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abomasal disorders Flashcards

1
Q

what part of the stomach is the abomasum?

A

glandular stomach

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2
Q

how many times does the abomasum contract a day?

A

18-20x

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3
Q

which part of the stomach predominates in pre-ruminant calf?

A

abomasum

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4
Q

what results in reduced motility of the abomasum?

A 
hypoCa
hypoCl
hypoNa
hypoK
metabolic acidosis
ketosis and acidosis
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5
Q

list the various abomasal dxs

A

check slide 10

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6
Q

where is the abomasum normally located?

A

right ventrum

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7
Q

what types of abomasal displacements are there?

A

left (most common)
right - dilation & volvulus
(also cranial btwn liver & diaphragm but v rare)

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8
Q

explain DA pathogenesis

A
  1. reduced abomasal motility: reduced plasma Ca2+ conc.
  2. gaseous distention
  3. displacement: L/R
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9
Q

when does LDA occur?

A

during transition period

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10
Q

risk factors for LDA

A

breed: dairy > beef
gender: female > male
yield: higher > lower
genetics: motilin gene influences abomasal motility, can affect abomasal displacement risk

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11
Q

external risk factors for LDA

A

immediate pp period
diet
concurrent dx (pp dx)
pp dx can be related to transition diet

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12
Q

pp risk factors

A 
rumen reduces in size in the lat month before calving = cranioventral part of abdomen is more empty than normal 
allows abomasum (if filled w gas) to move across the left because less obs c.f. peri-partum period 
1st 4-6wks pp
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13
Q

dietary risk factors

A

pre-calving diet
reduction in DMI before calving which can result in: ketosis, hepatic lipidosis, NEB
high grain intake pre-calving = high CHO intake
low crude fibre <17%

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14
Q

prevention for LDA

A 
focus on transition period
max. DMI 
prevent pp dx
treat ketosis & other conditions promptly (cow w NEB higher risk of LDA)
min. stress
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15
Q

what is the target LDA incidence for a herd?

A

<3%

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16
Q

when should you start investigating causes of LDA in herd?

A

if overall annual LDA incidence > or = 2%
cluster cases in short time
client concerns

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17
Q

what should you start with for herd approach regarding LDA?

A

transition management:

  • diet
  • stocking density
  • calving management
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18
Q

how to diagnose LDA?

A

hx and CE

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19
Q

what would the hx be like for a cow w LDA?

A

depressed feed intake/anorexia
drop in milk pdtn
recent calving
transition period problems

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20
Q

clinical findings on CE for LDA?

A

abnormal faeces
decreased rumination sounds +/- decreased rumen size
auscultation & ballottement of abdomen: pinging
+/- dehydration (skin tent/sunken eyes)
+/- concurrent dx
HR & RR norm/increased, occasional sinus arrhythmia

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21
Q

other diagnostic methods for LDA

A

abomasocentesis: 10/11th ICS, pH 2-3, no protozoa, small vol
US: last 3 ICS on LHS, ventral to dorsal

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22
Q

DA prognostic categories: group 1

A

gas distension only
HR wnl
excellent px: conservative, no fixation needed

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23
Q

DA prognostic categories: group 2

A

gas distention + <20% fluid
HR < 100bpm
good px: percutaneous fixation - “closed surgery”

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24
Q

DA prognostic cat: group 3

A

gas distension + >/= 20% fluid
HR >/= 100bpm
mod (guarded px): surgical - open (traditional)/laparoscopic

