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540 (cow class) > Abomasal Displacement & Volvulus > Flashcards

Abomasal Displacement & Volvulus Flashcards

1
Q

Define LDA

A

left displaced abomasum

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2
Q

Define RDA

A

right displaced abomasum

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3
Q

Define RTA

A

right torsion of the abomasum (used interchangeable with right abomasal volvulus)

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4
Q

define antro pexy

A

pexy of the antral portion of the abomasum

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5
Q

define pyloro pexy

A

pexy of the pylorus (not commonly done due to risk of stricture formation)

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6
Q

define abomasal pexy

A

pexy of the abomasum

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7
Q

define omental pexy

A

pexy of the greater omentum

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8
Q

LDAs are a _____ issue.

A

management

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9
Q

most abomasal displacements are ____s.

A

LDAs

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10
Q

DAs are most likely to occur… when? why?

A

at start of lactation, or 45 days after calving. because this is when peri parturient diseases take place

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11
Q

what signalments of cows are more likely to get DAs ?

A
  • holsteins, Ayrshires, guernseys
  • large abdominal cavities
  • age 4-7 (multiparous)
  • start of lactation, after calving
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12
Q

what the risk factors predisposing to DAs?

A
  • spring szn
  • rapid change in diet
  • decreased exercise
  • high concentrate diet
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13
Q

what diseases increase risk of getting DAs? tell me one word for each as to why this predisposes to DAs

A
  • hypocalcemia - motility
  • ketosis - appetite
  • retained placenta - appetite
  • metritis - appetite
  • mastitis - appetite/motility
  • endotoxemia - appetite
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14
Q

describe the pathophys of DAs

it is a multifactorial syndrome based on ____.

A

hypomotility

decreased appetite –> small rumen –> decreased motility –> abomasal atony –> microbial fermentation –> gas production –> displaced abomasum

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15
Q

tell me the pathway of the abomasum during an LDA

A

abomasum fills up with gas and. becomes distended, then slips under the rumen to the left and goes to the left

creates a partial pyloric outflow obstruction

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16
Q

tell me the pathway of the abomasum during a RDA

A

abomasum becomes gas distended, floats dorsally (it’s already on the R)

creates a partial pyloric outflow obstruction

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17
Q

DAs create what metabolic derangement? why?

A

metabolic alkalosis w/ paradoxic aciduria

HCl produced in abomasum, because of pyloric outflow obstruction, HCl is trapped in abomasum, so you get metabolic alkalosis.

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18
Q

tell me the pathway of the abomasum during an RTA

A

abomasum becomes gas distended, floats dorsally (it’s already on the right) – starts as a RDA

twists counterclockwise when viewed from behind

additional counterclockwise turn when viewed from above

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19
Q

RTAs may include the ____.

A

omasum

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20
Q

why are RTAs so much worse than RDAs?

A

RTAs create a complete pyloric outflow obstruction, while RDAs create a partial pyloric outflow obstruction

RTAs cause vascular compromise and potential tissue revitalization

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21
Q

true or false: an animal with signs of colic is never alright until morning, and usually requires immediate surgical intervention.

A

TRUE!!!!!!!

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22
Q

how do you diagnose an LDA/RDA/RTA? general

A

PE
- auscultation/percussion
- succussion
- rectal

can use BHBA test, stall side Ca test (v expensive), blood lactate

can technically do CBC/chem, but it would be ridiculous to (but values might show up on NAVLE)

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23
Q

tell me about the HR when cow has LDA/RDA/RTA

A

potentially normal for RDA/LDA

tachycardia for RTA

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24
Q

tell me about the rumination when cow has LDA/RDA/RTA

A

RDA: usually still present

LDA: usually still present. harder to hear b/c of rumen displacement by distended abomasum

RTA: absent

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25
Q

tell me about temp when cow has LDA/RDA/RTA

A

usually normal

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26
Q

tell me the C/S for LDA

A

decreased appetite –> decreased rumen motility

decreased milk production

hyperketonemia

feces normal or slightly softer

rectal temp = N

resp = N

pulse = N

rumen contractions decreased (Hard to hear)

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27
Q

tell me the C/S for RDA/RTA

edit: this is more for RTA!!

