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LA Clinical Medicine > Unit 3 - Sx of the Neonate Abdomen > Flashcards

Unit 3 - Sx of the Neonate Abdomen Flashcards

1
Q

What is all contained within the umbilical stalk?

A

Umbilical arteries, urachus, and umbilical vein

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2
Q

What structures can cause umbilical enlargement?

A

Umbilical arteries, umbilical veins, urachus, and hernia

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3
Q

In what breeds are uncomplicated umbilical hernias hereditary in?

A

Holstein-Fresian

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4
Q

What contents are typically within uncomplicated umbilical hernias?

A

Omentum, abomasum, and intestines

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5
Q

T/F: Uncomplicated umbilical hernias are strangulating and should still be assessed/

A

False - they are non-strangulating

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6
Q

If an uncomplicated umbilical hernia is <5cm, what treatment is recommended?

A

Conservative treatment

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7
Q

What are some types of conservative treatment for uncomplicated umbilical hernias?

A 
Clamps
Bands
Irritant injection
Support bandages
daily palpation
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8
Q

If an uncomplicated umbilical hernia is > 5cm what is the recommended therapy?

A

Herniorrhaphy - either closed where the sac is not entered or open where the sac is entered (this is preferred)

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9
Q

What additional lesions are often present with umbilical hernias that have subcutaneous infection and abscess?

A

Adhesions

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10
Q

What is the treatment for umbilical hernias with subcutaneous infection and/or abscess?

A

Open herniorrhaphy

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11
Q

What is omphalophlebitis?

A

Infection of the umbilical vein

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12
Q

What is omphaloarteritis?

A

Infection of the umbilical arteries

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13
Q

Aside from vein and arteries, what other umbilical remnants can become infected?

A

The urachus - abscess

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14
Q

What are the common isolates for umbilical remnant infections?

A

T. pyogenes, E. coli, Proteus, Enterococcus, Streptococcus, and Staphylococcus

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15
Q

How do calves with umbilical remnant infections present?

A

With enlarged, draining umbilicus

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16
Q

How do calves with urachal infections present?

A

Dysuria, pollakiuria, pyuria, and cystitis

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17
Q

What concurrent diseases are associated with umbilical remnant infections?

A

Septic arthritis, pneumonia, peritonitis, and sepsis

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18
Q

How are umbilical remnant infections treated?

A

Umbilical remnant resection - ligate proximal to affected region and marsupialization

19
Q

T/F: An umbilical abscess with chronic omphalitis is associated with a hernia, but no drainage.

A

False - its is associated with no hernia and drainage

20
Q

How do you treat umbilical abscesses with chronic omphalitis?

A

Drainage and lavage

21
Q

What can be done if you are worried about cosmesis in a patient with an umbilical abscess and chronic omphalitis?

A

Open herniorrhaphy, en bloc resection

22
Q

What is a patent urachus?

A

The failure of a urachus to involute

23
Q

How does a patient present with a patent urachus?

A

They dribble urine from the umbilicus

24
Q

What are the general surgical principles for umbilical conditions?

A

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

25
Q

What post-op care needs to be done for surgical correction of umbilical conditions?

A

Antibiotics, anti-inflammatories, small pen confinement, and monitor for complications

26
Q

What complications are associated with surgery for umbilical conditions?

A

Abscess, seroma, hematoma, and dehiscence

27
Q

What is atresia coli?

A

Complete absence of a portion of the intestinal lumen

28
Q

What portion of the colon is commonly affected with atresia coli?

A

The ascending colon

29
Q

At what age is there an increased incidence of atresia coli?

A

<42 days

30
Q

What clinical signs are associated with atresia coli?

A 
Normal until 12-48 hours
Inappetance
Abdominal distention
Abdominal pain
Progressive depression, weakness
31
Q

What will you find on exam in a patient with atresia coli?

A

No manure passed
Tachycardia, tachypnea
Normal digital rectal exam
Percussion, succussion

32
Q

What is recommended for stabilization of patients with atresia coli?

A 
Hydration
Correct electrolyte/acid-base imbalance
Confirm successful passive transfer
Antimicrobial therapy
NSAIDs
33
Q

What is the surgical approach for atresia coli correction?

A

Left lateral, right PLF exploratory

34
Q

What are the general steps to surgical correction of atresia coli?

A

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

35
Q

What post-op care is recommended for patients with atresia coli correction?

A

Electrolyte and fluid therapy
Antimicrobial therapy for 5-7 days
Oral feeding 6-12 hours post-op

36
Q

An anion gap of ___ mEq/L in an atresia coli patient is predictive of death.

A

24

37
Q

What is the prognosis for atresia coli?

A

Poor - 12-37% have long-term survival, loose feces, and poor growth

38
Q

What breeds get atresia ani more commonly?

A

Beef breeds > dairy breeds

39
Q

Patients with atresia ani commonly have concurrent abnormalities. What are they?

A 
Lack of tail
Rectovaginal fistula
Rectourethral fistula 
Polydactyly
Cleft palate
40
Q

What clinical signs are associated with atresia ani?

A 
Progressive abdominal distention
Straining
Signs of abdominal pain
Depression, weakness
Rectum 'bulges' subcutaneously
41
Q

What is the procedure for atresia ani correction?

A

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

42
Q

What post-op care is recommended for atresia ani correction?

A

Electrolyte and fluid therapy
Antimicrobial therapy for 5-7 days
Oral feeding 6-12 hours post-op

43
Q

What is the prognosis for atresia ani?

A

Favorable - normal weight gain and permanent fecal incontinence

LA Clinical Medicine (33 decks)

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