Umbilical sx

Question 1

in a calf with an umbilical swelling - what signs on the clinical exam do you look for

Answer 1

suck reflex?
warm?
pain?
obv source of infection - was it iodine dipped?
lung sounds?
CNS signs (bacteriaemia)
joint ill too?
oedema - pitting (suggests protein - urolithiasis or ruptures urethra?)

Question 2

if on palpation the swelling is reducible - what is it

Answer 2

simple hernia

Question 3

if on palpation it is only partially reducible - what is it

Answer 3

suggest a hernia + abscess

Question 4

if on palp it isn’t at all reducible - what is it

Answer 4

abscess + hernia (WITH an incarceration, strangulation + / or adhesions

Question 5

what a good dx modality for getting more info about an umbilical swelling - give specific details

Answer 5

US - in ‘b mode’

7.5-5MHz linear head

Question 6

how can you find where the origin/extension of a d/c tract

Answer 6

insert a bitch urinary catheter and inject contrast medium - RADs

Question 7

what structures can you ‘easily’ ID on a B-mode US view

Answer 7

abscesses/pus
urachus
vessels
GIT content +- peristalsis

Question 8

how can ID the structures, particularly vessels and urachus be useful in dx, px and tx

Answer 8

ID whether/where the infection has progressed to
if bladder patents/entire
detect any adhesion of omentum to urachus or body wall
detect peritonitits

Question 9

what structures can you follow to find liver and bladder

Answer 9

• move anteriorly to follow umbilical vein to liver

- move posteriorly to follow the umbilical a/ urachus to bladder

Question 10

what other investigations could you undertake to gain more info about a swelling than just US

Answer 10

• paracentesis (IF swollen abdo and signs of peritonitits)
• plasma TP and ZnSulphate turbidity - determine MDA levels
• diff WBCC - how acute is this, any response yet?
• fibrinogen - indicates chronic inflammation

Question 11

is there a higher risk of an umb hernia if the umbilicus gets infected

Answer 11

YES 5x higher

Question 12

what can be done to reduce umbilical infections

Answer 12

iodine
colostrum
hygeine

Question 13

what sthe basic idea about surgery of hernia (see more on SA sx)

Answer 13

elliptical incision - don’t go through peritoneum
push hernia down (carefully)
Mayo overlapping = ‘vest over pants’ suture to close

Question 14

do you always surgically close hernias

Answer 14

no - not if only 1 finger width + reducible

Question 15

what suture material is approp for hernia repair

Answer 15

permenant
- prolene monofilament (wont wick) or supramide (cheaper, might wick)

OR slowly absorbable suture:
- vicryl, PDS monofilament (softer, may pull through)

Question 16

if the hernia was too large - how can you close it/

Answer 16

use a prolene mesh

Question 17

what is the advice (STICK TO IT FARMERS) about the aftercare of umbilical hernia repairs

Answer 17

• 1 mth box rest

- 3 mth turn out with YOUNGER animals

Question 18

desc the suitable anaesthesia for hernia in cattle (calves)

Answer 18

xylazine

local (procaine) around sx site

Question 19

if the umbilicus became infected and lead to abscess formation OUTSIDE body wall - what pathogens are likely culprits and how do you tret it

Answer 19

actinobaciilous pyogenes
e coli

amoxicillin + flush with saline + leave open

Question 20

what about if there was a patent urachus and an infection tracked up the umbilical artery? how to tx

Answer 20

flush + abx (amox)
sx - removal urachus AND infected umbilica a
LARGE defect - post-op care ++
1 or 2 stage procedure

Question 21

how do you tx an infected umbilical vein?

Answer 21

• if it reached liver - partial hepatectomy
• marsupialise vein
• px = poor

Question 22

what complications are there with umbilical sx

Answer 22

seroma formation
wound bdown
infection