Unit 3 - Sx of the Neonate Abdomen Flashcards
What is all contained within the umbilical stalk?
Umbilical arteries, urachus, and umbilical vein
What structures can cause umbilical enlargement?
Umbilical arteries, umbilical veins, urachus, and hernia
In what breeds are uncomplicated umbilical hernias hereditary in?
Holstein-Fresian
What contents are typically within uncomplicated umbilical hernias?
Omentum, abomasum, and intestines
T/F: Uncomplicated umbilical hernias are strangulating and should still be assessed/
False - they are non-strangulating
If an uncomplicated umbilical hernia is <5cm, what treatment is recommended?
Conservative treatment
What are some types of conservative treatment for uncomplicated umbilical hernias?
Clamps Bands Irritant injection Support bandages daily palpation
If an uncomplicated umbilical hernia is > 5cm what is the recommended therapy?
Herniorrhaphy - either closed where the sac is not entered or open where the sac is entered (this is preferred)
What additional lesions are often present with umbilical hernias that have subcutaneous infection and abscess?
Adhesions
What is the treatment for umbilical hernias with subcutaneous infection and/or abscess?
Open herniorrhaphy
What is omphalophlebitis?
Infection of the umbilical vein
What is omphaloarteritis?
Infection of the umbilical arteries
Aside from vein and arteries, what other umbilical remnants can become infected?
The urachus - abscess
What are the common isolates for umbilical remnant infections?
T. pyogenes, E. coli, Proteus, Enterococcus, Streptococcus, and Staphylococcus
How do calves with umbilical remnant infections present?
With enlarged, draining umbilicus
How do calves with urachal infections present?
Dysuria, pollakiuria, pyuria, and cystitis
What concurrent diseases are associated with umbilical remnant infections?
Septic arthritis, pneumonia, peritonitis, and sepsis
How are umbilical remnant infections treated?
Umbilical remnant resection - ligate proximal to affected region and marsupialization
T/F: An umbilical abscess with chronic omphalitis is associated with a hernia, but no drainage.
False - its is associated with no hernia and drainage
How do you treat umbilical abscesses with chronic omphalitis?
Drainage and lavage
What can be done if you are worried about cosmesis in a patient with an umbilical abscess and chronic omphalitis?
Open herniorrhaphy, en bloc resection
What is a patent urachus?
The failure of a urachus to involute
How does a patient present with a patent urachus?
They dribble urine from the umbilicus
What are the general surgical principles for umbilical conditions?
Fusiform incision around umbilicus
Blunt, sharp dissection of subcutaneous tissue to the body wall
Enter the abdomen cranial or lateral to the umbilicus
Insert a gloved finger, palpate for adhesions, and structures
Sharply incise the body wall adjacent to the hernia, umbilicus
Ligate umbilical remnants, remove en bloc
3 layer closure - body wall, subcutaneous tissue, and skin
What post-op care needs to be done for surgical correction of umbilical conditions?
Antibiotics, anti-inflammatories, small pen confinement, and monitor for complications
What complications are associated with surgery for umbilical conditions?
Abscess, seroma, hematoma, and dehiscence
What is atresia coli?
Complete absence of a portion of the intestinal lumen
What portion of the colon is commonly affected with atresia coli?
The ascending colon
At what age is there an increased incidence of atresia coli?
<42 days
What clinical signs are associated with atresia coli?
Normal until 12-48 hours Inappetance Abdominal distention Abdominal pain Progressive depression, weakness
What will you find on exam in a patient with atresia coli?
No manure passed
Tachycardia, tachypnea
Normal digital rectal exam
Percussion, succussion
What is recommended for stabilization of patients with atresia coli?
Hydration Correct electrolyte/acid-base imbalance Confirm successful passive transfer Antimicrobial therapy NSAIDs
What is the surgical approach for atresia coli correction?
Left lateral, right PLF exploratory
What are the general steps to surgical correction of atresia coli?
Evacuate gas from the distended cecum and spiral colon
Perform an enterotomy at either the cecal apex or blind end colon (double layer closure)
Perform an anastomosis either end-to-side (preferred) or side-to side and close (single layer)
Lavage abdomen and routine closure
What post-op care is recommended for patients with atresia coli correction?
Electrolyte and fluid therapy
Antimicrobial therapy for 5-7 days
Oral feeding 6-12 hours post-op
An anion gap of ___ mEq/L in an atresia coli patient is predictive of death.
24
What is the prognosis for atresia coli?
Poor - 12-37% have long-term survival, loose feces, and poor growth
What breeds get atresia ani more commonly?
Beef breeds > dairy breeds
Patients with atresia ani commonly have concurrent abnormalities. What are they?
Lack of tail Rectovaginal fistula Rectourethral fistula Polydactyly Cleft palate
What clinical signs are associated with atresia ani?
Progressive abdominal distention Straining Signs of abdominal pain Depression, weakness Rectum 'bulges' subcutaneously
What is the procedure for atresia ani correction?
Perform caudal epidural with lidocaine
Place in sternal recumbency with hind limbs forward
1.5 cm skin incision at the anus
Cranial dissection to rectum with careful caudal traction
Tack rectal serosa to subcutaneous tissue
Incise the rectum
Tack mucosa to the skin
What post-op care is recommended for atresia ani correction?
Electrolyte and fluid therapy
Antimicrobial therapy for 5-7 days
Oral feeding 6-12 hours post-op
What is the prognosis for atresia ani?
Favorable - normal weight gain and permanent fecal incontinence
