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Y4 Farm - GI > Abdominal distension > Flashcards

Abdominal distension Flashcards

1
Q

All clinical exams should include assessment of rumen:

A
  • shape
  • fill
  • motility
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2
Q

Rumen contour

A

= Shape
- Early in exam
- From a distance
- Rear and side of cow
- Gaunt, normal or distended

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3
Q

Rumen motility

A
  • Simultaneous auscultation and palpation
  • Count contractions
  • Primary and secondar contractions not differentiated
  • normal = 3 contractions in 2 minutes
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4
Q

Hypermotility

A
  • Relatively uncommon finding on clinical exam
    – Early rumen distension -> as stretch receptors stimulated
    – Increase in primary contractions as result
    -> Physiologically normal response to a large meal
  • Contractions cease if distension continues
    – Causes of distension to follow
  • More than 5 contractions in 2 minutes = hypermotility/hypercontractility
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5
Q

Hypomotility

A

Much more common in unwell ruminants

  • Systemic inflammation
  • Increased sympathetic tone (due to pain)
  • Rumen distension or acidosis
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6
Q

Differential diagnoses: Abdominal distension

A
  • Bloat (frothy or free gas?)
  • Acidosis
  • Oesophageal obstruction (choke - feed source?)
  • Pregnancy (gravid uterus +/- oedema?) (ddx: hydros, pre-pubertal tendons rupture)
  • Vagal indigestion (ruminal atony)
  • Urethral obstruction (+/- ruptured urethra)
  • GI obstruction, impaction or displacement
  • Traumatic reticulitis/TRP
  • Peritonitis
  • Ascites (liver, cardiac or renal failure; hypoproteinaemia)
  • Miscellaneous (clostridial dz, neoplasia, overeating etc)
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7
Q

Diagnosis - distance exam

A
  • Dull/depressed
  • History of inappetence
  • Decreased productivity
  • Silhouette
    – Rear and side
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7
Q

Diagnosis - TPR

A
  • Heart rate and resp rate vary massively
    – Depending on cause
  • Temperature usually WNL
    – Unless infectious cause
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8
Q

Diagnosis - abdominal exam

A
  • Ausculatation
    – Rumen contractility
  • Percussion
  • Succussion
  • Rectal examination
    – Faecal abnormalities?
    – Palpation of rumen
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9
Q

Ancillary diagnostic testing

A

Rumen fluid analysis
- Colour, pH, protazoal activity, methylene blue reduction time, chloride concentration
- collect via orogastric tube, or rumenocentesis
- want to see a nice variation of big active protozoa
- protozoa in rumen should change methylene blue colourless in 2 mins
- increased chloride concentration due to acid secretion from the abomasum, if have pyloric outflow obstruction would get HCl in the rumen -> uncommon but useful to test for

Blood chemistry profiles
- Metabolic state?

Ultrasonography

Rumenotomy

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10
Q

What is bloat?

A
  • Ruminal dilation or abdominal distension?
  • Rumen most commonly responsible
  • Ruminal tympany = same thing
  • Primary = frothy bloat
  • Secondary = gassy bloat
  • Emergency -> will suffocate, lack of venous return
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11
Q

Frothy Bloat - definition & aetiology

A
  • Formation of stable froth in rumen as a result of diet
  • Usually associated with lush pasture, clover and legumes
  • Fatal
    – Severe distension -> Compression of thoracic viscera
  • Cattle > sheep
    – Same presentation in sheep
    – Easily missed in heavily fleeced sheep
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12
Q

Frothy Bloat: Pathophysiology

A

Legumes
- High threshold stretch receptors inhibit motility
- Less saliva -> increase in rumen liquor viscosity
- Fluid higher in chloroplast membrane fragments and soluble proteins -> prevents reflex relaxation of cardia -> eructation not possible

Low fibre and high concentrates diet
- Less saliva -> increase in rumen liquor viscosity
- Microbial polysaccharide production
- Polysaccharides + increased liquor viscosity = stable foam
- Stable foam -> can’t educate so gas trapped below it

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13
Q

Frothy bloat - CS & ddx

A

CS
- Abdominal enlargement of left-hand side when viewed from rear
- Colic
– Kicking, treading, lying down and rising, vocalisation
– Stretched stance, rear feet placed far behind
- Decreased rumen motility
- Beware heavily fleeced sheep

Ddx
- Stomach tube passes but doesn’t decompress (tube goes straight into the foam -> doesn’t reach the gas

