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Module 21: Ruminant Production > Abomasal Disorders > Flashcards

Abomasal Disorders Flashcards

1
Q

what reduces motility of the abomasum

A

Hypocalcemia

Hypochloremia

Hyponatremia

Hypokalemia

Metabolic acidosis

Ketosis and acidosis

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2
Q

how many times does the abomasum contract per day

A

18-20

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3
Q

what are the types of abomasal displacements

A

LDA

RDA

right abomasal volvulus

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4
Q

where does the abomasum normally sit

A

right ventrum of the cow

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5
Q

what is the pathogenesis of displaced abomasum

A
  1. reduced abomasal motility (reduced plasma Ca concentration)
  2. gaseous distention (rumen origin, ventral fermentation)
  3. displacement (left or right)
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6
Q

when do LDAs normally occur

A

~90% in the first 4-6 weeks PP

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7
Q

what are the risk factors for LDA

A

Dairy vs beef

Female vs male

High yielding at higher risk

Genetics

Peri-partum period

Diet

Concurrent disease

Ketosis, hypoca etc

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8
Q

why do LDAs normally occur in the first 4-6 weeks PP

A

In last month before calving, moves slightly to left and cranially

The rumen reduces in size, which means cranioventral portion is more empty than it normally be which allows the abomasum to move across

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9
Q

what are the pre-calving dietary risk factors for LDAs (3)

A

Reduction in DMI before calving

  • Ketosis
  • Hepatic lipidosis
  • NEB

High grain intake pre-calving

  • High CHO intake

Low crude fibre

  • <17%
  • Pre-disposes the rumen fibrous mat to become thinner and allows grain to drop and ferment in the ventral rumen which forms gas which can go into the abomasum
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10
Q

how are LDAs prevented

A

Focus on transition period

Everything possible should be done to maximize DMI

Prevent post partum disease

Treat ketosis and other conditions promptly

  • A cow with NEB is more likely to develop a displaced abomasum

Minimize stress

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11
Q

how are LDAs prevented on a herd basis

A

Traget LDA incidence <3%

Investigate if

  • Overall annual LDA incidence >2%
  • Several cases inshore time period (clusters)
  • Client concerns

Start with the transition management

  • Diet
  • Stocking density
  • Calving management
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12
Q

how are LDAs diagnosed

A

history

clinical exam

abomasocentesis

US

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13
Q

what in the history could help diagnose LDA

A

Depressed feed intake/anorexia

Drop in milk production

Recent calving

Transition period problems

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14
Q

what in the clinical exam could help diagnose LDA

A

Abnormal feces

Decreased rumination sounds

  • +/- decreased rumen size

Auscultation and ballottement of abdomen

  • Characteristic ping

+/ dehydration (sunken eyes/skin tent)

+/- concurrent metabolic disease

HR and RR normal or increased

  • Occasionally sinus arrhythmia
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15
Q

what does the left ping sound like

A

Ping LHS

High pitched

Metallic resonant

Splashing/tinkling

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16
Q

where is the abomasocentesis done

A

10th or 11th IC

pH 2-3

No protozoa

Small volume

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17
Q

where is the abomasal US done to diagnose LDA

A

Last 3 ICS on LHS

Ventral to dorsal

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18
Q

what are the 3 prognostic categories of DAs

A

Group 1:

  • Gas distention only
  • HR WNL
  • Excellent prognosis

Group 2:

  • Gas distention + <20% fluid
  • HR <100bpm
  • Good prognosis

Group 3:

  • Gas distention + >20% fluid
  • HR >100bpm
  • Moderate (guarded prognosis)
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19
Q

what are the correction techniques for LDA

A

Conservative

  • No fixation

Percutaneous fixation

  • ‘closed surgery’

Surgical

  • open (traditional)
  • laparoscopic
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20
Q

how can LDAs be managed medically

A

Prokinetics

Limited evidence and availability

Metoclopramide

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21
Q

how is a cast and roll done to treat an LDA and what are the pros/cons

A

Inexpensive and simple technique

Cast cow onto RHS

  • Method 1: roll over onto LHS (180º) + ballottement of ventral abdomen
  • Method 2: roll onto dorm then tilt the cow 45º alternately left and right several times before rolling onto LHS

Hold cow in left lateral recumbency for 5-10 mins before returning to standing/sternal

High recurrence rate (>80%)

