Unit 2 - Forestomach and Abomasum Part 3 Flashcards
What are the fates of a nail or another metal object inside of a cow?
Attachment to a previously administered magnet with no clinical disease
Penetration of reticular wall without entry into peritoneal cavity
Perforation of reticular wall and entry into peritoneal cavity
Perforation of reticular wall and entrance into peritoneal or thoracic cavity
What disease will a metal object cause if it penetrates the reticular wall without entry into the peritoneal cavity?
Localized/focal reticulitis and mild disease
What disease will a metal object cause if it perforates the reticular wall and enters into the peritoneal cavity?
Localized traumatic reticuloperitonitis (TRP)
What disease will a metal object cause if it perforates the reticular wall and enters into the peritoneal or thoracic cavity?
Pericarditis, myocarditis, abscesses, adhesions and vagal indigestion
What history is commonly associated with acute cases of TRP?
Clinical signs occur within 24 hours - anorexia, profound drop in milk production, reluctance to move, and anxiousness
Uncomplicated cases of TRP may resolve within ___ - ____ days.
3-5
What possible history is associated with complicated cases of TRP?
It lasts days to weeks and progression may be due to failure to localize peritonitis or organ involvement
Decreased feed intake, milk production, and fecal output
Development of ‘vagal’ appearance or become gaunt
T/F: TRP is the most common cause of cranial abdominal pain in mature cattlle.
true
What will you find on PE in a patient with TRP?
Fever, anorexia, decreased rumen motility, cranial abdominal pain, tachypnea, and abducted elbows
+/- peritonitis, pleuritis, pericarditis
+/- papple shape
What behaviors are associated with cranial abdominal pain in cattle?
Absent ventroflexion with pressure applied to the withers
Grunt with pressure applied to the withers
Grunt with dorsal pressure applied to the xyphoid
Reluctance to move
Arched back when standing
Forelimbs held in an abducted position
What ancillary diagnostics can be done for TRP?
CBC and fibrinogen
Total protein
Abdominocentisis
What will your CBC and fibrinogen results be in patients with TRP?
Neutrophilia and hyperfibrinogenemia
What will the total protein be in a patient with TRP?
High - but absence of a high total protein doesn’t rule it out
What will the abdominocentesis results show in patients with TRP?
TNCC > 6000 cells/ul
TP >3 g/dL
Neutrophils > 40% consistent with peritonitis
If you are able to take radiographs for a possible TRP patient, where anatomically should you take the radiograph? What will you see?
Cranial abdomen
Will see a metallic foreign body and likelihood of penetration of the reticular wall
What will you seen on ultrasound in a patient with TRP?
Abnormal motility due to peri-reticular adhesions
Peri-reticular abscesses
Peritoneal, thoracic, and pericardial effusions
How is TRP treated?
Magnet Broad-spectrum antibiotics NSAIDs Fluid resuscitation Rumenotomy
What causes an LDA?
It is unknown, but it is a multifactorial syndrome - Abomasal hypomotility prerequisite
Ketosis, hypocalcemia, RFM
Is an LDA or an RDA more common?
LDA
What clinical signs are associated with an LDA?
Anorexia Drop in milk production Ketosis Reduced manure output, soft Rumination, but reduced fill Variable pitched ping on the left
What will an abomasocentesis show in a patient with an LDA?
The pH will be <4.5 and will smell like burnt almonds
What will you see on ultrasound in a patient with an LDA?
The pylorus is not living where it normally should
The fluid filled viscus looks different from the normal rumen wall
What will you see on clin path in a patient with an LDA?
Metabolic alkalosis, hypochloremia, and a mild increase in HCO3
Increased liver enzymes if concurrent ketosis
What causes hypokalemia in patients with an LDA?
Shifts in H-K due to acid-base status
What causes the hypocalcemia and hypophosphatemia in patients with an LDA?
Reduced feed intake
What is the goal for treatment of an LDA?
Create an attachment to prevent recurrence
What are the types of techniques that can be used to treat an LDA?
Blind techniques, open surgical techniques, right paramedian approach, and laparoscopic
What blind technique can be used to correct an LDA?
Roll and toggle
What open surgical techniques can be used to correct an LDA?
Omentopexy, pyloropexy, and abomasopexy
What are the advantages to the roll and toggle?
