal septicemia
  • Salmonella
  • Clostridium perfringens
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8
Q

Dfdx for colic in neonates that are non-infectious

A
  • Meconium impaction
  • Birth asphyxia related
  • Congenital disorders
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9
Q

Older foals infectious dfdx

A
  • Rotavirus (1 week to 2 weeks up to 3-4 months)
  • Lawsonia intracellularis
  • Parascaris equorum (couple of months)
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10
Q

Older foals non-infectious dfdx

A
  • Gastroduodenal ulcer syndrome
  • Sand
  • motility issues in the colon
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11
Q

Aspects to diagnose colic in a neonate

A
  • Palpate thorax and abdomen
  • Neonates can have rib fractures
  • Abdominal distension
  • Clinical evidence or suspicion of sepsis
  • Lab data showing neutropenia or leukopenia
  • Ultrasound (do you see a lot of fluid?)
  • Radiography
  • Nasogastric tube and reflux
  • Abdominocentesis
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12
Q

Normal abdominocentesis

WBC Count
Protein
Lactate

A
  • White blood cell count (<5,000 cells/mL)
  • TP <2.5
  • Lactate <2 mmol
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13
Q

Differentials for small intestinal distension in foals

A
  • ileus (asphyxia or sepsis)
  • Enteritis (often origin of systemic sepsis)***
  • Small intestinal strangulation or obstruction
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14
Q

Differentials for colonic tympany in foals

A
  • Secondary to meconium impaction**
  • Secondary to ileus +/- colitis
  • Congenital conditions
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15
Q

Differentials for Peritoneal effusions in foals

A
  • Uroperitoneum***

- Peritonitis

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16
Q

Clinical signs of a foal with meconium impaction

A
  • 6 hour old foal
  • Progressive abdominal distension
  • Recurrent colic, rolling
  • Non-productive soapy water enema
  • Cannot palpate meconium in the rectum with your finger
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17
Q

What is different about the colic exam in the neonatal foal from the adult?

A
  • Unable to perform extensive rectal examination
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18
Q

Other things to consider on a neonatal colic exam

A
  • Observe
  • Degree of frequency and pain
  • Abdominal distension
  • Auscult
  • Digital rectal exam and check for feces**
  • Check inguinal area for hernia
  • Costochondral junction to detect rib fractures
  • Ultrasound is more helpful in foals
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19
Q

Pain behavior in foals

A
  • Rolling on the ground

- They look like they are dying

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20
Q

What is the most common cause of colic in neonates?

A
  • Meconium impaction
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21
Q

What causes meconium impactions

A
  • Immature colonic pacemaker neurons?

- Interstitial cells of Cajal are immature in the neonate even full-term

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22
Q

How long does it take meconium impaction signs to occur?

A
  • 12-24 hours
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23
Q

Other clinical signs of meconium impaction

A
  • Decreased suckling
  • Depression
  • Variable pain (straining to defecate; rolling)
  • Abdominal distension
  • Colonic tympany
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24
Q

Differentiate posture to urinate from posture to defecate

A
  • make sure you can do it
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25
Q

What is meconium?

A
  • First fecal excretion of the newborn
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26
Q

What is meconium composed of?

A
  • Bile
  • Epithelial cells
  • Mucus
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27
Q

Diagnosis of meconium impaction

A
  • Physical exam
  • Digital rectal
  • Ultrasound
  • Gas distended colon
  • meconium?
  • Abdominal radiographs
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28
Q

Colonic tympany in meconium impaction

A
  • Abdomen is filled

- Large viscus that contains multiple parallel horizontal echogenic lines and gas

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29
Q

Abdominal radiographs in foals with meconium impaction

A
  • Differentiate large vs small intestinal gas
  • meconium
  • Abundant gas
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30
Q

Medical management of meconium impaction overview

A
  • Oral laxative
  • Enemas: Soapy water enemas, acetylcysteine enema, Fleet enema
  • IV fluids
  • Pain control
  • +/- Prokinetic
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31
Q

Fleet enemas for Meconium Impaction

A
  • Phosphate
  • Often requires multiple doses
  • Risk of hyperphosphatemia
  • Not enough by the time the foal is colicky
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32
Q

