Ikke-infektiøse lidelser i fordøjelseskanalen hos kvæg Flashcards

Question

Kan rumen/vommen mærkes ved rektalundersøgelse?

Answer 1

1) Moderate degrees of free gas accumulationare often more easily detectable per rectum. 2) Palpation per rectum is also useful in distinguishing the presence of an L shaped rumen, in which the ventral sac of the rumen is grossly distended in cases of vagalindigestion. It is important to differentiate an L-shaped rumen from either abomasal distention or impaction, which can display a similar external abdominal contour. 3) It is also important to palpate for the size of the lymph nodes in the longitudinal groove of the rumen. These can enlarge to prominent size when rumenitis is present.

Answer 2

External palpation using both hands can be valuable in these animals. In calves and goats it is the best method for detecting **bezoars** or **clotted clumps of milk** in the rumen and for palpating **intussusception**, **umbilical abscesses**, or g**rossly abnormal kidneys.** A bezoar /ˈbiːzɔər/ is a mass found trapped in the gastrointestinal system (usually the stomach), though it can occur in other locations. An intussusception is a medical condition in which a part of the intestine has invaginated into another section of intestine, similar to the way in which the parts of a collapsible telescope slide into one another.[1] This can often result in an obstruction.

Answer 3

Palpation of the left paralumbar fossa reveals the presence of ruminal contractions. In a normal animal, three contraction s should occur over a 2-minute period. One of these contractions should be associated with an eructation of gas, which can be appreciated both visually and audibly.

Answer 4

The motility pattern is characterized by changes in both **frequency** and **strength**, and weak contractions can also be detected by palpation .

Answer 5

Some cases of secondary indigestion, in which the decreased ruminal function is a result of **inappetence** rather than an inhibition of ruminal motility, show **a normal contraction frequency but decreased contraction strength**.

Answer 6

Decreased ruminal fill, decreased fiber content of the ingesta, or overdistention of the ruminal wall musculature results in reduced strength and duration of the contraction sequence.

Answer 7

Ved palpation og auskultation, og sammenligne de to.

Answer 8

The ruminal contents of animals fed a high-concentrate diet produce less sound because very-low-fiber rations induce **weaker contractions** and because **less fibrous material is in contact with the ruminal wall.**

Answer 9

The ruminal motility pattern is disrupted in vagal indigestion. Although contractions are present and maybe more frequent than normal, their lack of normal coordination can lead to a churning (kværning) of the ingesta without the usual progression of transport. This disrupts the normal stratification of the contents and produces abnormal sounds that are heard as a rumbling, bubbling, or splashing.

Answer 10

When stratification is disrupted because of a hypoactive rumen and more fluid is present in the dorsal area of the rumen, contractions produce splashing sounds.

Answer 11

The accumulation of gas (i rumen) under these circumstances may produce ringing tones as the fluid moves, similar to the pings found with a displaced abomasum.

Answer 12

Some circumstances require a distinction between primary and secondary contraction cycles, and they can be differentiated by ausculting for reticular contractions. Holding the stethoscope at the seventh intercostal space at the level of the costochondral junction, the examiner can detect a tinkling fluid sound as the reticulum contracts. A hand held in the para lumbar fossa (hungergruben) can detect the tensed bulging of the dorsal sac as it contracts, allowing the examiner to determine if the ruminal contraction is associated with a reticular contraction. Reticular contraction and motility can also be assessed by transabdominal ultrasound.

Answer 13

Combining the auscultation with percussion or ballottement allows assessment of gas or fluid accumulations. The sounds heard in the left flank should be compared with those in the left rib area and right side of the abdomen.

Answer 14

High-pitched pings and fluid tinkling sounds suggest a viscus filled with gas and fluid. In the left flank th is may represent a displaced abomasum, gas-forming abscess, pneumoperitoneum, or static rumen.

Answer 15

Generally the rumen can be ruled out as the source of pings if palpat ion reveals normal doughy ruminal contents, no ruminal tympany is felt per rectum, and sounds of normal ruminal contractions are heard in the paralumbar fossa.

Answer 16

Prolonged anorexia associated with infectious or inflammatory diseases such as pneumonia or mastitis can result in a staticunderfilled rumen, and occasionally a prominent ping can be ausculted in the left flank. where a filled rumen normally would be found. This condition has been called "ruminal collapse," and careful evaluation is required to distinguish it from **left-displaced abomasum (venstresidet løbdrejning)**.

Answer 17

Ballottement of the rumen may reveal splashing fluid sounds without a high pitch in cases in which the rumen has accumulated significant fluid. This occurs frequently in cases of **severe ruminal acidosis**.

Answer 18

Tests of pain sensitivity in the anterior abdomen (percussion, deep palpation, withers pinch, xiphoid pressure) are performed to examine for localized **peritonitis caused by TRP** or **abomasal ulceration.** The same procedures, especially percussion or application of pressure to a localized area in the ventral abdomen, can be used to localize pain associated with **rumenitis** or **ruminal abscessation** or **perforating abosomal ulceration.**

Answer 19

NEJ The feces are abnormal in most cases of forestomach dysfunction.

Answer 20

In adult cattle, passage of ingesta through the digestive tract requires 1,5 to 4 days. Changes in the feces caused by **acute diseases** therefore are often delayed by a day or longer beyond the first appearance of other clinical signs.

Answer 21

Diseases that reduce the flow of ingesta from the rumen to the lower gastrointestinal tract typically result in feces of reduced volume that are firm (fast) and dry (pga større resorption af vand). These findings are also present with reduced feed or water intake.

Answer 22

In severe instances the feces form into firm disks or balls with a dark, shiny mucous covering. These findings are typical of **vagal indigestion** and **forestomach diseases that produce ruminal stasis** without a grossly abnormal fermentative pattern.

Answer 23

Intestinal obstructions also decrease fecal passage to the point of absence, but usually the material passed also presents other gross abnormalities such as blood. melena, or discolored mucus.

Answer 24

Plant fibers in normal bovine feces measure up to 0.5 cm. Particles with inadequate breakdown may measure 1 to 2 cm or longer. This long particle size may be seen in the feces of cattle with **TRP**, some cases of **vagal indigestion,** and **poor-quality roughage (grovfoder) with insufficient microfloralactivity.** Similar findings occur with **tooth disease** and some cases of **abomasitis** or **cellulitis at the cardia or esophageal groove**, in which rumination or activity of the retlculoomasal orifice is inhibited.

Answer 25

Whole cereal grains (especially whole corn) may pass in the feces of normal cattle. but excessive amounts of grain should raise suspicion of excessive intake and **acute ruminal addosis**.

Answer 26

Feces with an abnormally fine particle size and greasy-pasty texture are associated with delayed passage from the forestomach. These are common findings in most cases of **vagal indigestion** and **abomasal displacement.**

Answer 27

Foamy, fluid feces with a yellow-brown color and acidic smell are typical of **ruminaI lactic acidosis** in adult cattle.

Answer 28

Abnormal ruminal fermentation not only produces feces with **abnormal odor** but also typically leads to a pasty or fluid consistency as well. Thus abnormal odor typically occurs when the ruminal fermentation pattern is altered, as in simple indigestion caused by **abnormal feed, ruminal acidosis, ruminal alkalosis, or ruminal content putrefaction (forrådnelse).**

Answer 29

Frothy bloat (see p. 855) and acute ruminal lactic acidosis or grain engorgement (overfyldning). The severe form of indigestion leads to severe systemic involvement, with depression, severe dehydration, weakness, recumbency, profuse (voldsom) diarrhea, and eventually death

Answer 30

In cattle with intermediate degrees of rumina! acidosis, other signs may develop secondarily. **Acute or chronic laminitis **is a common complication.

Answer 31

**Bradycardia** of 40 to 60 beats/min is frequently associated with certain types of indigestion. The bradycardia can be alleviated (afhjulpet) by subcutaneous administration of 30 mg of **atropine**, differentiating increased vagal nervetone from a primary cardiac conduction disturbance. Recognition of bradycardia in association with other signs of ruminal dysfunction is probably most useful as evidence that stimuli for an increased heart rate, such as inflammatory, infectious, or fluid balance disturbances, are not prominent factors in individual disease occurrence.

Answer 32

Animals with advanced cases with severe abdominal distention or fluid imbalances (or both) frequently show elevated heartrates (over 80 beats/min) .

Answer 33

Vomiting is uncommon in ruminants, but when it does occur, it generally reflects **forestomach disease.** **Explosive vomiting of fluid ingesta in large quantity** occurs when the reticulorumen is irritated and occasionally when it is overdistended. Vomiting may accompany diaphragmatic herniation of the reticulum, inflammation of the reticulorumen caused by actinobacillosis, vagal indigestion, or obstruction of the reuculoomasal orifice. Vomiting also occurs with certain intoxications , most notably azalea, rhododendron, and sneezeweed toxicity and some organophosphate toxicities .

Answer 34

Evaluation of ruminaI fluid characteristics is an essential procedure in establishing the cause of the indigestions of abnormal fermentation. Needle puncture of the ventral rurninalsac (rumenocentesis) may yield a satisfactory fluid sample. Oral or nasal passage of a collection tube. Ruminal fluid samples collected in an expeditious (hurtig) manner yield the most useful results. When the animal strongly resists sampling and a prolonged time is required from introduction of the tube until the fluid is obtained, saliva contamination of the sample increases. This contamination alters the pH and consistency of the sample. The sample should be evaluated as soon as possible after collection to minimize the effects of cooling and air exposure on protozoal activity and pH. The more elaborate (omfattende) chemical tests such as chloride, acid, and ammonia concentrations can be delayed up to 9 hours for a room temperature sample and up to 24 hours for a refrigerated sample and still yield reliable results.

Answer 35

Fluid from cattle with acidosis tends toward a milky gray.

Answer 36

Ruminal fluid from animals with prolonged stasis or decomposition of the ruminal ingesta (or both) is a darker greenish black.

Answer 37

Normal ruminal fluid has a slightly viscous consistency. The fluid becomes more watery when the rnicroflora is inactive.

Answer 38

Ruminal fluid has a typical odor that has been called "aromatic." The odor is less prominent when the microflora is inactive. Abnormal odors include the acidic smell of lactic acidosis, the putrid, foul odor of protein decomposition or spoiled milk with putrefaction of rumlnal ingesta, or the ammonia smell of urea poisoning .

Answer 39

Ligger normalt mellem 6 og 7, eller 5,5-6,5 ved dyr som mest fodres med korn. Spyt = Forhøjer pH Fermentering = sænker pH In animals heldoff feed the ruminal pH rises above 7 within 12 hours after a hay meal and within 24 hours after a high-grain meal. Therefore consideration of the most recent feed consumption is important to the interpretationof the ruminal fluid pH measurement. Rumina! pH values of 7 to 7.5 are common in animals with anorexia. A cow with ruminal acidosis can be normal if a sufficient period of anorexia precedes the ruminal fluid analysis. Subacute or chronic ruminal acidosis usually is accompanied by a ruminal pH in the range of 5 to 5.5.

Answer 40

Abomasal reflux into the reticulorumen caused by abomasal disease, vagal indigestion, or intestinal obstruction can cause **mild decreases** in ruminal pH because of the acidic nature of abomasal contents. Abomasal reflux is better assessed by measurement of the ruminal chloride concentration.

