Abomasal Disease Flashcards
Discuss abomasal related conditions?
Several related conditions
- Left displaced abomasum (LDA)
- Right displaced abomasum (RDA)
- Abomasal torsion/volvulus(AV)
- Abomasal ulceration
Relatively common in dairy cows
Common features in pathophysiology
Discuss the occurence of the related conditions in abomasal disease?
Left displaced abomasum very common
- Range of incidence rates quoted from 0.25 –5% in UK
- Probably near 5% in USA (more difficult to manage in more high yielding herds)
- Around 1.5% in Germany
Right displaced abomasum
- Similar signs to LDA
- Less common
Abomasal torsion
- Abdominal emergency
- Severe colic signs
- Even less common
Abomasal ulceration
- May be no/mild signs or can be severe/fatal
- Incidence uncertain!
What can lead to a drop in abomasal motility?
What can lead to RDA and LDAs?
What happens after abomasal dilation?
How do LDA, RDAs and AVs occur?
Pathophysiology
- Similar mechanisms behind all three presentations (LDA, RDA, AV)
- Which one occurs may depend on stage of lactation (LDA most often close to calving)
- There is also an element of chance!
What are the risk factors abomasal disease?
Things that decrease DMI around calving
- Cows over-fat at calving
- Often also have fat infiltration of liver
- Poor calving management
- Periparturient disease/problems e.g. hypocalcaemia, mastitis, metritis, dystocia
- Poor feed access/palatability
Lack of dietary long fibre
- (poss related to rumen fill)
Poor control of energy balance around calving
- (often have subclinical ketosis before LDA)
Sudden concentrate feeding at calving/no concentrate fed in transition
Hypocalcaemia
- Decreased GI motility
Often peak incidence in spring
- ? Related to lack of fibre in spring grass or sudden change in diet at turnout
LDA clinical signs?
Clinical signs
- Decreased yield (classically 5-10 ltrs)
- Decreased feed intake (especially concentrate)
- Poor rumen turnover
- May be signs of underlying primary disease (e.g. metritis, mastitis)
- May show mild colic (rare)
LDA diagnosis?
Diagnosis –percussion auscultation “ping”
LDA diagnosis extra?
Diagnosis
- May also hear spontaneous abomasal noises on left (“tinkling”)
- May elicit spashing/tinkling/ping on ballottment
- Very commonly ketotic
- Positive Rotheras/urine ketonetest
- ALWAYS look for underlying primary disease!!!
- May come and go
- “swinging LDA”
LDA Abomasum treatment options?
- Coservative
- Semi-surgical
- Surgical
Discuss LDA conservative treatment?
Conservative treatment
- Roll the cow (+/-sedation)
- Cast onto right hand side
- Reuff’s method (ref AHW1)
- Slowly roll through dorsal recumbency onto left side
- +/-…
- Brief “stop” in dorsal recumbency
- Shaking the cow from side to side while in dorsal
- Other reason to roll a cow is for uterine torsion
Depict LDA rolling?
Discuss conservative treatment to be used alongside rolling?
The following may be used in conjunction with rolling…
- Oral propylene glycol
- Oral fluids/electrolytes (stomach tube)
- Oral probiotics
- Systemic prokinetics(metoclopramide (promote abomasum contractility), erythromycin???, iv calcium?)
- Licensing –can’t use metoclopramide
- Long-fibre only diet for 24hrs (e.g. good quality hay)
Conservative treatment
- ~75-80% reported to relapse
Discuss semi-surgical treatment for LDA?
Semi-surgical treatment
- toggle
- Roll as for conservative treatment (+/-sedation)
- Insert “toggles” through trochar into abomasum while cow in dorsal recumbency
Surgical treatment options for LDA?
- Paramedian
- Bilateral flank
- Left flank
- Right flank
Discuss the surgical paramedian approach to LDA treatment?
Paramedian approach
- As toggle but open abdomen to visualise abomasum
- Requires more sedation, local anaesthesia
- Remember licensing!
- Suture abomasal fundus to ventral body wall –partial thickness
- Often include abomasum in closure of muscle layer
Discuss the surgical bilateral flank approach to LDA treatment?
Surgical – bilateral flank approach
- Two surgeons, standing cow
- Local anaesthesia (e.g. paravert) & skin prep
- Paralumbar fossa incision on each side
Left surgeon…
- Identifies and decompresses abomasum (ballottment, can use sterile 16g needle and tubing)
- Passes under abdominal contents via ventral midline to…
Right surgeon
- Brings abomasum to right side
- Fixes abomasum in place
Surgical - bilateral flank approach options for fixation?
Omentopexy:
- Continuous suture in omentum, each end sutured to muscle layer
Pyloropexy:
- Suture through partial thickness pylorus and through muscle
What can be seen here?