Oral laxatives for Meconium Impaction

A
  • Mineral oil (not for adult horses; the goal here is to actually help it slide out)
  • Milk of magnesia
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33
Q

Soapy water enemas

A
  • Ivory soap in water
  • Harris flush tube
  • Enema bucket
  • Occluding anus can provide some hydropropulsion effect
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34
Q

Cautions with enemas in foals

A
  • Delicate rectal mucosa
  • Use of abundant sterile lubricant jelly
  • Do not force the catheter
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35
Q

Acetylcysteine retention enema

A
  • Intended to aid in breaking down the disulfide bonds in mucus component of meconium
  • Acetylcysteine solution and warm water with sodium bicarbonate to help adjust the pH
  • Technique is soft flexible Foley catheter with an inflatable cuff
  • Insert into rectum 6-10 inches
  • Inflate cuff with water
  • Apply clamp to Foley catheter once in place and leave for 30-45 minutes
  • Repet several times if necessary
36
Q

IV fluid goals in meconium impaction

A
  • Restore circulating fluid volume

- Hyperhydration of the luminal material

37
Q

Pain control for meconium impactions with foals

A
  • Flunixin meglumine
  • Butorphanol
  • Buscopan
38
Q

Prokinetics for meconium impaction with colonic tympany

A
  • Neostigmine (cholinesterase inhibitor)

- She does not use this, but it may help

39
Q

Meconium impaction feeding recommendations

A
  • Hold them off of the mare
40
Q

Monitoring for meconium impactions

A
  • Serial ultrasounds

- can determine if ileus and or gastric distension present before administration of laxatives via NG tube

41
Q

Indications for referral in meconium impaction

A
  • Profound abdominal distention and unrelenting pain

- Indications for referral +/- surgery

42
Q

What is the risk of surgery in foals that is more than normal?

A
  • They are little adhesion machines

- They adhese a LOT

43
Q

Two possible complications with meconium impaction

A
  • Sepsis

- Urinary bladder or urachal leak

44
Q

Sepsis complication of meconium leak

A
  • Inadequate nursing due to pain and straining
  • Possible mucosal injury leads to translocation of bacteria
  • Occasionally transmural necrosis of the intestine
45
Q

Urinary bladder or urachal leak in a horse with meconium impaction

A
  • Straining

- Over hydration with fluids

46
Q

Age period for meconium impaction

A
  • 1-2 days usually
47
Q

Dfdx for meconium impaction

A
  • Sepsis
  • Infectious diarrhea
  • GI ulcer
  • Volvulus, intussusception
  • Peritonitis
48
Q

Other differential that can cause gas distension of the small or large intestine in a 1-2 day old foal?

A
  • Atresia ani
49
Q

Other differential that can cause meconium impaction in a 1-2 day old foal?

A
  • Aganglionosis or lethal white foal syndrome
50
Q

Atresia coli timeline

A
  • first 1-2 days
51
Q

Atresia coli - how common?

A
  • SUPER RARE
52
Q

Atresia coli what will you feel on rectal?

A
  • No feces
53
Q

Other signs with atresia coli

A
  • Abdominal distension
54
Q

How do you diagnose atresia coli?

A
  • Radiographs

- Endoscopy

55
Q

What is the pattern of inheritance of Lethal white syndrome or aganglionosis

A
  • Autosomal recessive
56
Q

What is the mutation in lethal white syndrome?

A
  • Mutation in the endothelin B receptor gene
57
Q

What is the fundamental pathologic problem with lethal white syndrome?

A
  • Lack of submucosal and myenteric ganglia

- Small intestine to colon

58
Q

Which breeding cross is at risk for offspring with lethal white syndrome?

A
  • Overo paint x Overo paint
59
Q

Clinical signs of Lethal white overo

A
  • No meconium production

- Colic soon after birth

60
Q

Enteritis in foal diagnosis

A
  • Ultrasound - rapid
  • Thick walls
  • Fluid distended
  • Variable SI motility
  • May be primary site for bacterial sepsis
61
Q

Clinical signs of foal diarrhea

A
  • Vague signs of illness
  • Fever, obtundation, colic, decreased nursing
  • Signs will start prior to nursing
62
Q

How can you help differentiate surgical lesions from enteritis?

