Umbilical pathologies and sepsis in foals (Initial therapy (Antibiotics:…
Umbilical pathologies and sepsis in foals
Meconium retention (abdominal straining)
Prolonged recumbency (IUGR, dystocia, NMMS, premature/dysmature)
Systemic infection (esp. secondary to FPT), diarrhoea, pneumonia
Ultrasound of umbilical structures (look for widened umbilical stump, thickening of urachal/vessel walls, luminal dilation/fluid accumulation, gas shadows, abscesses)
CBC/Biochem: haemoconcentration, systemic inflammation, and evidence of organ dysfunction
Blood culture: screen for common sepsis agents (Enterobacteriaceae, Staph/Strep)
PE: pyrexia of unknown origin, injected mucous membranes, evidence of omphalitis, septic arthritis/osteomyelitis, diarrhoea, pneumonia
Faecal culture/PCR (if diarrhoea): screen for Clostridium, Salmonella, Rotavirus
Serum [IgG]: evidence of complete/partial FPT (< 4g/L or 4-8 g/L)
Systemic broad-spectrum antibiotics + topical treatment
Indicated for congenital patent urachus and/or mild omphalitis
Many cases of patent urachus are responsive to medical therapy.
Resection of umbilical remnant via coeliotomy. Indicated if extreme umbilical enlargement, venous/liver involvement, evidence of septic foci, evidence of purulent material on U/S.
Generally need 1-4 days parenteral antibiotics before surgery to minimise abdominal contamination.
Antibiotics: if evidence of omphalophlebitis/systemic infection (contraindicated if not present). Mixed infections likely, so broad-spectrum bactericidal (beta lactam + aminoglycoside + metronidazole if anaerobes suspected). If dehydrated/renal compromise, use TMS and/or ceftiofur instead of Pen/Gent.
Plasma transfusion (if low serum IgG @ >12 hrs old): ROT is 1 L plasma raises IgG by 2-3 g/L.
Fluid therapy (if endotoxic shock, hypovolaemic, dehydrated): 94-240 mL//hr for 50kg foal (94 is maintenance). Can give repeated (up to 4) 1 L boluses over
5-20 mins with continual reassessment.
Colostrum (if low IgG within first few hours of life): 1-2 L will raise IgG to > 4g/L.
+/- Anticoagulant therapy (if endotoxic shock): heparin/citrate to reduce risk of microthrombosis/infarction (esp. if giving plasma).
Joint lavage (if evidence of septicaemia): reduces bacterial load and prevents septic arthritis/osteomyelitis.
Flunixin (if endotoxic).
Septicaemia, endotoxaemia and SIRS
Septic foci (septic arthritis/osteomyelitis, pneumonia, diarrhoea, bacterial meningitis)
Common umbilical pathologies
Urachus connects foetal bladder and allantois in utero. Normally closes at parturition. Can be congenital or acquired (acquired most common). Acquired due to umbilical infection, abdominal straining, prolonged recumbency.
Typically due to Enterobacteriaceae or Staph/Strep infection. Typically no gross navel signs. Suspected with fever of unknown origin, unexplained hyperfibrinogenaemia, septic foci. Diagnosed via clinical signs and U/S examination. Usually responsive to medical treatment unless severe.