FAM Exam 4 - Camelid

Choanal Atresia

• Congenital and Hereditary

• MOA: Inherited failure of nasal opening

• CS: cleft palate, wry face, missing kidneys, Open-mouthed breathing, high aspiration pneumonia risk

• ID: nasal fluid test: back flow, rubber tube: cant pass beyond eye level, High BUN/creatinine

• Prognosis: poor, surgical correction: balloon dilator, euth 90%

  • Complete: fatal after birth

  • Partial: survival 5-8m

    • semi-obligate nasal breathers

Wry Face

• MOA: Inherited, llamas > alpacas

• CS:  dental issues, eating difficulties

  • leads to euthanasia

• ID: palpation of bony deviation and Xray

• TX: dentals 2-3x annually

Blue-Eyed White (BEW)

• Alpacas

• AKA: Lethal White

• MOA: Inherited, All-white with blue eye

  • two tuxedo grey parents

• CS:  deaf / does not respond, fail to move w/ herd, welfare issue

• ID: genetic test

Ventricular Septal Defect (VSD)

• MOA: Congenital or Hereditary

• May have normal lifespan: small defect

• CS:  Stunted growth, poor exercise tolerance, murmur, progresses to heart failure

• ID: US, necropsy

• Prognosis: good if minimal, fatal if >1 inch (mins after birth)

Patent Ductus Arteriosus (PDA)

• MOA: Congenital or Hereditary, failure of closure @ 4d

• CS: Continuous "machinery" murmur, bounding pulses, tachycardia, resp distress(severe), pericardial effusion(advanced cases)

• ID: Echo, Lg left ventricle enlargement

  • Left-to-right shunting (most common)

• TX: Surgical closure

• Prognosis: poor

Polydactyly

• MOA: Congenital or Hereditary

  • 3+ claws

• Lifespan: 6-8m

• CS: develop arthritis, poor mobility

• Prognosis: poor, euth due to welfare

Carpus Valgus

• MOA: Congenital, trauma, nutrition: Lateral carpus deviation

• TX: Early splinting/casting, transphyseal bridging (if growth plate open)

• Prognosis: good with early intervention

Female Hereditary Urogenital Defects

• Uterus unicornis: Congenital, one uterine horn, leads to dystocia

• Double cervices: fail to conceive, leads to dystocia

• Segmental aplasia: lead to infertility

Hypospadia

• MOA: Urethra opening wrong location, Congenital or Hereditary

• CS: Abnormal urination, urine scalding, infections, infertility

• TX: Urethroplasty, euth

Hermaphrodites

• MOA: Congenital or Hereditary

  • True: both ovarian + testicular tissue

  • Pseudo: genital discrepancy (internal vs. external)

• CS: Enlarged clit, underdeveloped penis, infertility

• ID: hormone testing, US, laparoscopy(identify parts)

• TX: gonadectomy

• Prognosis: Poor for repro

Primary Immunodeficiency Syndrome in Llamas

• MOA: Congenital or Hereditary

• CS: chronic sick, poor condition, slow healing, Persistent diarrhea or respiratory illness, poor weight gain, delayed wound healing

• ID: Leukopenia, Low IgG/IgM/IgA, Genetic testing

• Prognosis: Grave

Berserk Male Syndrome

• AKA: Aberrant Behavior Syndrome, Novice Handler Syndrome

• MOA: learned behaviors, excessive human bonding

  • Avoid over handling crias

• CS: aggression

• Prognosis: Poor often irreversible - Euthanasia

  • Castration may reduce the risk but not guaranteed

Spitting

• MOA: Normal for social hierarchy or defense,

  • Excessive: stress, fear, poor socialization

• TX: Proper socialization, calm environment, remove stressors, training

Obesity

• MOA: Overfeeding high quality forage, low activity

• CS: Heat stress, Hepatic lipidosis, infertility, dystocia, joint/hoof problems.

