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Year 1/2 > Digestion & Metabolism 2: Neonate Foal > Flashcards

Digestion & Metabolism 2: Neonate Foal Flashcards

1
Q

6 common DDxs for COLIC in neonatal foals?

A
  1. MECONIUM IMPACTION
  2. ENTEROCOLITIS
  3. NECROTIZING ENTEROCOLITIS
  4. INTUSSUSCEPTION
  5. CONGENITAL ABNORMALITIES (intestinal atresia, ileocolonic agangliosis)
  6. GASTRODUODENAL ULCER SYNDROME
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2
Q

what should be your TOP ddx for a foal within 12-24 hours of age with COLIC?

A

MECONIUM IMPACTION

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3
Q

when is meconium formed?

what 4 things is it made of?

when does it FIRST APPEAR?

when is BILIRUBIN EXCRETED

A

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

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4
Q

why would meconium look YELLOW upon birth?

A

if MECONIUM IS RETAINED/NOT PASSED WITHIN AN HOUR AFTER BIRTH, starts to ABSORB BILIRUBIN

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5
Q

ID what this is

A

this is MECONIUM, defined HYPOECHOIC SHAPE with HYPERECHOIC SPECKLES

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6
Q

ID LESION in foal 24 HOURS OLD

A

GAS DISTENTION around GUT from MECONIUM IMPACTION

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7
Q

STANDARD ENEMA vs. RETENTION ENEMA for MECONIUM

A

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

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8
Q

if a STANDARD ENEMA doesn’t work for MECONIUM IMPACTION after a couple times, we should… (2)

A

STOP, do not want to cause RECTAL TEARS FROM STRAINING!

should do RETENTION ENEMA

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9
Q

2 steps for RETENTION ENEMA…

A
  1. put FOLEY IN LATERAL RECUMBENCY with HIND ELEVATION FOR 20 MINS
  2. GRAVITY-FEED IN ACETYL CYSTEINE to BREAK DOWN DISULFIDE BONDS in MECONIUM
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10
Q

ORAL Tx for MECONIUM IMPACTION? (2)

A
  1. ORAL LAXATIVES via MINERAL OIL (given NGT to avoid ASPIRATION PNEUMONIA)
  2. ONLY ALLOW NURSING if NOT PERSISTENTLY COLICKY/DISTENDED ABDOMEN, otherwise NPO
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11
Q

if NPO, neonates should receive… (2)

A
  1. IV FLUIDS
  2. DEXTROSE
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12
Q

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!)

A

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

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13
Q

trophic feeding definition?

A

= feeding SMALL volumes of ENTERAL FLUIDS to STIMULATE DEVELOPMENT OF IMMATURE GI TRACT in NEONATES

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14
Q

TREATMENT for NEONATAL GASTROENTEROPATHY (2)

A
  1. treat/manage OTHER PROBLEMS (perfusion, sepsis, etc)
  2. TROPHIC FEEDING
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15
Q

NECROTIZING ENTEROCOLITIS..

can be secondary to WHAT dz?

= definition

2 causes?

diagnosis via… & what 2 things do we see?

A

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

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16
Q

TREATMENT for NECROTIZING ENTEROCOLITIS… (2)

why is RESECTION & ANASTOMOSIS not helpful here?

prognosis for ADVANCED lesions?

A

2 treatments?
1. treat UNDERLYING PROBLEMS
–> fluid resuscitation
–> RESPIRATORY function
–> OXYGENATION

  1. 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

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17
Q

why should we give foals with NECROTIZING ENTEROCOLITIS nutrition via TOTAL PARENTERAL versus PO?

A

want to PREVENT BACTERIAL PROLIFERATION

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18
Q

Dx this lesion & define it!

what DISEASE is this typically associated with?

