Difference between revisions of "Meconium Impaction - Horse"
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| − | + | Also known as: '''''Meconium Retention — Colic in foals — Impaction — Simple Obstruction — Rectal Obstruction — Large Intestinal Simple Obstruction — Small Colon Impaction — Descending Colon Impaction | |
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| + | ==Introduction== | ||
Meconium impaction or retention is the most common cause of colic in the first 24 hours of life and the most common cause of rectal obstruction in foals.<ref>White, N.A, Lessard, P (1986) Risk factors and clinical signs associated with cases of equine colic. ''Proc Am Ass Equine Practnrs'', 32:637-644. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref>Meconium is mucilaginous material in the intestine of the term fetus containing a mixture of cellular debris, secretions of the intestinal glands, bile and swallowed amniotic fluid.<ref name="Pusterla">Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> It is dark brown to black and cement- or pellet-like in texture. Most foals defaecate shortly after their first meal, with meconium being evacuated from 3 hours after birth.<ref name="Pusterla">Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> Once meconium has been passed, the faeces become a dark yellow, reflecting milk digestion. Retention is suspected if the foal makes frequent attempts but fails to produce meconium by 12 hours.<ref name="Pusterla">Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> | Meconium impaction or retention is the most common cause of colic in the first 24 hours of life and the most common cause of rectal obstruction in foals.<ref>White, N.A, Lessard, P (1986) Risk factors and clinical signs associated with cases of equine colic. ''Proc Am Ass Equine Practnrs'', 32:637-644. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref>Meconium is mucilaginous material in the intestine of the term fetus containing a mixture of cellular debris, secretions of the intestinal glands, bile and swallowed amniotic fluid.<ref name="Pusterla">Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> It is dark brown to black and cement- or pellet-like in texture. Most foals defaecate shortly after their first meal, with meconium being evacuated from 3 hours after birth.<ref name="Pusterla">Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> Once meconium has been passed, the faeces become a dark yellow, reflecting milk digestion. Retention is suspected if the foal makes frequent attempts but fails to produce meconium by 12 hours.<ref name="Pusterla">Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> | ||
==Signalment== | ==Signalment== | ||
| − | + | Newborn foals. More common in '''colts''' than fillies, particularly if they are overdue. This may be related to a narrower pelvic inlet in colts.<ref>Martens, R.J (1982) Pediatrics. In: Mannsman, R.L, McAllister, E.S '''Equine Medicine and Surgery''' (Third Edition), American Veterinary Publications, Santa Barbara. pp 333-334. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> | |
| − | Newborn foals. | ||
==Aetiology== | ==Aetiology== | ||
| − | + | Meconium retention may result from a lack of colostrum ingestion, since colostrum is a natural laxative. Thus foals with meconium retention should also be checked for [[Failure of Passive Transfer|'''failure of passive transfer (FPT)''']]. Intestinal dysmotility may also be an indication of '''perinatal asphyxia'''. Other factors predisposing to meconium retention include maternal malnutrition and other conditions that compromise the foal such as dystocia, prematurity, low birth weight, and dehydration.<ref>Semrad, S.D, Shaftoe, S (1992) Gastrointestinal diseases of the neonatal foal. In: Mills, L '''Current Therapy in Equine Medicine''' (Third Edition), W.B. Saunders, Philadelphia. pp 446-447. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> Most impactions are in the small colon at the pelvic inlet, but retention may also occur in the dorsal or transverse colon.<ref name="Pusterla">Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> | |
| − | Meconium retention may result from a lack of colostrum ingestion, since colostrum is a natural laxative. | ||
==Clinical Signs== | ==Clinical Signs== | ||
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*'''CAREFUL''' digital examination ''per rectum'' (for diagnosis only) | *'''CAREFUL''' digital examination ''per rectum'' (for diagnosis only) | ||
