I love the subject of surgery in equines, and especially in foals. Foals are usually very fragile creatures and many times at birth they will present umbilical problems.
Dr Carolyn E. Arnold and Baileys Horse feed brings us this talk where the diagnosis and management of common urogenital problems in foals, such as bladder rupture and septic umbilical remnant is discussed.
Dr. Arnold is a 1998 graduate of the College of Veterinary Medicine at Michigan State University. She completed an internship at Rood and Riddle Equine Hospital in Lexington, Kentucky and a surgical internship at the University of Pennsylvania’s New Bolton Center. She is currently an associate professor at Texas A&M University where she specializes in soft tissue surgery.
The webinar starts with a brief reminder of anatomy. It explains how the umbilical cord has both an internal and external part when the foal is born. She then lists each of the structures of the internal part. Some physiology is then covered and what happens to the foal in the foetal and neonatal stage is explained.
To diagnose umbilical problems, a physical examination, blood tests, ultrasound or abdominocentesis should be performed. The problems that present can be categorised by age, as in the neonate we may find remaining umbilical infection, urachus patent, bladder rupture and umbilical haemorrhaging. In juvenile foals we can find umbilical hernias.
Carolyn goes on to explain how umbilical remnant, also known as ‘Navel ill’ is one of the most common conditions and is an infection in the umbilical arteries and veins but can also be an infection of the urachus. Clinical signs are inflammation of the umbilical stump, necrosis, lethargy, the foal not nursing well and clinicopathological values such as neutrophilia and hyperfibrinogenia. Depending on the case there are two ways to treat this, either antibiotics or surgery.
Clinical signs of umbilical rupture will depend on the location of the rupture and immediate surgical intervention is recommended.
Pantent Urachus is an acquired condition. It can occur at birth when there has been trauma but is usually acquired a month later. It can be treated with medical treatment when the foal is not too sick or surgical therapy, both of which are described by the Dr in the webinar.
Umbilical haemorrhage affects neonates, and its aetiology can be trauma and coagulation problems. It can be purely external, either in the artery or vein, or in the bladder and treatment for external umbilical haemorrhage may be clamping or tying. For internal umbilical haemorrhage it can be medical or surgical. Case photos and ultrasound images are shown in the webinar.
The second part of the webinar is on bladder rupture and necrosis, which primarily affects neonates. This often presents as a distended abdomen, abnormal urine pattern and depression. Dr. Arnold shows pictures of cases she has had. The clinical pattern of a ruptured bladder is abnormalities in bloodwork and electrolyte disturbances, low sodium and chloride and high potassium levels. These cases are not surgical emergencies at first, they are medical emergencies, and the foals need to be stabilised. Dr Carolyn gives advice and explains how and with what to stabilise them.
The third part of the webinar is about surgical management. The same approach is used for all conditions. Before our patient goes to surgery, we must have adequate antibiotic, tetanus and anti-inflammatory prophylaxis. The foal is placed in lateral recumbency with a heating pad.
In the surgery an elliptical incision is made in the skin around the umbilicus, the subcutaneous tissue is dissected until the body wall is reached. When the wall is reached, we must enter the abdomen away from the umbilical arteries and veins. All this is explained in depth in the webinar.
The umbilical veins and arteries must be ligated, all abnormal portions removed, and care must be taken because some structures have purulent contents. After that transect apex of the bladder and repair defects, close it with 2 inverting layers. Dr Carolyn recommends the type of sutures to be performed and the type of suture materials. The closing of the body wall is explained, and best advice is given.
Dr Carolyn continues with the last part of the webinar, which deals with conditions that show up in juvenile foals such as umbilical hernia. They can be acquired or congenital and can be simple which are reducible or complicated which are parietal or Ritcher’s hernias. The therapy to be used may be conservative, but depending on the case, it may be surgical. A case is shown, and the treatment used is explained.
I highly recommend this webinar; it is very educational and incredibly interesting. Dr Carolyn has a simple way of explaining everything and it is very easy to take in the information presented.
