Difference between revisions of "Meconium Impaction - Horse"
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| − | Meconium impaction or retention is the most common cause of colic in the first 24 hours of life | + | |
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| + | {| cellpadding="10" cellspacing="0" border="1" | ||
| + | | Also known as: | ||
| + | |'''Meconium Retention<br> | ||
| + | '''Colic in foals<br> | ||
| + | '''Impaction<br> | ||
| + | '''Simple Obstruction<br> | ||
| + | '''Large Intestinal Simple Obstruction<br> | ||
| + | '''Small Colon Impaction<br> | ||
| + | '''Descending Colon Impaction''' | ||
| + | |} | ||
| + | |||
| + | ==Description== | ||
| + | |||
| + | Meconium impaction or retention is the most common cause of colic in the first 24 hours of life. | ||
| + | Meconium is mucilaginous material in the intestine of the | ||
| + | term fetus containing a mixture of cellular debris, secretions of | ||
| + | the intestinal glands, bile and amniotic fluid. Meconium | ||
| + | usually begins to be evacuated from the newborn foal within | ||
| + | 3 h after birth, and is considered retained if the foal makes | ||
| + | frequent attempts but fails to produce meconium by age 12 h.(Pusterla) | ||
==Signalment== | ==Signalment== | ||
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| + | Newborn foals. More common in colts than fillies, particularly if they are overdue. This may be related to a narrower pelvic inlet. | ||
==Aetiology== | ==Aetiology== | ||
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| + | Meconium is composed of glandular secretions, swallowed amniotic fluid and cellular debris. It is dark brown to black and cement- or pellet-like in texture. Most foals defaecate shortly after their first meal, within 24 hours of birth. Once meconium has been passed, the faeces become a dark yellow, reflecting milk digestion. 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. | ||
==Clinical Signs== | ==Clinical Signs== | ||
| − | '' | + | |
| + | *Colic (due to gas accumulation within the bowel) | ||
| + | *Continuous straining | ||
| + | *Classic 'arched back' stance | ||
| + | *Foal depressed or remains bright | ||
| + | *Normal or reduced level of suckling | ||
| + | *Tail swishing and elevation | ||
*Restlessness | *Restlessness | ||
| − | + | ==Diagnosis== | |
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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 |
| − | *Abdominal radiography | + | *Abdominal radiography |
| + | ==Differential Diagnoses== | ||
| − | |||
*'''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 |
**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. 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. | + | *'''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 | + | *'''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 adminstered 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. 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. | + | *'''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 at 0.05 to 0.1mg/kg<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> | ||
==Prognosis== | ==Prognosis== | ||
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Most cases resolve with medical management within 12-24hrs. | Most cases resolve with medical management within 12-24hrs. | ||
| + | ==Complications== | ||
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| + | 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== | ==References== | ||
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| − | + | [[Category:Medical_Colic_in_the_Horse]] | |
| − | + | [[Category:To_Do_-_Nina]] | |
| − | + | [[Category:To_Do_-_Review]] | |
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[[Category:Intestine_-_Mechanical_Obstruction]] | [[Category:Intestine_-_Mechanical_Obstruction]] | ||
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Revision as of 13:01, 10 August 2010
 |
This article is still under construction. |
| Also known as: | Meconium Retention Colic in foals |
Description
Meconium impaction or retention is the most common cause of colic in the first 24 hours of life. Meconium is mucilaginous material in the intestine of the term fetus containing a mixture of cellular debris, secretions of the intestinal glands, bile and amniotic fluid. Meconium usually begins to be evacuated from the newborn foal within 3 h after birth, and is considered retained if the foal makes frequent attempts but fails to produce meconium by age 12 h.(Pusterla)
Signalment
Newborn foals. More common in colts than fillies, particularly if they are overdue. This may be related to a narrower pelvic inlet.
Aetiology
Meconium is composed of glandular secretions, swallowed amniotic fluid and cellular debris. It is dark brown to black and cement- or pellet-like in texture. Most foals defaecate shortly after their first meal, within 24 hours of birth. Once meconium has been passed, the faeces become a dark yellow, reflecting milk digestion. 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.
Clinical Signs
- Colic (due to gas accumulation within the bowel)
- Continuous straining
- Classic 'arched back' stance
- Foal depressed or remains bright
- Normal or reduced level of suckling
- Tail swishing and elevation
- Restlessness
Diagnosis
- 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
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
- Small intestinal intussusception
- Torsion
- Atresia coli
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 adminstered under gravity and retained for 30-45mins by occluding the catheter.[1]
- 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 at 0.05 to 0.1mg/kg[2] may help to prevent straining. Hyoscine (Buscopan-Boehringer) may alleviate the colic.
- Intranasal oxygen: is useful for foals with significant abdominal distension.[3]
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.
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.
- ↑ 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.