Umbilical disorders of foals Flashcards
Predisposing factors to patent urachus
Excessive umbilical traction e.g at birth
Local infection
conservative vs surgical treatment of patent urachus basic
Conservative: dip in dilute iodine/leave alone
Surgical: done if it persists >7 days; = surgical removal of urachus or other umbilical remnants
Surgical technique for patent urachus
Fusiform skin incision around umbilicus; dissect umbilicus and urachus out and follow caudally to the bladder
Clamp and resect the tip of the bladder here then close in two inverting layers using asorbable suture
Keep urinary catheter in for a couple days
What to remember when suturing the bladder
Do not leave any suture in the lumen; can lead to stone formatino
What are indications for surgical intervention with umbilical infection
Ultrasound shows widespread/severe infection
No response to antibiotics
Concurrent joint sepsis or widespread sepsis warrants immediate operation
How are most umiblical infections dealt with
Medical treatment
Technique for surgery on umbilical infection
Elliptical incision around umbilicus, dissect away from body wall
Incise linea alba cranially and caudally to umbilicus and dissect vein and arteries out until a point of normal diameter
Double ligate arteries and vein
Close body wall in 3 layers
Cover wound with stent or body bandage
What can lead to ruptured bladder
Rapid and forceful parturition
What is the priority when going into rupture bladder surgery
Dealing with the hyperkalaemia first
Surgical treatment of ruptured bladder
Slowly drain abdomen of urine
Midline laparotomy; dissect around umbilicus and follow urachal stumb down
Usually find the tear on dorsal aspect of bladder hear neck so must retroflex
Excise tissue around tear and then oversew using two inverting continuous suture layers
Where do we usually find bladder tears
On dorsal aspect near the neck
Why do we drain the abdomen of urine slowly in a foal with rupture bladder
To avoid causing hypovolaemia
How common are umbilical hernias
Relatively
~2% in thoroughbreds
What are the issues with using elastrator rings to deal with hernias
Risk of gut getting trapped in ring if done standing
Once skin necroses, risk of leaving open hole into the peritoneum
Surgical technique for dealing with umbilical hernia
Elliptical skin incision around hernial sac, leaving enough skin to close
invert the sac
Place mattress sutures with large metric absorbable suture e.g 5/6 metric PGA/PDS, ensuring no intestine is trapped before tickening
Close body wall
Add stent or body bandage
Post-op care for umbilical hernia surgery
keep covered for 3-4 days, give NSAIDs, restrict exercise for 2-3 weeks and perhaps sedate when first turned out
INguingal hernia cause
Congenital in foals likely hereditary
Related to enlarged vaginal ring
Most self-resolve in 6 months
What signs of rupture/incarceration should we tell owners of foals with inguinal hernias to look out for
Cold-clammy feeling to scrotum
Colic/depression
Hernia becomes unreducible
With rupture, may see intestine travelled subcut
What tends to cause inguinal/scrotal hernias in adults
Post-jumping or breeding
Usually non reducible and often strangulating
What do we tend to do when dealing with hernia inguinal hernia in foals
Castrate at same time
How to do an elective castration and hernia repair in foals
Closed castration, twisting vaginal tunic to milk any intestine back into the bdomen
Ligate as low as possible to prevent recurrence
