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MODULE 19 - Reproduction and Fertility > PATHOLOGY - Equine Neonatal Pathology > Flashcards

PATHOLOGY - Equine Neonatal Pathology Flashcards

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1
Q

When is a foal classified as premature?

A

A foal is classified as premature if they have been born before 320 days of gestation and display immature physical characteristics

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2
Q

What is the prognosis for foals born before 320 days of gestation?

A

The foal will usually require veterinary attention

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3
Q

What is the prognosis for foals born before 305 days of gestation?

A

These foals will likely require more intensive care and they are less likely to survive if the placenta is normal

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4
Q

What is the prognosis for foals born before 280 days of gestation?

A

These foals are unlikely to survive

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5
Q

What is foal dysmaturity?

A

Foal dysmaturity is when a foal has been born premature however the mare has had a normal or even long gestation length

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6
Q

What causes foal dysmaturity?

A

Foal dysmaturity is caused by intrauterine growth restriction as a result of placental disease or insufficiency

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7
Q

What are postmature foals?

A

Postmature foals are normal foals that have been retained in utero for too long

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8
Q

What is the pathophysiology for foals born premature?

A

In foals that are born premature, there is incomplete maturation of the hypothalamic-pituitary-adrenal axis which has deleterious effects on organ maturation, ossification and thermoregulation at birth. These foals often make good progress in the first 24 hours of life and then rapidly deteriorate at day 2 and 3

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9
Q

What are the generalised causes of premature foals?

A

Placental abnormalities
Foetal abnormalities
Maternal abnormalities
Iatrogenic
Idiopathic

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10
Q

What are some iatrogenic causes of premature foals?

A

Early induction
Early C-section

You should NEVER induce a mare, the foal will come out when ready

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11
Q

What are the clinical signs of a premature foal?

A

Small frame
Periarticular laxity
Hypotonia
Generalised muscle weakness
Soft ribcage
Respiratory distress (low lung compliance)
Domed head
Floppy ears (due to poor cartilage development)
Short, silky hair coat
Weak suckling
Gastrointestinal dysfunction
Poor thermoregulation
Low urine output
Entropion
Foal slippers

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12
Q

What is indicated by foal slippers?

A

Foal slippers indicates the foal has not stood properly yet

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13
Q

How do you manage premature foals?

A

Premature foals require intensive care

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14
Q

What are the implications of incomplete ossification in premature foals?

A

Premature foals have incomplete ossification of the bones which most affectes the carpus and the tarsus. The bones and joints will be weak and cartilaginous making them susceptible to damage under normal weight bearing - which will have future athletic implications

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15
Q

How do you manage incomplete ossification in premature foals?

A

Radiography of the limbs to determine the severity and reduce activity and standing time. Full limb bandages may also be required

This can be a prognostic indicator

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16
Q

What is the prognosis for premature foals?

A

If the premature foals are nursed well and they have no other complciations, they can have a good prognosis. However this is very expensive

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17
Q

Why are foals born in an immunocompromised state?

A

Due to the structure of the equine placenta, there is no transplacental transmission of maternal antibodies to the foetus, and thus the foal is born in an immunocompromised state and very vunerable to pathogenic challenge

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18
Q

How do foals achieve passive immunity?

A

Foals need to ingest colostrum to develop passive immunity. Colostral antibodies will be absorbed via the neonatal enterocytes into the bloodstream

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19
Q

When can you measure serum IgG levels in foals?

A

You can measure serum IgG levels 12 hours after birth to assess for passive transfer of immunity

You can use an IgG SNAP test

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20
Q

What are the expected serum IgG levels in foals 12 hours after birth?

A

More than 800mg/dL

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21
Q

Which serum IgG levels indicate a complete failure of passive transfer?

A

Less than 400mg/dL

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22
Q

How much IgG is contained within ‘good quality’ colostrum?

A

500mg/dL of IgG

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23
Q

How do you manage failure of passive transfer in foals less than 12 hours old?

A

The enterocytes should still be absorbing IgG within the first 12 hours so you can nasogastric tube the foal with colostrum

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24
Q

How do you manage failure of passive transfer in foals more than 12 hours old?

