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Ruminant clinical medicine > Rumenotomy, displaced abomasum, cesarean > Flashcards

Rumenotomy, displaced abomasum, cesarean Flashcards

1
Q

Its hard to diagnose foreign bodies.
What are some tests to use? (4)

A
  • Pain tests. Withers pinch, Stick test
  • Fibrinogen (espesh when fever fluctuates)
  • Ultrasound of the reticulum
  • Laparotomy

Clinical findings depend on
* Foreign body type
* Duration of symptoms
* Possible perforations

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1
Q

Clinical signs of reticuloperitonitis. (8)

A
  • Sudden loss of milk yield
  • Loss of appetite
  • HR/RR elevated
  • Stands hunched over
  • Bruxism
  • Elbows point out
  • Rumen hypomotility, tympany
  • Dry feces
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2
Q

Treatment of Reticuloperitonitis.

A

Conservative method
* MAGNET!
* Procaine penicillin 20-22mg/kg i.m. SID 3-5d
*NSAIDs

Surgical method
* If the cow doesn’t feel better in three days -> discuss with owner
* Laparotomy -> rumenotomy

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3
Q

Surgical approach to traumatic reticuloperitonitis.

A

If possible
* Procainepenicillin (6h) before operation 20-22 mg/kg i.m.
* Ketoprofen 3 mg/kg i.v./i.m.

  • Distal paravertebral anesthesia (L1, L2, L4) + local infiltration anesthesia of the skin

If you detect tympany, put a stomach tube in before operation. It helps you get the gas / foam away 🡪 easier to operate.

If there is tympany, it can be hard to decide where to do the incision, use the Highest point.

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4
Q

WHat is Accessory rib resection?

A

may be in the way when performing laparotomy, cut with fetotomy wire

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5
Q

First an exploratory laparotomy. Check everything! Like what? (3)

A

Check for:
* Adhesions
* Abscesses
* Signs of peritonitis (odor, sight, free fluid)

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6
Q

Rumenotomy: before closing rumen do what

A

before closing rumen get excess feed + fluid out so you can close more easily and if the rumen begins to contract during closure, its less likely to spill ruminal contents on your closure site.

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7
Q

Rumenotomy: after closing the rumen, do what?

A

rinse rumen sutures with NaCl! room temp or 39’C fluid, NOT cold water

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8
Q

Close Rumen in 1 or 2 layers with what type of pattern?

A

do not go through mucosal layer, only muscular and serosal layers of the rumen.

2 layers using Schmieden and then Plahhotin (or Utrecht, or Cushing)

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9
Q

Rumenotomy – closing the abdominal wall

A

When Norway method, 1 layer
- (nonabsorbable) Vertical mattress

When 2-3 layers
* Peritoneum + muscles (absorbable)
* Muscles - absorbable. Simple continuous.
Skin – nonabsorbable
* X - sutures
* Horizontal mattress
* Ford interlocking (favorable)

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10
Q
A

Vertical mattress suture with tubing for dsitributing pressure, is not mandatory.

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11
Q
A

Horizontal mattress suture

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12
Q
A

Ford Interlocking

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13
Q

Peritonitis and rumenotomy.
* How to detect?

A
  • Rumenotomy has the highest risk of peritonitis.
  • Risk is present for two weeks after operation.
  • How to detect?
  • Tell the farmer to take the temperature 2 times per day after surgery + after the ab stops-> if over 39,5 2 times in a row -> suspect peritonitis and perform abdominocentesis to confirm.
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14
Q

When is displaced abomasum most likely to occur?

A

90% of cases in the first 6 weeks after calving
* Or in the last trimester of pregnancy

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15
Q

Which one is more common LDA or RDA?

Which one is more likely to torse?

A

90% LDA (left displaced abomasum)

RDA always has a risk of torsion

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16
Q

Name some causes of displaced abomasum. (8)

A
  • Abomasal atony
  • Hypocalcemia
  • Cow with no appetite
  • Change in diet after calving -> less fiber, more concentrates
  • More room in abdomen cavity after calving
  • Diseases that cause endotoxemia
  • Metritis, Colimastitis
    (40% of cows with displaced abomasums also have placental retention, mastitis or metritis)
  • Stress – animal are tied stall during calving or heatstress
  • Foreign bodies in reticulum, omasum, abomasum
  • Ketosis – chicken and egg situation
  • Fatty liver
  • Abomasal ulcers
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17
Q

RDA displacement location. (2)

A

Right - between rumen and the omentum
* ATTENTION! Always a risk of torsion!