Answer 41

The sedimentation activity time, or sedimentation- flotation test, provides a quick evaluation of microfloralactivity. It must be conducted promptly after collection of the sample. The aspirated fluid is allowed to sit in a tube, and **the time** for completion of sedimentation and flotation of the solid particles is measured. Normally the finer particles settle to the bottom and the coarser (grovere) particles float, buoyed by the gas bubbles of fermentation. The normal time for completion of this activity is 4 to 8 minutes. This test provides a crude evaluation of microfloral activity but does not differentiate well among the different forms of indigestion.

Answer 42

Grossly inactive fluid shows very rapid sedimentation, and none of the material may float. This occurs with rumina! acidosis, prolonged anorexia, and inactive microflora caused by indigestible roughage.

Answer 43

The redox [reduction-oxidation] potential of ruminal fluid is a biochemical characteristic that reflects the anaerobic fermentative metabolism of the bacterial population. Thus the methylene blue reduction time provides an assessment of the degree of bacterial fermentative activity. An indirect determination of the redox potential can be achieved by measuring the time required by ruminal fluid to decolorize methylene blue dye. Reduction times up to 15 minutes and longer occur with diets of indigestible roughage, in anorexia of several days' duration, and after ruminal acidosis.

Answer 44

Evaluation of the number and activity of protozoa in the ruminal fluid provides a sensitive indicator of the normalcy of the sample. This is easily accomplished by examining a drop of fresh, warm fluid under a microscope. Microscopically both ciliate and flagellate forms of varying sizes and shapes can be observed with ciliates usually outnumbering the flagellates.

Answer 45

The protozoa are normal inhabitants of a healthy ruminant's ruminal fluid.The importance of the protozoa from a clinical viewpoint is their sensitivity to abnormalities in the fluidmilieu. The normal animal should show a wide variety of sizes of protozoa, in large numbers that are easy to see, and with active motility.

Answer 46

Reduced numbers occur in inactive fluid samples. The larger species are more susceptible to abnormalities; therefore a predominance of only small protozoa would suggest a mild indigestive disturbance. All protozoa are killed off when the ruminal pH drops below 5.

Answer 47

Although elaborate isolation methods for evaluating ruminal bacterial growth are not clinically applicable. examination of an air-dried. Gram-stained smear of ruminalfluid can be useful in diagnosing ruminaI acidosis. Normal ruminal fluid should contain a variety of morphologically distinguisha ble bacterial forms, with a predominance of gram-negative organisms. After the overconsumption of readily digestible carbohydrate (grain engorgement), a population of **streptococci and lactobacilli** proliferates as **ruminal lactic acidosis** develops. This shift in the bacterial population can be distinguished microscopically, and **a predominance of gram-positive cocci and rods** is seen. The findings are best confirmed by comparing a smear from a herdmate.

Answer 48

The chloride concentration in ruminal fluid can be determined from the supernate from a centrifuged sample using standard chloride titration devices. A delay in measurement does not appreciably affect the value. The normal ruminal fluid chloride concentration is less than 30 mEq/L. Saliva contamination has minimal effect on the results. This test can be very helpful in differentiating **abomasal reflux**from**ruminal lactic acidosis**as the cause of**low ruminal pH**and**abnormal fluid accumulation** in the retirulorumen.

Answer 49

In the clinical evaluation of forestomach dysfunction , elevated ruminal chloride suggests secondary indigestion caused by **abomasal disease** or **obstruction of intestinal flow.** Generally cattle with elevated ruminal chloride also have hypochloremia (i blodet) and metabolic alkalosis as a result of the chloride sequestration in the forestomach.

Answer 50

Need le puncture of the ventral rurninalsac [rumenocentesis} may yield a satisfactory fluid sample. Oral or nasal passage of a collection tube produces more fluid volume with no risk of peritoneal contamination but with an increased risk of saliva contamination. 1) Color, Consistency, and Odor. 2) Ruminal fluid pH. 3) Sedimentation. 4) Redox potentiale. 5) Mikroskopisk undersøgelse (protozoer). 6) Ruminal chlorid koncentration. 7) Numerous other tests of the ruminal fluid have been described for the evaluation of digestive activity of the ruminal microflora. These include cellulose digestion, glucose fermentation, nitrite reduction, and measurements of titratable acidity, VFAs, lactic add, and ammonia concentration.

Answer 51

The primary exceptions are **TRP** or **rumenitis,** in which neutrophilia and hyperfibrinogenemia are routine findings. An inflammatory leukogram can also be observed in some cases of **vagal indigestion** when inflammatory disease is responsible for dysfunction of vagal innervation and forestomach motility. **Chronic bronchopneumonia i**n calves and **TRP** in adult cattle are commonly implicated as causes of vagal dysfunction. A hematologic reflection of an inflammatory response may also be seen after** ruminal acidosis** if the ruminal wall and other organs suffer secondary pathogen invasion, and likewise in the occasional cases of primary **rumenitis** or **reticulitis**. The more common hematologic abnormalities associated with indigestion are reflections of **fluid disturbance or stress response.** A stress leukogram would be anticipated in cases of indigestion that are acute or distressing, such as acute bloat. When indigestion is chronic, especially in calves, in which the Indigestive disturbance may go unrecognized or undiagnosed for a long time, a state of **malnutrition** may develop. In these instances a mild to moderate anemia may develop

Answer 52

In lactating or heavily pregnant animals, **anorexia** may induce a secondary form of **acetonemia**, which is detected by the presence of urine ketones. The animal must be carefully examined to differentiate ketosis with secondary anorexia and decreased ruminaI activity from primary indigestion with secondary ketosis. Mild to moderate **hypocalcemia** and **hypokalemia** are commonly identified abnormalities in many cases of indigestion, especially when **anorexia** has been prolonged. Dramatic alterations of the blood biochemical characteristics may accompany **severe ruminal acidosis. **Affected animals have metabolic acidosis with **decreased blood pH and plasma bicarbonate.** Blood lactate levels rise with the acidosis.The urine pH falls into the acidic range as the kidneys excrete some of the excess acid, but eventually severe dehydration results in renal failure and anuria, elimina ting this route of acid excretion. Decreased renal function is reflected by **elevated serum creatinine and urea nitrogen concentrations.** Phosphat konc. = Stiger Calcium konc. = Falder lidt Portal bacteria and toxins from the damaged ruminal mucosa contribute significantly to the **increased serum liver enzymes**. Measurement of the serum electrolyte concentrations provides important clues about the site of obstruction of ingesta flow and is useful in adjusting fluid therapy.

Answer 53

When the primary problem is failure of flow through the reticuloomasal orifice, the rumen fills and grossly distends with fluid, but significant abomasal reflux does not occur. Affected patients generally show mild or no serum electrolyte abnormalities.

Answer 54

When ingesta fail to pass from the abomasum, reflux of the high-chloride abomasal contents into the rumen results in elevated ruminal chloride concentrations and associated hypochloremic, hypokalemic metabolic alkalosis.

Answer 55

Ruminal hypomotility, for example, is commonly a physiologic response to problems such as abnormal ruminaI contents, a ruminal wall lesion, pain, or overdistention. HUSK!! Eliminating the underlying causative problem more effectively resolves the disease than does treatment directed at the disease signs. Man skal i dette tilfælde IKKE give rumenatorlcs (e.g., nux vomica, ginger, tartar emetic) or parasympathomimetics (e.g., neostigmine, carbamylcholine) for at stimulere motiliteten.

Answer 56

The treatment of indigestions with alkalinizing agents such as magnesium hydroxide is indicated only when the pH of ruminal contents is low.

Answer 57

Kan forveksles med frothy bloat. Passage of a stomachtube to help in this differentiation is very important and may alleviate (lindre) the acute problem if free gas is present. Evidence of respiratory or cardiovascular distress indicates that the bloat is an acute, life-threatening problem that requires emergency treatment. Cardia og oesopagus obstruktion er alvorligt. Chronic free gas bloat does not respond to the antifermentatives or surfactants commonly used for frothy bloat. Only the restoration of physiologically normal reticuloruminal function corrects this type of bloat. Inflammatory lesions may respond to long-term administration of broad-spectrum antibiotics. This is also the treatment of choice when purulent lung infections appear to be the cause of the bloat. Man kan lave en fistula i siden af koen (vindue): Release of the fermentatlve gas in this manner is important for the reestablishment of normal forestomach motility, which is inhibited if distention is extreme. Ved free gas bloat pga løbedrejning, kan en operation være nødvendig. PROGNOSE = Failure to respond within about 3 weeks suggests that the treatment is not effective, and slaughter should be recommended after an appropriate withdrawal time.

Answer 58

Diseases of the ruminal wall may be suspected on the basis of the physical examination findings and results of a CBC, abdominocentesis, and ruminal fluid analysis. In most cases exploratory laparotomy is required to confirm the diagnosis. PROGNOSE: Rumenitis or reticulitis may respond to antibiotic therapy, but the prognosis in these cases is guarded. Parakeratosis is best treated by correcting the causal feeding error (reducing the amount of concentrate and increasing the feeding of long-stemmed forage). PROGNOSE for parakeratose: The prognosis associated with this problem is good if inflammation of the ruminal wall is not also involved.

Answer 59

Se også billede. Exploratory laparotomy and rumenotomy are essential for establishing an accurate assessment. The evaluation of animals with vagal indigestion with a large fluid-filled rumen should include assessment of the fluid and electrolyte stat s. Abnormalities such as dehydration, hypocalcemia, hypochloremia, and hypokalemia should be addressed with supportive fluid therapy. Treatment should be administered parenterally, because oral treatments are ineffective or deleterious (skadelig). The forestomach should be emptied of the excessive ingesta accumulation either at surgery or with a large-bore stomach tube. This procedure may have to be repeated if the recovery period is prolonged. Relief of persistent forestomach distention is cruical to the reestablishment of normal motility. **Limited feed and water** should be offered to prevent repeated accumulations in the reticulorumen, and **intravenous fluid therapy** should be continued until reticuloruminal motility is reestablished and oral fluid intake can be allowed at normal levels. Once the ruminal distention has been alleviated(lindret), **several liters of ruminal fluid transfaunate from a healthy donor** should be administered. The limited diet must be palatable (spiselig) and should consist primarily of **long-stemmed hay or green feed for maximum stimulation of the normal forestomach motility pattern**. A temporary ruminal fistula may be indicated if tympany is a prominent sign.

Answer 60

Se også billede. PROGNOSE: With the exception of severe acute ruminal acidosis, the disturbances of reticuloruminal fermentation generally are not fatal unless the disease is undiagnosed for a prolonged period, leading to extreme debility. Treatment of fermentation disorders centers around restoring a normal ruminal fluid environment that allows normal microbial metabolism. Identification of ruminal fluid parameters and the nature of the forestomach ingesta directs the appropriate treatment.

Answer 61

Vagal indigestion is a chronic and insidious problem that generally warrants a guarded to poor prognosis.

Answer 62

Diaphragmatic herniation and masses that obstruct the reticuloomasal orifice cause signs indistinguishable from those of vagal indigestion **that results from inflammatory lesions of the reticulum**. PROGNOSE: 1) Ved diafragma hernia er prognosen ikke så god. 2)Removal of pedunculated masses or foreign bodies at the reticuloomasal orifice can promptly correct such problems.