*Abdominal palpation (meconium may be palpable if abdominal tympany is not too advanced) | *Abdominal palpation (meconium may be palpable if abdominal tympany is not too advanced) | ||
| − | *Abdominal ultrasound | + | *[[Colic Diagnosis - Abdominal Ultrasound|Abdominal ultrasound]] |
*Abdominal radiography of faecal masses in the colon<ref>Edwards, G.B (1997) Diseases and surgery of the small colon. ''Vet Clin N Am: Equine Pract'', 13:359-375. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> | *Abdominal radiography of faecal masses in the colon<ref>Edwards, G.B (1997) Diseases and surgery of the small colon. ''Vet Clin N Am: Equine Pract'', 13:359-375. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) ''Special Article'': Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). ''Equine Vet Educ'', 16(3):133-136.</ref> | ||
==Differential Diagnoses== | ==Differential Diagnoses== | ||
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*'''Uroperitoneum''': the foal may assume a more extended stance (NB: a ruptured bladder may occur simultaneously with meconium retention) | *'''Uroperitoneum''': the foal may assume a more extended stance (NB: a ruptured bladder may occur simultaneously with meconium retention) | ||
*[[Gastric Ulceration - Horse|Gastrodudodenal ulceration]] | *[[Gastric Ulceration - Horse|Gastrodudodenal ulceration]] | ||
*Impending enteritis | *Impending enteritis | ||
*Obstructive gastrointestinal lesions | *Obstructive gastrointestinal lesions | ||
| − | **Small intestinal intussusception | + | **[[Intussusception - Horse|Small intestinal intussusception]] |
**Torsion | **Torsion | ||
**[[Atresia|''Atresia coli'']] | **[[Atresia|''Atresia coli'']] | ||
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*'''Enema:''' warm soapy water made with a mild soap that can be administered through soft rubber tubing by gravity. | *'''Enema:''' warm soapy water made with a mild soap that can be administered through soft rubber tubing by gravity. | ||
*'''Liquid praffin:''' 300ml by nasogastric tube for foals that do not respond rapidly to an enema | *'''Liquid praffin:''' 300ml by nasogastric tube for foals that do not respond rapidly to an enema | ||
| − | *'''Muzzling and maintenance rate fluids IV:''' for persistent meconium retention resulting in significant abdominal distension. | + | *'''Muzzling and maintenance rate fluids IV:''' for persistent meconium retention resulting in significant abdominal distension. A constant rate infusion of 5-10% dextrose will provide some calories in addition to the free water needs. Dextrose should NOT be given as a bolus. |
| − | *'''Retention enema:''' a more aggressive treatment may be required using acetylcysteine which is an irritant and increases secretion. | + | *'''Retention enema:''' a more aggressive treatment may be required using acetylcysteine which is an irritant and increases secretion. 20g baking soda and 8g acetylcysteine are added to 200ml water to create a 4% acetylcysteine solution of pH7.6. A 30-french Foley catheter is inserted 2.5 to 5cm into the rectum and the bulb slowly inflated to occlude the rectum. 100-200ml of the solution is administered under gravity and retained for 30-45mins by occluding the catheter.<ref>Pusterla, N, Magdesian, K, Maleski, K, ''et al.'' (2004) Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987-2002). ''Equine Vet J'', (6):170-174. In: Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 21.</ref> |
*'''Surgery:''' may be required for extreme cases | *'''Surgery:''' may be required for extreme cases | ||
| − | *'''Analgesia:''' may be needed for some foals. | + | *'''Analgesia:''' may be needed for some foals. NSAIDs have deleterious effects on renal function and gastric mucosal blood flow, so they should be avoided if possible. '''Butorphanol''' given IM <ref>Arguedas, M.G, Hines, M.T, Papich, M.G ''et al.'' (2008) Pharmacokinetics of butorphanol and evaluation of physiologic and behavioural effects after intravenous and intramuscular administration to neonatal foals. ''J Vet Intern Med'', 22(6):1417-1426. In: Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 21.</ref> may help to prevent straining. '''Hyoscine''' (Buscopan-Boehringer) may alleviate the colic. |
*'''Intranasal oxygen:''' is useful for foals with significant abdominal distension.<ref>Wilkins, P.A (2004) Respiratory distress in foals with uroperitoneum: possible mechanisms. ''Equine Vet Educ'', 16(6):293-295. In: Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 21.</ref> | *'''Intranasal oxygen:''' is useful for foals with significant abdominal distension.<ref>Wilkins, P.A (2004) Respiratory distress in foals with uroperitoneum: possible mechanisms. ''Equine Vet Educ'', 16(6):293-295. In: Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), Saunders, Chapter 21.</ref> | ||
