Left Displaced Abomasum, AED, and Abomasal-Cecal Dilation-Dislocation Flashcards
Besides the rumen and abomasum, what 4 structures should you be able to palpate from a right flank celiotomy?
Left and right kidney
Liver
Urinary bladder
What are 3 causes of a left displaced abomasum?
Abomasal atony
Decreased rumen volume
Calving
What are 4 causes of abomasal atony?
Increased VFAs
Hypocalcemia
Metritis
Mastitis
When do we see marked changes in abomasal dimensions, position and volume?
Last 3 months of gestation and first 3 months of lactation
Why do we see marked changes in abomasal dimensions, position and volume?
Response to cranial expansion of the gravid uterus
What position do the gravid uterus push the abomasum into?
More transverse and leftward position on ventral abdominal wall.
What are some basic clinical signs of a LDA?
Refuse grain
Normal temp and still passing feces
Tympany in left flank
With surgery of an LDA, RDA or abomasal volvulus, what is the main goal?
Replace the abomasum to the normal position and stabilize it there.
What are the 4 different procedures for LDA?
Right flank omentopexy
Left flank abomasopexy
Right paramediam abomasopexy
Closed suture or bar technique
What are 4 big considerations to choosing an approach to an LDA?
Time required
Man-power needed
Complications
Success rate
What is “pinging”?
Listening to the flank with your stethoscope and flicking to hear if there is a gas distended structure right there.
Why do we have increased urine ketones in a cow with a LDA?
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.
A cow with LDA and diarrhea is usually..?
…toxic, leukopenic and a poor surgical risk.
What do we often see in the chem profile of a cow with a LDA?
Hypocalcemia.
Before surgery on a cow with LDA, what 3 things do you need to consider and treat?
Metritis (lutalyse and tetracycline)
Hypocalcemia (calicium IV)
Ketosis (Dextrose IV)
How would you treat metritis in a cow with LDA?
Lutalyse and tetracycline
How would you treat hypocalcemia in a cow with LDA?
Hypocalcemia
How would you treat ketosis in a cow with LDA?
Dextrose IV
For a right flank omentopexy, what 4 nerve block options do you have?
Proximal paravertebral
Distal paravertebral
Inverted L
Line block
For a right flank omentopexy, where do you make your incision?
Halfway between the tuber coxae and the last rib, right in the middle of the paralumbaar fossa.
Roughly how long should you make your incision for a right flank omentopexy?
At least 6 inches.
When correcting a LDA, what is the purpose of going into the abdomen with a needle and sterile tubing?
To vent the gas off the abomasum.
Where do you place the suture in an omentopexy?
Place it through the abdominal wall, through the omentum and back through the abdominal wall.
Where is the omentum that you will use for an omentopexy attached?
At the pylorus.
When performing an omentopexy, what 3 things do you include in your sutures to complete it?
The omentum, the peritoneum and the transverse abdominal muscles.
NOTE: Use a simple continuous suture pattern.
Why do you suture the omentopexy from ventral to dorsal?
Because you want to prevent things from falling out.
What suture pattern do you use to close the oblique muscles after an omentopexy?
Simple continuous.
What suture material should you use for the omentopexy and muscle apposition?
Absorbable 2 or 3 in cows, 00 for the sheep.
What suture pattern do you use to close the subcutaneous layer in the celiotomy in a sheep?
00
When closing the skin in a celiotomy, what suture do you use?
Non-absorbable suture, 2 or 3 in the cow, and 00 or 0 in the sheep.
What are 5 advantages of the right paralumbar omentopexy?
Cow in standing One person can do it Can use for LDA, RDA and RTA Less traumatic Gives good exploration
What are 4 disadvantages to the right paralumbar omentopexy?
Needs more skill/experience
Difficult if omentum is friable
Surgeon size can cause problems
Not easy in 3rd trimester
When performing an left flank abomasopexy, what structure do you need to be careful of with your incision?
The abomasum because it’s distended with fluid and gas.
What special piece of equipment do you need when performing a left flank abomasopexy?
Two straight intestinal needles with 3 feet of suture in between.
Describe simply how to perform a left flank abomasopexy.
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.
What do you need to be careful of when performing a left flank abomasopexy?
Make sure no viscera gets caught between the abomasum and body wall.
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?
The milk vein.
What are 5 advantages of performing a left flank abomasopexy?
Cow standing Advanced pregnancies Visual inspection Ulcers can be oversewn Rumenotomy
NOTE: This is the procedure of choice for cows during gestation.
What are 3 disadvantages of performing a left flank abomasopexy?
Not to be used to RDA or RTA
Assistant needed
Size of the surgeon can be restrictive
Where is the incision made when performaing a right paramedian abomasopexy?
Between midline and the right sq abdominal vein, starting 8cm behind the xyphoid.
When performing a right paramediam abomasopexy, what is the preferred location for abomasopexy?
20 cm caudal to the xypohid and 5-10 cm to the right of ventral midline.
What is an advantage of performing a right paramediam abomasopexy?
The size of the surgeon doesn’t matter.
What are 3 disadvantages of performing a right paramediam abomasopexy?
Inability to visualize and cut adhesions
Cow is in dorsal recumbency
Risk of infection and dehiscence
What are the 2 minimally invasive procedure for a LDA?
