Soft tissue surgery of foals

Question 1

What is the most common route of synovial sepsis in foals

Answer 1

Haematogenous spread of local or systemic infection

Question 2

Clinical signs of synovial sepsis in foals

Answer 2

Joint distension in key
Usually febrile
Often more than one joint affected

Question 3

What are some predisposing factors to synovial sepsis in foals

Answer 3

Failure of passive transfer
Premature/dysmature/dystocia
Immunocompromise
Systemic illness

Key one = infection at another site; mostly umbilicus

Question 4

What pot do we need to put synovial fluid into

Answer 4

EDTA

Question 5

Normal synovial fluid characteristics

Answer 5

• Straw coloured
• Viscous
• Low white cell count <10 x10^9/L
• <15% neutrophils [but NB can be higher ]
• Low total protein <10g/L

Question 6

When might a normal joint shower higher neutrophil percentages ~50-60%

Answer 6

If recent joint injection

Question 7

Characteristics of septic joint fluid

Answer 7

• Cloudy/turbid
• Serosanguinous
• Watery
• High white cell count >20 X 10^9/L with >90% neutrophils
• Total protein high >30g/L

Question 8

Why do we always radiographs foals with septic joints

Answer 8

To look for signs of osteomyelitis in physis and epiphysis
This is a poor prognostic signs and must be addressed at surgery as it can continue to seed infection into the joint

BONE INFECTION

Question 9

Septic joint treatment in foals

Answer 9

1) Synovial lavage: arthroscopic/tenoscopic high volume 5-15L
+ debridement after lavage and closure

2) Antibiotics

Question 10

Antibiotic protocol for synovial sepsis in foals

Answer 10

Pen/gent systemically, can do oxytet
Locally gentamycin; tends to be injected into synovial structure at the end of surgery so gives a high concentration for 1-2 days

Question 11

Prognosis for septic joints in foals

Answer 11

Survival 60-80%
Racing ability 30-60%

Question 12

How to tell if naso-gastric reflux in foals is normal or due to obstruction

Answer 12

Test the pH
- If acidic = reflux from stomach; normal
- If more basic = backing up from small intestine due to obstruction

Question 13

What is a possible stomach disorder of foals

Answer 13

Gastric outlet obstruction
Pseudo obstruction

Tends to be the result of severe ulceration and most treated medically since surgery high risk and expensive

Question 14

Aside from congenital factors what can lead to hernias in foals

Answer 14

high forces at parturition

Question 15

What tends to be the cause of small intestinal obstructive lesions

Answer 15

Impaction of parascaris equiorum in weanlings following anthelmintic treatment by a few days

Question 16

How to surgically deal with SI obstruction in foals

Answer 16

= indicated if complete obstruction present
Do enterotomy and evacuation then closing
May need to resect some if bowel devitalised

Question 17

What is the most common surgical lesion in foals, esp when <3mo

Answer 17

Small intestinal volvulus
= where intestine rotates around long azis

Question 18

Clinical signs of small intestinal volvulus

Answer 18

Severe pain, recumbent, SI and abdominal distension, no SI movement on U/S, increased RR/HR, injected MMs, may be pyrexic

Question 19

What to do with atresia coli cases

Answer 19

Euthanise

Question 20

What to do with atrexia ni

Answer 20

Incise the persistent anal membrane
Or remove circular piece of skin and suture the rectal wall to skin

= good prognosis for survival but poor for normal anal function