The straining foal

Question 1

What are the causes of straing/colic in the neonate?

Answer 1

• Meconium impaction
• Enterocolitis
• Dysmotility
• Small intestinal strangulation
• Intussusceptions
• Hernias
• Gastric or duodenal ulceration
• Lactose intolerance
• Uroabdomen
• Congenital abnormalities - gastro or uro
• Umbilical infection

Question 2

What are the risk factors for straining/colic in the neonate?

Answer 2

• Maternal:
  
  • Dystocia
  • Concurrent illness in dam
  • Gestation (Prematurity)
  • Bonding
  • Parity
• Placental:
  
  • Placentitis
  • Placental insufficiency
• Foal:
  
  • Failure of passive transfer
  • Sepsis
  • Encephalopathy (Maladjustment syndrome)
  • Omphalitis
  • Congenital defects
  • Trauma

Question 3

What clinical exam aspects must you do in a neonate that is presenting with straining/colic?

Answer 3

congenital defects and signs of prematurity
* Digital exam - patent anus
* Abdominal palpation - impaction

Question 4

What diagnositic test/imaging can you do with a neonate that is straing/ showing signs of colic?

Answer 4

• IgG
• Glucose
• Lactate
• Haematology and Biochemistry
  
  • Sepsis/SIRS Criteria?
• Inflammatory Markers
• USG
• Enema - to see if there is an improvement after
• Ultrasound
  
  • Any probe can give you information
  • Different transducers may yield optimal images in different regions
  • Take lots of videos and images
• Radiography
  
  • Abdomen
  • Ambulatory equipment

Question 5

What is the most common cause of intestinal obstruction in neonates?
In what time period and where does this obstruction occur?
What will you see?
How do you diagnose this?

Answer 5

• Meconium impaction
• If not passed by 12 h, likely to cause an obstruction
  
  • Small colon
  • Pelvic inlet - Colts
• Progressive intestinal +/- abdominal distension if impacted
• No meconium, colic, tail flagging

Diagnosis:
* Abdominal palpation, Gentle
* Digital exam - Often can feel it at the tip of your finger
* Abdominal ultrasound - More specific and sensitive
* Hypoechoic-anechoic, Intestinal wall contracted around it, Speckled

Question 6

What is the treatment for meconium impaction?

Answer 6

• Phosphate enema
  
  • Routinely used
  • Max 2 in first 24 hours
  • Hyperphosphataemia
• Warm soapy water (johnsons baby wash)
  
  • Foley catheter
  • Gravity flow
  • Approx 200mL

If don’t respond:
Acetylcysteine retention enema
* 4% acetylcysteine is made (normally 150-200mLs)
* Foal is sedated (Diazepam + butorphanol)
* Lateral + elevated hindend
* Foley placed in the rectum and cuffed gently. Ideally 5cm in but don’t push!
* Solution administered via gravity flow and foley clamped closed
* Clamp released after 45min
* Can repeat in 12-24h

IF still impacted, with persistent colic and distension then surgery

Question 7

What are the causes of umbilical infection?
How can this be diagnosed?
What is the treatment?

Answer 7

Umbilical stump –> Urachus, Umbilical artery, Umbilical vein
* Infection of any structure or multiple structure
* primary or secondary - Foci or bacteraemia
Patent urachus - more prone to infection (will see urine drips, should close within a few days)

Diagnsosis: Ultrasound and palpation

• Medical
  
  • Broad spectrum antimicrobials
    
    • Concurrent disease?
  • Prolonged treatment (weeks)
  • Serial ultrasounds
• Surgical
  
  • Poor response to medical management
  • Umbilicus + Other infections
    
    • Debateable: surgery vs stabilisation first

Question 8

When does a uroabdomen occur?
What occurs?
Which sex is presisposed in the neonatal period?

Answer 8

• First few days of life
• Mostly bladder wall rupture
  
  • Can have ureteral tears
  • Most caused during parturition
    
    • Full bladder + birth canal pressures
• Colts over represented in cases shortly after birth

Question 9

what are the clinical signs of uroabdomen?

Answer 9

Clinical signs vary based on size of defect and rate of urine leakage into peritoneum
* Depression
* Weakness
* Signs of hypovolaemia
* Stranguria/anuria
* Bradycardia!
* Hard to differentiate from sepsis (could be both too!)
* Refer?

Question 10

How can you diagnose uroabdomen?
What clinical pathology will you see?

Answer 10

• Ultrasound
  
  • Most useful in the field
  • Identify fluid in the abdomen (hypoechoic)
  • Degree of fluid accumulation
  • +/- site of leakage
• Abdominocentesis
  
  • Confirmation: Peritoneal creatinine x2 serum creatine
  • May not be suitable in the field
    
    • Complications with drainage

Clinical Pathology
* Increased serum creatinine
* Hyperkalaemia
* Reabsorption from abdomen
* Hyponatraemia + hypochloraemia
* Reabsorption of water from abdomen
* Meatablic acidosis

Question 11

What is the treatment for uroabdomen?
What is the prognosis?

Answer 11

Refer for surgical repair

Prognosis - Good for bladder rupture, less so for ureteral disorders

Delay in identification + concurrent disease –> worse prognosis
* Physical exam
* Identify sepsis early!