A

IV transfusion of equine plasma

Approx 2-4L of plasma for less than 400mg/dL serum IgG

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25
What is 'dummy foal syndrome'?
'Dummy foal syndrome', also known as neonatal hypoxia ischaemia syndrome, is a condition seen in newborn foals that display abnormal behavior and neurological signs due to impaired oxygen delivery to the cells at some point which results in the production of proinflammatory cytokines and cellular degeneration
26
What are some of the possible causes of 'dummy foal syndrome'?
Dystocia Placentitis Red bag delivery Meconium aspiration Twin foals | Can also occur with normal parturition
27
What are the clinical signs of 'dummy foal syndrome'?
Unable to find the udder Inappropriate nursing behaviours Loss of suckle reflex Loss of recognition of the environment Loss of affinity for the mare Abnormal vocalisation Dysphagia Central blindness Abnormal respiration CNS deficits
28
How do you generally manage 'dummy foal syndrome'?
Generally 'dummy foal syndrome' can be managed with supportive care until the inflammation regresses and resolves. Ensure these foals receive enough colostrum and nutrition and give broad spectrum antibiotics as they are at a high risk of infection
29
How do you manage severe 'dummy foal syndrome'?
Good nursing care Support the organ systems Nutrition Oxygen supplementation Broad spectrum antibiotics IV plasma transfusions Neuroprotectants
30
How much milk should foals be ingesting per day?
20% of their body weight in milk per day
31
How do you approach nutritional support in foals?
If possible carry out nasogastric tubing, start with smaller amounts of milk every hour and build up to 20% of their body weight in milk per day. If enteral nutrition is not possible, carry out parenteral nutrition
32
What is the prognosis for 'dummy foal syndrome'?
Generally a good prognosis unless they develop complications
33
What is the endocrinopathy subform of 'dummy foal syndrome'?
The endocrinopathy subform of 'dummy foal syndrome' is where the clinical signs are primarily due to abnormal persistence of neurosteroids and dysregulated endocrine function, rather than hypoxia alone | This is associated with rapid births and C-sections
34
How can you manage the endocrinopathy subform of 'dummy foal syndrome'?
Squeeze induced somnolence to mimic the neural reflex which occurs when the foal is being squeezed through the birth canal during parturition. This should be done along with supportive care
35
What are risk factors for sepsis in foals?
Maternal influences on colostrum Failure of passive transfer 'Dummy foal syndrome' Poor hygiene Premature Dysmature
36
What are the most common groups of bacteria implicated in foal sepsis?
Gram negative bacteria
37
What are the potential clinical signs of sepsis in foals?
Pyrexia to hypothermic Petechiae Ecchymoses Dehydration/hypovolaemia Uveitis Hypopyon Hypoglycaemia Hot, painful umbilicus Lameness *(if joints are infected)* Respiratory signs Gastrointestinal signs
38
How can you diagnose sepsis in foals?
History Clinical signs Haematology and biochemistry Blood culture Ultrasound Sepsis score
39
How do you manage sepsis in foals?
IV broad spectrum antibiotics IV fluid therapy Equine plasma transfusions Oxygen supplementations Nutritional support Anti-endotoxic drugs Nursing care | This ideally should be done in an equine hospital
40
What nursing care should you provide septic foals?
Warming Foal beds Keep the foal in sternal recumbency Incontinence pads and bathing *(may have diarrhoea)* Nutritional support Milk the mare regularly if the foal isn't suckling *(as lots of mare in the udder will be painful)*
41
Why should you try and keep foals in sternal recumbency?
Keeping foals in sternal recumbency allows the lungs to expand more effectively
42
How can you transport a foal to a referral hospital?
If a horse box will not be available to transfer both the mare and foal in a timely manner, give the foal some fluids, wrap the foal in blankets and put them in the car to transport to the referral hospital
43
What are some of the key indicators that foals need IV fluid therapy and cardiovascular support?
Dull mentation Cold extremities Weak or absent peripheral pulses Prolonged CRT Prolonged skin tenting Not nursing *(for more than 4 hours)* Has ongoing losses
44
What is the maintenance fluid rate for foals?
80 - 120ml/kg/day
45
What is the shock dose rate for foals?
50-80ml/kg
46
How should you administer shock doses in foals?
Give half of the shock dose and then reasses, give a quarter of the shock dose and then reassess, and give another quarter of the dose in severly hypovolaemic patients