A

PNEUMATOSIS INTESTINALIS = HYPERECHOIC, GAS-CASTING LESIONS in INTESTINAL WALL indicating that GAS IS GOING THROUGH IT

usually associated with NECROTIZING ENTEROCOLITIS

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19
Q

INTUSSUSCEPTION in foals can be….

but once it is a problem, usually a ____ problem

can cause issues with…

A

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

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20
Q

CONGENITAL INTESTINAL ATRESIA…

tend to see colic WHEN?

2 clinical signs?

A

tend to see colic WITHIN FIRST 24 HOURS OF AGE

2 clinical signs?
1. ABDOMINAL DISTENTION
2. NO FECES

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21
Q

OVERO LETHAL WHITE SYNDROME

aka?

occurs in WHAT breed with WHAT genetic mutation?

not ALL…

can be….

A

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

22
Q

4 possible presentations of GASTRIC ulcers in FOALS? which one tends to occur in OLDER foals?

pathophysiology?

3 common locations for ulcers?

A

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

23
Q

3 RISK/PREDISPOSING factors for ULCERS in FOALS?

A
  1. PERINATAL HYPOXIA
  2. SYSTEMIC ILLNESS such as SEPSIS or D+ that affects CARDIOVASCULAR STABILITY
  3. use of ANTI-INFLAMMATORIES –> mucosal HYPOXIA & ISCHEMIA –> loss of PROTECTIVE FACTORS
24
Q

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?

A

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

25
Q

3 medications for TREATMENT of GASTRIC ulcers? which one should be used for PREVENTION?

why should we AVOID gastric suppression in foals <2 weeks of age?

prognosis in SIMPLE & PERFORATING ulcers?

A

3 medications?
1. PROTON PUMP INHIBITORS (dec HCl)
2. SUCRALFATE (protective) –> PREVENTION
3. H2 ANTAGONISTS

ACID HELPS PROTECT AGAINST BACTERIAL ENTEROCOLITIS so NO GASTRIC SUPPRESSION in young foals

prognosis in…
SIMPLE = OVERALL GOOD but RISK OF PERFORATION higher in FOALS
PERFORATING = GRAVE

26
Q

GASTRODUODENAL ULCER SYNDROME…

common in WHAT AGE RANGE FOALS?

2 common causes?

4 sequelae?

A

common in OLDER foals 2- 6 MONTHS

2 common causes…
1. IDIOPATHIC
2. SECONDARY TO OTHER CHRONIC CONDITIONS

4 sequelae?
1. ESOPHAGITIS
2. GASTRIC SQUAMOUS & GLANDULAR ULCERATION
3. PYLORIC ULCERATION
4. PYLORIC STRICTURE

27
Q

GASTRODUODENAL ULCER SYNDROME…

5 clinical signs?

3 diagnostics?

5 treatment options?

OFTEN requires ___ intervention

A

5 clinical signs?
1. UNTHRIFTY
2. POT-BELLIED APPEARANCE
3. BRUXISM
4. PTYALISM
5. COLIC

3 diagnostics?
1. ABDOMINAL US
2. GASTROSCOPY
3. NASOGASTRIC INTUBATION

5 tx?
1. FREQUENT GASTRIC DECOMPRESSION
2. GASTROPROTECTANTS
3. IV FLUIDS
4. ANALGESICS
5. PROKINETICS

28
Q

in GASTRODUODENAL ULCER SYNDROME, prognosis is ____ with MEDICAL management and ____ with SURGICAL intervention

A

POOR, GUARDED

29
Q

usually by the time we DIAGNOSE GASTRODUODENAL SYNDROME, WHAT has formed?

A

A STRICTURE (likely at PYLORUS) has formed

30
Q

FOAL HEAT DIARRHEA…

this is a ___-____ condition that lasts for ___-___ ____

common in foals aging (range)..?

fever?

2 possible causes?