Pyloric region of abomasum
Discuss surgical right flank surgery to treat LDA?
Surgical – right flank approach
- One-surgeon version of bilateral flank
- Paralumbar fossa incision on right side
- Abomasum palpated on left side by reaching round behind rumen
Discuss right flank approach further?
- +/-abomasum deflated using needle/tubing
- Falls/guided into ventral midline
- Located by surgeon and gently pulled up to incision
- Pylorus/omentum indentified and pexied
Describe left flank approach to LDA surgery?
Surgical – left flank approach
- Standing, left paralumbar fossa incision
- Abomasum identified and continuous suture line placed in fundus with very long ends left on suture material
- Abomasum decompressed if necessary
- Needle attached to one end of suture material and passed ventrally through abdomen (guarded!) and poked out through ventral body wall to assistant
- Repeated with second needle, two ends of material secured on outside as abo repositioned
Discuss surgical laproscopy treatment for LDA?
- Various techniques described
- Becoming more popular in Europe and UK
- Some methods involve rolling
- Others are done standing
Discuss LDA prevention?
Prevention
Key points
- Maximise DMI around calving/early lactation
- Transition diet: some but not too much concentrate, sufficient long fibre
- Fresh calved diet: sufficient long fibre
- Early lactation energy balance
- Check milk fever control (e.g. high incidence clinical cases?)
- Check incidences of other diseases (e.g. metritis) and association with LDA cases
Look at this flow diagram of LDA?
Describe the pathophysiology of RDA?
Clinical signs of RDA and diagnosis?
Clinical signs
- Similar to LDA but usually more severe
- May also show mild colic
Diagnosis
- Auscultation during percussion and ballottment
- Similar sounds to LDA, different location!…
Where does a RDA go?
RDA conservative treatment?
Treatment-conservative
- Often first line if no signs of a torsion
Medical
- Gastric motility modifiers (metoclopramide (NO), hyoscine/dipyrone (Buscopan), erythromycin?)
- Usually repeated x2-3 q12hrs
- NSAIDs? Meloxicam
- Iv calcium also sometimes used in hope will stimulate abomasal contractility
Dietary management
- Long fibre only diet (hay)
- Comes down to feeding lots of hay and giving meloxicam
Buscopan commonly used (unlikely to be gastric prokinetic, response ? related to analgesia) –little evidence to justify. Also not permitted for use in lactating cows –VMD have suggested they wouldn’t support this as use under the cascade
RDA Surgical treatment?
Treatment – surgical
- If significant colic, HR or conservative Tx fails
- Standing right flank approach
- Abomasum decompressed
- Best by exeriorising/emptying
- Can use needle/tubing or large bore tube/purse string suture
- Checked for signs of ulceration (oversewn if severe)
- Pyloropexy normally performed to prevent torsion
Prognosis not as good as LDA
Discuss abomasal torison (AV)?
- Normally a sequel of RDA, but may not present until torsion occurs
- Require emergency surgery
Clinical signs of abomasal torsion (AV)?
Similar signs to RDA but…
- Usually some colic signs, may be severe
- HR normally higher (typically >80-100/min)
- Usually sparse/no faeces in rectum
- May be signs of circulatory compromise
- Low temperature, discoloured mucous membranes, clinically evident dehydration, poor pulse quality
Discuss abomasal torsion surgical treatment?
Treatment – surgical
- Standing right flank laporotomy
- Empty abomasum as much as possible (tube)
- Identify and correct torsion
- Often several axes of torsion (can be very difficult!)
- Perform pyloropexy and close
SuppportiveTx…
- Fluids, NSAIDs etc
- Guarded/poor prognosis (consider euthanasia)
Discuss abomasal uclers?
Abomasal ulceration
- May be secondary to LDA/RDA
- Also appears to occur by itself
- Possibly related to…
- Stress/concurrent disease
- Ingestion of soil/sand?
Discuss abomasal ulceration?
- Probably significantly under-diagnosed
- Common incidental finding at slaughter/PME
- Signs often mild, may self-cure
- Even if penetrated, omentummay seal off (picture courtesy of BCVA photo library)
- Can also cause severe signs (colic, poor production)
- May even be fatal
Abomasal ulceration clinical signs and management?
Clinical signs
- Mild colic, may be inapparent
- Pain on ballottement right ventral abdomen
- Melaena/faecal occult blood
- Signs of peritonitis
Management
- Euthanasia often advocated once melaena established Analgeisa? (care –NSAIDs may be ulcerogenic) Antacids?
- Antibiotics
Conclusions on abomasal injury?
Conclusions
- The abomasal disease complex consists of a variety of related conditions
- LDA is very common in dairy cattle and has major welfare/economic consequences
- There are a variety of treatment options
- As always, prevention is better than cure!
