Page 1376 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

The foal 1351

VetBooks.ir to disease severity and in concordance with the com- achieved by allowing normal feeding habits with the
Prevention of gastroduodenal ulceration is best
plete clinical picture. Any underlying disease also
needs to be treated. Treatment should continue
prophylactic use of antiulcer medications in foals
until the clinical signs or ulceration have completely mare and foal, careful use of NSAIDs in the foal and
resolved; in some cases, this may be several weeks. In subjected to stressors such as surgery, other drug
cases of pyloric and/or duodenal stenosis, response therapy or other diseases. The use of prophylactic
to treatment is disappointing. Various drugs have antiulcer medication in the foal remains controver-
been used to treat gastroduodenal ulcers: sial and is reported to be associated with increased
risk of developing diarrhoea in neonatal intensive
• Proton pump inhibitors: omeprazole (4 mg/ care cases. The acidic gastric environment is bacte-
kg p/o q24 h) is the drug of choice for treatment ricidal and could be protective for some hospitalised
of ulcerative gastric disease. Clinical signs foals. Prophylactic antiulcer medication in a hospital
often improve within days of medication, but setting should be carefully evaluated on an individ-
it is important to treat for an adequate time to ual basis to determine whether such use is warranted;
allow complete lesion resolution. Most cases many clinicians currently do not endorse its use.
of squamous disease will resolve in 3–4 weeks.
Glandular or duodenal gastric disease often Prognosis
takes longer. A number of licensed buffered The prognosis is good with early diagnosis and effec-
omeprazole formulations are available. tive treatment but is poorer if adhesions or pyloric/
• H2-receptor antagonists: histamine H2-receptor duodenal stenosis are present. Perforated ulcers have
antagonists have been widely used for gastric acid a grave prognosis.
suppression. Research indicates that they must
be given at adequate dose rates and frequency to UMBILICAL INFECTIONS:
be effective. Oral ranitidine (6.6 mg/kg q8 h) is OMPHALITIS, OMPHALOARTERITIS
available. Ranitidine is the only intravenous ulcer AND OMPHALOPHLEBITIS
treatment (1–2 mg/kg q8 h) available in many
parts of the world and its use may be necessary Definition/overview
when the condition of the foal precludes the use of Infection of the external umbilical remnants or the
oral drugs. Cimetidine (16–20 mg/kg p/o q6 h) is internal umbilical vessels is quite common in the foal.
also available but is of questionable efficacy.
• Sucralfate: the mechanisms of action for this Aetiology/pathophysiology
sulphated sugar are: adherence to ulcerated mucosa; Infection occurs either due to contamination of the
stimulation of mucous secretion; prostaglandin E external remnants of the umbilical vessels during
synthesis; and enhanced blood mucosal blood flow. the peripartum period, or as a result of deposition
These effects are particularly important for healing of bacteria in thrombosed vessels from haematog-
in cases of glandular gastric disease where the enous spread. The infection can then either form
presumed aetiology is loss of such protective factors a focal abscess, with or without surrounding body-
within the glandular mucosa. Sucralfate is often wall cellulitis, or extend into the thrombi and infect
used alongside omeprazole and administered orally the intra-abdominal portion of the vessels and/
to foals at 20 mg/kg q6 h. or urachus. Many cases will involve both internal
• Others: depending on the age of the foal and the and external umbilical remnants. Infection of the
severity of the clinical signs, supportive care and the umbilical vein may result in hepatic abscess forma-
judicious use of analgesics (opioids) may be useful. tion. Rarely, cases will exhibit signs of generalised
septicaemia or localised bacterial infection such as
Foals with gastroduodenal stenosis may require pneumonia and septic arthritis/osteomyelitis. The
repeated nasogastric decompression and in severe bacteria most often involved are those seen in neona-
cases may only recover with gastrojejunostomy tal septicaemia (i.e. Enterobacteriaceae, Streptococcus
bypass surgery. spp. and Staphylococcus spp.).