Disease of the abomasum Flashcards
1
Q
What are common problems of the abomasum?
A
- Dilation + displacement =
- Left sided displacement (LDA)
- Right sided dilation + displacement
- Abomasal ulcers
- Geo-sedimentum abomasi (sand)
2
Q
What are risk factors for abomasal problems?
A
- Usually seen in early lactation
- Traditionally in housed but also seen at grass
- “imbalance of fibre and concentrate” – SARA
- Associated with ketosis and FMS
- Hypocalcaemia (clinical & sub-clinical)
- Concurrent inflammatory disease
- Cow comfort, lameness etc etc
- i.e. Anything that reduces DMI
3
Q
What is the most common abomasal disorder?
A
LDA - twisted stomach
4
Q
What are clinical signs of Left displaced abomasum
A
- Reduced milk yield - not as marked or sudden as a wire
- Not reaching expected yield - parlour monitoring
- Ketosis
- Selective appetite - prefers fibre
- Usually 0-4weeks post calving
5
Q
What are Ddx for LDA?
A
- Vagal indigestion
- Peritonitis
- Gas in rumen (starved cattle / bloat)
- ‘Swingers’ (transport)
- May get LDA + another condition
6
Q
What are abomasal sounds?
A
- Spontaneous - tinkling + gurgling
- Ping - tap / flick rib hard + map out area of pings
- Absence of rumen sounds over displaced abomasum
- Fat cows = no ping
7
Q
How can you roll a cow to try fix a LDA?
A
- Cast - right lateral recumbency
- then roll to dorsal
- then roll over to left lateral
- ping to see if moved – can repeat - Good quality roughage
8
Q
What are advantages / disadvantages of rolling cows?
A
- Advantages =
- cheap
- non invasive
- concurrent disease
- Disadvantages =
- Least successful
- ulcer rupture
9
Q
What is toggling?
A
- Place sutures where abomasum naturally lies.
- Clip up before casting.
- Avoid getting you head kicked in!
- Avoid major abdominal blood vessels – mark with pen?
- Ample labour
- Put trochar in to get rid of distension + tie to the side?
10
Q
What are advantages / disadvantages of toggling?
A
- Advantages =
- Cheap
- Minimally invasive
- Relatively straight forward
- Quick
- Disadvantages =
- Going blind
- do not see if abomasum has ulcers / adhesions
- fistula formation
- risk of getting kicked
11
Q
What are surgical methods to fixing LDA’s?
A
- L + R sided approach - 2 operators
- L side (Utrecht)
- R side
- R paramedian approach - cow is cast
12
Q
What is the left to right / bilateral flank approach?
A
- Paravertebral incision 5cm caudal to last rib
- both slide hand down wall of abdomen and shake hands
- Decompress abomasum (manual / needle on flutter valve tube)
- Push abomasum to midline
- Pull up to R incision
- Omentopexy
13
Q
What is the right side approach to a LDA?
A
- Identify pylorus (‘sows ear’)
- Pylorus palpated (‘sausage’)
- Omentopexy using omentum near pylorus
- Stich omentum by pylorus into wound closure
14
Q
What is post-op care of LDA’s?
A
- Antibiotics = pen/strep or Oxytet
- Treat underlying conditions =
- Ketosis = propylene glycol
- Endometritis
- High fibre diet
15
Q
Regarding RDA, What is metabolic sequelae of dilatation?
A
- Pooling of H+ and Cl- in abomasum
- Upper intestinal obstruction = metabolic alkalosis + hypochloraemia
- 35-50L in abomasum
- Dehydration
16
Q
Regarding RDA, what is metabolic sequelae of displacement + torsion?
A
- Mucosal damage
- Cytokine release + endotoxaemia
- Metabolic acidosis
- Severe dehydration
17
Q
What is seen in the dilatation + displacement phase of a RDA?
A
- Inappetent / depressed.
- Reduced faeces.
- Dehydrated.
- Tachycardia.
- Pale MM and dry.
- Doughy rumen – total outflow obstruction
- Reduced rumen turnover.
- Ping (middle to upper 1/3rd right side of abdomen)
- Tense viscus felt cranially per rectum
18
Q
What else is seen with torsion?
A
- Much sicker
- Severe dehydration
19
Q
What are Ddx for RDA + torsion?
A
- Abomasal impaction
- Caecal torsion
- Traumatic reticulitis
- Intestinal obstruction
20
Q
What is Tx of RDA?
