Left Displaced Abomasum, AED, and Abomasal-Cecal Dilation-Dislocation

Question 1

Besides the rumen and abomasum, what 4 structures should you be able to palpate from a right flank celiotomy?

Answer 1

Left and right kidney
Liver
Urinary bladder

Question 2

What are 3 causes of a left displaced abomasum?

Answer 2

Abomasal atony
Decreased rumen volume
Calving

Question 3

What are 4 causes of abomasal atony?

Answer 3

Increased VFAs
Hypocalcemia
Metritis
Mastitis

Question 4

When do we see marked changes in abomasal dimensions, position and volume?

Answer 4

Last 3 months of gestation and first 3 months of lactation

Question 5

Why do we see marked changes in abomasal dimensions, position and volume?

Answer 5

Response to cranial expansion of the gravid uterus

Question 6

What position do the gravid uterus push the abomasum into?

Answer 6

More transverse and leftward position on ventral abdominal wall.

Question 7

What are some basic clinical signs of a LDA?

Answer 7

Refuse grain
Normal temp and still passing feces
Tympany in left flank

Question 8

With surgery of an LDA, RDA or abomasal volvulus, what is the main goal?

Answer 8

Replace the abomasum to the normal position and stabilize it there.

Question 9

What are the 4 different procedures for LDA?

Answer 9

Right flank omentopexy
Left flank abomasopexy
Right paramediam abomasopexy
Closed suture or bar technique

Question 10

What are 4 big considerations to choosing an approach to an LDA?

Answer 10

Time required
Man-power needed
Complications
Success rate

Question 11

What is “pinging”?

Answer 11

Listening to the flank with your stethoscope and flicking to hear if there is a gas distended structure right there.

Question 12

Why do we have increased urine ketones in a cow with a LDA?

Answer 12

Because they are in a high energy demand state, and should be getting 1lb of grain per 3-4lbs of milk produced, but with an LDA they refuse grain and so they switch to metabolizing fat which releases ketones.

Question 13

A cow with LDA and diarrhea is usually..?

Answer 13

…toxic, leukopenic and a poor surgical risk.

Question 14

What do we often see in the chem profile of a cow with a LDA?

Answer 14

Hypocalcemia.

Question 15

Before surgery on a cow with LDA, what 3 things do you need to consider and treat?

Answer 15

Metritis (lutalyse and tetracycline)
Hypocalcemia (calicium IV)
Ketosis (Dextrose IV)

Question 16

How would you treat metritis in a cow with LDA?

Answer 16

Lutalyse and tetracycline

Question 17

How would you treat hypocalcemia in a cow with LDA?

Answer 17

Hypocalcemia

Question 18

How would you treat ketosis in a cow with LDA?

Answer 18

Dextrose IV

Question 19

For a right flank omentopexy, what 4 nerve block options do you have?

Answer 19

Proximal paravertebral
Distal paravertebral
Inverted L
Line block

Question 20

For a right flank omentopexy, where do you make your incision?

Answer 20

Halfway between the tuber coxae and the last rib, right in the middle of the paralumbaar fossa.

Question 21

Roughly how long should you make your incision for a right flank omentopexy?

Answer 21

At least 6 inches.

Question 22

When correcting a LDA, what is the purpose of going into the abdomen with a needle and sterile tubing?

Answer 22

To vent the gas off the abomasum.

Question 23

Where do you place the suture in an omentopexy?

Answer 23

Place it through the abdominal wall, through the omentum and back through the abdominal wall.

Question 24

Where is the omentum that you will use for an omentopexy attached?

Answer 24

At the pylorus.

Question 25

When performing an omentopexy, what 3 things do you include in your sutures to complete it?

Answer 25

The omentum, the peritoneum and the transverse abdominal muscles. NOTE: Use a simple continuous suture pattern.

Question 26

Why do you suture the omentopexy from ventral to dorsal?

Answer 26

Because you want to prevent things from falling out.

Question 27

What suture pattern do you use to close the oblique muscles after an omentopexy?

Answer 27

Simple continuous.

Question 28

What suture material should you use for the omentopexy and muscle apposition?

Answer 28

Absorbable 2 or 3 in cows, 00 for the sheep.

Question 29

What suture pattern do you use to close the subcutaneous layer in the celiotomy in a sheep?

Answer 29

00

Question 30

When closing the skin in a celiotomy, what suture do you use?

Answer 30

Non-absorbable suture, 2 or 3 in the cow, and 00 or 0 in the sheep.

Question 31

What are 5 advantages of the right paralumbar omentopexy?

