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TNG Exam 4 > LA Neonatalogy > Flashcards

LA Neonatalogy Flashcards

1
Q

If you decide to manually separate the umbilicus post-partum, what should you make sure to do?

A

separate it more distally (not near the body wall)
leave a stump of 2.5-4 cm

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2
Q

Which neonatal structure goes cranial towards the liver?

A

umbilical vein

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3
Q

What is the appropriate diameter of the 2 umbilical arteries when you are ultrasounding?

A

0.5-1.0 cm

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4
Q

T/F: when ultrasounding, the umbilical veins should normally have a hyperechoic center

A

false – hypoechoic
hyperechoic could indicate infection

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5
Q

When ultrasounding, what is the normal position of the urachus?

A

in between the 2 umbilical arteries

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6
Q

You are called to a farm to see a 12 day old foal that the owner reports has been straining to urinate multiple times a day, but doesnt produce a ton of urine. When you do your physical exam, you notice the umbilicus is wet with urine, has a small amount of purulent debris, and is swollen. The foal also has a fever. What is your presumptive diagnosis?

A

omphalitis

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7
Q

You suspect your patient has omphalitis after assessing clinical signs and doing an exam. You do a CBC and ultrasound, what are the expected findings?

A

CBC: leukocytosis or leukopenia, hyperfibrinogenemia
U/S: hyperechoic structures (umbilical arteries and urachus)

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8
Q

What are some potential complications of omphalitis?

A

dissemination creating systemic infections – septicemia, septic joints, osteomyelitis, peritonitis, pneumonia, meningitis, etc.

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9
Q

If you are examining a foal with mild omphalitis and this foal has a normal temp, normal CBC, and no systemic complications, what is your treatment protocol?

A

antimicrobials

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10
Q

If you are examining a foal with omphalitis and this foal has an abnormal temp, inflammatory leukogram, and you detected ultrasound abnormalities. What is your treatment protocol?

A

Surgery

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11
Q

What is the treatment for omphalitis in which there is subcutaneous abscess present?

A

lance and drain

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12
Q

What is the prognosis for cases of omphalitis that were treated with surgery?

A

good, surgery sites are expected to heal well. Complications are uncommon (intestinal adhesions, incisional infection, hemoperitoneum, uroperitoneum)

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13
Q

T/F: A patient with omphalitis that has disseminated to systemic infection likely has a worse prognosis.

A

true

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14
Q

An owner calls you out to the farm to assess a foal born 4 hours ago that has an abnormal protrusion on the ventral abdomen. You decide to do palpation and ultrasound. You diagnose this patient with an umbilical hernia. What is the treatment protocol?

A

Reduce if appropriate.
If not reducible, then this is an emergency sx because strangulation can occur and cause necrosis.

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15
Q

You are called to a farm to assess a neonatal foal that has a wet stomach that is otherwise healthy. You diagnose this foal with patent urachus. What is the pathophysiology / etiology of this condition?

A

congenital – failure of the urachus to close (could be d/t excessive traction on umbilicus before it ruptured, too much abdominal pressure during foaling, or twisting of umbilicus)
acquired – closes then reopens d/t inflammation, infection, or too much abdominal pressure.

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16
Q

What is the appropriate way to pick up a neonate to avoid placing too much abdominal pressure and causing urachal problems?

A

one arm in front of front legs, one are behind back legs
NEVER arms under abdomen

17
Q

You are called to a farm to assess a neonatal foal that has a wet stomach and anorexia. Your PE reveals fever and lethargy. You diagnose this foal with patent urachus and omphalitis. How will you treat this patient?

A
  1. place a urinary catheter
  2. 0.5% chlorohex dip 2x/day OR cautery (silver nitrate)
  3. it should close within a few days
  4. provide care for the omphalitis infection and monitor
18
Q

What are the potential etiologies of a foal that was born normal, acted normal for the first 48-72 hrs, but then crashed and became lethargic, anorexic, developed abdominal distention, stranguria, and colic signs intermittently?