• TX: Low-quality forage, Avoid grain

Protein-Energy Malnutrition (PEM)

• MOA: Inadequate feed, young, pregnant, lactating, cold stress

• CS: starving, hepatic lipidosis, poor BCS, dull/brittle hair, patchy alopecia

• ID: Feed analysis, look at DDX

• TX: : Gradually improve feed quality and quantity

  • Long term monitoring

Vitimite deficiency

• Vit D: Angular limb deformities, rickets, fractures

  • reduced Ca/P absorption ( Ca:P >1.5:1)

    • Tx w/ Vit D injections in late autumn and mid-winter

• Cu: Rusty color fiber, stringy fiber, lame, anemia

  • high molybdenum ratio: Ca:Mo 6–10:1

    • tx w/ injections or feed legumes

• Iron: Poor growth, Non-regen microcytic hypochromic anemia.

  • Parenteral injection (not oral) iron dextran

• Se: White muscle dx, acute death, infertity, stillbirths

  • ID w/ Bld level selenium or glutathione peroxidase

    • Tx w/ Selenium/vitamin E

• Zi: Dry, thick, cracked skin, alopecia on nose bridge

  • TX w/ supplements and emollients for dry/cracked skin

• Ca(hypo): peak lactation, sternal recumbency, low body temperature, C1 atony, bloat.

  • Tx w/ IV calcium borogluconate

• Mg(hypo): lush grass, low quality dry grass hay, recumbency, convulsions w/ stress, grave prognosis

• Ph(hypo): decreased bone density, pica, risk of botulism

  • Tx w/ Sodium phosphate injections

Recumbency

• MOA: Colic, tracheal collapse, Hypocalcemia, hypomagnesemia, fatty liver, P. tenuis, trauma, fractures, Endotoxemia

• ID: everything

• TX: repositioning, soft bedding, ANTI ULCER meds

• Risks: aspiration pneumonia, bloating, ulcers

Hyperlipemia

• MOA: Neg energy balance: ill, preg, starved

• CS: Lethargy, weakness, anorexia, seizures, hepatic lipidosis(fatal)

• ID: high triglycerides in blood, milky plasma

• TX: fluids, insulin, GI protectants, high energy diets

• Prognosis: guarded to poor

Hepatic Lipidosis

• MOA: Neg energy balance, Secondary to hyperlipemia

• CS: Lethargy, weakness, anorexia, seizures, hepatic encephalopathy

• ID: high triglycerides in blood, milky plasma, high liver enzymes (AST, GGT), US, biopsy

• TX: fluids, insulin, GI protectants, high energy drenchs

  • avoid propylene glycol (toxic)

• Prognosis: poor

Polioencephalomalacia (PEM)

• MOA: Vit B1 Deficiency, disrupted rumen microbiome

• CS: Muscle tremors, incoordination, recumbency, opisthotonos, blindness w/ intact PLR

• ID: blood levels, UV fluorescence of brain tissue

• TX: Thiamine q4 hrs, IV fluids

• Prognosis: good if treated early, fatal if delayed

Urolithiasis

• Risks: Males, Low Ca:P ratio

• MOA: struvite/phosphate stones: High-grain/low-fiber diet

• CS: Anuria, teeth grinding, straining, abdominal distension, colic, shock, 48h death

• ID: Ultrasound/X-ray.