Answer 63

The two most common causes of vagal indigestion syndrome are inflammatory lesions of the reticuloomasal region and abomasal diseases that involve gross distention, twisting, or vascular impairment of the organ. PROGNOSE: Vagal indigestion caused by abomasal disease carries a poor prognosis, whereas the prognosis for animals with reticular involvement is more variable. When abscesses are identified at the reticulum or liver, surgical drainage may help resolve the forestomach motor disturbance.

Answer 64

Identification of adhesions and active inflammation indicates that broad-spectrum antibiotic therapy may be beneficial; it is essential that **aggressive antimicrobial therapy** be administered before and after the surgical correction of a right -sided abomasal displacement or volvulus.

Answer 65

Ændrer foderet. Because the imbalance may have gone on for weeks, especially in cases of calf indigestion, correction of the problem may also take some time. Fresh green grass, however, remains one of the best means of stimulating normal forestomach digestion and motility. The second best type of diet includes a balance of palatable (spiselig) and digestible sources of energy, protein, fiber, and mineral nutrients.

Answer 66

When the viability or activity of the ruminal microflora is in question, as in the primary fermentative disorders and most cases of secondary indigestion, **ruminal transfaunation** is indicated. This should be obtained from a healthy individual that preferably is adapted to a ration similar to the one the patient is expected to consume. After the large particulate matter has been strained from the fluid (cheesecloth or large stockinette can be used), it can be administered through a stomach tube. In calves inoculation with 1 L is appropriate, whereas 3 L is minimal in an adult cow, and 8 to 16 L is more desirable. As discussed, one of the primary stimuli for active ruminal contraction is mild forestomach distention. In addition to the administration of ruminal transfaunate, it usually is beneficial in these cases to administer enough oral fluid to produce mild ruminal distention. Vandet skal opvarmes, tilføres salt (isotonisk opløsning. Saltet hjælper mod mangel og giver en hurtig omsætnng af væsken fra rumen til den nedre mavetarmkanal. When the distention is caused by accumulation of abnormal ingesta, normal contractions do not return and the **ruminal tympany is not resolved until the distention is relieved**. This situation is best exemplified by cases of **microfloral inactivity** caused by **poor-quality roughage (grovfoder) **and is the underlying problem in calves with haybelly. One approach to this problem is to restrict the animal to small quantities of readily digestible feed given several times a day. Repeated transfaunations during this time help reestabllsh a more normal microflora. This approach relies on motility and microbial activity sufficient to break downthe ingesta and pass them to the lower tract. An alternative approach is **to remove the accumulated ingesta by means of rumenotomy**, after which the animal is transfaunated and allowed access to moderate amounts of feed until normal motility is restored.

Answer 67

Ruminal acidosis eller alkalosis. **Alkalinizing agents** such as **magnesium hydroxide** and sodium bicarbonate are indicated for t**reatment of acidosis** at an initial dose of 1 g/kg. Emptying the rumen surgically is the treatment of choice when spoiled milk, putrefactive ruminal ingesta, or severe **ruminal acidosis** is detected. Ruminal alkalosis can be corrected with the infusion of acetic acid (vinegar, initial dose of 2 ml/kg. up to 12 I.). All of these agents are best administered in several liters of warm water to ensure good distribution through the ruminal fluid.

Answer 68

Overdistention of the ruminaI wall may be a primary inhibitor of forestomach motility in some cases of indigestion caused by abnormal fermentation.

Answer 69

Animals with prolonged anorexia caused by a depressant or febrile disease that produced secondary indigestion may not return to feed or have normal ruminal motility even after normalcy of the ruminal contents has been restored. **Chewing activity is one of the strongest stimulants for ruminal motility**, and these individuals sometimes benefit if palatable hay or grass is placed forcefully into the mouth by hand. An alternative is to give such individuals access to pasture. Both the ruminant and its ruminal microflora have trace mineral requirements that are often **not met by the type of diets that may induce microfloral inactivity**.

Answer 70

The ruminal microflora is also responsible for supplying the animal with its vitamin B requirements.

Answer 71

The stunted, poor body condition of calves affected by chronic indigestions may reflect these deficiencies (vitamin B), as well as protein energy malnutrition. Oral supplementation of minerals and parenteral supplementation of the B-vitamins may be helpful until normal ruminal digestive function is established. Adult cattle, especially lactaring animals with high metabolic demands, may also benefit from B vitamin supplementation when ruminal function is impaired.

Answer 72

lntraruminal administration of antibiotics has been used to kill undesirable populations of ruminal mikroflora. A 2- to 3-day course of treatment with a broad-spectrum antibiotic that is not readily absorbed is useful only when an overgrowth of undesirable bacterial species is present and should be followed by **transfaunation**. Drugs used for this effect include **neomycin or tetracycline for ruminal alkalosis **or **urea toxicosis and chlortetracycline or erythromycin for ruminal acidosis.**

Answer 73

Severe grain overload requires prompt and aggressive treatment. Animals showing severe depression, an unresponsive condition, apparent blindness, and gross ruminal distention warrant a grave prognosis. Immediate slaughter should be considered for animals with similar signs that are still able to stand. Emergency rumenotomy and removal of the acidic ruminal contents may be lifesaving if the procedure can be performed before significant amounts of ingesta have passed into the lower gastrointestinal tract. An alternative treatment in less severe cases is repeating flushing of the rumen with wann water th rough a largebore stomach tube. Administration of **magnesium hydroxide** into the rumen and **sodium bicarbonate solution** (5%) IV is necessary to counter the acidosis. Intravenous fluid therapy should be continued until the animal has recovered to provide support against hypovolemic shock. Other treatments that may be considered include NSAIDs and intraruminal antibiotics. The other therapeutic measures discussed, such as transfaunation and dietary adjustment, should be continued during the recovery phase.

Answer 74

Indigestion often is accompanied by varying degrees of **dehydration** and **electrolyte imbalance.** When these abnormalities are only mild or moderate, the animal's fluid homeostasis may correct as the normal digestive processes are restored. Restoration of normal fluid balance improves attitude and appetite and normal gastrointestinal motility. Empiric treatment with a **balanced electrolyte solution administered IV** is sufficient in most cases, because gross disturbances of the body fluid electrolytes are uncommon in most in digestions. The greatest exceptions to this are cases of **severe ruminal acidosis** or **vagal indigestion with pyloric outflow failure** and **sequestration of abomasal chloride**.

Answer 75

Hypocalcemia and hypokalemia are routinely present in many cases of indigestion. Low serum concentrations of these elements can produce muscular weakness and impair gastrointestinal motility. Both calcium and potassium should be included in the administered fluids.

Answer 76

The most common cause of vagal indigestion syndrome is inflammation of the reticular area caused by TRP. Prevention of this disease by keeping metallic foreign bodies out of the feed or by prophylactic administration of a ruminal magnet.

Answer 77

The microbial-fermentative forestomach disorders are best prevented by proper feeding management. A wellbalanced diet of palatable feeds with an adequate amount of well-structured roughage (not finely ground or pelleted} prevents most problems.

Answer 78

Dietary changes should be introduced slowly (over 2 to 3 weeks) to allow adaptation of the microbial flora to the new substrate.

Answer 79

Because they reduce the disease problems associated with heavy grain feeding and diets that are low or marginal in effective fiber. These buffers stabilize the ruminal pH and alter the mechanics of ruminal fluid outflow, thus decreasing the chances of overgrowth of the lactate-producing organisms. Commonly used buffers include sodium bicarbonate, sodium sesquicarbonate. sodium bentonite, magnesium oxide, and calcium-magnesium carbonate, of which only the sodium carbonates are truly buffering agents in the chemical sense.

Answer 80

The ionophore antibiotics (e.g., lasalocid, monensin) and some other antibiotics (e.g., the sulfur-containing peptide antibiotic thiopeptin) have also proved effective in reducing lactate production in animals fed high-grain diets. ## Footnote The effect of these agents is to suppress the lactate-producing organisms while not appreciably affecting the lactate users.

Answer 81

Vagal indigestion

Answer 82

Vagal indigestion syndrome (vagus indigestion, Hoflund's syndrome) is composed of a group of motor disturbances that hinder passage of ingesta from the reticulorumen or abomasum or both. Failure of omasal transport with hypermotility of the rumen is the most common naturally occurring form of the disease. **Failure of omasal transport.** **Pyloric outflow failure.** **Chronic recurrent (tilbagevendende) bloat.**

Answer 83

Omasal transport failure (anterior functional stenosis). which impairs flow of ingesta through the reticuloomasal orifice and occurs with: a. atony of the reticulorumen, often associated with chronic recurrent bloat, or b. normal to increased ruminal motility. Vagal denervatlon does not produce a true stenosis, but rather a paralysis and relaxation of either the reticuloomasal orifice or the pylorus.

Answer 84

Pyloric outflow failure (posterior functional stenosis) , which impairs flow through the pylorus and occurs: a. continuously or b. in an intermittent, recurrent pattern (incompletely) Vagal denervatlon does not produce a true stenosis, but rather a paralysis and relaxation of either the reticuloomasal orifice or the pylorus.

Answer 85

Failure of omasal transport with hypermotility of the rumen is the most common naturally occurring form of the disease vagal indigestion. Accumulation of ingesta in the reticulorumen leads to gradually progressive distention of the forestomachs, whereas the omasum and abomasum remain relatively empty. The animal's appetite diminishes as the rumen becomes overfilled, producing one of the most characteristic signs of the disease: **inappetence ****with gross distention of the rumen in the left flank.** The rumen assumes an L shape because the ventral sac occupies both the right and left ventral quadrants of the abdomen. The resultant characteristic abdominal contour often is called a "papple" shape because the left side of the abd omen is distended and assumes the appearance of an apple, whereas the right side assumes the contour of a pear. The diminished passage of ingesta results in reduced fecal volume. The normal ruminal process of selective retention (tilbageholdelse) of fibrous material is disturbed, leading to large particle passage and feces with increased fiber length and a greasy or pasty consistency. Affected animals often continue to drink water, but absorption from the rumen is poor, and the water accumulates in the forestomach while the animal becomes mildly **dehydrated**. **Abnormal flow of ingesta and normal or increased forestomach contractions.** **Forestomach distention, empty omasum and abomasum. and stasis of the forestomach with resultant free gas bloat.** **Hypermotilitet.** **The typical stratification of the ingesta would be disturbed. as is usua lly observed.**

Answer 86

The most common predisposing cause of naturally occurring omasal transport failure (anterior function al stenosis) is TRP. Other causes of anterior functional stenosis include abscesses, adhesions, and peritonitis at the reticulum (especially the right side of the reticulum) or retlculoomasal area without identification of an offending foreign body; hepatic abscesses; diffuse peritonitis; neoplasia of the ruminoreticular fold and esophageal groove; inflammatory disease of the reticular and ruminal walls; papilloma or other mass at the retkuloomasal orifice; and herniation of the reticulum through a diaphragmatic defect.