A

decrease appetite

feces absent or scant

sunken eyes

HR=elevated

weak pulse (poor venous return)

bilateral abdominal distention

ruminal stasis & bloat

colic

8th rib –> middle paralumbar fossa ping and succession

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28
Q

tell me about the bloodwork with an LDA

A

alkalotic
increase bicarb
hypochloremia
hypokalemia
hypoglycaemia
ketonemia
stress leukogram

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29
Q

tell me about the bloodwork with an RDA/RTA

A

hypovolemia
dehydration
hemoconcentration
hyperglycaemia
metabolic alkalosis
hypochloremia
hypokalemia
hypocalcemia
hyponatremia

paradoxic aciduria

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30
Q

what do you expect to hear upon auscultation and percussion with an LDA/RDA/RTA?

A

high pitched “hyper resonant” metallic ping (caused by gas)

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31
Q

where do you auscultate and percuss on PE?

A

above and below the line made from the tuber coxa to just above the olecranon

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32
Q

other than DAs, what conditions cause a “false ping”? how do you rule them out?

A

gas filled rumen on L, pneumorectum

do a rectal exam

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33
Q

why do we do a rectal exam last?

A

introduces air

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34
Q

what do you expect to feel on a rectal for an LDA/RDA/RTA?

A

you can feel the displaced abomasum if quite large

feces dry (decreased passage of ingesta)

35
Q

How do you differentiate b/t RDA and RTA?

A

RTA will be an emergency, cow will be in shock (high HR, dehydration, hypovolemia, etc)

36
Q

what are the ddx for an LDA? (left side ping and possible distension)

A

ruminal tympany
pneumoperitoneum

37
Q

what are the ddx for an RDA (right side ping and possible distension)

A

cecal distention
gas in spiral colon
pneumorectum
pneumoperitoneum
physeometra

38
Q

what is the general tx of choice for LDA, RDA, and RTA?

A

surgery

39
Q

for DA sx, where do you make your incision? how big?

A

paralumbar fossa, at least one hand from transverse process, mid paralumbar fossa, ensure a few inches caudal to 13th rib at ventral end) antro-pexy benefits from a lower incision)

20cm incision (may enlarge if required)

40
Q

when you make your incision for repairing an LDA or RDA, what layers are you cutting through? from outside to inside

A

skin + sq
external abdominal oblique
internal abdominal oblique
transverse abdominus + peritoneum

41
Q

tell me how you’re going to make your incision in the paralumbar fossa for a right-sided sx to fix an LDA or RDA. like when you go through each layer, what do you do?

A
  1. skin + external abd. oblique: sharp dissection
  2. internal abd. oblique + transverse abdominius: blunt dissection (preferred) or careful sharp dissection
  3. transverse abdominus + peritoneum: blunt dissection
42
Q

tell me the broad steps to fixing an LDA using the right flank approach

A
  1. incision
  2. quick exploratory
  3. approach - find the abomasum
  4. reduction - deflate and move abomasum
  5. perform pexy
  6. close
43
Q

fixing LDA using right flank approach:
what are you doing during the quick exploratory part?

A

looking for adhesions
palpating liver and omasum

44
Q

fixing LDA using right flank approach:
what are you doing during the approach part?

A
  1. move to caudal abdomen with L hand
  2. pass around omental sling and under L kidney
  3. move up and around caudal dorsal rumen until you hit L body wall
  4. move cranially until you feel distended viscous of the abomasum
45
Q

fixing LDA using right flank approach:
what are you doing during the reduction part?

A
  1. passive or active deflation - use large bore (10-12ga) needle attached to sterile tube or vacuum pump
    remember to guard needle on the way to abomasum and kink/guard upon removal
  2. L hand placed on top of abomasum, gently push it under rumen

alternatively, gently pull on greater momentum at 45 degree angle until you pull abomasum under rumen

46
Q

why do you deflate the abomasum before moving it under the rumen?

