11.3.4: Abdominal pain Flashcards
Differentials for acute abdominal crisis
Gastrointestinal disease
* Abomasal volvulus
* Abomasal displacement
* Haemorrhagic jejunitis
* Caecal torsion
* Primary/ secondary bloat
* Intestinal torsion/ intussusception
* Mesenteric torsion
* Peritonitis
Non-GI diseases
* Uroliths
* Uterine torsion
* Pyelonephritis
History questions to ask for the animal in the acute abdominal crisis
- Age
- Sex
- Breed
- Stage of production
- Nutrition
- Management system
- Stage in reproductive cycle
- Previous surgery
- Previous treatment
What aspects of your clinical exam should you pay particular attention to in the ruminant with the acute abdominal crisis? What findings would you expect?
- Cardiovascular status: HR elevated, mm tacky, CRT prolonged, prolonged skin tent
- Abdominal silhouette: assess rear and side for abdominal distension, assess back position (flat or arched)
- Abdominal examination: reduced rumen contractility, listen for pings, listen for splashing on succussion
- Look for signs of pain: bruxism, abducted elbows, reluctance to dip on wither’s pinch indicates cranial abdo pain
- Assess viscera on rectal palpation
- Assess faecal output, check for frank blood, melena, fibrin and mucus
What additional diagnostic tests could you employ in the ruminant with the acute abdominal crisis?
- Abdominocentesis and peritoneal fluid analysis
- Imaging: ultrasonography
What aspects of peritoneal fluid will you analyse?
- Colour
- Volume
- Turbidity
- Odour
- Protein content
How will you ultrasound the abdomen and what should you see?
Use 7.5 MHz transrectal probe to identify the presence of fluid.
- Look for reticular contractions on ultrasound
- Located left of the midline, caudal to the xiphoid
- Rumen and reticulum contract in “seagull-like” contractions
- Can also assess for adhesions, abscess, fluid accumulation
A
Reticulum
B
Rumen
What is indicated by 4?
4 = free fluid. This is abnormal.
Aetiology and clinical presentation of peritonitis
Aetiology
Primary: associated with systemic infection
Secondary: after abdominal surgery
Clinical presentation
* Acute: abdominal discomfort, pyrexia, ± toxaemia, altered faecal output
* Chronic: non-specific clinical signs (“off-colour cow”, reduced production)
Causes of diffuse peritonitis
- Urethral obstruction
- Acute acidosis/ rumenitis
- Toxic mastitis
- Postpartum metritis
- Perforated abomasal ulcer
Causes of local peritonitis
- LDA/ RDA
- Caecal torsion
- TRP
- Uterine torsion/ rupture, dystocia, caesarean, vaginal tear
- Intestinal obstruction, volvulus strangulation, intussusception, perforation
- Splenic/ hepatic/ umbilical abscess
- Fat necrosis
Diagnostics for acute peritonitis
- Wither’s test
- Eric Williams test
- Rectal palpation
- Clinical pathology
- Abdominocentesis
- Exploratory laparotomy
Diagnostics for acute peritonitis
1-6
EW test = listen over trachea
Treatment of acute peritonitis
- Oral fluids or IVFT - lactated ringers/0.9% saline/ Hartmann’s
- NSAIDs e.g. meloxicam SC
- Antibiotics: amoxicillin or oxytetracycline (long course; consider licensing)
- Surgery: debridement, lavage and drainage. Cows wall off infection well.
- PTS if v severe adhesions and peritonitis
Signalment for caecal torsion
- Usually early lactation dairy cows
Aetiology of caecal torsion
- Poorly understood
- Possibly increased VFAs in the intestines -> atony and dilatation -> if the free end kinks over then torsion
What is abnormal and what are your differentials?
Abnormalities
* High end of HR, RR
* Distended right upper quadrant, R-sided ping
* Prolonged skin tent
* Scant faeces with some blood and mucus
* Tense distended viscus on upper R flank on rectal
Ddx: RTA/RDA (would expect more cranial position), caecal dilatation/ torsion
Treatment of caecal torsion
- Surgical: R flank laparotomy, empty caecum using purse string suture and reposition
- Oral fluids
- Calcium borogluconate IV
- NSAIDs e.g. ketoprofen for 2 days
- Antibiotics e.g. procaine penicillin for 3 days
Measure the fluid that comes out; more fluid = worse prognosis
Signalment of Haemorrhagic jejunitis (Haemorrhagic bowel syndrome)
- Usually but not always early lactation
- Unusual in UK
- Typically diagnosed at PM
Aetiology and clinical signs of haemorrhagic jejunitis (haemorrhagic bowel syndrome)
Aetiology: unknown, possible link with Clostridium perfringens Type A
Clinical signs
* Haemorrhage in small intestine causes massive clots
* Clots -> obstruction -> colic
* Red to dark black blood in faeces (“raspberry jam”)
* Often fatal
Treatment of haemorrhagic jejunitis
- Usually fatal
- Some reports of surgery to remove clots
- Otherwise supportive care: oral or IV fluids, NSAIDs, deep straw bed, no competition for food and water
How common are strangulations, intussuceptions and intestinal obstructions in cows? How will they present?
- These are rare.
- Will present with severe abdominal pain, circulatory compromise, abdominal bloat, and death in hours.
- Lack of faecal output = very bad sign
How will you diagnose and treat strangulations, volvuluses, intussusceptions, and intestinal obstructions?
- Diagnosis on rectal palpation and exploratory laparotomy
- Treatment = surgery, right flank approach
History for TRP
- Tyres used to hold down silage
- Non-specific history: off-colour cow with milk drop, reduced appetite, change in behaviour
Clinical signs of acute TRP
- Severe CV compromise
- Cardiac tamponade
- Pain
- Tachycardia
- Pyrexia
- Associated BRD signs
Clinical signs of chronic TRP
- Jugular distension
- Ventral oedema
- Tachycardia
- Dyspnoea
- Injected scleral vessels
- Muffled heart sounds
Clinical pathology findings with TRP
Non-specific findings:
* Leukocytosis
* Hyperfibrinogenaemia
* Elevated total protein
* Neutrophilia
* Elevated liver enzymes due to hepatic congestion if congestive heart failure
Treatment of TRP
- Early stages: bolus with magnet and give broad spectrum antibiotics (amoxicillin, oxytetracycline IM), give NSAIDs (meloxicam SC)
- Late stages: PTS