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14
Q

Frothy bloat: Treatment

A
  • Anti-foaming agents (e.g. Mineral oil, poloxalene – “BloatGuard”)
    – lowering the surface tension of bubbles -> they burst and go back to a liquid -> the gas can escape
    – vegetable oil is a good alternative
  • Rumenotomy decompression
    – Severe cases
    – (prognosis?)
    – cut into the rumen just behind the last rib at the highest point of the swelling (hand down from the paralumbar fossa) with a sterile knife
    -> not ideal as will probs get a localised peritonitis but won’t die from this
  • Diet management:
    – Pasture: take off pasture, late morning grazing, strip graze, feed hay before going onto grass
    – Add long fibre to diet
    – Farmers often put blood guard into pasture water supply
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15
Q

Free gas bloat - definition and aetiology

A

Secondary: inability to eliminate gas by eructation secondary to another condition
- Obstruction: foreign body (may be palpable)
- Hypocalcaemia (lose contractions so unable to eructate, would have lots of other issues evident)
- Prolonged lateral recumbency
- Vagal nerve damage
- Tetanus (rigidity, protrusion 3rd eyelid, hyperesthesia, locked jaw)
- Actinobacillus (can cause granulomas anywhere in the GIT, which would cause pressure
- Outside pressure (carcinoma, papilloma, EBL, bTB)

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16
Q

Vagal nerve damage/injury - ‘Vagal indigestion’

A

enlarged rumen>bloat
- Secondary to hardware disease/TRP, actinobacillosis (rumen/reticulum), peritonitis, abscessation
- characterized by dysfunction of reticulorumen
- hinders the passage of ingesta from the reticulorumen, abomasum or both, resulting in the distension of the abdomen

any problem anywhere down the nerve will cause a problem to where that nerve is controlling

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17
Q

Vagal nerve damage/injury - CS

A

non-specific
- Decreased milk yield, anorexia
- Abnormal faeces
- Recurrent bloating
- Decreased ruminal motility

18
Q

Vagal Indigestion - 2 forms

A
  • Anterior (proximal) functional stenosis
  • Pyloric (caudal) outflow failure
19
Q

Vagal indigestion - anterior functional stenosis

A
  • insufficient excitatory stimuli from vagus nerve ->
  • decreased motor drive of the primary reticular cycle ->
  • paralysis of omasum and reticulo-omasal orifice ->
  • substantial reticular adhesions prevent normal ingests and fluid flow to reticulo-omasal orifice ->
  • decreased/absent flow into omasum so rumen distends
  • wire top cause
20
Q

Vagal indigestion - pyloric outflow failure

A
  • accumulation of ingests in abomasum and omasum ->
  • abomasal content enters the rumen ->
  • severe distension and decrease in forestomach motility ->
  • increased fluid retention in rumen ->
  • marked dehydration and hypochloremic metabolic alkalosis
  • e.g. LDA - stretching and damaging the vagal nerve
21
Q

Choke

A
  • Common in sheep and cattle
  • Large quantities of feed, rapid intakes
  • Root crops
    – Potatoes, turnips, apples, fodder beet etc
  • Placenta (sheep)

Diagnosis = history and CS

EMERGENCY
- time when could get farmer to put sterile knife into rumen to decompress it

22
Q

Choke CS

A
  • Profuse salivation and bloat
  • Distressed, extended neck, coughing
  • Obstruction sites:
    – Oropharynx, thoracic inlet, heart base
    – Palpable/pass stomach tube
23
Q

Choke: Treatment

A
  • Attempt removal using fingers or gentle pressure with stomach tube (using paraffin/cooking oil or lubricant)
  • Leave to macerate if rumen trocar/red devil is present
  • If severe relieve rumen tympany
  • Trocar and cannula in left paralumbar fossa
  • Oesophagotomy?
    – jugular, carotid, vagus nerve very close so care
    – manage client expectations
24
Q

Therapeutics for choke

A

Spasmolytic IV/IM
- To relax the oesophagus, can help move the FB down
- Hyoscine Butylbromide + Metamizole
– Spasmium comp.
– Licensing:
-> Has license for dairy cows
-> Use in pregnancy after benefit-risk assessment by vet (could potentially be damaging to the foetus but if she’s dying…)
-> As supportive therapy for acute diarrhoea
But, do not use in cases of:
- gastro-intestinal ulceration
- chronic gastro-intestinal disorders
- mechanic stenoses in the gastro-intestinal system

Sedation IM/IV
- Xylazine
– Licensing:
-> Pre-medication for minor superficial operations, painful manipulative procedures and local or regional anaesthesia.
But :
- Increased risk of regurgitation
- Increased risk of recumbency
- Not for use in latter stages of pregnancy except at parturition
- alpha-2s decrease GI transit so could cause a different type of bloat - so O expectations…