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==Prognosis== | ==Prognosis== | ||
| + | Most cases resolve with medical management within 12-24hrs. | ||
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==Complications== | ==Complications== | ||
| + | Foals with meconium retention may be at risk of '''sepsis''' because bacterial translocation may occur across the disrupted intestinal mucosa. Blood cultures are thus advisable and foals should be monitored closely for clinical signs of sepsis. Continuous straining may lead to '''patent urachus'''. | ||
| − | + | {{Learning | |
| − | + | |literature search = [http://www.cabdirect.org/search.html?rowId=1&options1=AND&q1=meconium&occuring1=title&rowId=2&options2=AND&q2=horses&occuring2=od&rowId=3&options3=AND&q3=&occuring3=freetext&x=55&y=15&publishedstart=yyyy&publishedend=yyyy&calendarInput=yyyy-mm-dd&la=any&it=any&show=all Meconium impaction in horses publications] | |
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==References== | ==References== | ||
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<references/> | <references/> | ||
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| + | {{review}} | ||
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[[Category:Medical_Colic_in_the_Horse]] | [[Category:Medical_Colic_in_the_Horse]] | ||
| − | [[Category: | + | [[Category:Expert_Review]] |
| − | [[Category: | + | [[Category:Colic - Small Colon Causes]] |
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[[Category:Intestine_-_Mechanical_Obstruction]] | [[Category:Intestine_-_Mechanical_Obstruction]] | ||
| + | [[Category:Impaction - Horse]] | ||
| + | [[Category:Colic - Large Colon Causes]][[Category:Colic - Small Colon Causes]] | ||
Latest revision as of 13:25, 18 July 2012
Also known as: Meconium Retention — Colic in foals — Impaction — Simple Obstruction — Rectal Obstruction — Large Intestinal Simple Obstruction — Small Colon Impaction — Descending Colon Impaction
Introduction
Meconium impaction or retention is the most common cause of colic in the first 24 hours of life and the most common cause of rectal obstruction in foals.[1]Meconium is mucilaginous material in the intestine of the term fetus containing a mixture of cellular debris, secretions of the intestinal glands, bile and swallowed amniotic fluid.[2] It is dark brown to black and cement- or pellet-like in texture. Most foals defaecate shortly after their first meal, with meconium being evacuated from 3 hours after birth.[2] Once meconium has been passed, the faeces become a dark yellow, reflecting milk digestion. Retention is suspected if the foal makes frequent attempts but fails to produce meconium by 12 hours.[2]
Signalment
Newborn foals. More common in colts than fillies, particularly if they are overdue. This may be related to a narrower pelvic inlet in colts.[3]
Aetiology
Meconium retention may result from a lack of colostrum ingestion, since colostrum is a natural laxative. Thus foals with meconium retention should also be checked for failure of passive transfer (FPT). Intestinal dysmotility may also be an indication of perinatal asphyxia. Other factors predisposing to meconium retention include maternal malnutrition and other conditions that compromise the foal such as dystocia, prematurity, low birth weight, and dehydration.[4] Most impactions are in the small colon at the pelvic inlet, but retention may also occur in the dorsal or transverse colon.[2]
Clinical Signs
Early signs:
- Restlessness
- Tail swishing
- Frequent posturing to defaecate or continuous straining
- Tail elevation
- Reduced sucking[5]
Advanced cases:
- Colic (due to gas accumulation within the bowel)
- Abdominal distension
- Classic 'arched back' stance
Diagnosis
- Clinical signs
- Lack of passage of a milk stool[2]
- CAREFUL digital examination per rectum (for diagnosis only)
- Abdominal palpation (meconium may be palpable if abdominal tympany is not too advanced)
- Abdominal ultrasound
- Abdominal radiography of faecal masses in the colon[6]
Differential Diagnoses
- Uroperitoneum: the foal may assume a more extended stance (NB: a ruptured bladder may occur simultaneously with meconium retention)
- Gastrodudodenal ulceration
- Impending enteritis
- Obstructive gastrointestinal lesions
Treatment
- Enema: warm soapy water made with a mild soap that can be administered through soft rubber tubing by gravity.