A

reduces trauma upon reduction attempts

47
Q

fixing LDA using right flank approach:
when is the reduction part done?

A

when you can visualize the pyloric antrum at the incision site

48
Q

what are the pros to using the right flank approach to fixing an LDA?

A
  • can be done standing
  • can be done w/o assistance
  • can do through abdominal explore
  • useful for LDA, RDA, RTA, and other intestinal accidents
49
Q

what are the cons to using the right flank approach to fixing an LDA?

A
  • hard to navigate a late term pregnancy
  • adhesions from abomasal ulceration and peritonitis are harder to visualize and navigate from the R side
50
Q

tell me the broad steps to fixing an RDA using the right flank approach

A
  1. incision
  2. quick exploratory (?)
  3. ID abomasum
  4. ID if displaced or volvulus
  5. reduction - deflate and move abomasum
  6. pexy
  7. close

right flank approach is the only way to do it

51
Q

how do you ID the abomasum while fixing an RDA using the right flank approach?

A

ID the gas filled viscous immediately cranial to your incision against the R body wall

52
Q

how do you know if the abomasum is in volvulus or just displaced when going from the right flank to fix an RDA/RTA?

A

move hand down medial side of distended abomasum

if you can run your hand down the medial aspect until you reach the abdominal floor, it’s just displaced

53
Q

tell me the broad steps to fixing an RTA using the right flank approach

A
  1. incision
  2. quick exploratory (?)
  3. ID abomasum
  4. ID if displaced or volvulus
  5. reduction - deflate, untwist, move abomasum
  6. pexy
  7. close

right flank approach is the only way to do it

54
Q

describe the reduction part of the sx to fix an RDA using the right flank approach?

A
  1. passive/active deflation using large bore (10-12ga) needle attached to sterile tube or vacuum pump
    must guard needle on the way in and kink/guard on the way out
  2. L hand placed on top of abomasum and gently pushed down, correcting CCW twist
  3. gently pull on greater momentum or pylorus at 45 degree angle until you pull the abomasum up to the incision site
55
Q

fixing RDA using right flank approach:
when is the reduction part done?

A

when you can visualize the pyloric antrum at the incision site

56
Q

describe the reduction part of the sx to fix an RTA using the right flank approach?

A
  1. passive/active deflation using large bore (10-12ga) needle attached to sterile tube or vacuum pump
    must guard needle on the way in and kink/guard on the way out
  2. correct CCW twist as seen from above by moving abomasum in CW direction
  3. correct CCW twist as seen from behind by moving abomasum in CW direction
  4. gently pull on greater momentum or pylorus at 45 degree angle until you pull the abomasum up to the incision site
57
Q

why is it especially important to deflate abomasum before fixing an RTA?

A

abomasum is often fluid filled and impossible to reduce without emptying

58
Q

fixing RTA using right flank approach:
when is the reduction part done?

A

when you can visualize the pyloric antrum at the incision site

59
Q

with an RTA, should you correct the electrolyte imbalances and fluid loss before or after sx?

A

before

60
Q

before closing while fixing an RTA, should you check the tissue viability?

A

yes!
euth cow if tissue compromised

61
Q

for LDA/RDA/RTA, the pexy part is the same. what are the 2 ways to do the pexy?

A

omentopexy
pyloro/antero-pexy

62
Q

describe an omentopexy

A
  1. 2 horizontal mattress sutures (3 chromic gut) are placed in the greater momentum approx. 1 inch from greater curvature of abomasum
  2. sutures anchored through the transverse abdominus/peritoneum at the cranial ventral aspect
  3. greater omentum is incorporated into the closure of the T. abdominus
63
Q

why is the greater omentum incorporated into the closure of the transverse abdominus during an omentopexy?

A
  • allows for close anatomic anchoring of abomasum
  • no chance of causing iatrogenic pyloric obstruction or abomasal leakage (no suture placed in abomasum)
64
Q

what is the risk when performing an omentopexy?