Short procedure Minimal invasion of peritoneal cavity Minimal equipment Most don't need to withhold feed or water Economics
What are the disadvantages to the roll and toggle?
Inability to confirm return of abomasum to normal position
Tack the wrong viscus
NOT to be used with R sided pings
Abomasum needs to be freely moveable
Cannot assess the abomasum and abdomen for abnormalities
Labor intensive and risk to handlers
What complications are associated with the roll and toggle?
Tacking the rumen Tacking the pylorus without return of the abomasum to normal position Peritonitis Fistula formation Thrombosis and cellulitis
What surgical procedures can be done with the standing, right flank approach when repairing a LDA?
Omentopexy and pyloropexy
In a nutshell, what is the standing right flank approach?
Block the R paralumbar fossa, cut your way in, deflate the abomasum, bring it under the rumen and back to normal position, bring the pylorus up to the incision, create a pexy of your choosing
How do you deflate the abomasum?
With IV simplex tubing and teat cannula
Protect the needle with your palm on the way in
Go south first and then head north
Poke the abomasum once at the highest point and push down with steady pressure
Once the abomasum is deflated, what should you do next?
Push and sweep it under the rumen by laying your forearm and left arm on top of it
What are the keys to a stable omentopexy?
Choose a site as close as possible to the normal position of the pyloroduodenal juncture without interfering with duodenal function
Distribute the pexy over as wide an area of omentum as possible
Incorporate peritoneum into the pexy
Use a suture that will last long enough for firm fibrous adhesion to form
Describe your first step of the omentopexy.
Hang the omentum like a curtain and incorporate it into your first layer of the closure - use a simple continuous with generous bites through the omentum
When doing a pyloropexy, what anatomical landmarks do you need to be aware of?
The pyloric sphincter - be at least 5 cm orad to the pyloric sphincter within the antrum
What is the suggested way to perform the pyloropexy?
Use 2 or 3 suture with 2 or 3 horizontal mattresses. Begin cranial to the incision.
Start on the outside of the internal abdominal oblique, through the transversus, into the abdomen, through (not full thickness) the pylorus, back through the muscle, and tie knot on the outside of the muscle
A standing, left sided abomasopexy is not indicated for what?
Right displacements/volvulus
A standing, left sided abomasopexy gives you access to the greater curvature of the abomasum, what can that cause?
ulcers and adhesions
Regardless of the surgical correction performed, what medical stabilization needs to be done for LDA patients?
Fluids Address hypocalcemia Treat ketosis Perioperative Abx NSAIDs
Clinical signs of a RDA are similar to an LDA. What more severe signs do RDA/AV (abomasal volvulus) patients have?
Dehydration, complete lack of manure production, tachycardia, potential colic, and evidence of shock
Where will you hear a ping with a RDA?
On the right side between the 10th and 13th ribs along the line from hip to elbow
What will you see on ultrasound in patients with RDA/AV?
Displacement of the liver from the body wall and the omasum is shifted ventrally
What clin path signs are associated with a RDA/AV?
Metabolic alkalosis, hypochloremia, hyponatremia, hypokalemia
What clin path findings will you see in severe cases of RDA/AV?
Metabolic acidosis (due to ischemia)
T/F: An L-lactate of >6 mmol/L is a better prognosis than of <2 mmol/L.
False - >6 is a worse prognosis
A vast majority of RDA/AV are turned in what direction?
Counter-clockwise direction around the axis of the lesser omentum
How is a RDA/AV treated?
Decompression and draining - place a purse string, drain with a stomach tube, tighten w/ tube removal
What pexy’s can be done for an RDA/AV?
Pyloropexy, omentopexy
What post-operative care is needed for a RDA/AV?
The same for LDAs: Fluids Address hypocalcemia Treat ketosis Perioperative Abx NSAIDs
What complications are associated with RDA/AV?
Abomasal perforation Peritonitis Septicemia Omental tearing Abomasal neuromuscular dysfunction (type III indigestion)
What are some poor prognostic indicators for a RDA/AV?
HR > 100 bpm Dehydration > 6% Hypochloremia <79 mEq/L L-lactate > 6mmol/L Nectrotic and thrombosis at sx
Is an LDA or a RDA/AV more emergent?
RDA/AV
