Soft tissue surgery of foals Flashcards

Question

Treatment of umbilical infection

Answer 1

Surgical vs medical Surgical indicated if: - clinician preference - progress not attained medically - Signs of systemic disease - U/S shows widespread/severe infection - No response to Abx or recurs - Concurrent joint sepsis or widespread sepsis

Answer 2

Suture umbilical opening closed first to prevent contamination of site Elliptical incision around umbilicus Dissect off body wall Then incise linea alba cr and cadual to umbilicus Identify the umbilical vein running cranially -> trace to a normal section (not thickened) and ligate Repeat with both umbilical arteries body wall closed in 3 layers (linea alba, s-cut and skin) Cover wound with stent (sutured on) or body bandage

Answer 3

Quite common ○ Prevalence 0.5-2% Often occurs during parturition (rapid and forceful); can occur in septic/recumbent foals (monitor) Rapid and forceful parturition in horses ○ Ruptured bladder in foals ○ Fractured ribs in foals ○ Occasionally ruptured bladder in mare Tears most common dorsally

Answer 4

- Dorsal recumbency - midline laporotomy - May need to reflect prepuce to extend laporotomy caudally - Drain abdomen of urine slowly first - Midline (dorsal tear) of bladder edges resected - Then repaired with inverting absorbable sutures (none left in lumen - Resect other umbilical remnants - close bladder tip - double layer inverting (Cushings) - Close linea alba, s-cut, and skin)

Answer 5

Stabilize Correct Hyperkalemia § Can cause muscle tremors and cardiac arrythmias § Goal = < 5.5 mEq/l prior to surgery Broad spectrum abx

Answer 6

To repair a tear in the bladder check full extent of bladder—some can be quite long and difficult to exteriorize Can use fluorescein to visualize tear if small via catheter Excise margins; culture neck of bladder before closure

Answer 7

Common (around 2% TBs); most are congenital Usually chronic, small, uncomplicated Size: commonly measured in 'finger' width Usually cosmetic but serve as a potential site of bowel incarceration (8-10% referred for emergency surgery) Should be easily reducible ○ If not - gut or omentum may be trapped § CS = colic, oedema/clammy skin over hernia site § Need surgery relatively urgently -> open sx under GA

Answer 8

<5cm; reducible § Reduce hernia daily to check size and ensure nothing entrapped § Frequently close as foal matures § Hernia clamps not advised as can entrap bowel § If not closed by 4 months; surgery >5 cm; non reducible § Surgery § Will not close on its own; strangulation risk high § Elliptical incision, invert sac or cut out, close body wall, sub-q and skin

Answer 9

1. elliptical skin incision around the hernial sac - leave enough skin to close easily afterwards 2. carefully dissect skin from hernial sac - try not to penetrate 3. invert the sac (into abdomen) 4. pre-place mattress sutures to close the hernia 5. tie all mattress sutures at the end -> appositional closure of the abdomen wall 6. close subcut and skin 7. add stent or body bandage - young animal will be lying on wound If large hernia then refer

Answer 10

Keep covered for 3-4 days Elective clean surgery - shouldnt need antibiotics NSAIDs indicated RESTRICT exercise for 2-3 weeks - prevent pull through of sutures

Answer 11

If used, for SMALL hernias only (<1 finger width) Fibrous tissue fills the gap but this is not a true repair 3-4 weeks for hernia skin to slough off Significant risk of getting gut trapped in the ring if done standing, or can necrose skin and leave an open hole into the peritoneum

Answer 12

Congenital, likely hereditary Cause = congenitally enlarged vaginal ring (internal ring of inguinal canal Usually easily manually reducible Most are self-resolving within 6mo Low risk of bowel incarceration Tell owner to reduce manually SID adv re-signs to look for if ruptures or bowel becomes incarcerated - Cold, clammy feel to scrotum - Colic/depressed - Irreducible

Answer 13

Entire adult males (large inguinal rings/canal) Post jumping/breeding Usually non-reducible, often strangulating intestine

Answer 14

Foals - rare that intesting incarcerated/strangulated Ruptured hernia -> vaginal tunic ruptures (often during birth) § Intestine can then travel sub-cutaneously § Swollen, non-reducible, cold, clammy oedematous scrotal skin, colic signs Both require urgent surgery (referral) at this stage

Answer 15

Need CLOSED castration Twist vaginal tunic -> bowel into abdomen Ligate as low as possible, prevents recurrence

Answer 16

Back up constantly Tail flag Dull/not nursing Abdominal distension Show typical signs of colic

Answer 17

Enteritis Small intestinal mesenteric volvulus Meconium impaction Ascarid impaction Intussusception Congenital anatomic abnormalities (atresia ani; atresia coli)

Answer 18

More challenging to diagnose as can not perform rectal exam etc § Rely on u/s + rads Perceived increased risk of intra-abdominal adhesions post op § Perhaps not more so than adults? Beware if has pyrexia – may be enteritis or sepsis rather than surgical lesion? § But also seen with SI volvulus etc Abdominal distension – common § Can measure with tape at specific points on abdomen to detect changes § If severe can cause dyspnoea Naso-gastric reflux in foals – does not always indicate mechanical obstruction (unlike adults) § Do pH test – acid reflux from stomach vs basic reflux from SI Common DDx for colic/distension § Uroperitoneum § Enteritis

Answer 19

Gastric outlet obstruction/pseudo obstruction - relatively rare § Result of severe ulceration § Most tx medically § Surgery possible but quite difficult, high risk of complications, ££££

Answer 20

Hernias that entrap SI (rare § Scrotal, inguinal § Diaphragmatic SI obstructive lesions § ascarid impactions SI strangulating lesions § SI volvulus § intussusceptions

Answer 21

Not so common these days Parascaris Equorum Usually weanlings 4-24 months ® Often thin/unthrifty appearance ® Impaction follows anthelmintic tx by 1-5d Surgery indicated if complete obstruction present ® Enterotomy and evacuate then close ® Occasionally enterectomy if bowel devitalised

Answer 22

most common surgical lesion of foals esp <3mo Variable length of intestine rotates around its long axis Often jejunum and ileum involved In some cases, entire SI rotates around root of mesentery -> massive ischaemia -> Poor prognosis due to large amount of gut that is compromised

Answer 23

pain becomes severe- often recumbent, SI and abdominal distension, no movement of SI on U/S, increased RR and HR, injected MM, can be pyrexic

Answer 24

Foals/young horses Simple obstruction first -> strangulating as more gut drawn in Typical 'bulls eye' appearance on u/s

Answer 25

Foal colic Failure to pass meconium/no meconium staining

Answer 26

May be able to digitally palpate atresia ani, but not always Barium enemas may be helpful for both , but sometimes are difficult to interpret, especially with atresia coli Often diagnosed via exploratory celiotomy Always look for other congenital abnormalities (i.e. contracture ect)

Answer 27

If complete rectal pouch persistent anal membrane incised or small circular piece of skin removed + rectal wall sutured to skin Prognosis for life favourable, but normal anal function may not be obtained

Answer 28

euthanasia