digrum 4 1 abomasum-2005(sinistra) ( dextra) torsion (cum torsione) reflux syndrome (regurgitatio...

Internal medicineLectures for students, 7th semester

Digestive diseases of ruminants IV.Abomasal diseases

Dr. Vörös KárolyBelgyógyászati Tanszék és Klinika

Diseases of the abomasum

Abomasal displacement Abomasal Abomasal obturation(dislocatio abomasi) (obturatio abomasi)

DA inflammation ulcer(abomasitis) (ulcus abomasi)

left sided right sided(sinistra) ( dextra)

torsion(cum torsione)

reflux syndrome(regurgitatio ingestae abomasi)

Pathogenesis of abomasal displacement

Nutritional abnormality (++ grain, -- fiber)

Abomasal atony

Abomasal dilatation

Anatomical factors Mechanical factors

LDA RDA Abomasal torsion

accompanying dis. hypochloremia accumulation of fluidlocal complications hypokalemia within the abomasumreflux syndrome metab. alkalosis ischemia (necrosis)

+dehydration, (--) tissue perfusionhemoconcentration (++) lactate

metabolic acidosis

Other abomasal disord.Intercurrent diseases(endotoxins)

Fetus,move-ments

Topography of the bovine abdominal

organs (Gyarmati 1954)

Location of the abomasum

normal situation LDAdigvideo7

Clinical signs of LDA I.

Occurence:mainly post partum within some days/weeks

Course:

subacute, chronic (often masked by intercurrent diseases)

General symptoms:

“only” depression, weight loss, (--) milk production

Basic clinical values:

T: n, P: n, R: n /(--) (shallow)(--) rumen movements

Digestive symptoms:

(--), variable appetite, decreased ruminationthin-pasty feces+/- positive reticular pain probes

rumen: small, firm, decreased motility

abomasum: severe LDA: visible, palpable• percussion: oval, tympanic region• auscultation: spontaneous tinkling sounds (30- 40 % )

(bubbling sounds)• auscultation with ballotment: splashing sounds (50-60 %)• auscultation with percussion: metallic sounds (90-95%)

(steel band effect)

Clinical signs of LDA II.

Degrees of LDA

Clinical signs of LDA Spontaneous tinkling sounds

Clinical signs of LDA

Auscultation with ballotment:

splashing sounds

Clinical signs of LDA

Auscultation with percussion:

metallic sounds

(steel band effect)

Clinical signs of LDA III.

Rectal examination: abomasum is not to be palpated (1:100 )medially displaced rumen

Signs of intercurrent diseases:mastitis, foot diseases, puerperal disorders

Symptoms of joint diseases and complications:secondary ketosis, fat mobilisation syndrome, reflux syndrome

Laboratory examinations:blood: (++) PCV, (--) Cl , (--) K, metab. alkalosis, (++) glucose, ketone in milk, urine

Diagnostic work-up of LDA

DiagnosisMost important is the targeted examination of the abomasum !!!

(The finding can change ! Screening examination !)

Differential diagnosisA) diseases with anorexia and ruminal stasis

B) intercurrent diseases, joint diseases, complications

C) diseases with similar finding of auscultation + percussion (differentiation: localisation, probing, puncture )

D) other abomasal diseases

Differential diagnosis of LDA during simultaneous auscultation and percussion

After Rebhun, 1991

Left sided abomasal displacementFree gas + fluid within the rumen(posterior funct. stenosis, acidosis)Pneumoperitoneum

Surgical treatment of LDA I.(Utrecht method)

Surgical treatment of LDA II.(Utrecht method)

Surgical treatment of LDA III.(Utrecht method)

Surgical treatment of LDA IV.(Utrecht method)

Videos

Surgical treatment of LDA V.(Utrecht method)

digvideo7

Surgical treatment of LDA.(Hannover method)

Development of right sided abomasal displacement and abomasal torsion

RDA Abomasal torsion

Clinical signs of RDA and abomasal torsion I.

Course: acute, subacute

General symptoms:

• after calving, within a few weeks• more severe, than those of the LDA; especially with torsion• serious deterioration, weakness, +/- good body condition• (moderate) abdominal pain

basic clinical values:T: n /(--), P: ++, R: variable

Skin:dehydration (+ sunken eyes)

Mucous membranes:

dry, pale, dirty redCRT: prolonged

Circulatory organs:

signs of peripheral circulatory failure

Clinical signs of RDA and abomasal torsion II.