• TX: support, Cystotomy, urethrotomy, urethrostomy, Feed grass hay, ammonium chloride to diet to acidify urine

• Prognosis: good if bladders intact, treated early

Liver Abscess

• MOA: Secondary to rumenitis, rumen acidosis

• CS: chronic/subclinical, weight loss, lethargy, reduced appetite

• ID: high WBC + fibrinogen, US

• TX: Long term Antibiotics, prevent rumen acidosis(limit grain)

• Prognosis: guarded to poor

Pericarditis and epicarditis

• MOA: Idiopathic: most common, Secondary to infection 

• CS: Lethargy, anorexia, fever, muffled heart sounds, tachycardia, weak pulses

• ID: echo, rads, pericardiocentesis

• TX: NSAIDs, antibiotics, IV fluids, pericardiocentesis 

• Prognosis: good if not septic

Parelaphostrongylus tenuis (P. tenuis)

• AKA: Meningeal worm: deer

• MOA: White tail deer, snails/slugs, larvae migrate to spinal cord/brain

• CS: Hindlimb weakness, ataxia, circling, head tilt, blindness, seizures, paralysis, recumbency, coma(fatal) 

• ID: necropsy is definitive - L4/L5 larvae present

  • CSF high protein w/ mild pleocytosis but NOT specific

• TX: tall fences, snail control, monthly ivermectin(high risk) - critical prevention!!

  • no effective TX

• Prognosis: poor once CNS signs

Internal parasites

• MOA:

  • GIT: Haemonchus contortus

  • Resp: Dictyocaulus viviparus

  • Fluke: Fasciola hepatica

• CS: Anemia, poor growth, rough hair coat, diarrhea 

• TX: targeted worming(based on worm count), clean pasture p3-4d, selective culling, Ivermectin/Doramectin injection monthly in snail infested areas, monthly fecals, selective culling

Anemia

• ID: PCV <12-15%

  • recheck PCV 3-5 days after event

• Regen:

  • Blood loss: Haemonchus contortus 

  • Hemolysis: Mycoplasma hemolamae, red maple, bracken fern

• Non-regen:

  • Low Copper, Low cobalt, Low iron Chronic dx

• TX: transfusion if severe

  • Cross-match if repeated transfusions

  • PCV >30% for donor

  • 10-20 mL/kg

Coccidiosis

• MOA: Eimeria macusaniensis (llamas, alpacas)

  • most pathogenic

• CS: Severe Diarrhea, weight loss, poor growth, rough hair coat

• ID: Fecal smear/flotation, Ulcerated intestines

• TX: Amprolium, Sulfas, Ponazuril, Toltrazuril, Decoquinate in feed, cleaning

Foot mites

• MOA: Chorioptes

  • Most common ectoparasite llamas/alpacas!!

  • Highly contagious 

• CS: Intense pruritus, alopecia, crusting, scaling

  • legs, ventrum, tail base

• ID: Deep skin scraping 

  • DDX: zinc deficiency, dermatophytosis

• TX: Ivermectin, topical acaricides, quarantine

  • Treat all in-contact animals

Munge

• MOA: unknown

• CS: dermatitis, hyperkeratotic crusts on the bridge of the nose, periocular, and periaural areas

• ID: skin biopsy, skin scraping, culture

  • DDX: Viral contagious pustular dermatitis, Dermatophilosis, Dermatophytosis, Bacterial dermatitis, Immune-mediated disease, Sarcoptic mange 

    • Rule out zinc: give injection: wont respond

• TX: Topical antoparasitic, antibacterial, antifungal, and soothing emollients

  • some animals do not respond to treatment.

Lice

• MOA: Close body contact transmission

• Suckling lice: Anemia, debilitation

  • head, neck and withers. 

• Biting lice: Feed on skin and hair

  • base of tail or the side of the neck.

• TX: insecticides dusting,

  • ivermectin (sucking lice only)!

Ticks

• MOA: The Rocky Mountain wood tick, hemoplasma

  • also known as: Mycoplasma hemolamae

• CS: tick paralysis

• TX: Insecticides dusting, Ivermectin

Heat stress

• MOA: Poor ventilation, high ambient temperature and high humidity, obesity.

• CS: Depression, dehydration, RR >30, HR >100, drooping lower lip and frothing at the mouth, collapse, >105F

• TX: fans, pools, tube w/ cold water, IV cool fluids, shade, low protein diet, ponds, timely shearing

  • Grave @ temp >108°F.