Closed suture
Toggle pin technique
What do we see when a cow is roughly 10% dehydrated?
Sunken orbit
What percentage of cows will redevelop an LDA following rolling and medical treatment?
75%
How is the closed suture technique for correcting a LDA performed?
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.
How do you place a toggle pin to correct a LDA?
Shake the abomasum as per the closed suture technique, then use the trocar to help introduce the toggle.
When correcting an LDA, when should you stop the procedure?
If a distinct ping cannot be identified at the appropriate location.
What are 3 advantages to the closed suture and toggle pin procedures?
Quick
Inexpensive
Simple
What are 4 disadvantages to the closed suture and toggle pin procedures?
Can’t visualize abomasum
Must be absolutely sure of diagnosis
Fistula possible
Potential for catastrophic complications
How can you eliminate the lack of abomasal visualization from the closed suture and toggle pin technique?
Laparoscopy
What is a fistula?
A communication between a hollow or tubular organ and the body surface.
What is something that you often find in a fistula?
Non-absorbable suture material.
NOTE: Suture went into lumen of the abomasum.
How do you repair an abomasal fistula?
En bloc resection, suture the abomasum with a double inverting pattern and repeat abomasopexy.
What suture is very inert allowing it to be used in inflamed/infected tissue?
Stainless steel
What are some differentials for a right sided ping? (Name as many as you can, 8 total)
RDA Abomasal volvulus Cecal dilation/volvulus Intussusception Pneumorectum Gas in the uterus Gas in the spiral colon Penumoperitoneum
How can you treat a simple RDA medically (3 ways)?
Calcium
Dextrose
Exercise
Where do you expect to find a ping with an RDA?
Paralumbar fossa to rib 8.
What organ should you be thinking about if there is a ping auscultated in the right parlumbar fossa more caudally?
Cecum
In an abomasal volvulus, how does the abomasum twist?
Counterclockwise from behind and counterclockwise from the right side.
Why would you expect to see a tachycardia with an RDA?
Because of endotoxic shock, pain and hypovolemia.
What 2 surgical options do you have to repair an abomasal volvulus?
Right flank omentopexy**
Right paramedian abomasopexy
What are 2 things that can go wrong with performing fluid decompression on a chronic abomasal volvulus?
Peritonitis from leakage
Loss of HCl leading to alkalosis
Once the abomasal volvulus has been corrected, pull the omentum until you see what structure to know the volvulus has been corrected?
The pylorus.
When are abx indicated in an abomasal volvulus?
Anytime there is a strangulating obstruction.
What is the prognosis of an RDA post surgery?
Good.
In a case of abomasal volvulus, what are 2 causes of immediate death?
Hemodynamic/metabolic derangement
Circulatory collapse
In a case of abomasal volvulus, what are 2 causes of delayed death?
Abnormal abomasal transport
Damage to the abomasal vasculature, nerves and muscle
What are 5 causes of death from abomasal volvulus?
Abomasal ulceration Luminal hemorrhage Venous thrombosis Necrosis of the abomasum Peritonitis
What are 3 good prognosticators post-abomasal volvulus surgery?
Sternal
Good appetite
Feces on the wall
If a cow stops eating, how much weight can she lose in 24 hours?
10kgs
What are 3 common clin path changes seen in cattle with upper GI obstructions?
Hypochloremia
Hypokalemia
Metabolic alkalosis **different from monogastric species who go right to metabolic acidosis
In a chronic case of abomasal volvulus, what is the development of an acidosis due to?
Due to the release of lactic acid due to shock.
What hormone is secreted during dehydration to cause increase in sodium reabsorption?
Aldosterone.
What happens in the face of metabolic alkalosis?
Paradoxical aciduria
What is a major prognostic indicator with cases of abomasal volvulus?
Heart rate, the higher it is, the worse things are.
What do we see in sheep instead of LDA, RDA and abomasal volvulus (because we don’t see those)?
Abomasal emptying defect.
What 4 clinical signs do you see in a sheep with abomasal emptying defect?
BAR, but poor appetite.
Elevated HR and RR, normal rumen contractions
Decreased fecal output
Abdominal distention in the right ventral quadrant
What sheep are commonly affect by abomasal emptying defect?
Pregnant sheep on a high concentrate diet.
In a sheep with abomasal emptying defect, what would you see on ultrasound?
A large viscus against the body wall.
How do you treat abomasal emptying defect medically?
IV fluid with electrolytes
Mineral oil
Cholinergic drugs
How do you treat abomasal emptying defect surgically?
Abomasotomy using a right paracostal approach or a right paramedian approach.
What 2 breeds of sheep are predisposed to abomasal emptying defect?
Suffolk
Dorset
What is the prognosis for a sheep with abomasal emptying defect?
Guarded to poor.
What are 3 causes of cecal dilatation, displacement/volvulus?
Accumulation of VFAs in the cecum after heavy grain feeding
Ileus from concurrent dz
Advanced pregnancy
How can you repair a cecal dilatation, displacement/volvulus?
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.
Post-typhlotomy, what 3 things do you treat the animal with?
Abx
Flunixin
Calcium
What is the recurrence rate of cecal dilatation, displacement/volvulus?
10%
If there is recurrence of cecal dilatation, displacement/volvulus, what is done next?
Removal of the apex and body of the cecum.
