Umbilical hernias Flashcards
Umbilical swellings
- Not all umbilical swellings are hernias
Causes of umbilical hernias in calves
- Genetic
- Abscess
- Hernias
- Combos
Most likely thing to see in terms of umbilical infections between:
Subcutaneous abscess, omphalophlebitis, omphaloarteritis, and urachal abscess?
- Omphaloarteritis
SC abscess signs
- Will be swollen
Omphalophlebitis complication
- Connects to the liver
How to examine umbilical hernia?
- Palpation (Classically based on how many fingers wide it is)
- Ultrasound
What size umbilical hernias can cause the most problems?
- Medium
- Stuff can get through but trapped on the way back
Repair options for umbilical hernia?
- Rubber band technique
- Irritation
- Surgical correction
Irritation to reduce umbilical hernia
- If it’s small, you can use an irritant
- You can have owners irritate it by rubbing i ta couple of times a day or use a chemical irritant
Surgery for reducing umbilical hernia
- Anesthesia, preparation
- Reduce hernia
- Understand complications
- Abd closure
Irritant injection substance examples
- You could use dilute betadine
Cautions for irritant injection technique for reducing umbilical hernia
- You don’t want to go into the peritoneal cavity
- If you irritate it while something is sticking out, that can be a problem
Banding for umbilical hernia reduction
- Put them on their backs and put a rubber band around it
- Keep it on there with a Steinman pin
Umbilical hernia surgical repair anesthesia
- Heavy sedation or general anesthesia
- Can do local anesthesia too
Umbilical hernia surgical repair recumbency
- Dorsal recumbency
Umbilical hernia surgical repair procedure (up to but not including closure)
- Prep a sterile field
- Elliptical incision in female; curved in males to avoid prepuce
- Dissect skin by blunt or sharp dissection
- Watch out for abnormal umbilical vessels or abscesses
- remove abscess intact if you can
- Dissect down to the sac and cut it out if you can
- He usually goes caudal so you don’t accidentally cut into the vein
Closure for umbilical hernia surgical repair
- Can close without opening peritoneum or you can open the peritoneum to examine for adhesions
- Standard abdominal closure
- Continuous, simple interrupted, far-near-near-far pattern for tension
- Subcutaneous closure
- Skin closure
Post op care for umbilical hernia repair
- Antibiotics
- A few may dehisce deep especially if associated with omphalitis
- Difficult to correct a second time due to scar tissue
Direct scrotal or inguinal hernia
- Through the fascia of the abdominal wall
Indirect scrotal or inguinal hernia
- Through inguinal ring, within the vaginal tunic (where the cord is)
Who can get scrotal or inguinal hernias?
- Breeding bulls
- Calves
- Limbs
- Pigs
Causes of scrotal or inguinal hernias
- Genetic vs trauma
Complications of scrotal or inguinal hernias
- Strangulation
- Testicular degeneration
Where is the inguinal ring
- within about 2cm of the pubis
Who has an inguinal ring?
- Males and females
When are scrotal hernias found?
- Often at the time of castration
Differentials for scrotal hernias (remember this)
- Hydrocele
- Hematoma
- Scirrhous cord
- Arteriovenous shunt
Hydrocele
- Fluid accumulation between vaginal tunic and testis
Scirrhous cord
- Post-castration
- Spermatic cord stump that is inflammatory
A/V shunt
- Arteriovenous shunt
- You can feel the phremitus of the buzzing
- Lots of blood when you ultrasound
Scrotal hernia taping method
- 1” elasticon figure 8 around legs post-castration
- Puts pressure on inguinal rings
- remove tape in 4-5 days
Scrotal hernia surgical correction timing (pre or post-castration?)
- Pre-castration
- Can train farm personnel
Scrotal hernias surgical repair procedure
- Incision over inguinal ring
- Bluntly dissect testicle and spermatic cord - vaginal process
- See intestines within vaginal tunic
- Twist tunic to push intestines into peritoneal cavity (may have to open peritoneum if adhesions)
- Transfixation ligature around spermatic cord
- Close inguinal rings
- Remove other testicle!
Closure for surgical repair of scrotal hernia
- can leave open for drainage
- Put a couple of sutures in the inguinal ring
Rectal prolapse who gets it?
- sheep, cattle, swine, camelids - male, female, castrates
Etiology of rectal prolapse
- Straining: parasites, urolithiasis, struggling
- “Hormonal” - estrogens, Zearalenone (mycotoxin in cereal crops)
Anesthesia for rectal prolapse corrction
- Epidural
- Saccrococcygeal or Inter-coccygeal
- Typically use (1.5 mL 2% lidocaine or bupivacaine)
Analgesia for rectal prolapse repair
- Flunixin
- Meloxicam
- Post-op you want them on a non-steroidal
What four techniques can you use for rectal prolapse repair?
1 . Replace and purse string
- Submucosal resection and purse string
- Peri-rectal counterirritant and pure-string
- Amputation - AVOID! Iether ischemic or surgical amputation
Replace and purse string repair of rectal prolapse
- Temporary purse string around the anus
- As the prolapse occurs there is a lot of swelling due to occlusion of blood supply
- Very quickly, swelling goes down
- If you get rid of the original insult, should get better
- If they continue to prolapse, it can get worse and worse
Submucosal resection and purse string
- Peeling off the mucosa of the rectum
- Can get 2-3 inches thick in a bovine
- Usually just peel it off with your fingers :(
Technique for caudal epidural
- Feel pop of the dorsal ligament
- Hanging drop
- Fill hub with lidocaine; air “sucks” in
- Also a bubble technique
- 18-20 ga needle that is 1- 1.5 inches long
His technique for purse string on a rectal prolapse
- Purse string 1 cm away from the mucocutaneous junction
- He likes to start at the top and tie it at the top (avoiding the feces)
- He likes to use something heavy that it’s wick-like (e.g. Vetafil)
- He takes as big of a bite as he can (dotted line is underneath)
- Purse string you can’t see as much, and you tie the bow up on top
- If it’s too big they will prolapse through it
- Bow makes it adjustable
What material is good to use for a prolapse repair?