A

omentum can stretch/tear, resulting in recurrence of displacement

65
Q

describe an pyloro/antro-pexy

A
  1. horizontal mattress sutures placed in pyloric antrum, 3-5cm proximal to pylorus - do not take full thickness bites only seromuscular bites
  2. sutures anchored through the transverse abdominus/peritoneum at the cranial ventral aspect
66
Q

why should you not take full thickness bites while performing a pyloro/antro-pexy?

A

to reduce occurrence of fistula formation

67
Q

when should you choose a pyloro/antropexy over an omentopexy?

A

in fat cattle (bc their omentums are more fragile or torn)

68
Q

toggle suture surgery is only performed when there’s an ____.

A

LDA

69
Q

performing a toggle surgery when there’s an RDA results in what?

A

may result in volvulus

70
Q

when a cow is rolled on her back and slightly left, what happens to her abomasum?

A

back: abomasum floats to ventral abdomen

left: abomasum floats into a R paramedian position

71
Q

give me the step by step to a toggle suture

A
  1. cow cast on R side
  2. 3-6 in caudal to xiphoid & 3-6 in R of midline = prepped
  3. surgeon or assistant applies pressure to caudal abdomen
  4. ID abomasum by percussion/auscultation
  5. trocar placed over ping caudal to xiphoid and medial (R) of midline avoiding large vessels
  6. trocar quickly and forcefully pushed through body wall and into abomasum
  7. remove handle, reinsert stylet, keeping gas from escaping with a finger over trocar
  8. confirm abomasal placement by smell or pH (should be acidic)
  9. remove stylet, push 1st suture through w/ stylet, remove trocar, clamp 1st suture w/ hemostats so you don’t lose it
  10. place 2nd suture 2-3in cranial-medial to first
  11. evacuate gas, THEN remove trocar
  12. tie ends together using a button (or similar), 3-4 in of slack b/t button and abdominal wall
  13. roll cow completely over CW from the rear
  14. admin tx and allow to rise
72
Q

why do you evacuate the gas before removing the trocar in a toggle suture procedure?

A

you don’t want there to be a big tug on the suture from inflated abomasal and rip out the suture

73
Q

what are the pros to using the toggle suture technique to fix an LDA?

A
  • cheaper than sx
  • quicker w/ less prep and clean up
  • if successful (and case dependent), faster recovery and less peritonitis
  • less muscle trauma
74
Q

what are the cons to using the toggle suture technique to fix an LDA?

A
  • blind technique
  • sutures can rip out
  • requires additional help
  • reserved for “loser cases”
  • adhesions prevent success
  • cow is now down
75
Q

what is the medical therapy option to fix an LDA?

A

rolling
but this results in 70% recurrence

76
Q

what are the post-sx treatments?

A

IV fluids - Ca2+ SQ for hypocalcemia, hypertonic solution so they get up and drink

pump rumen - K, Na, etc. to help rumen function

antibiotics and pain mitigation

77
Q

true or false. there is an association between LDA surgical procedure and longevity in the herd.

A

FALSE! THERE IS NO ASSOCIATION!

78
Q

a cow with dystocia and low BHBA that has an LDA is (more/less/the same) likely to be culled within 60 days

A

more

79
Q

true or false. blood calcium is NOT predictive of success of LDA sx

A

TRUE!!

80
Q

a cow with an RDA/RTA with a HR >100 bpm had a 56% of what?

A

being salvaged, euthanized, or dying

81
Q

how does blood lactate dictate RDA/RTA prognosis?

A

pre-sx lactate <2mmol/L = good outcome

pre-sx lactate >6mmol/L = poor outcome

82
Q

which is the better prognostic indicator of RDA/RTA, HR or lactate?

A

lactate

83
Q

how does chloride dictate RDA/RTA prognosis?

A

hyperchloremia = more likely to be culled within 30 days

84
Q

what are the possible complications of fixing displaced abomasums?

A
  • dehiscence and SSI
  • omentopexy failure and re-displacement
  • peritonitis
  • fistulation (full thickness antropexy)
  • pyloric stricture w/ pyloropexy
  • hemorrhage - trocar misplacement

540 (cow class) (32 decks)

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