Answer 31

``` Cow in standing One person can do it Can use for LDA, RDA and RTA Less traumatic Gives good exploration ```

Question 32

What are 4 disadvantages to the right paralumbar omentopexy?

Answer 32

Needs more skill/experience Difficult if omentum is friable Surgeon size can cause problems Not easy in 3rd trimester

Question 33

When performing an left flank abomasopexy, what structure do you need to be careful of with your incision?

Answer 33

The abomasum because it's distended with fluid and gas.

Question 34

What special piece of equipment do you need when performing a left flank abomasopexy?

Answer 34

Two straight intestinal needles with 3 feet of suture in between.

Question 35

Describe simply how to perform a left flank abomasopexy.

Answer 35

Place a simple continuous pattern on the greater curvature of the abomasum, pass each needle through the right paramedian area with the second needle roughly 6 inches caudal and tie.

Question 36

What do you need to be careful of when performing a left flank abomasopexy?

Answer 36

Make sure no viscera gets caught between the abomasum and body wall.

Question 37

When passing the straight intestinal needles through the body wall during a left flank abomasopexy, what structure do you need to be careful not to hit?

Answer 37

The milk vein.

Question 38

What are 5 advantages of performing a left flank abomasopexy?

Answer 38

``` Cow standing Advanced pregnancies Visual inspection Ulcers can be oversewn Rumenotomy ``` NOTE: This is the procedure of choice for cows during gestation.

Question 39

What are 3 disadvantages of performing a left flank abomasopexy?

Answer 39

Not to be used to RDA or RTA Assistant needed Size of the surgeon can be restrictive

Question 40

Where is the incision made when performaing a right paramedian abomasopexy?

Answer 40

Between midline and the right sq abdominal vein, starting 8cm behind the xyphoid.

Question 41

When performing a right paramediam abomasopexy, what is the preferred location for abomasopexy?

Answer 41

20 cm caudal to the xypohid and 5-10 cm to the right of ventral midline.

Question 42

What is an advantage of performing a right paramediam abomasopexy?

Answer 42

The size of the surgeon doesn't matter.

Question 43

What are 3 disadvantages of performing a right paramediam abomasopexy?

Answer 43

Inability to visualize and cut adhesions Cow is in dorsal recumbency Risk of infection and dehiscence

Question 44

What are the 2 minimally invasive procedure for a LDA?

Answer 44

Closed suture | Toggle pin technique

Question 45

What do we see when a cow is roughly 10% dehydrated?

Answer 45

Sunken orbit

Question 46

What percentage of cows will redevelop an LDA following rolling and medical treatment?

Answer 46

75%

Question 47

How is the closed suture technique for correcting a LDA performed?

Answer 47

Cow is cast, and the surgeon kneels on the cow to "shake" the abomasum back into place, then with the cow in dorsal, a curved needle is pushed through the body wall into the abomasal lumen and back out through the body wall.

Question 48

How do you place a toggle pin to correct a LDA?

Answer 48

Shake the abomasum as per the closed suture technique, then use the trocar to help introduce the toggle.

Question 49

When correcting an LDA, when should you stop the procedure?

Answer 49

If a distinct ping cannot be identified at the appropriate location.

Question 50

What are 3 advantages to the closed suture and toggle pin procedures?

Answer 50

Quick Inexpensive Simple

Question 51

What are 4 disadvantages to the closed suture and toggle pin procedures?

Answer 51

Can't visualize abomasum Must be absolutely sure of diagnosis Fistula possible Potential for catastrophic complications

Question 52

How can you eliminate the lack of abomasal visualization from the closed suture and toggle pin technique?

Answer 52

Laparoscopy

Question 53

What is a fistula?

Answer 53

A communication between a hollow or tubular organ and the body surface.

Question 54

What is something that you often find in a fistula?

Answer 54

Non-absorbable suture material. NOTE: Suture went into lumen of the abomasum.

Question 55

How do you repair an abomasal fistula?

Answer 55

En bloc resection, suture the abomasum with a double inverting pattern and repeat abomasopexy.

Question 56

What suture is very inert allowing it to be used in inflamed/infected tissue?

