LA Neonatalogy Flashcards
(39 cards)
If you decide to manually separate the umbilicus post-partum, what should you make sure to do?
separate it more distally (not near the body wall)
leave a stump of 2.5-4 cm
Which neonatal structure goes cranial towards the liver?
umbilical vein
What is the appropriate diameter of the 2 umbilical arteries when you are ultrasounding?
0.5-1.0 cm
T/F: when ultrasounding, the umbilical veins should normally have a hyperechoic center
false – hypoechoic
hyperechoic could indicate infection
When ultrasounding, what is the normal position of the urachus?
in between the 2 umbilical arteries
You are called to a farm to see a 12 day old foal that the owner reports has been straining to urinate multiple times a day, but doesnt produce a ton of urine. When you do your physical exam, you notice the umbilicus is wet with urine, has a small amount of purulent debris, and is swollen. The foal also has a fever. What is your presumptive diagnosis?
omphalitis
You suspect your patient has omphalitis after assessing clinical signs and doing an exam. You do a CBC and ultrasound, what are the expected findings?
CBC: leukocytosis or leukopenia, hyperfibrinogenemia
U/S: hyperechoic structures (umbilical arteries and urachus)
What are some potential complications of omphalitis?
dissemination creating systemic infections – septicemia, septic joints, osteomyelitis, peritonitis, pneumonia, meningitis, etc.
If you are examining a foal with mild omphalitis and this foal has a normal temp, normal CBC, and no systemic complications, what is your treatment protocol?
antimicrobials
If you are examining a foal with omphalitis and this foal has an abnormal temp, inflammatory leukogram, and you detected ultrasound abnormalities. What is your treatment protocol?
Surgery
What is the treatment for omphalitis in which there is subcutaneous abscess present?
lance and drain
What is the prognosis for cases of omphalitis that were treated with surgery?
good, surgery sites are expected to heal well. Complications are uncommon (intestinal adhesions, incisional infection, hemoperitoneum, uroperitoneum)
T/F: A patient with omphalitis that has disseminated to systemic infection likely has a worse prognosis.
true
An owner calls you out to the farm to assess a foal born 4 hours ago that has an abnormal protrusion on the ventral abdomen. You decide to do palpation and ultrasound. You diagnose this patient with an umbilical hernia. What is the treatment protocol?
Reduce if appropriate.
If not reducible, then this is an emergency sx because strangulation can occur and cause necrosis.
You are called to a farm to assess a neonatal foal that has a wet stomach that is otherwise healthy. You diagnose this foal with patent urachus. What is the pathophysiology / etiology of this condition?
congenital – failure of the urachus to close (could be d/t excessive traction on umbilicus before it ruptured, too much abdominal pressure during foaling, or twisting of umbilicus)
acquired – closes then reopens d/t inflammation, infection, or too much abdominal pressure.
What is the appropriate way to pick up a neonate to avoid placing too much abdominal pressure and causing urachal problems?
one arm in front of front legs, one are behind back legs
NEVER arms under abdomen
You are called to a farm to assess a neonatal foal that has a wet stomach and anorexia. Your PE reveals fever and lethargy. You diagnose this foal with patent urachus and omphalitis. How will you treat this patient?
- place a urinary catheter
- 0.5% chlorohex dip 2x/day OR cautery (silver nitrate)
- it should close within a few days
- provide care for the omphalitis infection and monitor
What are the potential etiologies of a foal that was born normal, acted normal for the first 48-72 hrs, but then crashed and became lethargic, anorexic, developed abdominal distention, stranguria, and colic signs intermittently?
this is uroperitoneum
etiologies include:
1. ruptured bladder d/t increased intravascular pressure during parturition or lifting
2. ruptured bladder d/t congenital malformation of the bladder
3. rupture of the urachus d/t omphalitis
What diagnostics are important when working up a uroperitoneum case?
- clinical signs
- abdominal ultrasound (fluid)
- blood chemistry
What type of abnormalities would you see on a blood chemistry in a foal with uroperitoneum?
hyponatremia
hypochloremia
hyperkalemia
azotemia
If you were to test the urine of a foal with suspected uroperitoneum, what would the electrolyte composition look like (K, Na, Cl, and creatinine)?
Na - low
Cl - low
K - high
creatinine - high
You perform an abdominocentesis to collect peritoneal fluid from a foal with suspected uroperitoneum. What is the peritoneal fluid to serum creatinine ratio?
> 2:1
What are the biggest risks/concerns in foals with uroperitoneum? (2)
- the hyperkalemia will cause inhibition of atrial myocardial depolarization which slows the HR and causes muscle tremors
- the distention of the abdomen decreases lung capacity and can lead to hypoxemia
How do you treat uroabdomen?
- correct the hyperkalemia (IV fluids, Sodium bicarb)
- peritoneal drainage (slowly)
- calcium (raises membrane threshold potentials)
- sx - urachal remnant resection and cystorrhaphy (not until stable, K <5.5)