Answer 87

Failure of pyloric outflow (posterior functional stenosis) causes accumulation of ingesta in the abomasum and omasum. Advanced stages of this form of the syndrome also display gross distention o f the reticulorumen. Generally the motility of the forestomach is not markedly affected in the early stages, and **normal stratification** of ingesta is maintained. Overfilling of the forestomach as a result of reflux of ingesta from the abomasum (internal vomiting) may occur, causing the chloride content of the ruminal fluid to increase. With severe distention forestomach motility is reduced, and the ruminal contents become more fluid. Failure of ingesta to flow into the intestinal tract, combined with sequestration of chloride-rich fluid in the stomach chambers, can cause bo th marked dehydration and hypochloremic metabolic alkalosis. Fecal production in these cases tends to be even less than with the anterior stenosis form of the syndrome. **Complete inhibition of flow from the abomasum.** The synd rome of recurrent (tilbagevendende) atony of the abomasum. The term stenosis is a misnomer, because a true stenosis or spasm of the pylorus is not identified. Det er mere en lammelse. Ingesta drives ikke frem. Animals affected with any form of vagal indigestion for a prolonged time lose body cond ition because the failure to pass ingesta into the intestinal tract produces a state of starvation. **The weight loss may be overlooked because of the impression of full body size produced by the abdominal distention .**

Answer 88

A common predisposing cause of pyloric outflow failure syndrome is volvulus of the abomasum. Other abomasal disturbances, including right and left displacements of the abomasum and abomasal ulceration. can cause the disease as well. Inflammation and ad hesions involving the abomasal fundus and reticulum have been associated with posterior functional stenosis in some studies. This form of vagal indigestion may be more frequently associated with true vagal nerve impairment than appears to be the case in anterior functional stenosis. Alternatively, reticular adhesions may prevent normal motility, alter the flow of ingesta to the omasum and abomasum, and lead to abnormal filling of the abomasum because of decreased fluidity of abomasal coruents. Another predisposing cause of pyloric outflow failure is advanced pregnancy with a large fetus. This disease has been called indigestion of late pregnancy?? tror det er denne de mener?

Answer 89

Lesions of the vagal nerve inhibit motor impulse transmission, and bloat may arise from this mechanism. Overfilling of the reticulorumen with frothy ingesta, a common finding, can inhibit the cardia dilation reflex that is a prerequisite of eructation. Gross distention of the forestomach can also weaken the contractile ability of the rumen, so that the contractions are not strong enough to clear the cardia before eructation.

Answer 90

Gross abdominal distention. Vokser og aftager. Stops eructation (opstød) by causing complete forestomach stasis. Bradycardia is often identified in association with vagal indigestion but can also occur with other forestomach diseases. Once the forestomach has become severely distended, the heart rate tends to be elevated, probably as a result of deterioration (forværring) of hydration and cardiovascular parameters.

Answer 91

Abomasal ulcers occur in cattle of all ages and rarely in sheep and goats.

Answer 92

Signs of loss of gastric epithelium may range from no clinical signs, to hemorrhage and anemia and subsequent melena, to peritonitis if the erosive processes penetrate all layers of the abomasum.

Answer 93

In calves, development of abomasal ulcers has been proposed to be associated with: 1) mineral deficiencies (mainly Copper) 2) stress 3) proliferation of microorganisms (C perfringens type A, fungi, or others) 4) and/or abrasion of the abomasal mucosa by roughage. geosediments, or trichobezoars.

Answer 94

In adults the disease is associated with: 1) Stress such as recent parturition, peak milk production, or presence of concurrent diseases (mainly those of the peripartum period) 2) Diets high in starch (stivelse). 3) Lymphosarcoma of the abomasum also may lead to clinical signs of ulcer disease. 4) Abomasal ulcers are also an adverse effect of NSAIDS

Answer 95

Classification of abo masal ulcers into four types: (1) nonperforating with minimal signs. (2) nonperforating with severe blood loss. (3 ) perforating with local peritonitis. (4) perforating with diffuse peritonitis.

Answer 96

(1) = The signs are mild abdominal pain, shown by partial anorexia, decreased ruminal motility, and mild ruminal tympany. In one study about two thirds of such cows had a positive test finding for fecal occult blood.

Answer 97

(2) =In cattle with ulcers that erode into major gastric blood vessels (type II), blood loss can be sufficient to cause signs of anemia and hemorrhagic shock. These an imals have dark blood clots in their manure or tarry, black feces with the characteristic smell of partly digested blood.The mucous membranes may be pale, tachycardia may be pronounced, and the respiratory rate may be elevated. Total anorexia and ruminal stasis usually are present.

Answer 98

There are other possible sources of proximal gastrointestinal hemorrhage in cattle, but abomasal ulcers are by far the most common cause. Among them, bleeding abomasal ulcers must be differentiated from melena sometimes seen with intussusception or HBS(Hemorrhagic Bowel Syndrome? ) (jejunal hemorrhage syndrome (lHS)). The PCV (packed cell volume?) usually is increased with intussception, normal or increased in HBS, and decreased with a bleeding ulcer.

Answer 99

Abomasal ulcers that perforate the serosal surface lead to localized peritonitis (type III) from contamination with abomasal contents. If the lesion is small or the local inflammatory reaction sufficiently swift, localized peritonitis results. This condition is most like TRP in presenting signs. The animal may be moderately febrile and partly or totally anorectic, and milk production may decrease acutely. There is evidence of abdominal pain, usually localized to the right ventral quadrant (positive withers pinch test). Ruminal motility may be absent, and mild bloat may be present. In some cases the infection is confined to the omental bursa, where extensive fluid and pus may accumulate.