47
Which fluid types should **not** use in foals as first line fluids?
Hypertonic saline 0.9% NaCl Sodium bicarbonate
48
How do you treat hypoglycaemia in foals?
5% dextrose within fluids as a CRI (at 240ml/hr for a 50kg foal) | Aiming for 4 - 10ml/l in the blood of glucose
49
What can you do to assess if foals are rehydrated?
Improvement in clinical signs Adequate USG
50
Which USG indicates adequate hydration in the foal?
Foals are adequately hydrated when their USG is between 1.001-1.008
51
What is the most common cause of colic in foals?
Meconium impaction
52
When are meconium impactions typically seen?
Meconium impactions are typically seen in the first 6-24 hours after birth
53
Which history questions can you ask is you see a colicing foal?
Have they passed meconium and how much have they passed? Are they nursing? Are they passing faeces and urine? Have you tested the serum IgG? Have you taken their temperature? Are they pyrexic? Do you have other foals on the premises? Are they affected? | When they start passing yellowish faeces, all of the meconium has passed
54
What are the clinical signs of meconium impaction?
Failure to pass all of the meconium Progressive increase in abdominal pain Frequent posturing and straining to defaecate Depression Reluctant to nurse
55
How can you diagnose meconium impactions?
Clinical signs Digital rectal examination Abdominal palpation Abdominal ultrasound
56
How do you treat a meconium impaction?
Enema Buscopan Analgesia
57
Which analgesic drug is best for foals?
Butorphanol
58
What treatment can you try if the foal doesn't respond to your initial treatment of a meconium impaction?
Retention enema
59
What is a retention enema?
A retention enema is when you slowly infuse fluid and actelycysteine into the rectum via a foley catheter and allow the fluid to sit in the rectum for 15 - 30 minutes. This can be repeated
60
What are the indicators for colic surgery in foals?
Refractory to analgesia Severe abdominal distension Rapid deterioration
61
What can be done to prevent meconium impactions in foals?
Give the foal an enema after birth
62
What are some of the differential diagnoses for meconium impactions?
Enterocolitis Colonic atresia Colon torsion Small intestinal volvulus Intussusception Lethal white foal syndrome
63
What are the non-infectious causes of diarrhoea in foals?
Foal heat diarrhoea Dietary intolerance
64
What is the likely cause of foat heat diarrhoea?
Foal heat diarrhoea is likely due to developmental or maturational changes in the gastrointestinal tract associated with the initiation of feed ingestion and changes in the microbiome
65
What is the typical signalement for foal heat diarrhoea?
Foals 5-15 days old
66
What are the clinical signs of foal heat diarrhoea?
Mild to moderate diarrhoea with no systemic clinical signs
67
How do you manage foal heat diarrhoea?
No treatment required
68
What are the potential causes of dietary intolerance mediated diarrhoea?
Milk replacers Secondary lactase deficiency
69
What is a secondary lactase deficiency?
Secondary lactase deficiency is where there is loss of the small intestinal brush border resulting in lactose intolerance
70
How can you manage seconday lactase deficiency?
Lactase enzyme supplementation
71
What are the infectious causes of diarrhoea in foals?
Rotavirus Cryptosporidium parvum Clostridium perfringens Clostridium difficile Salmonella
72
What are the potential clinical signs of infectious diarrhoea in foals?
Reluctance to nurse Depression Diarrhoea Colic Pyrexia Dehydration Obtunded Recumbent
73
What is the typical signalement of rotavirus mediated diarrhoea in foals?
3 days to 5 month old foals
74
What is the pathophysiology of rotavirus in foals?
Rotavirus causes blunting of the microvilli resulting in maldigestion and malabsorption. This results in villous atrophy and compensatory crypt cell proliferation resulting in a net decrease in fluid absorption and increased secretion
75
How do you diagnose rotavirus in foals?
Immunoassays
76
How do you manage rotavirus in foals?
Strict isolation and biosecurity
77
(T/F) Clostridium perfringens and difficile can cause primary infections in foals
TRUE.
78
What is the pathophysiology of clostrial enteritis in foals?
Clostridium perfringens and difficile causes increased cellular permeability resulting in fluid secretion into the intestinal lumen, and eventual cellular apoptosis. Clostridia can also cause pseudomembranous colitis which appears as fibrin like tissue being passed in the faeces
79
How can you diagnose clostridial enteritis in foals?
