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
 
  
==Introduction==
+
{{unfinished}}
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>
+
 
 +
 
 +
{| 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==
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. More common in colts than fillies, particularly if they are overdue. This may be related to a narrower pelvic inlet.
 +
This condition is the most common cause of rectal obstruction
 +
in foals (White and Lessard 1986). Male foals appear to be
 +
more commonly affected than fillies due to the smaller pelvic
 +
inlet in the colt (Martens 1982).(Pusterla)
  
 
==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 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.
 +
Other factors predisposing
 +
to meconium retention include maternal malnutrition, delayed
 +
colostral intake with loss of its laxative effect, conditions that
 +
compromise the foal, such as asphyxiation, dystocia,
 +
prematurity, low birth weight, intestinal disease or
 +
hypomotility of the colon, and dehydration (Semrad and
 +
Shaftoe 1992).(Pusterla)
  
 
==Clinical Signs==
 
==Clinical Signs==
'''Early 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
*Tail swishing
+
Early signs of failure to pass meconium may
*Frequent posturing to defaecate or continuous straining
+
include restlessness, tail swishing, frequent posturing to
*Tail elevation
+
defaecate, tail elevation and disinterest in sucking (Madigan
*Reduced sucking<ref>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.</ref>
+
1994). Advanced cases may be presented with abdominal
'''Advanced cases:'''
+
distention and other clinical signs of colic. Most impactions are
*[[Colic Diagnosis - Clinical Signs|Colic]] (due to gas accumulation within the bowel)
+
located in the small colon at the pelvic inlet, but can also be
*Abdominal distension
+
located in the dorsal or transverse colon.(Pusterla)
*Classic 'arched back' stance
 
  
 
==Diagnosis==
 
==Diagnosis==
*[[Colic Diagnosis - Clinical Signs|Clinical signs]]
+
 
*Lack of passage of a milk stool<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>
 
 
*'''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)
*[[Colic Diagnosis - Abdominal Ultrasound|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
 +
Diagnosis is based on clinical signs and detection of a firm
 +
mass upon digital rectal, lack of passage of milk stool and
 +
abdominal palpation or radiography of faecal masses in the
 +
colon (Edwards 1997).(Pusterla)
  
 
==Differential Diagnoses==
 
==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  
**[[Intussusception - Horse|Small intestinal intussusception]]
+
**Small intestinal intussusception
 
**Torsion
 
**Torsion
 
**[[Atresia|''Atresia coli'']]
 
**[[Atresia|''Atresia coli'']]
Line 44: Line 85:
 
*'''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 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>
+
*'''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==
 +
 
Most cases resolve with medical management within 12-24hrs.  
 
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.
  
==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]
 
}}
 
  
 
==References==
 
==References==
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{{review}}
+
[[Category:Medical_Colic_in_the_Horse]]
 
+
[[Category:To_Do_-_Nina]]
{{OpenPages}}
+
[[Category:To_Do_-_Review]]
  
[[Category:Medical_Colic_in_the_Horse]]
 
[[Category:Expert_Review]]
 
[[Category:Colic - Small Colon Causes]]
 
 
[[Category:Intestine_-_Mechanical_Obstruction]]
 
[[Category:Intestine_-_Mechanical_Obstruction]]
[[Category:Impaction - Horse]]
 
[[Category:Colic - Large Colon Causes]][[Category:Colic - Small Colon Causes]]
 

Revision as of 13:02, 10 August 2010




Also known as: Meconium Retention

Colic in foals
Impaction
Simple Obstruction
Large Intestinal Simple Obstruction
Small Colon Impaction
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

Newborn foals. More common in colts than fillies, particularly if they are overdue. This may be related to a narrower pelvic inlet. This condition is the most common cause of rectal obstruction in foals (White and Lessard 1986). Male foals appear to be more commonly affected than fillies due to the smaller pelvic inlet in the colt (Martens 1982).(Pusterla)

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. Other factors predisposing to meconium retention include maternal malnutrition, delayed colostral intake with loss of its laxative effect, conditions that compromise the foal, such as asphyxiation, dystocia, prematurity, low birth weight, intestinal disease or hypomotility of the colon, and dehydration (Semrad and Shaftoe 1992).(Pusterla)

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

Early signs of failure to pass meconium may include restlessness, tail swishing, frequent posturing to defaecate, tail elevation and disinterest in sucking (Madigan 1994). Advanced cases may be presented with abdominal distention and other clinical signs of colic. Most impactions are located in the small colon at the pelvic inlet, but can also be located in the dorsal or transverse colon.(Pusterla)

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

Diagnosis is based on clinical signs and detection of a firm mass upon digital rectal, lack of passage of milk stool and abdominal palpation or radiography of faecal masses in the colon (Edwards 1997).(Pusterla)

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 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.

  1. 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.
  2. 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.
  3. 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.