A

this is uroperitoneum
etiologies include:
1. ruptured bladder d/t increased intravascular pressure during parturition or lifting
2. ruptured bladder d/t congenital malformation of the bladder
3. rupture of the urachus d/t omphalitis

19
Q

What diagnostics are important when working up a uroperitoneum case?

A
  1. clinical signs
  2. abdominal ultrasound (fluid)
  3. blood chemistry
20
Q

What type of abnormalities would you see on a blood chemistry in a foal with uroperitoneum?

A

hyponatremia
hypochloremia
hyperkalemia
azotemia

21
Q

If you were to test the urine of a foal with suspected uroperitoneum, what would the electrolyte composition look like (K, Na, Cl, and creatinine)?

A

Na - low
Cl - low
K - high
creatinine - high

22
Q

You perform an abdominocentesis to collect peritoneal fluid from a foal with suspected uroperitoneum. What is the peritoneal fluid to serum creatinine ratio?

A

> 2:1

23
Q

What are the biggest risks/concerns in foals with uroperitoneum? (2)

A
  1. the hyperkalemia will cause inhibition of atrial myocardial depolarization which slows the HR and causes muscle tremors
  2. the distention of the abdomen decreases lung capacity and can lead to hypoxemia
24
Q

How do you treat uroabdomen?

A
  1. correct the hyperkalemia (IV fluids, Sodium bicarb)
  2. peritoneal drainage (slowly)
  3. calcium (raises membrane threshold potentials)
  4. sx - urachal remnant resection and cystorrhaphy (not until stable, K <5.5)
25
Q

what is the prognosis of uroabdomen?

A

very good

26
Q

What is the most common congenital cause of urinary incontinence in dogs but can also occur in large animals?

A

ectopic ureters

27
Q

What is the difference between intramural and extramural ectopic ureters?

A

intramural – the ureter appears to be normally entering the bladder, however its on the outer edge and really terminates elsewhere/not the bladder
extramural – the ureter obviously terminates elsewhere/not within the bladder

28
Q

How do you diagnose ectopic ureters?

A

excretory urogram
cystoscopy

29
Q

what is the treatment for ectopic ureters?

A

ureterocystotomy

30
Q

T/F: 50% of animals are incontinent after surgery that is intended to correct ectopic ureters, so you should perform a urethral pressure profile prior to surgery to assess the risks.

A

true

31
Q

What diagnostic tests would be beneficial if you are presented with a foal that you suspect has an angular limb deformity?

A
  1. physical exam + palpation and manipulation (attempt to straighten the legs)
  2. radiographs (dorsal palmar and lateral views)
32
Q

_____________ results in compression and permanent deformation of the cuboidal bones.

A

incomplete endochondral ossification

33
Q

What is the concern for a foal with incomplete ossification once ossification occurs?

A

permanent lameness

34
Q

What is the treatment for incomplete ossification to prevent from causing an angular limb deformity?

A

stall rest
splint the limbs to keep them straight as they develop
foot care

35
Q

what is the treatment options for angular limb deformities?

A

hoof trimming/glue on extensions
growth acceleration (periosteal elevation/stripping)
slow growth (transphyseal bridging)
combo of the acceleration and and slowing
corrective osteotomy/ostectomy

36
Q

When should you intervene with a fetlock abnormality versus a carpal abnormality?

A

fetlock – 2-3 weeks for conservative management and < 4 weeks for other treatments
carpus – <3-4 months for conservative tx and <6 months for other treatments

37
Q

What diagnostic tests should you perform on a foal with suspected septic joints?

A
  1. physical exam
  2. arthrocentesis – normal = clear/pale yellow; abnormal = orange, red, turgid; do cytology and culture/susc.
38
Q

How do you treat septic joints in foals?

A

lavage – flush fibrin and bacteria out
antibiotics – systemic (IV) and regional limb perfusion (local), usually amikacin

39
Q

How do you treat a congenital flexural deformity?

A

trim foot
shoe with extension to build toe and force heel down

TNG Exam 4 (5 decks)

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