Equine Med- Neonatal Foal 2

kelseyfmeyer's version from 2016-10-03 18:55

Stuff brought up in cases (still super important): case 1

Question Answer
(mentioned in class) what might help mare pass placenta?being milked out (oxytocin release)
tongue protruding from mouth?think HIE (hypoxic ischemic encephalopathy)
Periods of somnolence-hyperexcitability -- think?think HIE (hypoxic ischemic encephalopathy)
Left sided systolic murmur in foal- are you worried?not continuous so prolly just physiological flow murmur
if its been 6 hours and foal hasn't eaten, what are they at risk for?hypoglycemia--> seizures
elevated CRT might mean...dehydration
FPT might mess up what chem val?low globulins- bc didnt get Abs from mom lol
if mom is making milk and baby is feeding well, is FPT a possibility?yes- if mom is making shitty milk. Or bb's GI is not absorbing right. or if septic in utero, globulins can be going to site of infection and then are gobbled up/used up. #1 reason for FPT is not getting (enough) colostrum tho
when does gut closure take place? when should you test for FPT?gut closure is at 8 hours.... test at 24 hours of age
what are two Stall side IgG Tests to test for FPT?(1) IdEXX snap test (2) gamma check E
what is gamma check e?stallside IgG test- it's a special tube and if blood clots in it, the IgG is adequate
levels of IgG which are considered complete FPT? partial? adequate PT?complete fail= <400mg/dL. Partial= 400-800. Adequate= >800
AKAs for HIE (hypoxic ischemic encephalopathy)aka Perinatal asphyxia syndrome , Neonatal maladjustment syndrome, “Dummy” or “Wanderer”
when do you see HIE start?can be born abnormal or start to see signs develop over 48 hrs
etiology of HIE?unclear. Theories include: Lack of oxygen? CNS/Organ dysfunction. Higher levels of sedative neurosteroids (UC Davis) (when get squeezed by vagina they get these neurosteroids released to keep them from freaking out in mom. maybe there are too many or sthing)
what are sedative neurosteroids, what relevance do they have?theory on HIE cause. These are released from baby from squeeze of birth canal on them, and allow easy delivery. they should subside at birth, but maybe dont for HIE foals.
cant figure out how to lie down or get up...thinkHIE
HIE dx?presumptive (is it dumb)
what is HIE tx?(1) supportive: specific to CSs/ nutritional needs. (2) Madigan Foal Squeeze Procedure: Gentle harness technique ( rope harness around them, and as pull on ropes squeezed thorax and abdomen gently-- its like mimcking a birth again. sometimes they get back to normal from just this. sometimes it work apparently. )
prog of HIE?should see steady improvement. if not nursing and such can get fatal complications, so it is a serious dz if dont deal with it in terms of supportive care. but with SC 90% of them get smarter and then get fine. If not improving, think of other differentials (such as hydrocephalus)
ddx for HIE if CNS signs?Meningitis, Metabolic derangements, CNS malformations
ddx for HIE if Weakness/Unable to stand?WMD, HYPP, botulism, etc
how much fluid can you put into a foals belly?adult stomach is like 10L (2gallons) so in a 100lb foal... come in 300ml bottle, thats about how much you should give (if a mini baby or sthing tho, obv less)
if you're gonna tube baby, what should its position be?should be sternal! or standing. Lateral recumb--> aspiration risk. (tube can be intermittant or indwelling)
what can you tube feed baby? milking out mare is best but udders arent big so you are gonna have to do a bit at a time. there are also milk replacers.
what did Wise say about bottle vs bucket feeding?if gonna have a foal that needs to be fed by humans, skip bottle and go to bucket feeding.
how much should you feed foal (% bwt) at first? how often? what is your goal %?start with 10-20% of bwt every 2 hours. goal of 20-30% of bwt. (so 50kg foal= 10-20L a day)
risks of tube feeding?Aspiration, Ileus, Diarrhea, Aerophagia
how can you determine if a foal is septic?i mean you can try blood culture but only about 25% successful. Use sepsis score sheet (probably score sheet)
what does a sepsis score sheet do, and what scores are relevant?lists all the things to look for in a septic foal-- add up how many the foal has and it will predict the chance the foal has sepsis. a score of 12+ is a 93% chance. 11 is 88% chance
what is a SCID foal/ which breed is prone?/ how do they get it?Severe Combined Immunodeficiency (SCID). arabians get it as autosomal recessive.
with SCID, what is actually the problem?they dont have any lymphocytes.
what happens to SCID foals?at first ok bc have moms Abs- as these wane they develop illness (usually chronic) Usually succumb to respiratory virus: Adenovirus (not pathogenic unless SCID)
dx SCID foal?profound lymphopenia (or PCR for gene)
prog of SCID?uniformly fatal
3 things to help prevent sepsis in foals?(1) Make sure they have IgG. (2) Prophylactic broad spectrum antibiotics (Naxcel aka ceftiofur 5mg/kg BID IV) (3) NSAIDs
banamine is antiinflammatory but is also useful for what other thing we do with foals?stop anaphylactic effects from plasma transfusion (from FPT)