Enterotoxemias

• Type C: Hemorrhagic enteritis - bloody gut

  • CS: sudden death, bloody diarrhea, blood-stained intestinal contents, abdominal cramps

• Type D😩 polpy kidney

  • CS: Sudden death, convulsions

• ID: PCR

• TX: IV fluids, Antisera, Antibiotics, Vax

Tetanus

• MOA: Clostridium tetani.

  • wounds, c-section

  • Blocks inhibitory NT

• CS: severe muscle spasms, rigidity, stiff gait, difficulty moving, lockjaw (trismus), hyperresponsiveness, resp failure

• TX: Antitoxin, Muscle relaxants (Diazepam, methocarbamol), wound debridement, vax, dark/quite environment

Dental issues

Tooth Root Abscesses

• MOA: molars : mandibular > maxillary

• CS: Facial swelling, reluctance to eat, purulent drainage

  • Bone sequestra, osteomyelitis

• ID: Oral exam, Rads (#1 gold standard), culture

• TX: systemic antibiotics, sxdebridement, tooth extraction

Stomatitis

• MOA: oral injuries from grass awns

• CS: Ptyalism (drooling), Dysphagia

• ID: oral exam

• TX: remove FB, mouth wash w/ disinfectant

Megaesophagus

• MOA: Segmental dilation of the esophagus. 

• CS: Postprandial regurgitation, chronic weight loss

• ID: Barium contrast rads or fluoroscopy

• TX: feed on elevated suface, sm frequent meals

  • Prognosis: Fair to poor

Acidosis or Grain Poisoning

• MOA: Overconsumption/change of grain

• CS: Depression, dehydration, left abdominal bloating, ataxia, recumbency, diarrhea after 48hrs, liver abscess(lactic acid), long-term poor performance.

• DDX: PEM, salmonella, entertox, preg tox, low Ca, luinosis

• TX: fluids, C1 sx, antibiotics, thiamine, quality grass hay, slow diet transition, no grain

  • NO sweet greens

• Prognosis: Poor if down

Stomach Atony

• MOA: C1-C2

  • Grain overload, soiled feed, Prolonged antibiotic therapy, abrupt feed changes

• CS: Depression, anorexia, weight loss

• DI: Absence of C1 contractions

• TX: fluids, transfaunation of C1 fluid

Gastric Ulcers

• MOA: compartment 3 and proximal duodenum

  • Stress

• CS: depression, anorexia, colic, bruxism, Melena, recumbency

• ID: US

• TX: Remove stressors, GI protectants (sucralfate), H2 receptor antagonist (ranitidine, cimetidine, famotidine), PPI (pantopazole or omeprazole)

Regurgitation and Emesis

• Regurgitation: Passive process

  • MOA: FB, megaesophagus, anesthesia/recovery complications

  • CS: Undigested food

• Emesis: Active process

  • MOA: Severe gastritis

  • CS: abdominal contractions, partially digested food + bile

Johne's Disease or Paratuberculosis

• MOA: Mycobacti avium

• CS: chronic PLE, weight loss, ventral edema, intermittent diarrhea

  • Infection starts early in age, CS appear when old

• ID: Fecal culture, Fecal PCR #1, serology after CS

• TX: none, remove crias, feed milk replacer, quarantine

Caseous Lymphadenitis

• MOA: Corynebacterium pseudotuberculosis

  • Transmits by direct contact with wounds

• CS: Abscesses in retropharyngeal, axillary, popliteal LN

• ID: culture abscess, serology

• TX: Antibiotics, sx removal of abscesses: not effective test & cull

Diarrhea

• Neonatal: Rotavirus, coronavirus, cryptosporidia, E. coli, Abundant dam milk production

  • virus, bacti, nutrition

• Mature: Eimeria spp., Salmonella spp., Mycobacterium paratuberculosis, Intestinal nematodes.

  • bugs

• ID: Fecal cultures, fecal smears, PCR, ELISA, EM.