A
- Dilatation / displacement =
- medical = Ca 40%, metoclopramide, Buscopan, fluids
- Surgical = drain + replace
- Torsion = slaughter / surgery
21
Q
How is surgery of RDA carried out?
A
- Give fluids pre-op (5L hypertonic saline)
- Balanced fluids during surgery
- Purse string suture, tube + drain
- Rotate abomasum, watch duodenum, anchor pylorus + stitch up
22
Q
What is post op care?
A
- Fluid therapy = 50-100L
- NSAIDs
- Antibiotics
- Oral KCl
- Ca 40%
- Propylene glycol
23
Q
How can you prevent RDA + LDA’s?
A
- Better dry cow management
24
Q
What is seen with intestinal conditions?
A
- Sudden milk drop
- Anorexia
- Ruminal stasis
- Abdominal pain
– Kicking flank
– Getting up and down - Minimal passage of faeces
- Palpation of loops of intestine per rectum
- Mild right sided bloat
25
What are Ddx for intestinal conditions?
* Intestinal obstruction
* Foreign body,
* Intestinal volvulus/torsion
* Intussusception
* Intestinal incarceration or strangulation
* Intestinal neoplasia
* Jejunal haemorrhage syndrome
* Peritonitis
* Acidosis
26
How is mesenteric volvulus diagnosed?
* Clinical signs - abdominal discomfort
* Palpation per rectum – Dilated loops of intestine enough to justify an exploratory laparotomy?
* Ultrasound
* Peritoneal fluid tap?
* Post mortem – may be a series of cases so useful
27
When would you perform surgery with mesenteric volvulus?
* Rapidity of deterioration
* Severity of colic and its response to analgesia
* Severity of the abdominal distention
* Absence of faecal output
* Heart rate
* Rectal palpation findings
* Blood lactate
* Blood Calcium – if low treat medically initially
28
What is jejunal haemorrhagic syndrome? CS? Tx?
* Clostridium perfringens type A toxin
* CS = Anorexia + lethargy
*Tx = Massage clots to move them on - Not v successful
29
What is noted on history of caecal dilatation?
* Dairy cow.
* 1st few months of lactation.
* Inappetent.
* Decreased milk yield.
* Ping in dorso-caudal right sublumbar fossa.
* Rectally = Distended, recognisable viscus into the pelvis
* Anorexia
* Reduced faeces
30
What is aetiology of caecal dilatation + volvulus
1. Excess carbs fermented in caecum =
2. Increased VFA, reduced pH =
3. Caecal atony =
4. Accumulation of ingesta and gas
= dilatation + torsion
31
CS of caecal dilatation + volvulus?
1. Anorexia
2. Mild abdominal discomfort.
3. Reduced milk yield.
4. Reduced faeces.
5. Ping (right sublumbar fossa)
6. Dehydration.
7. Tachycardia.
8. Abdominal pain
32
On rectal exam how do you tell the difference between distension + volvulus?
* Distension = Long cylindrical, movable organ. Blind end points to pelvic cavity.
* Volvulus = Points cranial and lateral or medial
33
How would you treat Caecal dilatation?
* Medically = good quality hay, TLC + monitoring hydration + HR (Only if not severe)
* Surgery = determine if torsion, purse string suture, small incision, milk caecal content out,
- deflate + correct torsion + suture up
34
What can cause abomasal ulcers?
* Other diseases = BVD
* NSAID use
* Lactating dairy cows = early lactation =
- stress of lactation
- high levels of grain
- increased incidence at grass
* Mature bulls + feed lot cattle =
- stressful events = transport, surgery, fractures
* Handfed calves = common at weaning
35
What are different types of secondary cases (LDA/RDA/vagal indigestion)?
* Type 1 = non-perforating, minimal amounts of intra-luminal haemorrhage
* Type 2 = major blood vessel perforates, severe blood loss, melena
* Type 3 = perforating ulcer, acute, local peritonitis, peritonitis localised by greater omentum
* Type 4 = perforating ulcer, diffuse peritonitis
36
Where do cattle / calves tend to get ulceration + perforation in the GIT?
* Cattle = fundic ulceration
* Calves = Pyloric ulceration
37
What are CS of fundic/pyloric ulcerations?
1. Abdominal pain.
2. Melena
3. Pale MM.
4. Sudden onset anorexia
5. Tachycardia
38
What is Tx of pyloric/fundic ulceration + perforation?
* Antacids = magnesium oxide + aluminium hydroxide
* Blood transfusion / fluids (20ml/Kg BW)
* Surgical excision - excise / oversew - NO NSAIDs
39