- Liquid praffin: 300ml by nasogastric tube for foals that do not respond rapidly to an enema
- Muzzling and maintenance rate fluids IV: for persistent meconium retention resulting in significant abdominal distension. A constant rate infusion of 5-10% dextrose will provide some calories in addition to the free water needs. Dextrose should NOT be given as a bolus.
- Retention enema: a more aggressive treatment may be required using acetylcysteine which is an irritant and increases secretion. 20g baking soda and 8g acetylcysteine are added to 200ml water to create a 4% acetylcysteine solution of pH7.6. A 30-french Foley catheter is inserted 2.5 to 5cm into the rectum and the bulb slowly inflated to occlude the rectum. 100-200ml of the solution is administered under gravity and retained for 30-45mins by occluding the catheter.[7]
- Surgery: may be required for extreme cases
- Analgesia: may be needed for some foals. NSAIDs have deleterious effects on renal function and gastric mucosal blood flow, so they should be avoided if possible. Butorphanol given IM [8] may help to prevent straining. Hyoscine (Buscopan-Boehringer) may alleviate the colic.
- Intranasal oxygen: is useful for foals with significant abdominal distension.[9]
Prognosis
Most cases resolve with medical management within 12-24hrs.
Complications
Foals with meconium retention may be at risk of sepsis because bacterial translocation may occur across the disrupted intestinal mucosa. Blood cultures are thus advisable and foals should be monitored closely for clinical signs of sepsis. Continuous straining may lead to patent urachus.
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References
Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) Equine Internal Medicine (Third Edition), Saunders, Chapter 21.
- ↑ White, N.A, Lessard, P (1986) Risk factors and clinical signs associated with cases of equine colic. Proc Am Ass Equine Practnrs, 32:637-644. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) Special Article: Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). Equine Vet Educ, 16(3):133-136.
- ↑ 2.0 2.1 2.2 2.3 2.4 Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) Special Article: Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). Equine Vet Educ, 16(3):133-136.
- ↑ Martens, R.J (1982) Pediatrics. In: Mannsman, R.L, McAllister, E.S Equine Medicine and Surgery (Third Edition), American Veterinary Publications, Santa Barbara. pp 333-334. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) Special Article: Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). Equine Vet Educ, 16(3):133-136.
- ↑ Semrad, S.D, Shaftoe, S (1992) Gastrointestinal diseases of the neonatal foal. In: Mills, L Current Therapy in Equine Medicine (Third Edition), W.B. Saunders, Philadelphia. pp 446-447. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) Special Article: Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). Equine Vet Educ, 16(3):133-136.
- ↑ Madigan, J.E (1994) Meconium retention. In: Madigan, J Manual of Equine Neonatal Medicine (Second Edition), Live Oak Publishing, Woodland. pp 114-117. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) Special Article: Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). Equine Vet Educ, 16(3):133-136.
- ↑ Edwards, G.B (1997) Diseases and surgery of the small colon. Vet Clin N Am: Equine Pract, 13:359-375. In: Pusterla, N, Magdesian, K.G, Maleski, K, Spier, S.J, Madigan, J.E (2004) Special Article: Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987–2002). Equine Vet Educ, 16(3):133-136.
- ↑ Pusterla, N, Magdesian, K, Maleski, K, et al. (2004) Retrospective evaluation of the use of acetylcysteine enemas in the treatment of meconium retention in foals: 44 cases (1987-2002). Equine Vet J, (6):170-174. In: Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) Equine Internal Medicine (Third Edition), Saunders, Chapter 21.
- ↑ Arguedas, M.G, Hines, M.T, Papich, M.G et al. (2008) Pharmacokinetics of butorphanol and evaluation of physiologic and behavioural effects after intravenous and intramuscular administration to neonatal foals. J Vet Intern Med, 22(6):1417-1426. In: Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) Equine Internal Medicine (Third Edition), Saunders, Chapter 21.
- ↑ Wilkins, P.A (2004) Respiratory distress in foals with uroperitoneum: possible mechanisms. Equine Vet Educ, 16(6):293-295. In: Wilkins, P.A (2010) 'Diseases Of The Gastrointestinal Tract' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) Equine Internal Medicine (Third Edition), Saunders, Chapter 21.
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