Rolling risks

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22
Q

what are the percutaneous fixation methods done to correct an LDA

A

roll & toggle (grymer/sterner technique)

blind suture

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23
Q

how is the roll and toggle prep done to correct LDA

A
  1. roll to dorsal recumbency (cast on RHS)
  2. clip from xyphoid to umbilicus
  3. local anesthetic blebs
  4. work quickly
  5. with cow in dorsal recumbency id the ping (don’t continue if no ping)
  6. insert trocar 10-15cm caudal to xiphoid and 5-7cm right of midline (avoid mammary vein)
  7. remove cannula and put 1st toggle suture through trocar lumen, ensure is fully through so plastic toggle is in abdomen
  8. remove trocar
  9. move 10cm caudally and repeat whole process with 2nd suture
  10. tie both sutures together, allow a hand’s width between body wall and suture (too tight = necrosis)
  11. roll cow clockwise into sternal recumbency
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24
Q

what are the advantages of roll and toggle method to correct LDA

A

Quick and easy to perform

Minimal specialist equipment needed

Inexpensive

Closed technique reduces risk of abdominal contamination

Reasonable success rate (~75% 60d survival)

  • Although lower than other techniques
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25
Q

what are the disadvantages of roll and toggle correction of LDA

A

Blind technique

  • No visualization of abomasum or abdomen
  • Incorrect fixation

Risk of rolling

2+ assistants needed

Only suitable if abomasum freely mobile

  • No adhesions
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26
Q

what are potential complications of roll and toggle technique

A

Incorrect fixation

  • Rumen
  • Omentum
  • Small intestine

Infection and fistulation

Peritonitis

Suture breakage

  • Recurrence of DA

Abomasal obstruction

Abomasal rupture

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27
Q

what are preoperative medications needed for abomasal surgery

A

Antibiotic therapy

  • Broad spectrum
  • Open surgeries

Analgesia

  • NSAIDs
  • All surgeries
  • Care if ulceration

Calcium

Fluid therapy

  • As needed
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28
Q

what are pre op preparations for abomasal surgery

A

Adequate restraint

  • +/- sedation

Regional anesthesia

Pre-op clip and scrub

  • Chlorhexidine/iodine
  • Surgical spirit
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29
Q

what are the options for regional anaesthesia

A

Line block

Inverted L

Paravertebral

  • Distal
  • Proximal
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30
Q

what are fixation techniques

A

Risk flank approach (standing)

  • Pyloropexy
  • Omentopexy

Left flank approach (standing)

  • Abomasopexy

Paramedian approach (recumbent)

  • Abomasopexy
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31
Q

what equipment is needed for the right flank approach

A

Standard surgery kit

Dissolvable suture and non-absorbable

  • Minimum size 5

Round bodied and cutting needles

Tubing from flutter valve sterilized

Wide bore needle 18G 1” or 1.5”

32
Q

how is the abomasum deflated in the right flank approach

A

Reach in through incision (right arm cranially, left arm caudally)

  • Adhesions
  • Liver

Using left arm reach caudally round rumen to find abomasum (between rumen and body wall) with needle and tubing

Deflate abomasum as much as possible

  • Try to avoid perpendicular puncture
  • Insert at a shallow angle at the dorsal-most aspect of the abomasum
  • Apply mild ventral pressure until just before the abomasum falls out of reach

To move the abomasum from the left side to the right:Using right arm with palm up, reach cranioventrally (aim for left elbow) to grasp pylorus and pull up to incision

  • Pylorus is relatively firm associated with the thick torus pyloricus muscle
  • Steady traction applied to the right
33
Q

what is needed for a successful omentopexy from the right flank approach

A

Chose site as close as possible to normal position of the pyloroduodenal juncture without interfering with duodenal function

Distributing the pexy over as wide an area of omentum as possible

Incorporating peritoneum in the pexy

Using suture that lasts long enough for a firm fibrous adhesion to form and that does not promote infection

34
Q

what are potential complications of pyloropexy and omentopexy from the right flank approach

A

Potential complications:

Difficulties finding landmarks

Difficulty moving abomasum

Peritonitis

Recurrence

Omentopexy performed too far from pylorus

Omentopexy breakdown

Pyloric stenosis

35
Q

what are the differences between omentopexy and pyloropexy

A
36
Q

how is the right paramedian approach done and what is the advantages

A

dorsal recumbency

Right of midline (rectus abdominis)

Fixation of the fundus

Allows maximum visibility of abomasum

Ulceration

Good visibility of abdomen

Good success rate (80-95%)

