14. Hardware disease (traumatic reticuloperitonitis): clinical signs, local and/or systemic consequences, diagnosis, and treatment Flashcards
Clinical signs?
Clinical (acute) signs in initial penetration
• General appearance:
o Sudden onset, sharp fall in milk yield
• Sound: grunt
o Vibrations can be felt over larynx/trachea with hand/stethoscope
o Everything more visible when in the acute phase than in chronic
o Real problem starts when it stops screaming (enters chronic stage) and there are adhesions—> can’t
go back to the healthy stage anymore!
• Basic clinical values
o T: 39,5-40,0 C (acute, mild fever)
o P: 80 - 100/min
o R: >30/min, rapid, shallow, costal (won’t do the normal abdominal breathing because it’s painful)
• Digestive signs: not pathognomonic signs
o appetite, belching, rumination! (–)
o rumen motility! (–)
o rumen: small, firm, separated content, +/- mild tympany
o reticulum: No reticular sounds!
o faeces: decreased, dry, poorly digested
Clinical signs in chronic cases?
Clinical signs in chronic cases
- If animals enter chronic stage, some of the acute stage signs disappear!
- Feed intake and faecal output ↓
- Milk production remains low
- Abdominal pain become less apparent
- T: usually returns to normal
- Some cattle develop vagal indigestion syndrome (Hoflund syndrome) (particularly on the ventromedial
reticulum)
If chronic case furthermore leads to complications such as Pleuritis/pericarditis?
If chronic case furthermore leads to complications such as pleuritis/pericarditis
- If the perforating object is min 8-10 cm long!
- Depressed (very painful)
- H: (>90 bpm) (tachycardic x2 to as much they normally have)
- T: >40°C
- R: fast, shallow respiration
- Washing machine murmur: Fluid accumulate in pericardium and gas production
due to bacterial infection. = splashing/pericardial friction rubs
- Jugular vein distention without it being raised and congestive heart failure
- Submandibular and brisket oedema (same as in brachycephalic dogs)
- Prognosis is poor with these complications (once heart is affected at least!)
- Penetration of pericardium into the myocardium: sudden death due to acute cardiac arrest!
Prognostics for traumatic reticuloperitonitis?
Prognostics for traumatic reticuloperitonitis
• History and clinical findings
o Surroundings/environment (construction=screws/nails around)
o abnormal general behaviour
o spontaneous grunting and groan
o sporadic onset
o sudden digestive disorder without changes in feeding
o fever: signs of (acute) inflammation
Methods for diagnosis?
Methods for Diagnosis
• Clinical examinations
o To elicit a grunt or groan
§ Reticular pain probes
§ Temporarily prevention of breathing
o Sensitivity of the wither’s region
§ Kalchsmidt
- Haematology
- Rumen fluid
- Ferroscopy
- Abdominocentesis
- Laparotomy
- Ultrasonography
- Radiography
Reticular pain probes: Back grip?
Reticular pain probes: back grip
- = To elicit a grunt/groan
- A fold of skin is pulled up with both hands, which forces the back to sink
Reticular pain probes: Pain percussion?
Reticular pain probes: pain percussion
• Heavy rubber hammer toward the area of the reticulum (A) for percussion of the region (B)
Reticular pain probes: Pole test?
Reticular pain probes: pole test
- 2 assistants hold the pole in place (A) and then pull the pole upwards against the cow’s abdomen (B)
- Repeat many times: start just in front of the udder and move a bit cranially every time. (Calibration area
needed to know the difference)
Knee elbow probe?
Knee elbow probe
• Crouching position of veterinarian, push your elbow on your knee and lift hand up towards the reticular
region
Temporarily prevention of breathing?
Temporarily prevention of breathing
• Rectal sleeve placed over the mouth and nose
o Apnoea
o Strong diaphragmatic contractions
o Pain
Sensitivity of the withers region?
Sensitivity of the withers region (Kalchschmidt)
• Touch, displace or pull the skin, or pull the hairs gently
Haematology?
Haematology
- Haematocrit ↑
- Leucocytosis (neutrophilia)
- Acute cases: neutrophilia
o Differential leukocyte count is a better diagnostic indicator for peritonitis (only in the first three
days) than the total leukocyte counts commonly with a left shift.
o Chronic cases: only moderate leucocytosis, neutrophilia and monocytosis
- Fibrinogen ↑
- Total protein↑
- Glutaraldehyde coagulation test (GCT) test is used to estimate the level of immunoglobulins and fibrinogen
- Gel formation: sensitivity (87.9 - 97.8%), coagulation time of 3 min and for 6 min
Rumen fluid and ferroscopy?
Rumen fluid
• Not so informative/pathognomic for TRP
Ferroscopy
- Metal detector
- Scanning on ventral and lateral thoracic and abdominal wall to find ferromagnetic foreign bodies!
- False negative result
o Dorsal penetration =too far away, aluminium/cupper (non-magnetic) material
• False positive
o Non-perforating ferromagnetic foreign bodies (bolt nuts) and magnets placed by farmers.
• Compass
o Identification of magnets that have been given previously (not nowadays)
Abdominocentesis?
Abdominocentesis
- Use hypodermic/spinal needle with stylet under US guidance
- Find the place first: general peritonitis has a special place and then do centesis
- Parameters of fluid: amount, colour, transparency, odour, consistency
- Refractometer for specific gravity
- Cytology and bacteriological examination:
- Exudate in 99% of the cases!
- Cloudy, heterogenous
- Echogenic sediment of bacteria/inflammatory cells/fibrin
- Watery-viscous
- Smelly
- Fibrin flecks
- Spec gravity >1.015
- Protein content high; > 30 g/
Laparoscopy?
Laparoscopy
- = opening of abdominal cavity: sometimes good enough without rumenotomy.
- Useful for detection of inflammatory changes
- Rumenotomy can be used but before removing foreign bodies examine the area involved, the degree and
direction of penetration.
è proper prognosis: from the previous lecture
o Simple ventral penetration: favourable
o Deep anterior penetration: unfavourable (pericarditis)
o Cranio-medial penetration: questionable (Vagus indigestion)
