Page 1375 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

1350 CHAPTER 14

VetBooks.ir perforation of the stomach and/or a major blood vessel, • Perforated ulcers in foals may originally present
with premonitory GDUS clinical signs, but most
which leads to fatal septic peritonitis. These cases in
the young foal are suspected to be due to focal isch-
concurrent disease appear to be most at risk of
aemia and hypoxia of the stomach, which is directly or often do not. Hospitalised neonatal foals with
indirectly related to other neonatal diseases. this presentation. The perforated ulcer will give
rise to a peracute septic peritonitis, distended
Clinical presentation abdomen and colic. Some foals present with
Gastroduodenal ulceration in the foal has a number sudden or unexpected death.
of different presentations: • Pyloric or duodenal ulceration can lead to severe
inflammation, fibrosis and resultant stenosis of
• Foals have small areas of squamous gastric the gastric outflow tract and duodenum. In turn,
ulceration (usually at the margo plicatus) without these foals will have delayed gastric emptying and
any clinical signs. These gastric ulcers are an present with colic, ptyalism, eructation, anorexia,
incidental finding if gastroscopy is performed. failure to thrive and dull demeanour. Reflux can be
Epithelial desquamation may also be identified easily obtained during nasogastric intubation, and
and is a normal part of mucosal maturation, in some cases arises spontaneously. Gastroscopy
which can be seen in healthy foals up to often also identifies reflux oesophagitis and
3 months of age. oesophageal ulceration. This presentation most
• Foals with clinically significant gastric ulcers commonly occurs in 2–5-month-old foals.
will typically show any, or all, of the following
signs: anorexia and reduced nursing, bruxism, Differential diagnosis
ptyalism (Fig. 14.17), dull demeanour and colic. Other causes of colic such as enteritis, septicaemia
There may be a failure to thrive (poor growth, and peritonitis may produce similar signs.
rough hair coat) or diarrhoea. Gastroscopy will
reveal the presence of ulcers that may be assessed Diagnosis
according to ulcer location and the scoring History and clinical signs are often strongly suggestive
systems that are used for adults. of gastroduodenal ulceration. Diagnosis may be con-
firmed with gastroscopy, but it is important to note that
this is a traumatic and invasive procedure for young
foals, and so is very rarely performed. The main indi-
14.17
cation is in an older foal with clinically complex gastric
disease and/or a historically poor response to treatment.
Positive contrast radiography with barium adminis-
tered by stomach tube can be performed to evaluate
gastric transit times but may be difficult to interpret.
If strictures occur in the region of the bile duct,
gamma-glutamyltransferase and serum alkaline phos-
phatase blood levels will be raised. Abdominocentesis
in severe cases will reveal evidence of septic peritoni-
tis associated with a perforated ulcer. In many cases, a
perforated ulcer can only be definitively found during
exploration of the abdomen at surgery or post-mortem
examination.

Management
The mainstay of treatment for GDUS is acid sup-
Fig. 14.17 A foal with gastric ulceration showing pression. The need for pharmacological intervention
hypersalivation. should be assessed on a case-by-case basis, in relation