Answer 100

``` Major leakage from a perforating ulcer leads to acute diffuse peritonitis (type IV).The course of the disease usually is rapid, with signs of septic shock developing within 24 hours of the onset. Total anorexia and ruminal stasis are accompanied by tachycardia with a weak, thready pulse and a heart rate over 100 beats/min. Pain may be evidenced by grinding of the teeth or groaning (stønne).The extremities are cool, and the animal generally becomes recumbent (liggende). ``` Abdominal enlargement may be evident as a result of both ruminal tympany and the accumulation of peritoneal fluid. Dehydration is detectable by skin pinch or by observation of the position of the eye in the orbit.

Answer 101

Løbesår type 4. Diffuse peritonitis from uterine, cecal, or intestinal ruptures have the same final course.

Answer 102

Abomasal volvulus of more than a day's duration has similar characteristics but can be differentiated by the rightsided ping and fluid in the abomasum .

Answer 103

The most useful diagnostic test for abomasal ulcer disease without visible melena is the fecal occult blood test. The test is inexpensive and can be performed during the physical examination

Answer 104

**Abdominocentesis** confirms diffuse peritonitis (a large quantity of abdominal fluid is obtainable); centesis fluid may contain leukocytes with phagocytosed or free bacteria, and even feed particles. In localized peritonitis the results of abdominocentesis may be normal. **Abdominal ultrasonography** is also useful for the dlagnosis and the evaluation of peritonitis. Percutaneous ultrasound-guided abomasocemesis can be safely performed for the evaluation of abomasal fluid. The presence of blood or hemoglobin is principally associated with abomasal ulcers. If peritonitis is present, leukocytosis usually is present, with neutrophilia predominating in many cases. The plasma fibrinogen is increased (over 700 mg/dL) in most cattle with peritonitis. This may be evaluated in the field with a **glutaraldehyde coagulation test** on whole blood.

Answer 105

Cattle over 5 years of age with a bleeding abomasal ulcer should be tested for **bovine leukosis virus.**

Answer 106

Ukendt, men: Cytoprotecrlve mechanisms include a mucous barrier, cloudy mucus containing bicarbonateions to neutralize backdiffusing hydrogen ions, and high submucosal rates of blood flow to remove back-diffusing hydrogen ions. When these mechanisms are disturbed, gastric (abomasal) ulcers can occur. Stress, concurrent diseases, corticosteroids, and NSAlDs are among factors known to contribute. Most adult cattle with abomasal ulcer disease are in the first month after calving and have a concurrent disease. Metritis, mastitis, and ketosis are the other diseases commonly seen with abomasal ulcers. The incidence of abomasal ulcers apparently increased with the advent of heavy corn silage and high-moisture corn feeding.

Answer 107

Cattle with diffuse peritonitis have many liters of foul-smelling (ildelugtende) fluid in the peritoneal cavity. **Fibrin** usually covers the serosal surface of all abdominal organs.

Answer 108

Most bleeding and perforating ulcers were found in the fundic portion of the abomasum in the region of the proper gastric glands. The most ventral portion of the abomasum in its normal position is frequently affected.

Answer 109

Treatment is aimed at correcting dietary problems, reducing stress, ameliorating concurrent disease prob lems, and initiating specific therapy for the clinical problems caused by the ulcer. Removal of high -energy feedstuffs and replacement with good-quality hay plus confinement to a stall are beneficial. The buffer effect of food is very important for the control of abomasal pH. Consequently, t**he return to a normal appetite is the main goal** of the treatment of abomasal ulcers. Blodtranfusion. Broadspectrum antibiotics are administered to cattle with signs of peritonitis. Intravenous or oral fluids may be necessary to treat dehydration and metabolic or acid-base disturbances that occur concurrently.

Answer 110

Animals with diffuse peritonitis must be given intravenous fluids with caution because of the risk of pulmonary edema associated with the low colloide oncotic pressure of their plasma.

Answer 111

The prognosis is good for ulcers that are not bleeding and not perforated. For those animals that stop bleeding and those with localized peritonitis, survival and eventual return to normal function can be expected. Many dairy cattle stop lactating during the acute course of the illness and do not return to milk until the next lactation. Because abomasal ulcers generally occur with in the first month after calving, most of these animals are salvaged for slaughter. Most cattle with diffuse peritonitis die despite aggressive specific therapy. Early recognition and immediate surgery followed by antibiotic and fluid therapy may save some valuable individuals. Cattle with ulcers that occur secondary to lymphosarcoma should be euthanlzed or slaughtered.

Answer 112

Man ved ikke præcis hvad forårsager løbesår, så forbyggelse er svær. Dietary management that reduces other abomasal diseases likewise reduces the incidence of abomasal ulcers. Avoiding abrupt changes in rations and including adequate fiber sources of sufficient particle size to facilitate normal ruminal function also promote normal abomasal function. Minimizing stress caused by overcrowding, excessive competition, and adverse environmental conditions, and minimizing mastitis and metritis should also reduce problems with abomasal ulcers. Elimination of animals infected with the bovine leukosis virus from the herd eliminates lymphosarcoma as a cause of abomasal ulcers. Judicious use of corticosteroids and NSAlDs is also important.

Answer 113

Four imponant questions should be addressed while dealing with an acute abdomen in ruminants: (I) Where does the pain originate? (2) Is it a medical or surgical problem? (3) Is medical treatment indicated before surgery! (4) What is the likelihood for survival and productivity?

Answer 114

Acute abdominal emergencies are often associated with either hypovolemic or septic shock. **Hypovolemic shock** is characterized by increased heart rate, pale mucous membranes, slow capillary refill time, and dehydration. Increased heart rate and dehydration are also observed in case of **septic shock,** but mucous membranes are hyperemic or bluish in color, and scleral vessels are engorged and dark. Intensive fluid therapy is the treatment of choice for both hypovolemic and septic shock. Consequently, an intravenous catheter should be placed and fluid therapy instituted immediately. However, a complete history and meticulous (omhyggelig) physical examination should be performed before emergency medical therapy if the condition of the patient is stable.

Answer 115

**Signalement** (nogle har en højere risiko for nogle sygdomme): Alder, køn, race og produktions stadie (til at vurdere differential diagnose) **Management (Foderprogram)**: Fodringsmanagement system, besætningsstørrelse. **Historie og kliniske tegn**: Tidligere tegn på operation = associeres med udvikling af adhæsioner og kolik. Kælvet fornylig og obstetriske manipulationer = kan give en fuld-tykkelse livmoder tear(rive) og efterfølgende peritonitis. Paralytisk ileus associeret md hypocalcæmi kan ske under østrus. Pleuritis, pleuropneumonia, or ribfractures may mimic abdominal pain. Tidligere behandlinger noteres (analgetika som NSAIDs kan fx kontrollere abdominal smerte, dæmpe koliktegn og sænke hjerterytmen). Ejerens beskrivelse af klinisketegn i kronologisk rækkefølge. (Intussusception in cattle is characterized by an acute onset of anorexia, decreased fecal output (often with dark feces containing blood) and milk production, as well as colic. However, even though the abdominal pain eventually becomes less severe, the depression progresses). Torsion of the mesenteric root has an acute onset withsevere colic and rapid deterioration. Fecal output, consistency, and appearance are relevant information. Stranguria manifested by unsuccessful micturition (vandladning) efforts is associated with urolithiasis.

Answer 116

Malkekvæg

Answer 117

Hovedsagelig ved tidspunktet for fødslen eller i den sidste trimester.

Answer 118

Det er et resultat af urolithiasis.

Answer 119

**Feeding management system** (feeding cows with silage or a total mixed ration (TMR), **herd size** (dairy farms with more than 100 cows), and **highintensity milk production** are risk factors associated with the devel opment of hemorrhagic bowel syndrome (HBS)

Answer 120

Struvite urolithiasis in cattle occurs more frequently in bulls or steers (stude) fed with high-grain diets.

Answer 121

Kælvet fornylig og obstetriske manipulationer = kan give en fuld-tykkelse livmoder tear(rive) og efterfølgende peritonitis.

Answer 122

Paralytisk ileus associeret med hypocalcæmi kan ske under østrus.

Answer 123

Pleuritis, pleuropneumonia, or ribfractures may mimic abdominal pain. ## Footnote

Answer 124

Tidligere behandlinger noteres (analgetika som NSAIDs kan fx kontrollere abdominal smerte, dæmpe koliktegn og sænke hjerterytmen).

Answer 125

Intussusception in cattle is characterized by an acute onset of anorexia, decreased fecal output (often with dark feces containing blood) and milk production, as well as colic. However, even though the abdominal pain eventually becomes less severe, the depression progresses

Answer 126

Torsion of the mesenteric root has an acute onset with severe colic and rapid deterioration.

Answer 127

Stranguria manifested by unsuccessful micturition efforts is associated with urolithiasis.

Answer 128

Complete Physical Examination. A thorough and complete physical examination is the most important step when approaching an acute abdomen. **Visual examination: **The animal's abdominal profile or silhouette should be observed from the rear (bagfra) and both sides to detect and characterize abdominal distention. Evaluere hvor slem smerten er, og skelne mellem parietal og viceral smerte. **Evaluering af vitale parametre:** Determination of rectal temperature, pulse or heart rate, and respiratory rate (TPR) should always be performed first, as manipulations performed during the physical examination of an abdominal emergency can elicit pain, modifying the heart rate. **Ekstraabdominal undersøgelse:** Examination of the thorax (pleuropneumia, rib fractures) and the musculoskeletalsystem (laminitis, myopathy) are important in eliminating diseases that mimic abdominal pain. **Abdominal undersøgelse:** Abdominal examination is performed by auscultation, percussion, ballottement. and succussion of the abdomen. Moving or constantly contracting viscera will have changing pitch of their pings, like gas in the left-displaced abomasum, descending duodenum, or proximal colon. For this particular reason, it is important to auscultate and percuss for a certain period of time to notice ping variation. **Rektal undersøgelse: ** Per rectum abdominal palpation of cattle is helpful in the differential diagnosis of an acute abdomen because the urogenital and digestive systems can be evaluated .

Answer 129

Tyndtarms disorders.

Answer 130

Cecal and/or colon disorders.

Answer 131

In cases of abomasal volvulus, the distended abomasum can be observed caudal to the last rib in the right paralumbar fossa.

Answer 132

Gas in the rumen causes a distended upper left abdomen, whereas some forms of vagal indigestion have a "pappie" shape (pear on the right and apple on left).

Answer 133

An arched back may be observed in cases of cranial abdominal pain or laminitis (sore feet).

Answer 134

Severe colics are classically associated with some surgical intestinal conditions, although animals with severe jejunal distention secondary to acute enteritis may have a similar clinical presentation.

Answer 135

Abdominal pain may be a consequence of execss. distention of a hollow viscus (excessive intestinal distention], spasms of intestinal smooth muscles, stretching of the mesenteric supporting structure, intestinal ischemia, or chemical irritation of the visceral or parietal peritoneum.

Answer 136

Abdominal pain can be classified into two main categories: 1) Visceral pain (hollow viscera and solid organs) 2) Parietal pain (parietal peritoneum, abdominal muscles, rib cage)

Answer 137

Pain sensation from the parietal peritoneum travels through the peripheral spinal nerves and usually localizes over the affected area. Because parietal pain is exacerbated by pressure and tension modification, the patient is **reluctant to move** and has a tonic reflex contraction of the abdominal muscles. N**o active clinical signs of colic are present.** This is typically observed in cases of **peritonitis**.The animal is reluctant to move, has a splinted abdomen, and is responsive to external palpation, such as having a positive xiphoid grunt test or not dipping the back when pinched over the withers.

Answer 138

Some pain fiber endings are located in the submucosa and muscle layers of hollow viscera (intestines, bladder) and in the capsule of solid organs (kidney, liver). Consequently, distention, forceful contraction, or traction will produ ce pain in a hollow viscus. Capsule stretching will create pain in solid organs. Visceral pain is typically recognized by **active manifestations of colic: kicking at the abdomen**; treading with the rear feet (tramper); lying down, standing, and stretching out; and grinding the teeth. Goats may also vocalize. The animal is **anxious** and has an apprehensive (ængstelig) attitude. Contrary to parietal pain, visceral pain is transmitted via **sensory fibers in the autonomic nerves.** Visceral pain is often diffuse and difficult to localize.

Answer 139

Assessment of **cardiovascular status** is essential in the evaluation of an animal with an abdominal emergency.

Answer 140

Hypovolemic and septic shock are associated with increased heart rate, pale or hyperemic mucous membranes, slow capillary refill time, and dehydration.

Answer 141

Low heart rate and adequate hydration status are considered good prognostic indicators regarding the out come of abomasal volvulus.

Answer 142

Circulatory insufficiency, secondary to hypovolemia and caudal vena cava compression, is a complication of abomasal volvulus.

Answer 143

Dehydration and acid-base abnormalities are principally caused by fluid accumulation in the abomasum and are associated with a high mortality rate.

Answer 144

Heart rate is increased secondary to hypovolemia, compression of the caudal vena cava, and sympathetic nervous system stimulation in response to distention and twisting of the abomasum.

Answer 145

