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Equine Medicine Final > GI disorders in the foal > Flashcards

GI disorders in the foal Flashcards

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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
What is meconium?
- First fecal excretion of the newborn
26
What is meconium composed of?
- Bile - Epithelial cells - Mucus
27
Diagnosis of meconium impaction
- Physical exam - Digital rectal - Ultrasound - Gas distended colon - meconium? - Abdominal radiographs
28
Colonic tympany in meconium impaction
- Abdomen is filled | - Large viscus that contains multiple parallel horizontal echogenic lines and gas
29
Abdominal radiographs in foals with meconium impaction
- Differentiate large vs small intestinal gas - meconium - Abundant gas
30
Medical management of meconium impaction overview
- Oral laxative - Enemas: Soapy water enemas, acetylcysteine enema, Fleet enema - IV fluids - Pain control - +/- Prokinetic
31
Fleet enemas for Meconium Impaction
- Phosphate - Often requires multiple doses - Risk of hyperphosphatemia - Not enough by the time the foal is colicky
32
Oral laxatives for Meconium Impaction
- Mineral oil (not for adult horses; the goal here is to actually help it slide out) - Milk of magnesia
33
Soapy water enemas
- Ivory soap in water - Harris flush tube - Enema bucket - Occluding anus can provide some hydropropulsion effect
34
Cautions with enemas in foals
- Delicate rectal mucosa - Use of abundant sterile lubricant jelly - Do not force the catheter
35
Acetylcysteine retention enema
- 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
IV fluid goals in meconium impaction
- Restore circulating fluid volume | - Hyperhydration of the luminal material
37
Pain control for meconium impactions with foals
- Flunixin meglumine - Butorphanol - Buscopan
38
Prokinetics for meconium impaction with colonic tympany
- Neostigmine (cholinesterase inhibitor) | - She does not use this, but it may help
39
Meconium impaction feeding recommendations
- Hold them off of the mare
40
Monitoring for meconium impactions
- Serial ultrasounds | - can determine if ileus and or gastric distension present before administration of laxatives via NG tube
41
Indications for referral in meconium impaction
- Profound abdominal distention and unrelenting pain | - Indications for referral +/- surgery
42
What is the risk of surgery in foals that is more than normal?
- They are little adhesion machines | - They adhese a LOT
43
Two possible complications with meconium impaction
- Sepsis | - Urinary bladder or urachal leak
44
Sepsis complication of meconium leak
- Inadequate nursing due to pain and straining - Possible mucosal injury leads to translocation of bacteria - Occasionally transmural necrosis of the intestine
45
Urinary bladder or urachal leak in a horse with meconium impaction
- Straining | - Over hydration with fluids
46
Age period for meconium impaction
- 1-2 days usually
47
Dfdx for meconium impaction
- Sepsis - Infectious diarrhea - GI ulcer - Volvulus, intussusception - Peritonitis
48
Other differential that can cause gas distension of the small or large intestine in a 1-2 day old foal?
- Atresia ani
49
Other differential that can cause meconium impaction in a 1-2 day old foal?
- Aganglionosis or lethal white foal syndrome
50
Atresia coli timeline
- first 1-2 days
51
Atresia coli - how common?
- SUPER RARE
52
Atresia coli what will you feel on rectal?
- No feces
53
Other signs with atresia coli
- Abdominal distension
54
How do you diagnose atresia coli?
- Radiographs | - Endoscopy
55
What is the pattern of inheritance of Lethal white syndrome or aganglionosis
- Autosomal recessive
56
What is the mutation in lethal white syndrome?
- Mutation in the endothelin B receptor gene
57
What is the fundamental pathologic problem with lethal white syndrome?
- Lack of submucosal and myenteric ganglia | - Small intestine to colon
58
Which breeding cross is at risk for offspring with lethal white syndrome?
- Overo paint x Overo paint
59
Clinical signs of Lethal white overo
- No meconium production | - Colic soon after birth
60
Enteritis in foal diagnosis
- Ultrasound - rapid - Thick walls - Fluid distended - Variable SI motility - May be primary site for bacterial sepsis
61
Clinical signs of foal diarrhea
- Vague signs of illness - Fever, obtundation, colic, decreased nursing - Signs will start prior to nursing
62
How can you help differentiate surgical lesions from enteritis?
- Physical exam and ultrasound findings
63
General diagnostics for foal diarrhea
- 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
What is the infectious agent in Potomac horse fever?
- Neorickettsia risticii
65
What changes often occur on the biochemistry panel?
- Sodium and chloride often drop
66
Infectious causes of foal diarrhea
- Rotavirus - Systemic bacterial sepsis - Salmonella - Clostridium perfringens A, B, and C - Clostridium dificile - Coronavirus - Parascaris equorum - Strongyloides westeri - Cryptosporidium
67
Foal diarrhea treatment decisions - what's the first question you should answer?
- Does it need intervention?
68
Questions to answer to determine if the foal needs treatment
- Is it still nursing the mare? - Signs of colic - Estimated volume of fecal fluid loss - Signs of systemic illness - How critical? - Referral?
69
What are differentials for abdominal ultrasound SI distension?
- Ileus and Enteritis
70
How can you differentiate ileus and enteritis in a foal with SI abdominal distension on ultrasound?
- WBC count could be low with either | - But enteritis is more likely to be low, whereas ileus isn't normally
71
When is there an indication in a foal to pass an NG tube?
- High heart rate (>80 BPM) in a foal - Indication to pass the tube - First priority with any colic
72
Overview of enteritis treatment
- Culture (feces or blood) - Broad spectrum antibiotics - Anti-endotoxin medications - IV fluids - Intestinal protectants - Nutritional management too
73
What to culture for enteritis?
- Blood | - Feces
74
Anti-endotoxin medications for use in foals with enteritis
- Flunixin meglumine | - Polymixin B (nephrotoxic)
75
IV fluids to use in foals with enteritis
- Crystalloids - Plasma - Hetastarch
76
Intestinal protectants to use with enteritis
- Bismuth subsalicylate (Pepto) - Biosponge (Smectite) - Sacchromyces boulardii
77
Nutritional management of enteritis foals
- Most foals require milk or enteral nutrition | - Parenteral nutrition possible but not ideal
78
How can you promote suckling behavior in a foal on parenteral nutrition?
- Gradually wean off parenteral nutrition to intermittent suckling - Start allowing foal to nurse for 1-2 minutes to start every 2 hours
79
Target sign
- Small intestinal intussusception | - Can see on ultrasound the loops of bowel inside of the other loops of bowel
80
Clinical signs of intussusception
- Decreased suckling - Dehydration - Diarrhea - PROGRESSIVE colicking - Slightly distended abdomen - May not be febrile
81
Treatment for intussusception
- Surgery
82
What is the most common cause of diarrhea in foals?
- Foal Heat Diarrhea
83
When does foal heat diarrhea occur?
- 7-12 days post partum - Same time as post-foaling estrus for a mare - Occurs in orphan foals as well
84
Mechanism of foal heat diarrhea
- 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
How do you treat foal heat diarrhea?
- Self-limiting and normal

Equine Medicine Final (10 decks)

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