A
  • Physical exam and ultrasound findings
63
Q

General diagnostics for foal diarrhea

A
  • Observation/clinical history
  • Assessment of systemic effects
  • Hematology/Biochemistry panel
  • Fecal PCR
  • Fecal cytology/bacterial culture
  • Bacterial toxin assay (C. difficile toxin A and C. perfringens enterotoxin)
  • parasitology
  • Electron microscopy
64
Q

What is the infectious agent in Potomac horse fever?

A
  • Neorickettsia risticii
65
Q

What changes often occur on the biochemistry panel?

A
  • Sodium and chloride often drop
66
Q

Infectious causes of foal diarrhea

A
  • Rotavirus
  • Systemic bacterial sepsis
  • Salmonella
  • Clostridium perfringens A, B, and C
  • Clostridium dificile
  • Coronavirus
  • Parascaris equorum
  • Strongyloides westeri
  • Cryptosporidium
67
Q

Foal diarrhea treatment decisions - what’s the first question you should answer?

A
  • Does it need intervention?
68
Q

Questions to answer to determine if the foal needs treatment

A
  • Is it still nursing the mare?
  • Signs of colic
  • Estimated volume of fecal fluid loss
  • Signs of systemic illness
  • How critical?
  • Referral?
69
Q

What are differentials for abdominal ultrasound SI distension?

A
  • Ileus and Enteritis
70
Q

How can you differentiate ileus and enteritis in a foal with SI abdominal distension on ultrasound?

A
  • WBC count could be low with either

- But enteritis is more likely to be low, whereas ileus isn’t normally

71
Q

When is there an indication in a foal to pass an NG tube?

A
  • High heart rate (>80 BPM) in a foal
  • Indication to pass the tube
  • First priority with any colic
72
Q

Overview of enteritis treatment

A
  • Culture (feces or blood)
  • Broad spectrum antibiotics
  • Anti-endotoxin medications
  • IV fluids
  • Intestinal protectants
  • Nutritional management too
73
Q

What to culture for enteritis?

A
  • Blood

- Feces

74
Q

Anti-endotoxin medications for use in foals with enteritis

A
  • Flunixin meglumine

- Polymixin B (nephrotoxic)

75
Q

IV fluids to use in foals with enteritis

A
  • Crystalloids
  • Plasma
  • Hetastarch
76
Q

Intestinal protectants to use with enteritis

A
  • Bismuth subsalicylate (Pepto)
  • Biosponge (Smectite)
  • Sacchromyces boulardii
77
Q

Nutritional management of enteritis foals

A
  • Most foals require milk or enteral nutrition

- Parenteral nutrition possible but not ideal

78
Q

How can you promote suckling behavior in a foal on parenteral nutrition?

A
  • Gradually wean off parenteral nutrition to intermittent suckling
  • Start allowing foal to nurse for 1-2 minutes to start every 2 hours
79
Q

Target sign

A
  • Small intestinal intussusception

- Can see on ultrasound the loops of bowel inside of the other loops of bowel

80
Q

Clinical signs of intussusception

A
  • Decreased suckling
  • Dehydration
  • Diarrhea
  • PROGRESSIVE colicking
  • Slightly distended abdomen
  • May not be febrile
81
Q

Treatment for intussusception

A
  • Surgery
82
Q

What is the most common cause of diarrhea in foals?

A
  • Foal Heat Diarrhea
83
Q

When does foal heat diarrhea occur?

A
  • 7-12 days post partum
  • Same time as post-foaling estrus for a mare
  • Occurs in orphan foals as well
84
Q

Mechanism of foal heat diarrhea

A
  • Hypersecretion into the small intestine overwhelming the capacity of immature colon
  • Normal physiologic mechanism
  • Likely due to changing of the microbiome (eating mom’s feces and solid feed
85
Q

How do you treat foal heat diarrhea?

A
  • Self-limiting and normal

Equine Medicine Final (10 decks)

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