Page 1374 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

The foal 1349

VetBooks.ir Management 14.16
Good colostrum intake will boost nutritional and
immunological status, but it also has a laxative effect
and may have benefits in preventing this condi-
tion. Primary treatment involves the use of enemas.
Buffered phosphate enemas are effective in mild cases,
but repeated use may result in hyperphosphataemia
and an inflamed rectal mucosa. Soap and water enemas
can also be used. The use of mineral oil by nasogas-
tric tube should be avoided because it coats rather than
rehydrates the meconium and takes some time to reach
the site of retention. In refractory cases the use of 4%
buffered acetylcysteine enemas has almost eliminated
the need to resort to surgery. Acetylcysteine (100– Fig. 14.16 Recorded image of an ultrasonographic
200 ml of warmed solution administered slowly via a examination of the cranial abdomen confirming the
30-Fr gauge Foley catheter with the balloon inflated presence of meconium within the bowel.
with 30 ml of air) is a powerful mucolytic that helps
break down the meconium. It should be retained in reserved for only severely intractable cases. The use
the rectum for 30–40 minutes if possible. The enema of fingers or instruments to remove pellets from the
may take several hours to work and occasionally it may rectum is contraindicated.
be necessary to repeat the process. The use of analge-
sics to control abdominal pain and ensuring adequate Prognosis
hydration are also important treatment priorities. The prognosis is usually good to excellent with cor-
Good nursing care, particularly protection against rect management, but it is compromised by the pres-
self-inflicted trauma, is important. Surgery should be ence of concurrent problems such as sepsis.

CONDITIONS AFFECTING BOTH YOUNG AND OLDER FOALS

GASTRODUODENAL Aetiology/pathophysiology
ULCERATION SYNDROME Ulcers develop in the stomach or duodenum when there
is an imbalance between the aggressive factors (e.g.
Definition/overview gastric acid, volatile fatty acids, pepsin) and the protec-
There are a variety of presumed causes of gastroduode- tive factors (e.g. normal GI motility, bicarbonate-rich
nal ulceration syndrome (GDUS) in foals, which include: mucus layer over the glandular mucosa, mucosal blood
physiological stress, hypoxia (neonatal foals), delayed flow, local prostaglandins and normal turnover of
gastric emptying, administration of non-steroidal anti- mucosal cells). The gastric environment in the young
inflammatory drugs (NSAIDs), prolonged feeding foal is highly acidic by 1 week of age and disruption
intervals and prolonged recumbency. The condition is of any protective mechanisms can result in ulceration.
also associated with cases of gastrointestinal disease or as Most diseases (particularly gastrointestinal), stress-
a complication of diarrhoea (particularly rotavirus diar- ors and any deviation from normal foal management
rhoea). All age ranges of foals may be affected. Clinical or feeding can lead to a reduction in innate gastric
signs are typically more severe in foals than in mature defences. NSAID administration reduces concentra-
horses, and rupture of a subclinical gastric ulcer, leading tions of protective prostaglandins. Ulceration can
to septic peritonitis and sudden death, is a rare but rec- occur at any point within the stomach of the foal but
ognised presentation. The prevalence of gastric ulcers is most commonly found within the squamous mucosa
in foals varies with age and is reported to be 25–57%. at the margo plicatus. In the most serious cases there is