Fluid Therapy

• Route: Oral = mild , IV = Jug, severe, shock, IO = neonates

• **Balanced crystalloid: LR, Plasma-Lyte

  • metabolic acidosis

• **NS: metabolic alkalosis

  • may cause hyperchloremic metabolic acidosis

• **Maintain: adults @ 50 or neonates @ 100 mL/kg/day

• Replace: BW × % dehydration

• **Ongoing: adults @ 25 or neonates @ 50 mL/kg/da

• Bicarbonate deficit: X × Body weight (kg) × Base deficit (mEq/L)

  • X = 0.3 @ adult or 0.6 @ neonate

  • Assume BD of 10

  • Add isotonic sodium bicarbonate or hypertonic sodium bicarbonate to NS

• TPN/PPN: Anorexic

  • Neonates use TPN, PPN for adults

  • Monitor glucose/PCV/TP, electrolytes/acid/base status, Fatty liver

  • MUST BE administered with fluid pump

Mycoplasma haemolamae

• MOA: Ticks

  • Unique to SACs

• CS: Extravascular hemolysis, fever, depression, anemia, icterus, poor growth.

• ID: bld smear, PCR, ELISA

• TX: Oxytetracycline, transfusions: PCV <15%

  • If +: Lifelong carriers: cant transmit

Pneumonia

• MOA: Pasteurella, Mannheimia, Haemophilus, Mycoplasma, Strep zooepidemicus (alpaca fever) , BHV-1, Adenovirus, coronavirus, aspiration

• CS: Depression, anorexia, fever, cough, nasal discharge, tachypnea

• ID: Rads, ultrasonography, culture (nasal swab, TTW, BAL)

• TX: antibiotics

  • Prognosis: Good w/ TX

Chronic Obstructive Pulmonary Disease (COPD)

• MOA: Chronic lung inflam due to dust, mold, and allergens.

• CS: Chronic cough, nasal discharge, labored breathing, exercise intolerance, weight loss.

• ID: Rads, BAL, endoscopy

• TX: Bronchodilators, corticosteroids, mucolytics, **Improve ventilation, offer low-dust diet **

Ringworm

• MOA: Trichophyton verrucosumis: fungal infection

• CS: Crusty, circular plaques on head, face, neck, body, and limbs.

• ID: Culture, direct microscopic exam of hair or skin scale

• TX: self-limiting, iodine topical application

Contagious Ecthyma (Orf)

• Sore mouth

• MOA: Highly contagious

  • Zoonotic

• CS: Crusty skin lesions on lips, mouth, teats.

• ID: PCR

• TX: Self-limiting, vaccine

Rabies

• MOA: rabid bites

• CS: Aggressive or furious, paralytic (dumb), Tenesmus, ptyalism, bloat.

• ID: call state vet, histopath, Negri bodies

• TX: Killed rabies vaccine, annually

Herpesvirus (EHV-1)

• MOA: horses

• CS: Fever, lethargy, nasal discharge, cough, conjunctivitis, : most common

• acute onset ataxia, hindlimb weakness, recumbency, late-term abortions

  • Secondary bacterial pneumonia 

• ID: PCR, Serology (paired samples for rising titers)**

• TX: IV fluids, NSAIDs, antibiotics, quarantine 30d, Vax (Equine EHV-1)

West Nile Virus

• MOA: Arbovirus (Flaviviridae)

  • mosquitoes, birds

• CS: Fever, lethargy, CNS: hindlimb weakness, ataxia, tremors, recumbency

• ID: IgM ELISA, PCR (CSF/tissue)

• TX: Vax, mosquito control

  • Prognosis: Guarded

Eastern Equine Encephalitis (EEE)

• MOA: Mosquito

• CS: Sudden neurologic deficits, rapid recumbency

  • Fever: 104 F

• ID: IgM ELISA / PCR (post-mortem brain)

