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Internal medicineLectures for students, 7th semester

Digestive diseases of ruminants III.Motoric disorders of the forestomachs

Dr. Vörös KárolyBelgyógyászati Tanszék és Klinika

Diseases of the forestomachs II.

Motoric disorders

1. Traumatic reticuloperitonitis2. Hoflund syndrome (vagal indigestion)3. Obturation of the forestomach openings4. Prolapse of the reticulum into the thorax5. Sand accumulation within the rumen,

abomasum and small intestine6. Obturation of the omasum

Traumatic reticuloperitonitis: Etiology

Traumatic reticuloperitonitis:Pathogenesis I.

Foreign body

Cattle:eating without selection, papillae on the tongue and buccal cavity,

strength and direction of reticular contractions

Sharp metallic body (weight, shape, length)

„Silent” 0,5-1,0 cm > 2 cm 8-10 cm

reticulitis RPT pericarditis

Penetration

pain, inflammation reticular/rumen atony

RPTadhesion wide wound channel

localized RPT diffuse peritonitis

acute/chronic/recurrent acuteblocked forestomach movements local/systemic sequela

(mechanical/reflectoric)

Traumatic reticuloperitonitis:Pathogenesis II.

Secondary disorders

> nephrosis> myocardosis/myocarditis> arthritis

Complications

> traumatic pericarditis, +/- pleuritis, pneumonia> traumatic splenitis, hepatitis, abomasitis> Hoflund syndrome> seldom: coronary bleeding, subcutaenous abscess

Toxins,bacteria

Furtherpenetration

Traumatic reticuloperitonitis:Pathogenesis III.

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General appearance sudden onset, sharp fall in milk yield

Signs of local pain:Posture: streched head and neck, kyphosis (arching of the back)

gaunt or "tucked up” (pulled-up) abdomenMovement: slow, rigid, “cautious”, difficult stand up/turningBehaviour: frightened glance, grunting

Basic clinical values

acute or recurrent form:

T: 39,5-40,0 OCP: 80 - 100/minR: > 30/min, shallow, costal)

Traumatic reticuloperitonitis:Clinical signs I.

Detailed clinical examination:

Digestive signs:

• appetite, belching, rumination: (--)• rumen motility: (--)• rumen: small, firm, separated content, , +/- mild tympany• reticulum: reticular sounds (--), (++) reticular pain probes !!! • feces: scant, dry, poorly digested

Traumatic reticuloperitonitis:Clinical signs II.

Traumatic reticuloperitonitis: Clinical signs

Back grip

Pain percuss.

Knee-elbow pr.

Pole test

Video

Additional examinations• ferroscopy• radiography• ultrasonography• abdominocentesis• endoscopy• diagnostic rumenotomy

Laboratory examinations• blood count: leukocytosis, neutrophilia• fibrinogen determination (plasma)• globulin determination(serum: total protein - albumin) • serum lability probes: glutaraldehyde probe

Traumatic reticuloperitonitis:Clinical signs III.

Complication of traumatic reticuloperitonitis:traumatic pericarditis

Complication of traumatic reticuloperitonitis:traumatic lienitis

VK III/86. film

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Complication of traumatic reticuloperitonitis:the pin has penetrated even the skin

Traumatic reticuloperitonitis:Diagnosis

Diagnosis:• +/- sporadic onset• sudden digestive disorder (without change in feeding)• signs of (acute) inflammation: fever, positive pain probes• additional methods: blood count, ferroscopy, US-examination• diagnostic laparorumenotomy

Differential diagnosis: (+ see RGB, p310: grunting)

• digestive disorders (primary, secondary)

• motoric disorders• pain (grunting)• abnormal posture, movement

What is your diagnosis?Dry pleuritis

Traumatic reticuloperitonitis: Treatment and prevention

•Conservative therapy•antibiotics*•diet•reticular magnet (?)• elevation of the cranial body, immobilization•Surgery

•laparorumenotomy

Treatment

Prevention

removal of foreign objects

reticularmagnet

*: penicillines, oxytetracycline, ceftiofur

Hoflund disease (vagal indigestion)Innervation of the bovine stomach

a)

Anterior functional stenosis

(achalasia)reticulo-omasal orifice

b) Posterior functional stenosis:

(achalasia)pylorus

t.d: truncus oesophagicus dorsalist.a: truncus oesophagicus ventralis

a

n. vagus

Hoflund syndrome

Etiology I.Reticular abscess

caudodorsal blind sacdorsal ruminal sac

liver

liver abscess

reticulumabomasum

atrium of the rumen

caudovent. blind sac

ventral sac of the rumen

Hoflund syndrome. Etiology II. Liver abscessAbscess in the left liver lobe and the bovine forestomach compartments

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Hoflund syndrome.Liver abscess

Hoflund syndromePathogenesis

Vagus lesion

functional central: first vagus excitement bradycardiavagal abnormalities periferal: sympathetic effect inactivity

disorders of stomach motility/rumination/belching

„functional stenosis”

blocked passage of feed: inanition”

anterior pump, esoph. groove, rumen

posterior reflux syndrome

omasum

abomasum

Hoflund syndrome: common clinical signs

Course: subacute, chronicGeneral symptoms: weakness, emaciationBasic clinical values:

T: n, [[[[--]]]] ; P: [[[[--]]]] [ ++][ ++][ ++][ ++] ; R: variableDetailed clinical examinationskin: exsiccosis, signs of a chronic diseasemucosal membranes: pale, drydigestive organs:[[[[--]]]] appetite, belching, eructation, fecesrumen: long-lasting, variable distension[++][++][++][++] abnormal contractionsabnormal ruminal content

rectal examination: abnormal content within the dilated rumen

Hoflund syndromeClinical signs: anterior functional stenosis

(extremely rare form with complete atony)

Complete ruminal atony, small, firm rumen, little gas in the dorsal sac.Regurgitation and aspiration pneumonia due to full cardial paralysis. Necropsy finding: completely inflammed reticulum, penetrated by several pins.

Hoflund syndromeClinical signs: anterior functional stenosis

(type with ruminal hypermotility)

Ruminal content: foamy, cream-like

A: Hoflund disease, B: normal finding

Dilated rumen, distended left flank

Hoflund syndromeDiagnosis:

anterior functional stenosis

Diagnostic rumenotomy

Abdominocentesis, intraoperative puncture of abscess

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Hoflund syndromeClinical signs: posterior functional stenosis

papple-shaped abdomen juicy-watery ruminalventrally distended rumen + abomasum content, Cl > 30 mmol/l

Rosenberger, 1979

Hoflund syndromeDiagnosis

Diagnosis:• chronic abdominal distension • abnormal ruminal movements• typical ruminal content (two types)• (bradycardia)• laparorumenotomy

(punction of abscess)

Differential diagnosis:a) primary and secondary ruminal tympanyb) diseases with (abdominal) painc) abomasal diseases

Hoflund syndromeTreatment and prognosis

Treatment:

Goal: to prolong patient’s life

1. Surgery (reticular or liver abscess)2. (Antibiotics)3. Artificial nutrition 4. Permanent rumen fistula

(slaughter)

Prognosis:

doubtful, unfavourable

Thank you for your attention.