Digestive organs:

complete inappetence, (++) thirstfeces: scant, pasty, +/- olive greencomplete ruminal stasis, +/- pozitive reticular pain probes(--) liver dullness

Abomasum: •visible and palpable in severe cases•percussion: tympanic oval region, horizontal dullness (pain)•auscultation: spontaneous tinkling/bubbling sounds (20 %)•auscultation with ballotment: splashing sounds (60-70 %)•Auscultation with percussion: metallic sounds (90%)

Clinical signs of RDA and abomasal torsion III.

Rectal examination:balloon-like, palpable abomasum(RDA: 60 %, + torsion: 90 %)firm rumen

Laboratory examinations:(++) PCV, (--) Cl , (--) Kmetabolic alkalosis acidosisleuko/neutropenia

Course:RDA torsion shock death

Clinical signs of RDA and abomasal torsion IV.

Clinical signs of RDA and abomasal torsionAuscultation with percussion: metallic sounds

Diagnostic work-up of RDA and abomasal torsion

Course: rapid

Diagnosis:based on the targeted examination

of the abomasum (including rectal finding !)

Differential diagnosis:

A) Diseases with similar auscultation + percussion(cecal torsion, small intestinal ileus, intestinal atony )

B) Diseases with abdominal pain

after Rebhun, 1991

Differential diagnosis ofRDA

during simultaneousauscultation and

percussion

Right sided abomasal displacement

Cecal dilatation and torsionSmall intestinal ileus

Differential diagnosis of RDA II. Cecal dilatation and torsion

Differential diagnosis of RDA III.Ileus

Surgical treatment of RDA I.

Surgical treatment of RDA II.

Fluid therapy using continuous drip infusion technique

The basics of fluid therapy and the rate of dehydration see at acute

rumen acidosis

A calf can also have an abomasal displacement and even the veterinarian can suffer from an accident.

Instead of the final word:

Abomasitis and abomasal ulcer(abomasitis, ulcus abomasi)

Forms: Primary Secondary

Occurence: rare more common

Cause:

stress other abomasal disease

grass, fertilizers, leukosis, GI helminths

herbicides VD, salmonellosis

calves: rough fodderfungi, hair balls

Clinical signs:

Mild form:no symptoms / mild general symptoms, inappetence

Sever form: (bleeding ulcer)anaemia, dehydration, peripheral circulatory failuremelenarumen stasis, positive reticular pain probesabomasum:

pain during pressure (palpation)gas and fluid accumulationabomasocentesis: typical finding

Perforation:localised /diffuse peritonitisrapid death

Abomasitis and abomasal ulcer

Abomasitis and abomasal ulcer in

cattle

Diagnostic work-up:

Diagnosis: feces, local findings, abomasocentesis !

Differential diagnosis:other abomasal diseases, acute enteritisdiseases with acute blood-loosing anemia

Treatment:• diet, adstringents, mucoprotective drugs• blood transfusion, • H2 receptor blocking drugs? (e.g.. cimetidine)• alkalisers (MgO, Mg silicate) • surgery

Abomasitis and abomasal ulcer

Abomasal obturationEtiology:

sand or rough, hard fodder + lack of drinking water(feedlot bulls, sheep)

Clinical signs:similar to abomasal ulcer, but other, characteristic local signs:

abomasum: firm, sand sack-like palpatory finding

Treatment: A) conservative: spasmolytics, laxatives

+ fluid and electrolyte replacement

B) surgery: rumenotomy or abomasotomy

Surgical treatment ofabomasal obturation

(sand obturation)

Pathogenesis of reflux syndromeAbomasal disorder

Back flow of the abomasal fluid

Rumen fluid Blood

(++) acidity by titration metabolic alkalosis(--) pH Cl- < 95 mmol/lCl- > 30 mmol/l hypokalemia(++) osmolality (++) PCV

Sequels

thin (watery) rumen fluid dehydration, (--) GFR

dilatation of the rumen extrarenal uremia

Dirksen, 1984 nyomán

Clinical signs of of reflux syndromeAccumulation of abomasal fluid within the rumen

Dehydration Metabolic Rumen distensionalkalosis

Exsiccosis Uremia Respiration: (++) undulating rumen

skin, urine-like (--) resp. rate thin, sour-smellingeyes, breath, shallow breathing ruminal contentCRT, PCV (++) creatinine

+Characteristic clinical signs of the underlying abomasal disease

DA, abomasitis, abomasal ulcer, obturation, posterior functional stenosis

Reflux syndrome in a cow

Hoflund syndrome, posterior functional stenosis

Study of the compensation of metabolic alkalosiswith pneumotachography

Healthy cow

LDA + reflux syndrome

Thank you for your attention.