A

this is a SELF-LIMITING condition that lasts for 3-4 DAYS

common in foals 5-15 DAYS OLD

AFEBRILE

2 possible causes?
1. CHANGE IN MARE’S MILK COMPOSITION with FOAL HEAT
2. change in FOAL’S INTESTINAL MICROBIOTA due to COPROPHAGY

31
Q

NUTRITIONAL DIARRHEA in FOALS often caused by…

A

often caused by FOALS EATING WEIRD THINGS LIKE SAND, ESPECIALLY WHEN BORED

32
Q

LUMINANT IRRITANT D+ can be caused by what 2 things?

A
  1. PICA –> irritation of intestinal mucosa –> D+ & COLIC
  2. SAND ENTEROPATHY
33
Q

LACTOSE INTOLERANCE can be caused by WHAT 2 things?

pathophysiology?

A

caused by?
1. ROTAVIRUS
2. C DIFF

pathophysiology? = ELIMINATE LACTASE BRUSH BORDER ENZYME

34
Q

5 INFECTIOUS causes of D+ in foals?

A
  1. BACTERIAL (clostridium, rhodococcus, lawsonia, salmonella)
  2. VIRAL (rotavirus, coronavirus)
  3. SEPSIS
  4. PROTOZOAL (crypto)
  5. PARASITICC (strongyloides westeri)
35
Q

3 NON-INFECTIOUS cases of FOAL D+?

A
  1. FOAL HEAT D+
  2. DIETARY INTOLERANCE
  3. ANTIMICROBIAL ASSOCIATED
36
Q

TRUE/FALSE = ONLY C. perfringens can INFECT FOALS and cause CLOSTRIDIAL ENTEROCOLITIS

A

NO, both C. DIFF AND PERFRINGENS possible but PERFRINGENS MORE COMMON IN FOALS

37
Q

how does CLOSTRIDIUM PERFRINGENS cause D+/disease?

how is it treated?

A

PRODUCES TOXINS

treated with METRONIDAZOLE

38
Q

SALMONELLOSIS…

can affect WHAT ages in horses? what age test CHRONIC infections?

salmonella is GRAM-____ _____

transmission?

diagnosis? (2)

treatment?

A

can affect ALL AGES, but ADULTS TEND TO GET CHRONIC INFECTIONS

salmonella is GRAM-NEGATIVE ENTEROBACTERIACAE

transmission via FECAL-ORAL

diagnosis…
1. FECAL PCR
2. FECAL CULTURE

treatment? = NO ANTIMICROBIALS, but because FOALS more prone to sepsis can use BROAD-SPECTRUM

39
Q

RHODOCOCCUS EQUI INFECTION…

this is a GRAM-____ BACTERIA

usually associated with foal ___ between the ages of ___-____ _____

can also cause WHAT OTHER 3 DISORDERS?

what 3 GI presentations can it have? do they also need to have the foal ___?

3 diagnostics?

A

GRAM-POSITIVE bacteria

usually associated with FOAL PNEUMONA between 1-6 MONTHS

can also cause…
1. MUSCULOSKELETAL DISORDERS
2. UVEITIS
3. NEUROLOGICAL DZ

3 GI presentations?
1. ABDOMINAL LYMPHADENITIS
2. ABDOMINAL ABSCESSES
3. ENTEROTYPHLOCOLITIS
–> DO NOT NEED TO HAVE CONCURRENT FOAL PNEUMONIA

3 diagnostics?
1. ABDOMINAL US
2. ABDOMINAL RADS
3. CULTURE

40
Q

what DIAGNOSTIC should we do in RHODOCOCCUS EQUI if we suspect respiratory component?

what is the DZ we’re looking for?

A

TRANS-TRACHEAL WASH & CULTURE!

looking for FOAL PNEUMONIA

41
Q

3 TREATMENTS for RHODOCOCCUS EQUI D+?

when can we do SX in these cases?

what is the MOST IMPORTANT COMPONENT TO CONTROLLING THIS DZ?