25
Q

Calves - ruminal bloat

A
  • Usually slightly older calves
    – Poor oesophageal groove closure
  • Often just after weaning
  • Causes not well understood
    – Related to poor rumen development
    – Clostridia could be related
26
Q

Calves - ruminal bloat CS

A
  • Much more chronic
  • Diarrhoea, poor hair coat, decreased DLWG
  • Often recurrent bloat
  • May follow concentrate feeding
  • Waxing and waning LHS bloat (as chronic)
27
Q

Calves - ruminal bloat management

A
  • Short term deflate with stomach tube
  • Long term fistula or trocar
  • ^ long term management as doesn’t solve the cause
28
Q

Abomasal Bloat - signalment

A
  • Pre-weaned calves
  • 1-3 weeks old
  • Usually dairy
29
Q

Abomasal Bloat - cause

A
  • Rapid gas production in abomasum
  • Excessive fermentation of simple carbs
  • Overgrowth of gas producing bacteria
  • Clostridia may be related?
30
Q

Abomasal bloat - clinical exam

A
  • Splashing on abdominal percussion (high pitched splash - like an RDA in an adult cow)
  • Right ventral abdominal distension
  • Colic
31
Q

Abomasal bloat - tx

A
  • Relieve bloat (tube [putting in a dog sitting position can help] or needle [risk of viscous leaking into the abdomen and causing peritonitis if do transcutaneous needle])
  • IVFT
  • Antibiotics (penicillin)
  • Hyoscine
  • NSAIDs
  • Chance of secondary ulcers from tx
32
Q

Abomasal bloat - management

A
  • Review milk feeding
  • Secondary abomasal ulceration?
33
Q

Left Flank Laparotomy

A
  • Clip, block and prep
    – Remember to “sweep” off transverse processes (lots of dust and shit accumulates here so need to remove it before surgery)
  • Incise in paralumbar fossa
    – 4cm caudal to ribs
    – Too close to ribs = hard to close
    – Incise skin, external and internal abdominal oblique muscles, transversus abdominis and peritoneum
  • Sheep = same but lateral recumbency and do big enough clip to remove wool from the incision, also use a drape (rarely used in cows)
34
Q

Cranial abdomen exploration

A
  • Pylorus
  • Abomasum
  • Omasum
  • Reticulum
35
Q

Caudal abdomen exploration

A
  • Bladder
  • Uterus
  • Left kidney
  • Intestines
36
Q

Rumenotomy - indications

A
  • Adhesions suspected
  • TRP, foreign body, toxins, frothy bloat
  • Access to rumen and reticulum
37
Q

Rumenotomy - approach

A
  • Restraint - don’t want the animal going down (contamination, poor visualisation)
  • Same as laparotomy
  • Suture rumen to body wall
    – Partial thickness
    – Short runs of Cushing pattern
    -> 3 or 4 separate lines of suture
    -> 1 big suture would become too tight and if ti comes undone the whole thing will come undone
    -> Stay sutures don’t really work
38
Q

Rumenotomy - other possibilities

A
  • Stay sutures
  • Weingarth apparatus
  • Wound edge protector
39
Q

Rumenotomy - peri-op considerations

A
  • Clean contaminated surgery
  • Perioperative antimicrobials and NSAIDs
  • Restraint!
40
Q

Rumenotomy - forming a seal

A
  • the seromuscular layer of the rumen is sutured to the skin in an inverting pattern to create seal
  • blood that has accumulated at the ventral aspect of the incision is left in place as it helps create a better seal
  • means that the ruminal contents come out of the body rather than into the cow
41
Q

Rumenotomy - preventing abdominal contamination

A
  • Gabel rumen retractor (rumen board)
    – used to prevent rumen retraction and abdominal contamination during rumenotomy
    – holds the rumen exterior to the body
  • Wound edge protector
    – a plastic drape that has an expandable rubber ring, holding the drape open on the interior of the rumen
    – the outside of the drape is adhered to the patient
    – it protects the surgical site from contamination from the rumen contents
42
Q

Rumenostomy

A
  • Recurrent bloat?
  • Self retaining trocar preferrable
    – But peritonitis risk
    – Red Devil: not a secure opening, will eventually fall out
  • Similar to laparotomy except only small circle of skin incised
    – Rumen stay sutured to body wall
    – Small circle of rumen mucosa removed
    – Rumen wall sutured to body wall in everting pattern
    -> Horizontal/vertical mattress
  • Gradually granulate and close

Y4 Farm - GI (14 decks)

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