• TX: none, supportive care, EEE vax, bug control

BVD

• MOA: Noncytopathic BVDV 1b: most common

• CS: Abortion, stillbirth, premature neonates

  • PI ciras: death to mucosal dx, stunted growth

• ID: PCR, VI

  • pooled bld for herd testing

• TX: vax, cull

  • identify the PI and cull

Foot & Mouth Disease (FMD)

• CS: 104°F fever, anorexia, vesicles on lips, gums, tongue, feet, teats

  • Aerosol, direct contact

• ID: VI, PCR, virus neutralization test  for serotyping, ELISA

  • DDX: Vesicular stomatitis and blue tongue.

• TX: Reportable

Tuberculosis (TB)

• MOA: Mycobacterium bovis

• CS: Chronic weight loss, poor body condition, chronic coughing, enlarged lymph nodes

• ID: Tuberculin skin test

• TX: Antibiotics long term

  • Reportable

  • Poor prognosis

Ulcerative Keratitis

• MOA: Trauma, FB, infection

• CS: Pain, corneal opacity, vascularization

• ID: fluorescein stain, culture, PCR

• TX: Triple antibiotic, Atropine ointment, NSAIDs

  • Prognosis is good

Anterior uveitis

• MOA: Infections: Lepto, systemic dz

• CS: Miosis(constriction), aqueous flare, hypopyon(pus)

• ID: fluorescein stain, culture, PCR, serology

• TX: Triple antibiotic, NSAIDs, corticosteroids

  • Prognosis is guarded: risk of glaucoma

Cataracts

• Opacity of the lens leading to vision impairment.

• MOA: Congenital, Age

• CS: Whitish/gray lens, blindness

• TX: Surgical removal

Glaucoma

• MOA: Elevated IOP (>30 mmHg), optic nerve damage, 2ndary uveitis, trauma

• CS: Tearing, squinting, redness, corneal edema (blue haze), enlargement of the globe, (buphthalmos), blindness.

• ID: Tonometry (IOP >30 mmHg)

• TX: NSAIDs, SX, Laser ablation of the ciliary body, enucleation if refractory.

  • prognosis is Guarded

Pinkeye

• MOA: summer, fly season, Moraxella spp

• CS: Blepharospasm, eye discharge, corneal opacity, ulceration, blindness

• ID: Ophthalmic swab for gram stain and culture

• TX: antibiotic ointments, NSAIDs, Autogenous vax, fly control

Otitis Externa

• MOA: Spinose ear tick, infection

• CS: Head shaking, scratching ears, foul odor

• ID: Otoscopic exam, cytology, Gram stain, mite check, culture

• TX: Chlorhexidine flush (2x daily), broad-spectrum antibiotic and anti-fungal otic ointment

Otitis Media and Interna

• MOA: bacti infection 

• CS: Head tilt, ear droop, flaccid lower lip, collapsed nasal opening with deviation, circling, Facial nerve paralysis

• ID: Rads

• TX: Antibiotic injections, NSAIDs

Chronic Wasting Disease

• MOA: Transmissible prion, deer, elk, moose

• Contaminated feed or water

• CS: Progressive weight loss, abnormal behavior, tremors, ataxia, difficulty swallowing. 

• ID: post-mortem histopath of brain

• TX: none

  • poor prognosis

Endometritis

• MOA: Primary cause of repro failure, Escherichia coli, Streptococcus zooepidemicus

• CS: Repeat breeding, early embryonic death, or abortion, abnormal vag discharge

• ID: US, bacti culture.

