25 - Umbilical disease

umbilical anatomy

vein goes to liver → falciform ligament

artery goes to internal iliac arteries → round ligament

urachus goes to bladder → 

etiology

occurs soon after birth → poor hygiene, FPT, weakness

lumen of umbilical structures doesn’t close immediately after birth

urachus > vein > artery

small hernias or abscesses may not be obvious until 1-6 weeks

painful swelling and palpable enlargement of umbilical vessels

septicemia

secondary to ascension of bacteria

acute

chronic

meningitis

uveitis

omphalophlebitis

chronic infection of umbilical vein

may cause hepatic abscessation

omphalitis

inflammation of umbilical structures or tissues immediately surrounding

can occur as early as 2-5 days after birth

clinical signs

heat

swelling

purulent discharge

pain

can progress to septicemia

diagnostic methods

ultrasonography

persistent dilation of umbilical vein or arteries

treatment

abx

supportive care

may require surgical removal

good prognosis with adequate passive transfer

omphalophlebitis

1-3 mo

umbilicus may not be enlarged

deep palpation detects cylindrical structure, painful

inappetence and low-grade fever

surgical management

ligation and removal of umbilical vein → for localized omphalophlebitis → does not involve the liver

marsupialization of infected vein → for liver involvement → flush daily with povidone-iodine

omphaloarteritis

clinical picture similar to omphalophlebitis

space-occupying mass above umbilicus → dorsocaudal coursing

surgical management

ligation and resection of involved tissue

urachitis

most common

chronic infection may cause chronic bladder infection

change in urination → mechanical interference with normal filling/emptying of bladder

urachus anchors bladder apex to ventral abdomen → stretches bladder → reduced volume

can go unnoticed for up to a year

surgical management

resect urachus and apex of bladder

leaving any portion of urachus could lead to urachal diverticulum that does not completely empty on urination

clin path abnormalities

non-specific

neutrophilic leukocytosis

hyperfibrinogenmia

septicemia → usually GN bacteria (E. Coli, Truepurella pyogenes)

neonatal calf with vascular thickening

if otherwise healthy other than palpable cellulitis:

remove scab over umbilicus → allows drainage

broad-spectrum abx

neonatal calve with fever

palpable umibilical lesions

evidence of septicemia

asses passive transfer

remove umbilical scab → culture discharge

can do blood culture → before abx

intensive abx therapy for GN organism (PPG, TMS, Naxcel)
address localized infections → septic joints

surgical resection of umbilicus once stabilized

patent urachus

less common in calves

predisposition to septicemia

urine dribbling from umbilical region → persistent moisture

tx: surgical resection, Lugol’s iodine/silver nitrate cautery

umbilical hernias

inherited

>10 cm are reducible

<4 cm can close spontaneously by 3-4 mo

>10 or persistence = medical or surgical therapy

treatment

taping → manual reduction, then tape abdomen for several weeks, good if <3 finger-widths

elastic band → <3 cm, caution of abdominal structures in band

herniorrhaphy

closed = peritoneum not opened

open = peritoneum opened