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25
conservative techniques for LDA
medical management | cast and roll
26
explain cast and roll technique
cast cow onto RHS method 1: roll over onto LHS + ballottement of ventral abdo method 2: roll over dorsum then tilt cow 45deg alternately L&R several times before rolling onto LHS hold cow in LLR for 5-10mins before returning to standing/sternal
27
cons of cast & roll technique?
high recurrence rate (>80%) | rolling risks
28
explain percutaneous fixation technique
roll & toggle: 'Grymer/Sterner technique' | blind suture: utilises large suture instead of plastic toggle
29
what is the prep for roll & toggle?
roll to dorsal recumbency: cast on RHS clip from xyphoid to umbilicus LA blebs be quick
30
advantages of roll & toggle?
quick & easy to perform min specialist eq needed inexpensive closed technique = reduced risk of abd contamination reasonable success rate (75% 60d survival)
31
disadvantages of roll & toggle?
``` blind technique: no visualisation of abomasum/abdomen/incorrect fixation rolling risks 2+ assistants needed only suitable if abdomasum freely mobile CI: adhesions present ```
32
potential complications of roll & toggle?
``` incorrect fixation: omentum/rumen/SIs infection & fistulation peritonitis suture breakage = recurrence of DA abomasal obstruction abomasal rupture ```
33
what are the pre-op meds for LDA sx?
abs: broad spectrum - open sx analgesia: NSAIDs - all sx, care if ulceration Ca fluid therapy as needed (can give oral fluid therapy post-op, don't give pre-op)
34
what are the pre-op prep for LDA sx?
adequate restraint +/- sedation regional anaesthesia pre-op clip & scrub: chlorhexidine/iodine, sx spirit
35
what are the various regional anaesthesia methods?
line block inverted L paravertebral - distal/prox
36
list the fixation techniques for DA
right flank approach (standing): pyloropexy, omentopexy (typically) left flank approach (standing): abomasopexy paramedian approach (recumbent): abomasopexy
37
what can be used as a landmark for finding omentum?
"sow's ear" - close to pylorus
38
what are you suturing for omentopexy?
suturing greater omentum to body wall at incision site - locate as close to pylorus as poss.
39
what are you suturing for pyloropexy?
muscular part of pylorus to body wall @ ventral aspect of incision site
40
how to avoid stenosis for pyloropexy?
locate sutures about 5cm cranial to pylorus | avoid entering pyloric lumen!
41
what else might be done tgt w pyloropexy?
omentopexy
42
potential complications for sx techniques?
``` difficulties finding landmarks difficulty moving abomasum peritonitis recurrence (if omentopexy performed too far from pylorus >8cm or omentopexy breakdown) pyloric stenosis ```
43
compare omentopexy vs pyloropexy
success rates abt same: 86-94% redisplacement rate higher in omentopexy (3.6-4.2% vs 3%) omento = indirect vs plyoro = direct fixation risk of omental breakdown in thin cows risk of penetration of pyloric lumen = pyloric stenosis pyloro can result in reduced abomasal motility
44
explain right paramedian approach
``` dorsal recum: xylazine right of midline (rectus abdominis) fixation of fundus allows max visibility of abomasum: ulceration good visibility of abdomen good success rate (80-95%) ```
45
what are you suturing for paramedian abomasopexy?
suture abomasal serosa and muscularis layer to internal rectus sheath & peritoneum
46
potential complications for abomasopexy?
fistulation @ suture site wound dehiscence: herniation (can be fatal) risk of recumbency CI in preg cows
47
where is the incision made for LHS abomasopexy?
10-15cm close to lat rib & ventral | utrecht technique
48
what are the complications for LHS abomasopexy?
peritonitis ventral fistulation milk vein damage failure to fix abomasum
49
what are the advantages of laparoscopic techniques?
``` high success rate visibility of abd min invasive short procedure small wound size quick post-op recovery ```
50
what are the disadvantages of laparoscopic techniques?
specialist eq: initial cost/maintenance further training adjustment to laparoscopic 'view' higher costs for farmer
51
what are the potential complications of laparo tech?
``` 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) ```
52
differentiate between RDA vs AV
RDA: - liver not displaced - no palpable twist - rotation not observable from RHS of animal (during sx) - serosal surface may/may not be covered w omentum (following incision) AV - liver displaced medially - palpable twist - rotation observable from RHS - serosal surface not covered w omentum
53
name the 3 different types of AV
1. abomasal volvulus (60% of cases): twist @ omasal-abomasal junction 2. omasal-abomasal volvulus (OAV) (40% of cases): twist @ reticulo-omasal junction 3. reticulo-omasal-abomasal volvulus (ROAV): v rare, twist @ jn of rumen & reticulum, PM dx
54
RDA epidemiology
adult female dairy cattle less common in: calves, males, beef
55
risk factors of RDA?
pp risk: lower than LDA high grain diet in early lactation iatrogenic: after LDA roll
56
approach to RDA + volvulus
severe life threatening | immediate tx = sx
57
consequences of RDA + volvulus?
severe dehydration, shock, death hypoCl hypoK metabolic alkalosis
58
diagnosis of RDA?
same as LDA
59
diagnosis of RAV?
same as RDA + increased thirst tachycardia (>100/min, worse px) abdo pain palpable distended viscus on rectal (adults) palpable distended viscus behind last rib (calves): painful to palpate
60
what are the surgical sites for RDA/RAV?
20cm incision, 4cm caudal to last rib | start 10cm distal to transverse processes
61
define erosion
superficial defects, mucosal membrane
62
define ulcer
defects including muscular layer
63
types of abomasal ulceration?
primary: cause unknown, high yielding dairy cows, veal calves secondary: DA, abomasal impaction, other dx
64
ulcer classification
type 1: non-perforating ulcers w/o bleeding: no/min. CS type 2: ulcers w bleeding into abomasal lumen: melena type 3: perforating ulcers w local peritonitis: no melena, CS may be min., US type 4: perforating ulcers w generalised peritonitis: no melena, CS non-spe, rectal exam & US decreasing px 1-4
65
pathogenesis of abomasal ulcers
injury to gastric mucosa H+ ions diffuse from lumen to mucosa pepsin diffuses into mucosa imbalance btwn ulcerogenic & protective mechanisms
66
CS of abomasal ulcers?
v variable & non-specific: no CS in type 1 ulcer, melena in type 2, septic shock w type 4 decreased feed intake & rumination cranial abdo pain anaemia
67
diagnosis of abomasal ulcers?
``` challenging! CS haem & biochem faecal occult blood test (type II) abdominocentesis & peritoneal fluid analysis (type III & IV) US (types III & IV) ```
68
tx of abomasal ulceration?
diet oral antacids (magnesium oxide, aluminium hydroxide) cimetidine, ranitidine, omeprazole NOT licensed in food producing animals sx in perforating ulcers supportive therapy blood transfusion NSAID v controversial (can make ulceration worse but only licensed analgesia for cattle)
69
what types of abomasal impactions are there?
primary: pp dairy cattle, 2dary to hypomotility secondary: TRP dietary: sand, poor Q roughage, beef cattle, cold weather
70
tx of abomasal impactions?
5L mineral oil mixed w 10L water: tube into rumen, SID for 3-5d sx correction: R paramedian, abomasotomy px = guarded to good

mod 21 (12 decks)

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