straining foal

History/presenting signs

·    How long been straining for?

·    Managed to pass anything?

·    Have they suckled?

·    Was meconium passed? – if not passed by 12h, likely to cause obstruction in small colon or pelvic inlet

·    Colic signs, abdominal distension – meconium impaction

·    Stranguria/anuria, bradycardia, depression – uroabdomen

Investigations

·    Clinical exam

o  Abdominal palpation

o  Digital exam – might be able to feel meconium impaction

o  Palpate umbilicus

·    Abdominal U/S – hypechoic-anechoic (speckled) appearance, contracted intestinal wall = meconium impaction, U/S umbilical stump – see enlargement of urachus, artery or vein, free fluid (can tap) = uroabdomen

·    Abdominocentesis if free fluid – if creatinine 2x blood level = urine

·    Blood sample:

o  IgG

o  Glucose

o  Lactate

o  Haematology – increased

o  Biochemistry – low Na, low Cl, high K = uroabdomen

o  Inflammatory markers

o  USG

Management

·    Meconium impaction – enema

o  Phosphate enema (max 2x in 24h or cause hyperphosphataemia)

o  Warm soapy water

o  Acetylcysteine retention enema (sedate foal with diazepam + butorphanol)

·    Umbilical infection – broad spec abx for 2w, repeat U/S to assess response to treatment

o  Risk of haematogenous spread – surgery required if no response to medical treatment

·    Uroabdomen – refer for surgical repair

·    Hypovolaemia – IV Hartmanns’s, 20ml/kg

·    Analgesia – butorphanol +/- NSAIDs (more side effects than adults)

Causes

Abdominal causes:

·    Meconium impaction

·    Enterocolitis

·    Dsymotility

·    SI strangulation

·    Congenital abnormality within GIT

·    Intussusceptions

·    Hernias

·    Gastric/duodeonal ulceration

·    Lactose intolerance

Urinary causes:

·    Uroabdomen – usually due to bladder wall rupture during parturition

·    Congenital abnormalities

·    Umbilical infection