- # 3 Vetafil
- Umbilical tape is NOT ideal
Post op care for rectal prolapse purse string repair
- Adjust the next day
- Remove in 5 days if doing well
Sheep purse string
- With sheep, the purse string by itself isn’t usually sufficient
- They often prolapse again
- Can be due to very short tail docking, which can result in a perineal stricture
- Also have to do conter-irritants
Counter irritants injection site for rectal prolapse repair on a sheep
- Insert your finger into the rectum, because you want to inject it just outside the wall of the rectum
- Oxytetracycline and insert the needle 1.5-2” and inject as you pull out to inject a line of stuff
Colopexy
- Can be done for rectal prolapse repair
- done but not as common
- More expensive
Ischemic amputation of rectal prolapse
- Things have gone to pieces
- Use a whistle or a tube with a groove through the middle of it
- Put that tube in and tie some umbilical tape over it
- Creates an ischemic amputation of the stuff distal
- Ideally the proximal parts will heal together
Digit amputation who for?
- Ruminants
- Anatomy of camelids is not conducive to amputation because the coffin joint is bearing more weight
Reasons for digit amputation?
- Lacerations
- Septic arthritis
- Fractures and dislocations
Presentations of animals that have septic arthritis?
- Fever
- Severe lameness (often)
- Spread toes
- Swelling
- Draining tract
- Circumferential swelling around the coronary band
Appearance of septic arthritis on x-ray
- Looking for a difference in joint space
- Acutely swell and be too wide
- Eventually collapses
With a septic coffin joint, where do you often notice swelling?
- Adjacent to the pastern
- Swelling is more proximal because the hoof wall prevents swelling
Approaches to repairing toe with injury (e.g. septic arthritis)
- Open drainage and arthrodesis
2. Amputation or disarticulation
Open drainage and arthrodesis for ankylosis
- Establish drainage of septic joint and curette the joint surfaces to remove damaged joint components and “destroy” the joint. He uses an 18g needle to try and find where the joint is, then uses the curette.
- May place a seton through the joint
- Flush with Betadine solution for 1-2 days until joint has closed over; maintain under a wrap
- May want to glue wooden block on good toe to elevate bad one to lower pain. May place a cast to immobilize the joint.
Ankylosis/arthrodesis drilling site
- 1/2 distance front to rear
- Third of the distance down from coronary band to sole
Anesthesia for both arthrodesis and digit amputation
- Regional limb perfusion (Bear block)
- Dorsal pedal vein or this other vessel
- Infuse about 20 mL of lidocaine into the closed off system and allow it to infuse in the tourniquet
- Put a little ampicillin in too
- Within a few minutes, leg is anesthetized
Who gets a digit amputation?
- Cattle, sheep, goats, wild ruminants
High digit amputation
- Through P1
- Never go proximal to the bottom of the dewclaw
- If you nick the joint capsule to the fetlock, you can have a major problem (stay below the dewclaw)
Low digit amputation
- DO NOT DO IT
- Through P1
- Joint capsule extends quite a ways above and below
- If you nick the joint capsule, that’s not ideal
Surgery procedure for digit amputation
- Sterile prep
- Place a tourniquet mid-carpus or mid-tarsus
- Anesthesia (20 mL of lidocaine + ampicillin)
- Anterior posterior incision and coronet to make flap
- T incision to make flap
- Can also just cut through with OB wire and not do a skin flap - healing will be just as rapid
- Interdigital incision to seat OB wre
- Wire saw started in the interdigital space and cut starts initially in a dorsal direction between the two claws and then redirected
- Do not approach level of fetlock joint in high amputation
- Avoid deep digital vessels by staying off of midline as much as possible
- If disarticulate - curette and remove joint capsule
- Sew flap edges if you maintained a skin flap
After care for digit amputation
- FIRST make sure you removed all of P2
- If the tissue has any movement, that’s probably P2, which you want to remove
- Bandage with tight hemostatic bandage and re-bandage for another three days
- Can stop bandaging when you have a complete bed of granulation tissue
Interdigital fibroma definition
- Chronic fibrotic lesion of the interdigital space as a result of chronic irritation
- Irritating the proximal interdigital ligaments
Causes of interdigital fibroma
- Genetics
- Excessive weight
- Previous interdigital disease
What causes the lameness with interdigital fibroma?
- Physical irritation and secondary sepsis
Surgical approach for interdigital fibroma
- Cauterization and thermocautery (older treatment)
- Surgical incision
Surgical removal of interdigital fibroma
- Put on a bear block and dissect out interdigital tissue (anethesia)
- Elliptical incision around involved tissues
- Avoid interdigital coronary band
- Remove entire fibrous mass using sharp dissection
- Remove fascia over fat pad
- Remove fat pad
What should you watch out for when removing interdigital fibroma?
- Pastern joint capsule
Post-op care of interdigital fibroma
- Suture part of the wound
- Antimicrobial ointment wrap
- Wire toes together to aid in healing and to decrease discomfort
- Change every 3-4 days for 3 to 4 times