A
  1. MACROLIDE & RIFAMPIN
  2. ANTI-INFLAMMATORIES
  3. SUPPORTIVE CARE

can only do SX if LARGE, DISCRETE ABSCESSES with ADHESIONS

PREVENTION IS KEY! give EQUINE PLASMA WITHIN FIRST 2 HOURS OF AGE

42
Q

LAWSONIA INTRACELLULARIS…

common in WHAT 2 SPECIES?

causes WHAT 2 GI manifestations?

transmission via…

3 diagnostic options?

A

common in…
1. PIGS
2. WEANLING HORSES 4-9 MONTHS

causes…
1. PROLIFERATIVE ENTEROPATHY of DISTAL SI
2. PROTEIN-LOSING ENTEROPATHY

transmission via FECAL-ORAL

3 diagnostic options?
1. FECAL PCR
2. IMPA
3. ULTRASOUND

43
Q

what US finding do we usually see for LAWSONIA INTRACELLULARIS?

why do we see this?

A

THICK SI that looks CORRUGATED

because it’s a CHRONIC PROLIFERATIVE DZ

44
Q

what is the best TREATMENT option for LAWSONIA INTRACELLULARIS?

when should we AVOID oral medication? what should we do in this case?

what OTHER therapy can we provide for animals with this dz?

A

best TREATMENT = TETRACYCLINES PO

AVOID oral medication if animal has DIFFUSE MALABSORPTIVE GI DZ, instead can give TETRACYCLINE IV and eventually PO

should also get SUPPORTIVE CARE like FLUID w/ COLLOIDS for PROTEIN LOSS (enteropathy)

45
Q

3 TETRACYCLINES?

A
  1. OXYTETRACYCLINES
  2. DOXYCYLINE
  3. MINOCYCLINE
46
Q

what is the MOST FREQUENT INFECTIOUS CAUSE OF D+ IN FOALS?

A

ROTAVIRUS

47
Q

ROTAVIRUS in foals…

contagion?

transmission?

incubation period?

this disease is usually ___-____

causes ____ D+

diagnosis?

treatment?

A

contagion? = VERY CONTAGIOUS, SHED IN HIGH CONCENTRATIONS IN FECES

transmission? = FECAL-ORAL

incubation period? = 1-4 DAYS

this disease is usually SELF-LIMITING

causes MALABSORPTIVE D+

diagnosis? = ROTALVIRUS FECAL PCR

treatment? = SUPPORTIVE

48
Q

3 PREVENTATIVE measures for ROTAVIRUS?

why might one of them NOT work?

A
  1. VACCINATE PREGNANT MARES –> might not be effective bc SO MANY STRAINS OF ROTAVIRUS
  2. ISOLATE CASES
  3. DISINFECTION
49
Q

CRYPTOSPORIDIUM more commonly causes D+ in ____ than ____

parasites need to be _____ in ____ to cause D+ in ____

A

CALVES > FOALS

parasites must be HIGH IN NUMBER to cause D+ in FOALS

50
Q

what clinical sign is COMMON in septic foals?

A

DIARRHEA

51
Q

E. COLI causes D+ in ____ (1) but NOT ___ (2)

in ____ (2), causes these 2 things…

A

ONLY CAUSES D+ IN CALVES, NOT FOALS

can cause in FOALS…
1. SEPSIS
2. BACTEREMIA

52
Q

3 unique clinical signs in ENTEROCOLITIS in foals?

5 treatment options for ENTEROCOLITIS? which one is a MUST?

A

3 clinical signs?
1. FEVER
2. COOL EXTREMITIES
3. SIGNS OF ENDOTOXEMIA

5 treatments?
1. IV FLUIDS sometimes with ELECTROLYTES
2. BROAD-SPECTRUM ANTIBIOTICS –> MUST be done!
3. PLASMA
4. NUTRITIONAL SUPPORT
5. ANTI-DIARRHEAL MEDICATIONS

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