Differential diagnosis of right sided pings in cattle

Question 1

DDx of left sided pings - 7

Answer 1

• RDA and volvulus
• caecal dilatation and volvulus
• pneuomoperitoneum
• pneumorectum
• distension of proximal colon
• peritonitis
• omental bursitis

Question 2

Is LDA or RDA more acute?

Answer 2

RDA most acute. Always consider potentially fatal. Don’t let the sun go down on an RDA!

Question 3

Aetiology - RDA

Answer 3

Abomasal atony factors (high concentrate/low fibre rations, periparturient disease and genetic selection) but it is a complex process - progression from simple dilattaion to dilatation and displacement and finally volvulus (complete occulsion of organ and BVs). This is therefore a more serious life-threatening metabolic condition, which requires prompt treatment

Question 4

Signs of right dilatation and displacement

Answer 4

sudden onset anorexia and milk drop, no rumination, sprung last rib (RHS), intial scour (maybe) followed by reduced pasty faeces with a rancid odour

Question 5

Signs - of following volvulus

Answer 5

Cessation of faecal output, normal-low temperature, HR (brady to tachycardia 60-110), dehydration with sinking of eyes, normal/reduced resp rate, cool extremities, death

Question 6

Prognosis - RDA

Answer 6

Pyrexia and inter-current disease such as metritis indicate a poor prognosis

Question 7

Diagnosis - RDA and volvulus - 3

Answer 7

• Auscultate/percuss - ping, extends cranially to 9th ICS (differentiates it from gas in proximal colon or caecum). Tinkle on ballotment.
• Rectal - distended organ may be palpable
• Clinical path - severe hypochloraemic, hypokalaemic metabolic acidosis (i.e. same as LDA). The lower the chloride levels, the more severe the prognosis (esp. <75mMol/l carry a poor prognosis). Ketosis and hypocalcaemia may also be present.

Question 8

Treatment - RDA

Answer 8

Medical or surgical
Medical = metoxlopramide or buscopan compositum
Surgical = right flank correction and omentopexy,

Question 9

Fluid therapy - RDA

Answer 9

Isotonic saline 30L via IV is beneficial if dehydrated

Continue with oral fluids 20-40L with 100g potassium chloride BID

Question 10

Post-op care RDA

Answer 10

Generally slower to recover than LDAs. Keep on hay or silage only for 7d before introducing concentrate

Question 11

Complications of RDA? 2

Success rate?

Answer 11

Volvulus –> vascular thrombosis (along greater curvature), vagal indigestion (wait 4d before offering prognosis after surgery).
Success rates usually around 40% (30-80%)

Question 12

What is caecal dilatation and volvulus a form of?

Answer 12

Segmental ileus

Question 13

Aetiology - caecal dilatation and volvulus?

Mechanism of this problem?

Answer 13

Factors causing abomasal atony (high concentrate/low fibre rations, periparturient disease, genetic selection). Most commonly present in early lactation in cows on a high concentrate diet or on lush pasture. Fermentation occurs and gas formed dilates the ccaecum, looses stability, apex rises, free distal end not supported by mesentery so rotates causing a volvulus. Vascular compromise and necrosis follow. Rarely, intraluminal haemorrhage may occur

Question 14

Signs -caecal dilatation and volvulus? 5

Answer 14

Rapid onset anorexia and milk drop
decreased faecal output
TPR normal
filling of the right paralumbar fossa
absence of rumination

Question 15

Signs - as volvulus occurs

Answer 15

Colic, dehyrdation and sinking of eyes, tachycardia (80-100)

Question 16

Diagnosis - RDA

Answer 16

• Auscultation/percussion - ring in right caudal abdomen, extends forward no further than first three caudal rib spaces. Ballotment often results in a tinkle.
• Rectal examination - large distended gas filled ‘sausage’ may be palpated filling the pelvic cavity. Occasionally free end of ceacum is deflected ventrally, cranial to pubic brim,. so only gas filled base may be palpable. Free end may also be displaced dorsally and cranially.
• Clinical pathology - mild metabolic alkalosis

Question 17

Treatment - RDA -2 When are each indicated?

Answer 17

Medical or surgical:

• Medical (if normal HR, not total anorexia, some faeces passed and dehydration is absent/mild) - take off concentrate (5-7d), buscopan (30mls IV,2 doses, 12 hour intervals) Also neostigmine (unlicensed - cow)
• Surgical (if raised HR, total anorexia and no faecal output, dehydration and colic). Administer IV fluids with flunixin meglumine and correct surgically (right flank laparotomy)

Question 18

Recurrence rate of caecal dilatation and volvulus after right flank laparotomy

Answer 18

10-20% cases

Question 19

Post-op care (right flank laparotomy)

Answer 19

keep on roughage and laxatives before introducing concentrate feed after 5-7 days.

Question 20

Aetiology - pneumoperitoneum

Answer 20

Ruptured abomasal ulcer (usually)

tearing of uterine wall at calving

Question 21

Sings - pneumonperitoneum

Answer 21

Bilateral abdominal distension
Dull ping high in abdominal cavity on both sides
Perforated ulcer may –> abdominal pain, fever etc.

Question 22

Pneumorectum = sign, not illness. Diagnosis

Answer 22

Always auscultate before performing a rectal exam or you will hear a ping on RHS, which must be differentiated forma caecal distension. Some cows will rectovaginal tears may suck in air spontaneously

Question 23

Distension of proximal colon - signs

Answer 23

right sided ping tucked into the costal arch in the paralumbar fossa. Ping doesn’t extend cranially to 9th rib (vs RDA), and a distended caecum will not be palpable per rectum. This reflects intestinal stasis. You must find out cause of this.

Question 24

Signs of peritonits

Answer 24

Accompanying ileus will result in multiple ping sover the right flank due to gas pockets forming in loops of intestine.

Question 25

What is omental bursitis a sequel to?

Answer 25

Ruptured abomasal ulcer on the lesser curvature and filling of the omental recess with pus and fluid. Leads to massive low abdominal swelling and compression of viscera.

Question 26

Diagnosis - omental bursitis

Answer 26

Multiple pings on right abdomen.
laparotomy - a firm viscus is palpable in the ventral abdomen
strings of fibrin throughout the omental recess
viscus = pus formed between the two layers of the omentum

Question 27

Treatment and prognosis - omental bursitis

Answer 27

Drainage of the omental pocket via a ventral abdominal approach.

Poor prognosis