Cranially – between liver and diaphragm

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18
Q

identify

A

Normal abdominal cavity from the right

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19
Q

identify

A

RDA + torsion counterclockwise

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20
Q

Clinical findings in LDA.

A
  • Doesn’t eat concentrates
  • Similar to subacute ketosis
  • Anorexia, apathetic, rumination ↓
  • Temperature normal
  • HR normal 40-80 x min
  • Feces can be watery, variable
  • Less feces ↓
  • Loss of BCS
  • Slow drop in milk yield
  • Slight metabolic alkalosis
  • Rarely fluid in abomasum
  • ! You don’t hear the ping in 15% of the cases !
  • Can manage with life for 2-4 weeks
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21
Q

Clinical findings in RDA + torsion.

A
  • Doesn’t eat concentrates
  • Similar to acute ketosis
  • Anorexia, apathetic, doesn’t ruminate
  • Temperature normal / lower
  • HR 100-120 x min
  • Feces can be watery initially -> then dry,
    dark pebbles
  • Less feces ↓ ↓
  • Abdominal pain
  • Quick drop of BCS
  • Sudden drop in milk yield
  • Strong alkalosis ->Strong metabolic acidosis
  • Fluid in abomasum
  • Ping sound can be with low tone
  • Dehydration
  • Shock ->death
22
Q

LDA DDx (4)

A
  • Rumen tympany
  • Peritonitis
  • Pneumoperitoneum
  • Physometra (air in the uterus)
23
Q

RDA DDx (8)

A

More ddx cause bowels are on that side as well. Recommend U/S on this side.