Determination of rectal temperature, pulse or heart rate, and respiratory rate (TPR) should always be performed first, as manipulations performed during the physical examination of an abdominal emergency can elicit pain, modifying the heart rate.

Answer 146

Pings are tympanic resonance caused by a gas-fluid interface (grænseflade) in a distended organ and can be detected by simultaneous auscultation and percussion. HUSK! Because rectal palpation may create an area of increased resonance on the right dorsal part of the abdomen, detection of pings should be performed before rectal palpation.

Answer 147

Pings localized from the thirteenth rib cranially to the ninth rib are typical of abomasal volvulus or a right-displaced abomasum.

Answer 148

**Cecal dilatation** or **volvulus** creates a ping in the right paralumbar fossa and caudal quadrant often extending to the hip.

Answer 149

Abomasal volvulus will be more likely to have a high-pitched ping, whereas animals affected with peritonitis may have a bilateral low-pitched ping in the upper paralumbar fossa.

Answer 150

Gas in the spiral colon.

Answer 151

On the left side, pings are principally associated with left abomasal displacement, ruminal collapse, and pneumoperitoneum. Left abomasal displacement typically creates variable pitch pings dorsally from the eighth to the thirteenth ribs. Pings associated with gas in the rumen, ruminal collapse, and pneumoperitoneum are localized dorsally in the left para lumbar fossa and extend cranially to the eleventh rib.

Answer 152

Simultaneous auscultation and ballouement (succussion) of the abdomen may permit detection of fluid trapped within the intestine or in a hollow viscus like the rumen or abomasum. The location of the fluid splashing sounds on auscultation-succussion may help to confirm and differentiate among auscultation-percussion findings.Tense abdominal muscles, secondary to parietal peritoneum inflammation, may also be detected during succussion.

Answer 153

Cattle with cranial abdominal pain are reluctant to move; they stand with elbows abd ucted and back arched. During examination, bruxism (grinding of the teeth ) may be present. Pain can be elicited by pinching over the withers or applying forceful movement with the knee or upward pressure with a bar or pole over the xyphoid area or anterior abdomen. In response, the animal in pain may grunt or kick and be reluctant to dip the back. **Cranial peritonitis,** secondary to **TRP or abomasal ulcers**, is an important cause of cranial abdominal pain. A complete card iorespiratory examination may help to differentiate this from thoracic pain.

Answer 154

**Cecal disorders** are clearly diagnosed per rectal palpation. Moreover, cecal dilatation or volvulus can be differentiated by **location of the apex.** Multiple, dilated, turgid (saftspændte) small intestine loops and a firm mass may be palpated in cases of **intususception** or **HBS.** Typical signs of **peritonitis** (adhesions between the kidneys and the rumen, and the intestinal convolutions (vindinger), and decreased rectal mobility) may be palpated when the posterior aspect of the abdomen is affeced. **Uterine wall integrity** may be evaluated during rectal palpation, although examination per vagina may be necessary to confirm a full-thickness laceration in the postpartum cow. In cases of **urolithiasis** in bulls or steers (stude), rectal palpation reveals a pulsatile pelvic urethra and a distended bladder. In cases of **pyelonephritis**, enlargement of one or both ureters may be palpated. The left kidney may be painful as well as bigger, without lobulation. Enlargement of the right kidney is sometimes palpable. In **small ruminants**, urolithiasis is manifested by pulsations in the pelvic urethra that may be felt by digital rectal examination, and distended bladder or enlarged kidney can be detected by deep abdominal palpation. Presence and macroscopic appearance of feces can be evaluated during rectal examination.

Answer 155

A decreased volume of feces is principally associated with **intestinal stasis or obstruction**, which may occur secondary to a direct mechanical obstruction (requiring surgical treatment ) or to **gastrointestinal ileus** (requiring only medical treatment. ## Footnote However, feces may he present in the first few days after an intestinal obstructlon.

Answer 156

1) PACKED CELL VOLUME AND TOTAL SOLIDS. 2) BLOOD GAS ANALYSIS AND ELECTROLYTES. 3) BLOOD LACTATE CONCENTRATION. 4) COMPLETE BIOCHEMICAL PROFILE. 5) WHITE BLOOD CELL COUNT AND DIFFERENTIAL. 6) FIBRINOGEN. 7) URINALYSIS. 8) ABDOMINOCENTESIS.

Answer 157

**Shock, sepsis, and toxemia** cause hemoconcentration and dehydration and are associated with an **increase** of PCV and total solids. On the other hand, **increased** PCV and **decreased **total solids are observed during the formation of a third compartment filled with a protein-rich fluid such as in **generalized peritonitis**.

Answer 158

Blood gas analysis as well as determination of electrolyte imbalance may be useful **before initiation of treatment.** Blood gas analysis and electrolyte measurement results are helpful in the institution and monitoring of **fluid therapy**.

Answer 159

Most adult ruminants with acute abdominal diseases suffer from** metabolic alkalosis.** Metabolic alkalosis is often associated with abomasal volvulus, intussusception, cecal disorders, abomasal ulcers, peritonitis, renal diseases, and reticulo peritonitis. Hypochloremia and hypokalemia are frequently combined with metabolic alkalosis.

Answer 160

**Metabolic acidosis** may be observed if urinary tract disease, small intestinal strangulation or obstruction, or enteritis with severe diarrhea is present.

Answer 161

**Serum chloride concentration, anion gap, and base excess,**have been proposed, as preoperative prognostic indicators in dairy cattle suffering from abomasal volvulus.

Answer 162

Blood lactate concentration, although r**arely used in ruminants,** can be used to assess cardiovascular or respiratory system compromise, to monitor the response to treatment, and to establish a prognosis for survival. In **horses,** blood lactate concentrations are an important indicator of adequate response to treatment and reperfuslon of ischemic tissues.

Answer 163

Evaluation of specific enzyme activity (e.g.. hepatic enzymes, BUN, and creatinine) combined with physical examination and other ancillary tests may be useful in establishing a diagnosis and assessing progress.

Answer 164

A WBC count **rarely** provides further information for establishing the exact cause of an acute abdomen . Hematologic findings are **rarely specific to a condition** and reflect the underlying **inflammatory process**. In most cases a minimal to moderate inflammatory process cha racterized by a **neutrophilic leukocytosis** is observed. Hematologic findings may also provide information about the **acuteness** of the disease and the **severity of the sepsis and toxemia** associated. Severe sepsis is associated with neutropenia, degenerative left shift, toxic changes of neutrophil morphology, and lymphopenia. **Hematology** is also an important ancillary test to monitor the response to treatment. Neutropeni er en hæmatologisk lidelse karakteriseret ved et unormalt lavt antal af neutrofiler, den vigtigste type af hvide blodlegemer i blodet.

Answer 165

In ruminants, increased fibrinogen concentration is an early indicator of inflammation. Normal fibrinogen concentration despite severe visceral involvement should be observed only in peracute cases (with in a few hours) (e.g., torsion of the root of the mesentery). Moderate to marked increased fibrinogen concentration is also the signature of an active **localized inflammatory condition**such as**retlculoperitonitis, liver abscesses, or pyelonephritis.**

Answer 166

Urinalysis is helpful in differentiating between colic of urogenital origin versus gastrointestinal disorders. Urinalysis can be rapidly performed using a urinary dipstick- and gross morphologic examination. Renal diseases are associated with proteinuria (\>1 +), glucosuria, and positive blood reaction. In case of acute urethral obstruction, hematuria and proteinuria are consistently observed. Determination of urinary specific gravity may help to characterize azotemia. Azotemia is a medical condition characterized by abnormally high levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood. It is largely related to insufficient filtering of blood by the kidneys.[

Answer 167

Collection and evaluation of peritoneal fluid is helpful in the diagnosis and the establishment of treatment, as well as prognosis, in many gastrointestinal disorders in cattle. Abdominocentesis is considered an essential ancillary test in the approach to acute abdomen in many species. Fluid can be evaluated macroscopically for color, volume, odor, and turbidity. Peritoneal fluid changes to cloudy yellow, then blood-tinged with fibrin, and finally to black in color as **bowel necrosis and hemolysis of extravasated RBCs occur**. In case of **generalized peritonitis, **fluid is abundant, cloudy, and sometlrnes foul-smelling. Occasionally, digestive fibers can be observed macroscopically if rupture has occurred. Lactate, glucose, alkaline phosphatase, and pH of the peritoneal fluid concentrations have been reported to be indicators of **intestinal ischemia** and **peritonitis in horses**.

Answer 168

**ULTRASONOGRAPHY. (Ultralyd)** **RADIOGRAPHS. (Røntgen):** Although the use of abdominal radiographs in adult cattle is limited to referral hospitals, and their effectiveness is limited to the cranial abdomen, they are one of the most helpful ancillary examinations for the diagnosis of **reticuloperitonitis**. Abdominal radiographs may help in the diagnosis of **intestinal atresia** and **intussusception** in calves. A lateral view of the abdomen of small ruminants may assist in the diagnosis of **urolithiasis** because stones in the urethra or in the bladder may be detected.

Answer 169

Man laver sin differentialdiagnose liste samt beslutter om det skal være en medicinsk eller kirurgisk behandling baseret på kliniske tegn og accesoriske test resultater.

Answer 170

Among surgical cases,** intestinal obstructions** are those requiring immediate surgery. A **mechanical obstruction** may be suspected when there is a suspicion of intestinal or cecal torsion on rectal examination, pings indicating a right abomasal displacement or volvulus, peritoneal fluid indicating bowel devitalization, or severe signs of active colic or rapid deterioration If an intestinal mechanical obstruction is not suspected during the first examination, exploratory surgery may be delayed for up to 36 hours. However, frequent monitoring should be performed and appropriate medical treatment provided to the animal. Der er to typer af tarmobstruktion: paralytisk ileus ( hvor musklerne i tarmen ophører med at fungere ordentligt uden fysisk årsag ) og mekaniske obstruktion ( hvor i tarmen kan bogstaveligt talt blokeret af en genstand, som komprimeret afføring, en tumor eller brok).

Answer 171

If the animal is **dehydrated** and/or manifests signs of **shock**, preoperative fluid therapy and analgesics are recommended.

Answer 172

Most abdominal surgeries in adult cattle are performed with the animal stand ing under sedation and local or regional anesthesia. Cattle can tolerate intestinal resection and anastomosis standing if adequate local anesthesia and systemic analgesia are provided. Because a right paralumbar fossa celiotomy provides the best exposure to the intestinal tract, left lateral recumbency should be favored. For the prevention of surgical infection, appropriate preoperative antibiotic administration is also recornrnended.

Answer 173

The goal of therapy in an animal with acute abdomen is to initially correct the h**emodynamic and metabolic imbalances** associated with **hypovolemic or septic shock,** to control pain, and to correct or treat the primary cause of the disease, when identified. Consequently, medical treatment is based on fluid therapy, NSAlDs, and antimicrobial drugs.

Answer 174

Væsketerapi Correction of Acid-Base and Electrolyte Imbalances. Control of Pain and Inflammation. Antimicrobial Drugs. Other Treatments.

Answer 175

**Crystalloid solutions (0.9% NaCl, Ringer's solution)** are indicated initially to replenish(genopbygge) fluid loss and improve the circulating blood volume. **Kritisk syge:** Studies demonstrated that perfusion rates of 40 and **80 mL** of an lsoosmotic crystalloid solution per kilogram of body weight per hour can be used safely in adult ruminants and dehydrated calves, respectively. If the animal is not critically ill, fluid and electrolyte deficits should be corrected over 2 to 8 hours.

Answer 176

Hypertonic solutions (7.2% or 7.5% NaCl) are also an alternative. Intravenous administration of hypertonic saline provides rapid resuscitation in dehydrated or endotoxemic ruminants. A rate of **4 to 5 mL** of hypertonic solution per kilogram should be administered IV through the jugular vein over **4 to 5 minutes.** Animals should be provided with a supply of fresh water immediately after the treatment, or an intravenous infusion of an isotonic crystalloid solution should be instituted. Cattle not observed to drink within 5 minutes should have 20 L of water pumped into the rumen. An administration rate for a hypertonic solution of over 1 ml/kg/min shoud be avoided because it induces a potentially fatal hypotension coupled with a decrease in cardiac contractility.

Answer 177

Factors Indicating Surgery Is Necessary: • Severe active signs of coIic • Rapid deterioration (forværring) of vital parameters • Heart rale \>100 beats/min • Pings compatible with cecal or abomasal conditons • Suspicion of intestinal or cecal torsion on RE (rektalundersøgelse) • Peritoneal fluid compatible with bowel devitalization

Answer 178

Correction of electrolyte imbalances should be **based on laboratory results** when available. Previous treatments should be considered (e.g., intravenous calcium, orally administered magnesium hydroxide) to initiate the most appropriate fluid therapy if **no laboratory results are available**.

Answer 179

Most animals with acute abdominal diseases suffer from **metabolic alkalosis**, **hypochloremia**, and **hypokalemia**.

Answer 180

Calcium homeostasis is in a precarious (skrøbelig) balance in postpartum dairy cattle.

Answer 181

Hypocalcemia is common in anorectic ruminants or in ruminants with gastrointestinal diseases. Moreover, metabolic alkalosis, frequently observed in cases of acute abdomen, is strongly associated with subclinical hypocalcemia. Calcium ions are of particular importance in gastrointestinal motility. First, in the **gastrointestinal smooth muscles**, the channels responsible for generating **action potentials **are calcium-sodium channels. Second, **gastrointestinal smooth muscle contraction** occurs in response to the entry of calcium into the muscle fiber.