Answer 56

Stainless steel

Question 57

What are some differentials for a right sided ping? (Name as many as you can, 8 total)

Answer 57

``` RDA Abomasal volvulus Cecal dilation/volvulus Intussusception Pneumorectum Gas in the uterus Gas in the spiral colon Penumoperitoneum ```

Question 58

How can you treat a simple RDA medically (3 ways)?

Answer 58

Calcium Dextrose Exercise

Question 59

Where do you expect to find a ping with an RDA?

Answer 59

Paralumbar fossa to rib 8.

Question 60

What organ should you be thinking about if there is a ping auscultated in the right parlumbar fossa more caudally?

Answer 60

Cecum

Question 61

In an abomasal volvulus, how does the abomasum twist?

Answer 61

Counterclockwise from behind and counterclockwise from the right side.

Question 62

Why would you expect to see a tachycardia with an RDA?

Answer 62

Because of endotoxic shock, pain and hypovolemia.

Question 63

What 2 surgical options do you have to repair an abomasal volvulus?

Answer 63

Right flank omentopexy** | Right paramedian abomasopexy

Question 64

What are 2 things that can go wrong with performing fluid decompression on a chronic abomasal volvulus?

Answer 64

Peritonitis from leakage | Loss of HCl leading to alkalosis

Question 65

Once the abomasal volvulus has been corrected, pull the omentum until you see what structure to know the volvulus has been corrected?

Answer 65

The pylorus.

Question 66

When are abx indicated in an abomasal volvulus?

Answer 66

Anytime there is a strangulating obstruction.

Question 67

What is the prognosis of an RDA post surgery?

Answer 67

Good.

Question 68

In a case of abomasal volvulus, what are 2 causes of immediate death?

Answer 68

Hemodynamic/metabolic derangement | Circulatory collapse

Question 69

In a case of abomasal volvulus, what are 2 causes of delayed death?

Answer 69

Abnormal abomasal transport | Damage to the abomasal vasculature, nerves and muscle

Question 70

What are 5 causes of death from abomasal volvulus?

Answer 70

``` Abomasal ulceration Luminal hemorrhage Venous thrombosis Necrosis of the abomasum Peritonitis ```

Question 71

What are 3 good prognosticators post-abomasal volvulus surgery?

Answer 71

Sternal Good appetite Feces on the wall

Question 72

If a cow stops eating, how much weight can she lose in 24 hours?

Answer 72

10kgs

Question 73

What are 3 common clin path changes seen in cattle with upper GI obstructions?

Answer 73

Hypochloremia Hypokalemia Metabolic alkalosis **different from monogastric species who go right to metabolic acidosis

Question 74

In a chronic case of abomasal volvulus, what is the development of an acidosis due to?

Answer 74

Due to the release of lactic acid due to shock.

Question 75

What hormone is secreted during dehydration to cause increase in sodium reabsorption?

Answer 75

Aldosterone.

Question 76

What happens in the face of metabolic alkalosis?

Answer 76

Paradoxical aciduria

Question 77

What is a major prognostic indicator with cases of abomasal volvulus?

Answer 77

Heart rate, the higher it is, the worse things are.

Question 78

What do we see in sheep instead of LDA, RDA and abomasal volvulus (because we don't see those)?

Answer 78

Abomasal emptying defect.

Question 79

What 4 clinical signs do you see in a sheep with abomasal emptying defect?

Answer 79

BAR, but poor appetite. Elevated HR and RR, normal rumen contractions Decreased fecal output Abdominal distention in the right ventral quadrant

Question 80

What sheep are commonly affect by abomasal emptying defect?

Answer 80

Pregnant sheep on a high concentrate diet.

Question 81

In a sheep with abomasal emptying defect, what would you see on ultrasound?

Answer 81

A large viscus against the body wall.

Question 82

How do you treat abomasal emptying defect medically?

Answer 82

IV fluid with electrolytes Mineral oil Cholinergic drugs

Question 83

How do you treat abomasal emptying defect surgically?

Answer 83

Abomasotomy using a right paracostal approach or a right paramedian approach.

Question 84

What 2 breeds of sheep are predisposed to abomasal emptying defect?

Answer 84

Suffolk | Dorset

Question 85

What is the prognosis for a sheep with abomasal emptying defect?

Answer 85

Guarded to poor.

Question 86

What are 3 causes of cecal dilatation, displacement/volvulus?

Answer 86

Accumulation of VFAs in the cecum after heavy grain feeding Ileus from concurrent dz Advanced pregnancy

Question 87

How can you repair a cecal dilatation, displacement/volvulus?

Answer 87

Right flank approach with a typhlotomy at the apex of the cecum to drain the contents, two inverting layers on the cecum with 00 absorbable suture.

Question 88

Post-typhlotomy, what 3 things do you treat the animal with?

Answer 88

Abx Flunixin Calcium

Question 89

What is the recurrence rate of cecal dilatation, displacement/volvulus?

Answer 89

10%

Question 90

If there is recurrence of cecal dilatation, displacement/volvulus, what is done next?

Answer 90

Removal of the apex and body of the cecum.