37
Q

how is a right paramedian abomasopexy done

A

Serosal surface, 10-12cm long

Fixation 2-4cm right of insertion of greater omentum

Suture to internal rectus sheath and peritoneum

Nylon continuous pattern

Start caudal and move cranially

Include abomasal serosa and muscularis layer

Do NOT penetrate abomasal lumen

Pay particular attention to closure of external fascial layer (strength holding)

38
Q

what are the potential right paramedian abomasopexy complications

A

Potential complications:

Fistulation at suture site

Wound dehiscence

  • Herniation
  • Can be fatal

Risks of recumbency

Contraindicated in pregnant cows

39
Q

how is the left hand side abomasopexy done

A

Utrecht technique

Incision 10-15cm close to last rib and ventral

Deflate abomasum

Insert suture through the greater omentum and abomasal wall

Push abomasum ventrally and pass needle through the ventral body wall to assist

Repeat ~5cm caudal to 1st suture

Push abomasum to ventral body wall whilst assistant ties 2 suture ends

40
Q

how is the abomasum deflated from the LHS

A

same as RHS

41
Q

what is the success rate of LHS abomasopexy

A

Success rate:

88-93%

42
Q

what are complications of LHS abomasopexy

A

Peritonitis

Ventral fistulation

Milk vein damage

Failure to fix abomasum

43
Q

what are the laparoscopic techniques

A

Two-step

One-step

44
Q

what are the advantages of laparoscopic techniques

A

High success rate (>90%)

Allows visibility of abdomen

Minimally invasive

Short procedure

Small wound six

Quick post op recovery

45
Q

what are the disadvantages of laparoscopic techniques

A

Specialist equipment needed:

  • Initial cost
  • Maintenance

Further training ended

Adjustment to laparoscopic view

Higher cost to farmer

46
Q

what are the potential complications of laparoscopic techniques

A

Reoccurrence (2-3%)

  • Rupture of suture

Rupture of abomasum

Reduced abomasal motility

Peritonitis

Milk vein perforation

Incorrect fixation (1 step)

Risks of recumbency (2 step)

47
Q

compare the DA fixation techniques

A
48
Q

what is a RDA and RAV

A

The abomasum dilates on the right side of the cow, it has the potential to float dorsally with a relatively flat or folded lesser omentum or to twist on the lesser omentum that supports it, creating an abomasal volvulus (RAV)

As gas accumulates in the abomasum the pyloric antrum may begin to move dorsally

The abomasal body may float dorsally along the right body wall

The abomasum and attached structures rotate in a counterclockwise direction around an axis through the centre of the lesser omentum, the cranial duodenum becomes trapped by the distended abomasal body, either between the abomasum fundus and omasum or more cranially between the omasum and reticulum

49
Q

how do you differentiate RDA and RAV

A
50
Q

what are the manifestations of AV

A

Abomasal volvulus (AV)

Omasal-abomasal volvulus (OAV)

Reticulo-omasal-abomasal volvulus (ROAV)

51
Q

what occurs during an abomasal volvulus

A

Twist at the omasal-abomasal junction

52
Q

what occurs during an omasal-abomasal volvulus (OAV)

A

twist at the junction of the rumen and the reticulum

53
Q

what occurs during a Reticulo-omasal-abomasal volvulus (ROAV)

A

Extremely rare

Twist at the junction of the rumen and the reticulum

54
Q

what are the incidences of AV’s

A

~60% are AVs

~40% are omasal-abomasal volvulus (OAV)

55
Q

what is the epidemiology of RDAs

A

Adult female dairy cattle

Less commonly:

  • Calves
  • Males
  • Beef breeds
56
Q

what are the risk factors for RDAs

A

Less well established than LDA

Post-partum risk

  • Lower than LDA

High grain diet in early lactation

Iatrogenic

  • After roll LDA
57
Q

what are the consequences of a RDA + volvulus

A

Severe life threatening condition

Immediate treatment

Surgery

Consequences:

  • Severe dehydration, shock, death
  • Hypochloremia
  • Hypokalemia
  • Metabolic acidosis
58
Q

how is RDA diagnosed from history

A

Depressed feed intake/anorexia

Drop in milk production

59
Q

how is RDA diagnosed from clinical exam

A

Abnormal feces

Decreased rumination sounds

  • +/- decreased rumen size

Auscultation and ballottement of abdomen

  • Ping

+/- dehydration (skin tent/sunken eyes)