Answer 182

The intravenous solutions used for the medical treatment of acute abdomen, secondary to a suspected digestive disorder, should contain Na, CI, K, and Ca.

Answer 183

Pain and inflammation are important causes of gastro intestinal hypomotility. Gastro intestinal pain increases sympathetic tone, causing general inhibition of the gastro intestinal tract. Numerous **inflammatory mediators** are released during disease of the gastrointestinal tract, leading to alteration of intestinal motility. **Peritoneal inflammation or irritation** and associated pain are well-recognized initiating factors of **ileus** in multiple species. Release of proteinases, vasoactive substances, free oxygen radicals, and endorphins secondary **to ischemia and reperfusion injury, or to endotoxemla**, impairs cardiovascular function and decreases gastro intestinal motility. **Inflammatory mediators** lead to a pain response and modulate the intensity of noxious (skadelig) stimuli.

Answer 184

JA NSAlDs may induce **abomasal ulcers**, particularly in an **anorectic** patient. Analgesics may **mask clinical signs (pain, fever)** and compromise adequate case management by **delaying surgery**.

Answer 185

NSAIDs (flunixin, ktoprofen) In **equine** gastrointestinal pain, a poor or short duration response to NSAIDs indicates a need for surgery.

Answer 186

Abdominale eller ekstraabdominale årsager, som yderligere kan inddeles.. se billedet.

Answer 187

Alpha2-Agonists that function as sedatives and analgesics, such as xylazine, detomidine. and medetomidlnel, could also be used to relieve pain in cases of acute abdomen. De er stærke analgetika. Bruges mest til hest. Kan fx bruges til stor tarm obstruktion hos kvæg. Different side effects must be considered before the administration of alpha-2 agonists. Xylazine is reported to have significant effects on the gastrointestinal tract in cattle, **decreasing reticuloruminal and intestinal motility.** Because of the **hemodynamic changes** associated with the administration of alpha-2-agonists, these drugs must he used with caution in patients with **arterial hypotension and/or shock**. Alpha-2 agonists can **mask surgical pain and delay the decision for surgery. **This is particularly critical with the use of detomidine. Finally, dose and administration of alpha2-agonists should be used with care if **standing surgery** is planned. NSAIDs

Answer 188

Bacterial translocation from the intestines can occur in cases of **mechanical or functional ileus** secondary to **bacterial overgrowth, inflammation, and impairment of barrier function** of the intestinal wall.

Answer 189

A **systemic broad-spectrum antibiotic treatment** should be instituted when a septic process is suspected, until bacterial culture results become available. This initial antibiotic therapy should be effective against gram-negative, gram-positive, aerobic, and anaerobic pathogens. Beta-lactams, tetracyclines, and trimethoprim-sulfadoxine appear to be good choices.

Answer 190

Nej. Giver kun yderligere distention af abdomen. Magnesium hydroxide may be responsible for detrimental effects such as metabolic alkalosis, sedation caused by hypermagnesemla, increased ruminal pH and decreased ruminal microbial activity. = IKKE GODT!

Answer 191

Ja. Motility-modifying agents may be used in the management of gastrointestinal disorders. In most cases **intestinal motility is restored when pain is relieved and electrolytic imbalances are corrected.**

Answer 192

Bethanechol alone or in combination with metoclopramide or erythromycin in polyethylene glycol for the postoperative treatment of right abomasal displacement or torsion.

Answer 193

**Bethanechol** can be used for conservative or postoperative treatment of cecal disorders and treatment of paralytic ileus. Continuous infusion of **neostigmine** was successfully used for the conservative and postoperative treatment of cecal disorders.

Answer 194

Transfaunation. Transfaunation may help to rapidly reconstitute the ruminal flora and hasten return to normal funct ion of the rumen and the digestive tract. The technique for and beneficial effects of transfaunation (reduction of ketonuria, increased feed intake, and higher milk yield ) have been reported in the postsurgical treatment of **left abomasal displacememt**.

Answer 195

Nej. **No** prokinetic drug is reported to directly increase ruminal motility.

Answer 196

When a definitive diagnosis cannot be made, a close monitoring of the animal may be indicated. Follow-up must also be performed secondary to surgery to ensure adequate response to surgical treatment and to allow possible adjustment of treatment. In a referral hospital the animal should be reevaluated every 4 to 6 hours. In field practice, vital parameters, rectal examination, presence and consistency of feces, and pain may be reevaluated every 6 to 12 hours.

Answer 197

Feces are passed with in 4 to 6 hours after surgery in cases of intestinal volvulus or cecal disorders.

Answer 198

Surgical exploration is indicated if the following clinical signs are observed: 1) persistence of colic 2) development of abdominal distention 3) heart rate over 100 beats/min 4) scant (sparsom) feces 5) typical abomasal or cecal pings 6) paracentesis indicating bowel devitallzatlon .

Answer 199

If the obstruction is complete, the condition is rapidly fatal (except in neonates) because of the **inability to eliminate the gases of fermentation** produced in the rumenoreticulum.

Answer 200

Partial obstruction produces dysphagia or anorexia.

Answer 201

Choke must be differentiated from diseases that cause dysphagia by means of **pharyngeal lesions and resultant neuromuscular dysfunction**. Congenital or acquired lesions of the esophagus such as aortic arch anomalies and diverticula may cause signs similar to those of esophageal obstruction.

Answer 202

Anxiety and ptyalorrhea [i.e. saliva dripping from the mouth because of an inability to swallow). The animal may violently swing the head from side to side and make repeated attempts to swallow. Staggering (which must be differentiated from ataxia caused by neurologic diseases) may be observed. Regurgitation. Bloat develops soon after at a rate that depends on the nature of the ruminoreticular contents.

Answer 203

Obstruction from intraluminal objects commonly occurs in the cranial part of the cervical esophagus, at the thoracic inlet, or at the base of the heart. External palpation may localize the site of obstruction in the cervical esophagus.

Answer 204

Cellulitis along the cervical esophagus may result in a reluctance to lower the head or bend the neck laterally. Possible causes of cervical cellulitis include perivascular injection of irritating substances, abscesses, and reaction to Hypoderma lineatum larvae.

Answer 205

Esophageal stricture may follow a previous episode of esophageal obstruction or inflammation in adjacent tissues. If no site of obstruction is externally evident, careful attempts to pass a **stomach tube** usually reveal the site of the problem. **Radiography** with barium contrast material may help identify the site of strictures, perforations, and diverticula. **Endoscopy** of the esophagus may also aid in identifying the specific nature of functional or structural abnormalities. An animal with an esophageal stricture or a diverticulum may reflux boluses of feed mixed with saliva or regurgitate liquid ruminal contents. Failure to gain weight or progressive weight loss accompanies the failure to swallow feed successfully. Signs may be seen only when forage is consumed, whereas water and grain are swallowed normally.

Answer 206

**Rabies** must always be considered when dysphagia is present, and appropriate precautions must be taken. **Botulism** also leads to esophageal transport failure, although dysphagia and a weak tongue are more pro minent in the failure of affected animals to eat. **Tetanus** may be similar in appearance to esophageal obstruction because of the presence of bloat, dysphagia, and drooling. * *Several poisonous plants,** including * *sneezeweed, Iarkspur, and milkweed.** may cause excessive salivation, drooling, and bloat. Consumption of **red clover **infected with the fungus Rhizoctonia leguminicola.,which produces the toxin slaframine, results in copious salivation. Pharyngeal trauma and subsequent cellulitis lead to dysphagia and drooling; severe bloat does not occur unless swelling is sufficient to occlude the esophagus. However, mild bloat frequently accompanies pharyngeal trauma caused by **associated vagal nerve inflammation and dysfuncnon.**

Answer 207

Common features of longstanding choke are **dehydration** and **metabolic acidosis** resulting from continued loss of sodium bicarbonate and sodium phosphate in saliva. As sodium depletion develops, the composition of saliva shifts to include more **potassium** under the influence of aldosterone.

Answer 208

In cases of complete esophageal obstruction, **relieving bloat** is the first concern. Passage of a stomach tube may be attempted if the animal is not in respiratory distress. Trocharization of the rumen or installation of a temporary fistula may be required. Until the esophagus has been cleared, it is important to keep the muzzle (mulen) level or pointed down to reduce the risk of aspiration of saliva. **Sedative drugs such as acepromazine or xylazine** may be useful to calm the animal and permit careful examination. Palpation of the neck along the **left** jugular furrow may reveal the site of obstruction in lean or thin-necked individuals. A manual oral examination should precede probing attempts with a stomach tube. If the object is solid (e.g., a potato ), it may be possible to massage it into the pharynx by pressing in the jugular furrow on both sides of the neck. Specialized equipment. such as a probang, is available with a corkscrew-like or pincer-like end that can be used to grasp or engage a foreign body and expedite its retrieval. If a mass of grain is obstructing the esophagus. external massage, probing with the stomach tube, or pumping fluid against the mass through the tube may break it up.

Answer 209

If the choke is intrathoracic and probing with a stomach tube does not relieve the problem, several courses of action are possible: A small ruminal fistula can be inserted to prevent bloat, and the animal can simply be placed in a pen without bedding, feed, or water. Many masses consisting of grain or hay spontaneously pass within 24 hours, whereas, solid objects rarely pass spontaneously. If the obstruction does not resolve in 24 hours, the animal can be heavily sedated, a cuffed endotracheal tube can be passed to **prevent aspiration**, and vigorous lavage with water through a stomach tube can be attempted. The head should be held lower than the body to minimize the risk of aspiration. If the obstruction still cannot be relieved or it is believed that the obstruction is a solid object, a **rumenotomy** can be performed. Access to the esophagus through the cardia should allow snaring of the object with a **loop of stiff wire or breakup of a mass of grain**.

Answer 210

The long-term prognosis after choke is good unless esophageal mucosal damage has occurred. Aftercare for the choked animal consists of a **soft diet** and **antiinflammatory drugs** to minimize tissue swelling. Hay and grain should be moistened before feeding, and grain should be offered only in small amounts at each feeding. Broad-spectrum antibiotics should be given if mucosal damage is suspected. Maintenance of an indwelling nasogastric tube for feeding for up to 10 days after severe esophageal trauma may be helpful in preventing strictures during healing. The animal can be fed and watered through a ruminal fistula. Abscesses may be drained, and granulomatous lesions resected

Answer 211

TRP or hardware disease is a common disease of cattle but is rarely seen in small ruminants. It is the most common cause of **anterior abdominal pain** in cattle.

Answer 212

Sluger fx metal som sætter sig i reticulum. Ingestion of a foreign body may also be associated with diseases that cause pica, such as phosphorus deficiency. Subsequently, the foreign object may enter the reticulum and (1) attach to a magnet without clinical diseases; (2) penetrate the reticulum wall only with intramural inflammation; (3) perforate the reticulum wall, penetrate into the peritoneal cavity, and create localized peritonitis; (4) migrate into the peritoneal and thoracic cavities.

Answer 213

The diaphragm, pericardium, and heart muscle are located just cranial to the reticulum, with the liver positioned medially and dorsally and the spleen laterally and dorsally. These organs may sometimes be penetrated by foreign bodies and become involved in the inflammatory process. The foreign body may penetrate the liver or spleen, leading to abscess formation. These abscesses as well as reticularadhesions may be responsible for ruminoreticular outflow problems and may lead to **vagal indigestion**.

Answer 214

TRP in the most severe, acute form is characterized by **fever, anorexia, decreased or absent ruminal contractions, and evidence of cranial abdominal pain** (Pinching of the withers or upward pressure on the xiphoid region may elicit a grunt on expiration. Affected cattle may stand with an arched back and resist ventral flexion of the hack when pinched over the withers (normal cattle flex ventrally). Some cattle grunt spontaneously whe n forced to move or when defecating or urinating) Lactating cows show a sudden decrease in milkproductlon. Some cows regurgitate ruminal fluid, especially if the oropharynx is mechanically stimulated. Tachycardia, reluctance to move or lie down, mild bloat, constipation (forstoppelse), or abducted elbows may also be seen. These typical signs often abate (aftager) within the first day or two, making diagnosis more difficult. Auscultation may reveal a pounding heart or muffled (dæmpede) heart sounds bilaterally if pericarditis with effusion has developed by the lime of examination. Sudden death has occurred as a result of the laceration of a coronary blood vessel or puncture of the heart by the foreign body. Cows in early lactation may have ketosis; however. a distinguishing feature of hardware disease (TRP) is the **abrupt (pludselige) onset of anorexia and hypogalactia. **Fever may be absent . Weight loss, rough hair coat, diarrhea, or generalized lameness, along with cranial abdominal pain that is difficult to localize, may be the only signs. Distended jugular and superficial abdominal veins and other signs of congestive right-sided heart failure are most common after pericardial effusion. Dyspnea may occur if left-sided failure is also present. The pain and inflammation associated with the trauma and infection lead to **decreased appetite and ruminal hypomotility or stasis.**

