Unit 3 - Sx of the Neonate Abdomen

Question 1

What is all contained within the umbilical stalk?

Answer 1

Umbilical arteries, urachus, and umbilical vein

Question 2

What structures can cause umbilical enlargement?

Answer 2

Umbilical arteries, umbilical veins, urachus, and hernia

Question 3

In what breeds are uncomplicated umbilical hernias hereditary in?

Answer 3

Holstein-Fresian

Question 4

What contents are typically within uncomplicated umbilical hernias?

Answer 4

Omentum, abomasum, and intestines

Question 5

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

Answer 5

False - they are non-strangulating

Question 6

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

Answer 6

Conservative treatment

Question 7

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

Answer 7

Clamps
Bands
Irritant injection
Support bandages
daily palpation

Question 8

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

Answer 8

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

Question 9

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

Answer 9

Adhesions

Question 10

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

Answer 10

Open herniorrhaphy

Question 11

What is omphalophlebitis?

Answer 11

Infection of the umbilical vein

Question 12

What is omphaloarteritis?

Answer 12

Infection of the umbilical arteries

Question 13

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

Answer 13

The urachus - abscess

Question 14

What are the common isolates for umbilical remnant infections?

Answer 14

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

Question 15

How do calves with umbilical remnant infections present?

Answer 15

With enlarged, draining umbilicus

Question 16

How do calves with urachal infections present?

Answer 16

Dysuria, pollakiuria, pyuria, and cystitis

Question 17

What concurrent diseases are associated with umbilical remnant infections?

Answer 17

Septic arthritis, pneumonia, peritonitis, and sepsis

Question 18

How are umbilical remnant infections treated?

Answer 18

Umbilical remnant resection - ligate proximal to affected region and marsupialization

Question 19

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

Answer 19

False - its is associated with no hernia and drainage

Question 20

How do you treat umbilical abscesses with chronic omphalitis?

Answer 20

Drainage and lavage

Question 21

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

Answer 21

Open herniorrhaphy, en bloc resection

Question 22

What is a patent urachus?

Answer 22

The failure of a urachus to involute

Question 23

How does a patient present with a patent urachus?

Answer 23

They dribble urine from the umbilicus

Question 24

What are the general surgical principles for umbilical conditions?

Answer 24

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

Question 25

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

Answer 25

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

Question 26

What complications are associated with surgery for umbilical conditions?

Answer 26

Abscess, seroma, hematoma, and dehiscence

Question 27

What is atresia coli?

Answer 27

Complete absence of a portion of the intestinal lumen

Question 28

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

Answer 28

The ascending colon

Question 29

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

Answer 29

<42 days

Question 30

What clinical signs are associated with atresia coli?

Answer 30

``` Normal until 12-48 hours Inappetance Abdominal distention Abdominal pain Progressive depression, weakness ```

Question 31

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

Answer 31

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

Question 32

What is recommended for stabilization of patients with atresia coli?

Answer 32

``` Hydration Correct electrolyte/acid-base imbalance Confirm successful passive transfer Antimicrobial therapy NSAIDs ```

Question 33

What is the surgical approach for atresia coli correction?

Answer 33

Left lateral, right PLF exploratory

Question 34

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

Answer 34

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

Question 35

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

Answer 35

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

Question 36

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

Answer 36

24

Question 37

What is the prognosis for atresia coli?

Answer 37

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

Question 38

What breeds get atresia ani more commonly?

Answer 38

Beef breeds > dairy breeds

Question 39

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

Answer 39

``` Lack of tail Rectovaginal fistula Rectourethral fistula Polydactyly Cleft palate ```

Question 40

What clinical signs are associated with atresia ani?

Answer 40

``` Progressive abdominal distention Straining Signs of abdominal pain Depression, weakness Rectum 'bulges' subcutaneously ```

Question 41

What is the procedure for atresia ani correction?

Answer 41

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

Question 42

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

Answer 42

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

Question 43

What is the prognosis for atresia ani?

Answer 43

Favorable - normal weight gain and permanent fecal incontinence