• TX: Uterine lavage w/ warm isotonic saline or antiseptic, Intrauterine antibiotics, Systemic antibiotics, Prostaglandins

  • moderate repo prognosis

Mastitis

• MOA: shortly after parturition

  • Acute: S. aureus, Strep, E. coli, Klebsiella spp., P. aeruginosa, Trueperella pyogenes

  • Chronic: high cell counts, Strep. agalactiae and S. aureus

• CS: watery or bldy mammary secretions, fever, anorexia, udder swelling, pain

• ID: Culture, CMT, SCC

• TX: Systemic or intramammary antibiotics, NSAIDs

  • penicillin, cephalosporins, or amoxicillin

Ulcerative Pododermatitis

• MOA: trauma, wet unsanitary conditions

• CS: Lameness, swelling, heat in the affected feet, and visible ulcers on the pads

• ID: PE, culture

• TX: farrier, debride, antibiotics, NSAIDs

Fracture Repair

• Types and TX

  • Comminuted diaphyseal fracture of the humerus

    • intramedullary pins and multiple cerclage wires

  • Comminuted mid-diaphyseal metatarsal fracture

    • compression plate

  • Comminuted diaphyseal and distal metaphyseal tibial fracture.

    • transfixation cast

• Complications: Implant failure, delayed union, malunion, non-union, osteomyelitis, sequestrum formation

Castration

• Why: Cohabitation between males, prevention of unwanted pregnancies, genetic control, reduce aggression

• When: 18-24m

• Pre OP: fast, Tetanus-toxoid vax, lay recombant, Intratesticular and incisional line blocks

• OP:

  • Scrotal: 2-cm incision lateral of median raphe, left open

  • Pre-scrotal: 2 cm ventral midline incision just cranial to the scrotal base, close insision

• Complications: joint issues

Abdominal Surgery

• Left paralumbar fossa

  • Sternal recumbency

  • sedation and local anesthesia

  • Uterus, C1 and spleen

  • Closure: All muscles are closed in one layer using a simple continuous or interrupted tension-relieving sutures w/ No. 1 PDS or No. 1 polyglactin 910

• Right paralumbar fossa

  • Sternal recumbency

  • sedation and local anesthesia

  • C3, liver, small intestine, cecum, spiral colon 

• Ventral midline

  • general anesthesia

  • C3, liver, small intestine, large intestine, bladder, or uterus

  • Closure of Linea alba: cruciate suture pattern w/ No. 1 polydioxanone or polyglactin 910.

  • Closure of Skin: subQ suture pattern

• Post OP: Antibiotics, NSAIDs, omiprazole

• Complications: Incisional infection, hernia, ileus, peritonitis and adhesions.

Colic

• CS: Kicking at the abdomen, rolling, and thrashing, restless, Lying with head and neck flat against the ground or down across their back, teeth grinding

• dramatic in young, less in adults

• ID: PE

• Indications for SX: continuous pain, fail to shit >24hrs, fail to piss >6hrs, US w/ distention, hypochloremic hypokalemic metabolic alkalosis, abnormal peritoneal fluid analysis

Cesarean Section

• MOA: Fetal malpositioning, poor cervical dilation, Uterine torsion, Schistosoma reflexus

  • Failure to transition from Stage I to Stage II labor or no progress for 30+ minutes in Stage II labor

• Exam: Check for dehydration, shock, fetal evaluation

  • No SX: Cervix is fully dilated, Pelvis is adequate in size

  • Needs SX: uterus or fetus are inaccessible, Cervix is closed
    Approaches

• SX: Left Paralumbar fossa, caudal epidural, sit sternal, line or inverted “L” block

  • Double layer closure with No. 0 polydioxanone or polyglecaprone

  • Lavage before replacement

Uterine Torsion

• MOA: near term gestation

• CS: Abdominal pain, lying down

• TX: Rolling, transvaginal manipulation, laparotomy

  • SX indications: not fixed w/ 2 other attempts, Cervix doesn't dilate, inhibitory fetal factors

  • SX approach: Left paralumbar fossa laparotomy

Fighting Teeth

• Upper and lower canine teeth

  • Upper third incisors

• Mature males

• Danger to handers

• Not effected by castration

• Cut w/ Tooth Saw or OB Wire