Exotoxin assay Faecal culture
80
How do you prevent clostridial enteritis in foals?
Hygiene Isolation protocols Vaccination of the mares
81
What is the general management for foal diarrhoea?
Fluid therapy IV equine plasma Haemodynamic support *(ionotropes and vasopressors)* Prevent endotoxin absorption *(biosponge, charcoal etc.)* Broad spectrum antibiotics Nutritional support Biosecurity Isolation
82
Which antibiotic should you use for clostridial disease?
Metronidazole
83
What is a patent urachus?
A patent urachus is when the urachus does not close after birth, causing the foals to urinate from their umbilicus
84
What is a risk factor for a patent urachus?
Prolonged periods of recumbency
85
What can cause a patent urachus?
Spontaneous Mechanical Infection
86
What is a mechanical cause of a patent urachus?
Abdominal straining
87
Which infectious causes can result in a patent urachus?
Infection of the internal umbilical remnant Systemic infection
88
How can a patent urachus due to infection present?
Umbilical swelling Purulent discharge Heat and pain on umbilical palpation Systemic signs
89
What should you do to further investigate a patent urachus?
Ultrasound to investigate for signs of infection
90
What is the prognosis for a patent urachus?
Generally a patent urachus will resolve spontaneously
91
How can you medically manage a patent urachus?
Disinfect the umibilcus with dilute chlorhexidine Keep the umbilicus clean and dry Vaseline as a moisture barrier to reduce urine scalding Broad spectrum antibiotic *(TMPS)*
92
How can you surgically manage a patent urachus?
Surgical resection of the internal umbilical remnant ## Footnote Indicated for umbilical remnant infection that won't respond to medical management
93
What are the potential causes of uroperitoneum in foals?
Trauma/traction of the umbilicus during parturition Disruption of the blood flow to the internal umbilical remnant Urachus infection | Usually history of dystocia or just sudden onset clinical signs
94
What are the clinical signs of uroperitoneum in foals?
Weakness Lethargy Abdominal distension Poor nursing Recumbency Bradycardia
95
How can you diagnose uroperitoneum in foals?
Biochemistry Ultrasound Abdominocentesis
96
What are the biochemical abnormalities associated with a uroperitoneum?
Azotaemia Hyponatraemia Hypochloraemia Hyperkalaemia
97
What is the main risk of hyperkalaemia?
Bradycardia
98
How do you manage uroperitoneum in foals?
Abdominal drainage *(place two as the omentum will try and close them off)* IV fluid therapy IV glucose Urinary catheter Manage hyperkalaemia Surgical correction
99
What are some of the most common respiratory diseases in foals?
Meconium aspiration Milk aspiration Rib fractures Bacterial pneumonia
100
What is a key sign that a foal may have aspirated meconium?
Meconium staining at birth
101
How do you manage meconium aspiration?
Clean and aspirate the nasal passages and pharynx Oxygen supplementation Anti-inflammatories Broad spectrum antibiotics
102
Milk aspiration is generally secondary to another underlying problem. List some examples of these
Incorrect NG tube placement Bottle feeding foals Generalised weakness Dysphagia Dummy foal syndrome Cleft palate
103
How can you diagnose milk aspiration in foals?
Auscultation of the trachea whilst drinking *(if you can hear fluid this is abnormal)* Endoscopy Thoracic radiography
104
How do you manage milk aspiration in foals?
Oxygen supplementation Indwelling nasogastric tube until the underlying disorder is corrected Antibiotics Anti-inflammatories
105
What should you make sure to check in every neonatal foal?
You should always palpate the ribs to assess for rib fractures as these are commonly seen with dystocia
106
What can be caused by rib fractures?
Pneumothorax Haemothorax
107
What are the potential clinical signs of rib fractures in foals?
Dyspnoea Tachypnoea Difficulty standing Colic Swelling over the ribs
108
How can you diagnose rib fractures in foals?
Ultrasound
109
How do you manage rib fractures in foals?
Rib fractures can generally be managed with several weeks of stall rest however if the ribs are markedly displaced, or could potentially damage vital organs it needs to be surgically stabilised
110
What are the potential causes of bacterial pneumonia in neonatal foals?
Haematogenous spread of bacteria Secondary to meconium or milk aspiration pneumonia
111
What are the potential causes of bacterial pneumonia in older foals?
Streptococcus zooepidemicus Rhodococcus equi

MODULE 19 - Reproduction and Fertility (18 decks)

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