Case 2+ 3

Question Answer
what does fibrinogen say about inflammation?chronic
foals are _________ until proven otherwiseseptic
if a foal looks septic but the blood culture comes back negative, what do you think?well the culture is only effective like 25% of the time anyway, and then they could have been septic and are now just dealing with effects of it
septicemia is caused by?bacteremia
septicemia is usually an opportunistic problem- what are some common routes (which is most common)Fecal oral (most common), inhalation, inoculation through umbilicus.
which pathogens are common causes of septicemia?****E coli, Actinobacillus, Pasterella, Streptococcus
if the causative agent of the septicemia is G-, what other problem can occur?Endotoxemia can occur as well (Clinically hard to differentiate ) (cascade of inflammatory cytokines--> Systemic decompensation --> Multiple Organ Dysfunction
what are the 3 clinical scenarios of septicemia, and which ones are ER?(1) Septic at birth: ER. (2) Neonatal septicemia (ER) (3) Chronic (not er)
how on earth can they be Septic at birth? how do you know this is the case? is this ER?due to In utero infection- Bacterial placentitis or metritis. they are bORN sick- this is an ER
Neonatal septicemia- when are they infected? when do you see signs? is this an ER? what lab stuff will you see?Infected soon after birth, signs develop within hours to days. this is an ER, Systemic decompensation occurs. You will see low WBC counts and FPT is often playing a role here
which septicemia results in LOW WBCs? which results in HIGH WBCs?LOW= neonatal septicemia (infected shortly after birth). HIGH= chronic (have time to make all these WBCs, makes sense)
chronic septicemia- how does this present? what are lab things like?They may no show signs of systemic illness! BUT there will be evidence of previous bacteremia weeks later. they will have a HIGH WBC count
in the chronic form of septicemia, where do bact like to go hide in the body? Joints, bones, umbilicus, lungs, GI tract, CNS, eyes usually evident early
what are the CSs of sepsis in neonates? what about older foals?neonates: Weak, Decreased or absent suckling, Hyperemic mucous membranes, Hypovolemic, hypotensive, Specific organ systems vary, LOW WBCs. In OLDER foals, the signs depend on the site of infection but there will be HIGH WBCs
dx/ tx/ prog of septic arthritis? (pic of big swollen joint)Dx: tap it. Look for change of viscosity, high protein count, high WBC count. You can also culture it (more sensitive than blood culture also). (can get baseline rads too) Tx: **Flush it out first! then intraarticular abx, also can add in systemic abx (bc if its in joint prolly in other places too) . Prog for septic arthritis? Depends on how many joints are affected!! more joints affected= poorer prog. basically prog aint fab, expensive, and more probs is worse.
dx/ tx/ prog of swollen and infected umbilicus?Dx: well palpation basically can tell you the story. US it to see how extensive the potential little puss bag is. (needle sticking is risky- do US but if have to stick it, be careful). TX: lots of Abx- long term abx can shrink down abscess. But for many foals you will have to take it out in sx= omphalectomy (risks of sx: could extend infection into abd but also WORRIED ABOUT ADHESIONS). PX: if only omphalitis, prog is good. with other complications, goes down.
what is foal heat diarrhea? what is the timeline for this? how will they present?happens when they are about 10-14d old. it is self limiting, and they are not sick
bacterial diarrhea: this usually happens why, and what is your main contender? what does the diarrhea look like and how can you dx?bacterial diarrhea is the result of sepsis, and and is usually due to clostridium perfringens or difficile. It is hemorrhagic, and you see it at <10 days (foal heat 10-14d and not hemorrhagic) Do a fecal toxin assay
viral diarrhea: which virus usually causes this? what age is usually affected? how do you dx?Usually rotavirus in a foal less than 2mo age, dx with Fecal PCR, Latex agglutination or ELISA
what parasite is the cause of parasitic diarrhea in foals, and how can this be prevented?caused by S. westeri, Prevent by deworming dam at birth
if mom's udder is full, what do you think is going on?bb not nursing :(
how does foal colic differ from adults?level of pain can be much lower and still cause colic (they are, anorexia and feed restriction is a Big Deal.
PE concerns for colic in adults and foals are the same, which areTachycardia, MM color, + Abdominal palpation (help you diff between strangulating and non-strangulating problem)
what is one of the main things we do in colicky adult horses which we can't do in foals?cant stop feeding foals
what are some diagnostics you can use with foal colic?NO rectal exams, but can pass a NG tube, US is easy to do, yay! can do rads. can also do guided abdominocentesis
in general, can break up causes of colic into what three categories?nonstrangulating obstruction, strangulating obstruction, inflammatory condition.
what non-GI thing can cause colic?uroperitoneum
FOAL causes of NONstrangulating the small intestine? Large intestine?SMALL: ascarid impaction (parascaris equorum), FB, trichobezoar, adhesions, intussusception. LARGE: Meconium impaction, trichobezoar, congenital malformation, gas colic
FOAL causes of STRANGULATING the small intestine? Large intestine?SMALL: volvulus, intuss, hernia. LARGE: torsion (rare in foals)
what are FOAL INFLAMMATORY causes of colic?ENTERITIS!!!! could be from diarrhea +/- reflux, bacteria or viruses, or lactose intolerance
what lab things will make you think there is a high chance of a ruptured bladder?azotemic with fluid in abd, high K, fluid can have high creatinine