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