Answer 215

TRP must be differentiated from other causes of cranial abdominal pain. They mainly include **abomasal ulcers, hepatic abscesses from other causes, and pleuritis.** When thoracic structures are involved, TRP must be differentiated from **primary pneumonia or pleuritis, diaphragmatic hernia,** and **heart diseases such as endocarditis, lymphosarcoma of the heart, and cor pulmonale.** Finally, TRP must be differentiated from **others causes of ruminal distention and vagal indigestion.**

Answer 216

The WBC count and differential, as well as the determination of plasma proteins and fibrinogen, may indicate an acute or chronic inflammatory process depending on the stage of the TRP. Neutrophilia and a left shift are expected in acute cases. However, in more chronic cases changes are less pronounced, and WBC count as well as differential may be normal. Neutrophilia (or neutrophil leukocytosis) describes a high number of neutrophil granulocytes in blood.

Answer 217

The WBC count and differential, as well as the determination of plasma proteins and fibrinogen, may indicate an acute or chronic inflammatory process depending on the stage of the TRP. High fibrinogen concentration may be observed in acute rases (2 to 3 days after the beginning of the disease) and chronic active cases.

Answer 218

The WBC count and differential, as well as the determination of plasma proteins and fibrinogen, may indicate an acute or chronic inflammatory process depending on the stage of the TRP. High total plasma proteins, primarily reflecting **high globulin levels,** were expected in **chronic** cases of TRP. Higher concentrations of total plasma proteins have been observed in cases of TRP compared with other abdominal disorder. All the results of the studies demonstrated that high values of plasma fibrinogen and plasma protein concentrations are highly suggestive of TPR. However, other disorders can induce the same modifications, and absence of these abnormalities does not rule out TRP.

Answer 219

Man kan bestemme **WBC count and differential, plasma fibrinogen koncentration og plasmaprotein koncentration.** Consequently, other diagnostic tests (**diagnostic imaging**) must be performed to confirm the diagnosis. **Biochemical profile and blood gas analysis** are usually within normal range but may reflect hypochloremic metabolic alkalosis associated with ileus and dysfunction of the abomasum. **Radiography and ultrasonography o**f the reticulum are very useful for the diagnosis of TRP. Radiographs of the reticulum are limited to referral centers. Location of the foreign body is the most reliable indicator for the diagnosis of TPR. **Abdominocentesis and pericardiocentesis** may be performed blind or with ultrasound guidance. **Pericardiocentesis** may be performed at the level of the point of the elbow in the fifth left intercostal space. Visual inspection of the fluid obtained is usually adequate to confirm the diagnosis of pericarditis; it is cloudy and foulsmelling. The fluid may be examined bacteriologically and cytologically. If ileus occurs or vagal indigestion develops, **analysis of the ruminal fluid**may reveal elevated chloride ion concentration as a result of reflux from the abomasum and omasum.

Answer 220

It develop in three phases. 1) The first one, characterized by poorly comminuted (findelt) feces, occurs secondary to virtual immobilization of the reticulum caused by pain and inflammatory adhesions. 2) With extension of the adhesions, additional impairment of reticulum motility develops. At this time, stratification of the food particles in the reticulorumen is lost, volume of these two forestomachs is in creased, and ruminal outflow is inhibited. 3) Finally, the consistency of ruminal contents is changed to a pasty mass with high viscosity. Increase in viscosity of ruminal outflow leads to inhibition of the transpyloric outflow. At this time, abomasumal volume increases and internal vomiting occurs.

Answer 221

Kvæg. Ingestion of such items by sheep or goats is extremely rare.

Answer 222

Cattle that die peracutely may have a lacerated myocardium with resulting hemorrhage or cardiac tamponade. Diffuse peritonitis characterized by copious, foul -smelling peritoneal fluid with an obvious reticular defect may be seen in acute cases.

Answer 223

More chronically affected animals may have extensive **pericardial effusion with a thick epicardial layer of fibrin.** The penetrating foreign body generally is still present in the wall of the reticulum or pericardium.

Answer 224

Conservative treatment generally is attempted first and includes the administration of a **forestomach magnet**, parenteral antibiotic therapy, and confinement (indespærring). Often the animal is confined to a stanchion or box stall. Many cattle recover after such a course of therapy with resumption of forestomach motility and appetite within 1 to 3 days. Animals that have not significantly improved by the third day may require a **rumenotomy** to remove the foreign object. Ideally, radiography combined with ultrasonography is recommended at this time to verify the diagnosis and objectively assess the response to treatment, but ultrasonography alone is most feasible (gennemførlig) in most practices. During rumenotomy, abscesses that are tightly adhered to the reticulum may be drained into the lumen of the reticulum. In some instances reticular abscesses may also be drained through an ultrasound-guided transcutaneous incision, ultrasound-guided insertion of a chest trocar, or insert ion of a trocar during ventral laparotomy. Treatment of peritonitis requires systemic antibiotic therapy and possibly drain age of the affected area.

Answer 225

The prognosis of TRP depends mainly on the location of the foreign body and the other organs affected. The prognosis is fair to good when TRP is associated with localized peritonitis and when only the spleen or the liver is also affected. In most cases as inflammation diminishes, the reticular function can return to normal. The prognosis is poor to guarded in TRP associated with pericarditis, pleuritis, or diffuse inflammatory adhesions in the abdomen.

Answer 226

Eliminating sources of sharp foreign objects in the feed supply prevents TRP. Installation of large magnets on feedhandling equipment and prophylactic administration of **forestomach magnets to all animals at 6 to 8 months of age** prevent almost all cases caused by magnetizable objects .

Answer 227

The peritoneal cavity (bughulen) is lined by a serous membrane composed of two layers called the peritoneum.

Answer 228

Peritonitis is an inflammatory process involving the peritoneal cavity and its serosal surface the peritoneum. Pertonitis er **_ikke_** et synonym for intraabdominal infektion. **Peritonitis** = Peritonitis should be considered as the localized, equivalent of SIRS. INFLAMMATION! The inflammation may result from trauma, surgery, or vascular damage associated with an intestinal obstruction and /or accident or from gastrointestinal ulceration. **Intraabdominal infektion** = an inflammatory response of the peritoneum to microorganisms and their toxins that results in purulent exudates in the abdominal cavity. Intraabdominal infection is the localized equivalent of sepsis. Intraabdorninal abscess is an intraabdominal infection confined within the abdominal cavity. **Because most often in farm animals peritonitis is caused by bacteria. the two terms are often used as synonyms.** Systemic inflammatory response syndrome (SIRS) is an inflammatory state affecting the whole body, frequently a response of the immune system to infection, but not necessarily so. It is related to sepsis, a condition in which individuals meet criteria for SIRS and have a known infection.

Answer 229

Clinical signs are often nonspecific but suggestive of gastrointestinal dysfunction . Peritonitis is a serious and complex process that is often accompanied by various degrees of abdominal pain, progressive signs of hypovolemia and septicemia, and/or endotoxemia. Hypovolemia, hypoproteinemia, bacteremia or septicemia, and toxemia are commonly observed in acute diffuse septic peritonitis. AKUT:Cattle suffering from acute peritonitis tend to show more characteristic signs. As the condition becomes less acute, the ability of the bovine to seal the infection will attenuate (dæmpe) the clinical signs. Abdominal rigidity and tenderness, abdominal distention, scleral injection, fever. anorexia, and sudden reduction in milk production are classic but not pathognomonic findings of acute peritonitis. In the acute stage, abdominal pain and the release of catecholamines often lead to a complete gastro intestinal stasis and ileus. The rumen is then completely atonic. Feces are abnormal in quantity and quality. In the acute stage, feces are present in small amounts and often dry. Pain, decreased plasma volume, and endotoxemia often result in persistent tachycardia KRONISK: Chronic but active peritonitis remains to this day a very difficult diagnosis to make without ancillary tests. In more chronic cases feces are present with a tendency to be diarrheic. It is my impression that one of the most reliable clinical sign of abdominal discomfort in cattle is reluctance to move. Scleral injection , fever, tachycardia, gastrointestinal stasis, and distention are the clinical signs that should be monitored to evaluate peritonitis.

Answer 230

Peritonitis may be classified according to the clinical presentation and/or the cause. Clinically relevant classifications include: acute versus chronic septic versus chemical localized versus generalized primary versus secondary.

Answer 231

The major adverse effects of peritoneal contamination are: (1) rapid clearance of bacteria, prodcing endotoxemia and/or bacteremia (2) rapid influx of fluid rich in protein, leading to hypovolemia and hypoproteinemia. (3) deposition of fibrin, occluding lymphatic drainage, contributing to abdominal distention, and enhancing the chance of abscess formation. (4) ileus. (5) adhesion formation, which may lead to obstruction.

Answer 232

Hemogram In less severe cases, a neutrophilic leukocytosis and hyperfibrinogenemia are often present. Hematologic analysis has been a useful tool to monitor response to therapy after a diagnosis has been made by other ancillary tests. The blood chemistry profile is rarely altered by peritonitis in a way that is diagnostically useful. Chronic inflammation causes a marked increase in serum proteins, particularly the globulin portion. In acute severe cases, secondary findings may include increased serum urea nitrogen and creatinine, mildly increased liver enzymes, reduction in total CO2, and strong ion difference and reduction in serum albumin. Ileus and upper gastrointestinal stasis may result in marked hypochloremia and alkalosis. Cytologic examination of the peritoneal fluid is a useful aid in making a definitive diagnosis of peritonitis. Abdominocentesis techniques have been described elsewhere. The right side just cranial to the udd er is the preferred site (to avoid stomach and omentum). It is imperative to remember that failure to secure fluid is common and should be interpreted with caution (because fibrinous peritonitis with fluid loculation is common). One should remember that because of the bovine's ability to deposit fibrin and seal areas of the peritoneal cavity, the interpretation of peritoneal fluid analysis applies only to the immediate area that was sampled. Abdominal radiographs using a high-power unit are extremely useful in cases in which TRP is suspected. They have limited value in other causes of peritonitis. Ultrasound examination is useful for assessing the size and anatomic relationships of lesions, particularly when considering drainage, aspiration. or surgical exploration of a mass surrounding vital structures. Higher-frequency probes produce finer images but have limited tissue penetration. Areas that should be scanned include the caudal lower flank area (right and left), right perirenal area. liver, abomasum and pylorus, and right paramedian area. During exploratory surgery, ultrasound can be used to image an internal mass or a viscera appearing abnormal. Surgical exploration is often used to confirm or rule out an Intraabdorninal probtem. Laparoscopy can be used to diagnose acute and chronic peritonitis, which is otherwise difficult to identify with ultrasound or abdominocentesis.

Answer 233

The basic elements of therapy are support, antibiotics, and surgery. **Supportive Therapy:** Depending on the severity of the process, the patient may be presented in **shock**. Large volumes of **isotonic intravenous fluids** are then indicated. Correction of any acid-base deficit is indicated. Electrolyte abnormalities (**hypokalemia and hypocalcemia**) should be identified and corrected. If the animal is **hypoproteinemic**, plasma or whole blood transfusions may be beneficial. **Nonsteroidal and/or steroidal antiinflammatory drugs** may be of importance to prevent the synthesis of more inflammatory mediators. **Pain control** is also important. **Transfaunation** may be beneficial in cases of **prolonged anorexia.** **Anlibiotic Therapy:** Systemic antibiotic therapy should be instituted as soon as a decision to treat is made. Until results of culture and antimicrobial susceptibility become available, a broad-spectrum antibiotic should be used. The choice should take into consideration the following: cost of treatment, withdrawal period in food animals, spectrum of activity, and treatment regimen (frequency and route). Tetracycline or a Beta-lactam antibiotic (third-generatio n cephalosporin or a synthetic penicillin) appears to be a good choice. Surgical Therapy: Surgical control of peritonitis includes peritoneal debridement and irrigation and drainage. Using ultrasound guidance, it is possible to safely establish drainage from the abdominal cavity. A thoracic chest trocar can be used temporarily until all fluid has been removed.

Answer 234

The early decision on treatment (medical and surgical), correct choice of antimicrobials, and adequate supportive therapy contribute to the success or failure of a therapy. The owner's delay in seeking therapy, the primary cause of peritonitis. and the patient's age are examples of important factors beyond the clinician's control. When aggressive therapy is economically possible, survival rates will be good, but long-term sequelae may compromise a complete recovery.