HR and RR normal or increased

60
Q

how is an RAV diagnosed

A

as RDA plus

Increased thirst

Tachycardia (>100/min)

Decreased prognosis

Abdominal pain

Palpable distended viscus on rectal (adults)

Palpable distended viscus behind last rib (calves)

61
Q

what is the prognosis of RDAs

A

Simple (right) displacement (DA)

  • ~90% survival

Abomasal volvulus (AV)

  • ~70%

Omasal-abomasal volvulus (OAV)

  • ~55%

Reticulo-omasal-abomasal (ROAV)

  • 0%
62
Q

what are the pre op prognostic indicators of RDA

A

Type of volvulus

HR

Biochemistry

  • Lactate
    • <2mmol/L associated with favourable outcome
    • >6mmol/L associated with negative outcome

Concurrent disease

Metabolic derangements

  • Anoin gap >30mEq/L = poor prognosis
63
Q

what are post op prognostic indicators in RDA

A

Appetite = good prognosis

Postop reduction in lactate = good prognosis

HR <80bpm = good prognosis

Decrease GI motility = poor prognosis

64
Q

how are RDAs corrected (7)

A

Pre-op prep and anesthesia as for LDA

20cm incision, 4cm caudal to last rib

Start 10cm distal to transverse process

Distended abdomen will be the first structure encountered, careful not to accidentally incise

1. Determine if RDA or RAV

  • Follow greater omentum ventral to the descending duodenum and place caudal tension on the omentum by walking hand over hand along the omentum in a cranioventral direction
  • Anti-clockwise: omentum pulled ventrally
  • Volvulus: distended abomasum + fluid

2. Remove air + fluid:

  • Purse string suture in abomasal mucosa
  • Tube through centre of purse string (make stab incision)
  • Tighten purse string suture onto tube
  • DO NOT LET GO OF SUTURE

3. Syphon fluid out

4. Remove tube and pull purse string suture tight to close deficit

  • Avoid abdominal contamination
  • Suture over purse string

5. Correct volvulus if needed

  • Push ventro-laterally, then caudally

6. Fix abomasum in place

  • Omentopexy or abomasopexy

7. Routine wound closure

65
Q

summarize the differences between LDA vs RDA correction

A
66
Q

what is the definition of abomasal ulcers

A

Erosion (superficial defects, mucosal membranes)

Ulcer (defects including muscular layer)

67
Q

what are the differences between primary ulceration and secondary ulceration

A

Primary ulceration:

  • Cause unknown
  • High yielding dairy cows
  • Veal calves

Secondary ulceration:

  • DA
  • Abomasal impaction
  • Other diseases
68
Q

what are the ulcer classifications

A
69
Q

what is the pathogenesis of abomasal ulcers

A

Injury to gastric mucosa

H+ ions diffuse from lumen to mucosa

Pepsin diffuses into mucosa

Imbalance between ulcerogenic and protective mechanisms

70
Q

what are the clinical signs of abomasal ulcers

A

No clinical signs in type I

Melena in type II

Septic shock with type IV

Decreased feed intake and rumination

Cranial abdominal pain

Anemia

71
Q

how are abomasal ulcers diagnosed

A

Clinical signs

Hematology and biochem

Fecal occult blood test (type II)

Abdominocentesis and peritoneal fluid analysis (type III and IV)

Ultrasound (type III and IV)

72
Q

how are abomasal ulcers treated

A

Diet

Oral antacids (magnesium oxide, aluminimum hydroxide)

Cimetidine, ranitidine, omeprazole not licensed in food producing animals

Surgery in perforating ulcers

Supportive therapy

Blood transfusion

NSAIDs?

  • COX sparing like meloxicam
73
Q

what are the types of abomasal impactions

A

Primary

  • Post-parturient dairy cattle
  • Secondary to hypomotility

Secondary

  • Ex traumatic reticuloperitonitis (TRP)
74
Q

what are dietary causes of abomasal impaction

A

Sand

Poor quality roughage

Beef cattle

Cold weather

75
Q

how are abomasal impactions treated

A

5L mineral oil in with 10L water

  • Tube into rumen
  • Once daily for 3-5 days

Surgical correction

  • Right paramedian
  • Abomasotomy
76
Q

what is the prognosis of abomasal impactions

A

Prognosis = guarded to good

Module 21: Ruminant Production (21 decks)

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