  • Gas in caecum
  • Gas in large bowel
  • Small intestine torsion
  • Mesentery torsion
  • Pneumorectum
  • Pneumoperitoneum
  • Physometra (air or gas in the uterus)
  • RDA + torsion
24
RDA + torsion DDx (5)
* Caecum torsion/gas * Gas in large bowel * Small intestine gas/torsion * Mesentery torsion * RDA
25
Ping sound DDx, both sides. (2+3)
Left side * Rumen collapse * Pneumoperitoneum Right side * Gas in caecum * Gas in large bowel * Pneumoperitoneum
26
Displaced abomasum - treatment options (4)
Conservative * i.v. Ca, glucose = results <5% * P.o. fluids Rolling Rolling + toggling/fixation of the abomasum Surgery * From left paralumbar fossa * From right paralumbar fossa * From linea alba * Laparoscopy
27
Explain Rolling
Conservative attempt at replacing displaced abomasum back into position. * Cure rate 25% * Pull the cow down on the right side -> get it on its back -> massage/(kick) the abomasum on the right place. * Danger of intestinal/mesentery torsion
28
Explain Rolling + toggle pin. pros and cons
Conservative attempt at replacing displaced abomasum back into position + pexying it. * Cure rate 75% + quick, easy, cheap + if surgery not an option - If you cannot hear the ping, you can’t do it - Risk of damaging other organs - Risk of intestines/mesentery torsion - Only if LDA! local peritonitis risk is present but not too bad
29
Left paralumbar fossa - Abomasopexy. pros and cons
Cure rate 85-95% + You can perform rumenotomy if needed + Can feel if there are adhesions + For cows that are in the last trimester of pregnancy - If the surgeon is small, its hard to do. - Only for LDA! - Mesentery/small intestines try to get in the way while fixating. - Need help for fixation, minimum 2 ppl. - min x5 Ford interlocking sutures nonabsorbable into abomasum musculature.
30
Abomasopexy from right paralumbar fossa. pros and cons
Cure rate - abomasopexy 85-95% - omentopexy 85-95% + you can do LDA, RDA, RDA + torsion from the right side + You can do abomasotomy + You can do abomasopexy, omentopexy and pyloropexy - Can’t do if abomasum has adhesion on the left side - Omentopexy -> omentum might rupture/stretch over the time - Intestines can herniate
31
When would you do Omentopexy?
Omentopexy can be performed to anchor the abomasum and omentum after repositioning and correcting the twist to prevent future displacement. For either LDA or RDA.
32
Surgery from linea alba in cattle. pros and cons
Cure rate 85-95% + You can do LDA, RDA, RDA + torsion + You can do rumenotomy - Abomasopexy only method - If adhesion are present, hard to do anything - Position (tympany, risk of aspiration) - General anesthesia required
33
Post op care in LDA, RDA vs Post op care in RDA + torsion
* AB for 3-5d * NSAIDs 1-2d * Can eat and drink straight away vs in torsion: * Wide spectrum AB 7d * NSAIDs 1-3d? * I.V. fluids * P.O. fluids * Slow feeding
34
Complications of abomasopexy. (5)
* Wound infection * Peritonitis * Abomasal fistula * Abomasal sutures tearing * Recurrent displacement
35
Before choosing cesarean...
First calving aid! * Consider Alternatives: * Uterine torsion and flipping/rolling the cow? * Use of hormones * Fetotomy if the calf is emphysemic and/or dead * Stretching of the cervix
36
Cesarean section - indications
Large calf * Absolutely large calf = fetal dystocia * Relatively large calf with smallish dam = maternal dystocia * Tight birth canal (heifers) * Abnormal presentation, position, and posturing of the calf * Monster calf (defects/deformities) * Uterine torsion * Rupture of the uterus * Cervix is not open * Twins * Rupture of abdominal muscles * Certain breeds
37
Swollen birth canal May be an indication for c-section.
38
Rupture of abdominal muscles indication for c-section
39
high risk c-sections (3)
* Emphysematous fetus * Very thin and sick animals * Long calving aid maybe consider fetotomy instead (obv if calf is already dead)
40
Factors to affect c-section Prognosis (6)
* Calving aid should not last longer than 2 hours. * How hygienic was the calving aid? * Condition of the cow * Reason for dystocia * Environment * How quickly is the situation discovered + aftercare by the owner
41
Cesarean section – surgical approach (3)
* Left paralumbar fossa most common * Right paralumbar fossa is possible too (but risk of small intestines falling out) – in case of tympany at least * Linea alba can be used with gen. anesthesia (risk of hernia)
42
Anesthesia for c-sections.
Sedation * Try to avoid using sedation (tympany, uterine contractions, affect to fetus, cow can lie down etc.) Local anesthesia * Distal paravertebral anesthesia + skin * L1, L2, L4 + between L3 and L4 Epidural anesthesia * Reduces the Ferguson reflex (contractions)
43
Getting the uterus out/ to the surgical wound:
Multiple ppl needed for c-section. * If the calf is in frontward position, get hold of one hind leg and pull carefully. * Cut the uterus with scissors/uterine safety cutter (on curvatura major). * Start from the middle, cut towards the hock, then towards the claws. * Be careful not to cut the carunculas cause they bleedy. * The cut must be as long as necessary but as short as possible! * Possible to open the uterus inside abdominal cavity but visibility is poor then and you risk uterine contents spilling into the abdo cavity. Is better to take the uterus out of the wound a bit. Remove fetal membranes before closing, if they are easily removed.
44
Uterine sutures
Can be done in 2 layers. * Schmieden (from inside out) Plahhotin / Utrecht (up-down)
45
identify
Uterine sutures – Utrecht method
46
identify
Uterine sutures - Utrecht method
47
Rinsing the abdominal cavity
* Saline/Ringer * Boiled water * Sterilised water Rinse until fluid is clear.
48
identify
Vertical mattress
49
identify
Horizontal mattress
50
identify
Ford interlocking
51
identify
X suture
52
Calf care after C-section. (6)
* Tell the owner what to do before the surgery! * Colostrum 2-3 l, potentially with a tube if its a dummy calf that wont suckle. * No more than 1h (2h) after birth * Put the calf in clean, soft box (straw bedding) * Heater lamp * Disinfect the umbilical cord with iodine

Ruminant clinical medicine (27 decks)

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