Practicals

List the steps of a cow clinical exam

Place cow in head bail and lock

DISTANCE

1. Signalment (breed, sex, ID tags)

2. BCS /10

3. Describe mentation, posture and demeanour

4. Symmetry of limbs, abdomen and udder (stage of production)

5. Evaluate skin and hair coat

6. Take respiratory rate

Remove back chain

TAIL PT1

1. Take temperature

2. Check tail tone, anal tone and coccygeal pulse

3. Evaluate vulval mucus membranes

4. Palpate mammary gland and supramammary lymph nodes

Put chain back up and put left side rail down

LEFT SIDE

1. Visually assess HL and claw

2. Visually assess lateral udder and ventral abdomen

3. Palpate pre-femoral lymph node

4. Auscultate rumen contractions over 2 minutes and palpate layers

5. Ping paralumbar fossa and ballot layers of rumen

6. Ping ribs 9 - 13

7. Auscultate lung field

8. Auscultate heart

9. Perform Wither’s pinch test x2

10. Palpate pre-scapular lymph node

11. Visually assess FL and claw

12. Examine brisket area

13. Evaluate jugular fill/pulses

14. Evaluate hydration with skin tent

Put left side rail up again

HEAD

1. Check symmetry of head

2. Visually check ears

3. Evaluate eyes, including 3rd eyelid

4. Check nostrils and nasal planum

5. Check muzzle and open mouth, palpate tongue

6. Palpate submandibular tissue and lymph nodes

Put right side rail down

RIGHT SIDE

1. Evaluate jugular region

2. Examine brisket area

3. Visually assess FL and claw

4. Palpate pre-scapular lymph node

5. Auscultate heart

6. Auscultate lung field

7. Check for palpable liver

8. Ping ribs 9 - 13

9. Auscultate and ping right paralumbar fossa

10. Palpate pre-scapular lymph node

11. Visually assess lateral udder and ventral abdomen

12. Visually assess HL and claw

Put right side rail up again and take back chain down

TAIL PT2

1. Describe collection of urine sample

2. Describe collection of milk sample

3. Describe collection of faecal sample

4. Discuss vaginal and rectal exam procedure

Put back chain up again and release cow from head bail

5 Features to assess when examining the farm

Clinical examination begins at the gate to observe:

1. General state of farm and geography

2. Condition of herd

3. Amount and types of feed present

4. Track/race condition

5. Facilities

6. Negative welfare indicators (eg. animals in deep mud, lack of shade or water)

→ Gives idea of what to expect of the client or animal

D1: Signalment

• Importance

• Example:

  • Bloat in cow vs. calf

  • Photosensitisation timing

Importance: Confirm correct patient and guide DDx list → Focus history questions and examination of relevant body systems

Examples:

• Bloat

  • Cow = Ruminal bloat

  • Calf = Abomasal bloat

• Photosensitisation

  • Late summer - autumn = Facial eczema

  • Spring = St John’s wort or brassicas

D2: BCS

• 10 features to assess

• Ideal BCS

Features:

1. Spine

2. Short ribs

3. Long ribs

4. Hips

5. Pins

6. Rump

7. Tail height

8. Thigh

Ideal: 5 (5.5 for heifer) at calving

D3: Mentation, Posture and Demeanour

• Examples to describe mentation

• Examples to describe posture

• Examples to describe demeanour

• 6 Signs of aggression

Mentation:

• BAR/QAR

• Obtunded = Reduced response to environmental stimuli

• Comatosed = Unconscious

Posture:

• Standing squarely with neutral head carriage and bearing weight x4

• Head down/tilted/deviated/elevated/opisthotonic

• Wide-based stance

Demeanour:

• Relaxed, agitated, compulsive behaviours, aggression

• Eating and chewing cud = Relaxed

Aggression:

1. High head

2. Pricked ears

3. Direct staring

4. Holding ground

5. Pawing

6. Bellowing or snorting

D4: Symmetry of Limbs, Abdomen and Udder

• Types of abdominal distension (+ DDx)

• Example description of udder

Abdominal Distension:

Udder: This cow is not lactating, the udder is small, shrunken and appears empty

D5: Skin and Hair Coat

• 4 Features to assess

• Normal description

• Describe the following lesions

Features:

1. Lesions

2. Colour changes

3. Faecal staining

4. Ectoparasites

Normal: The hair and coat is appropriate for the season and there is a little mud present on the limbs. Colour is normal and there are no lesions, faecal staining or ectoparasites observed.

Lesions:

• A: There is a large amount of perineal staining, faeces appears yellow and pasty to liquid. There are patches of alopecia on the caudal stifle, the skin appears erythematous

• B: The Jersey cow has a large number of proliferative, keratinised lesions that range from 0.5 - 10cm along the ventral aspect of the neck, jaw and side of face including the ears, periorbital skin, but not the node. The masses are grey with a rough, dry and irregular surface

• C: The back of a Friesian cow shows significant areas of photosensitivity lesions including alopecia and erythema of the non-pigmented skin and large areas of dry skin sloughing off, with some reddened ulcerative lesions beneath

D6: Respiratory Rate

• Where to observe

• Normal reference range

• 3 Abnormal features to observe

• Example normal description

Where: Thorax, nostrils or flank

Normal: 12 - 30brpm

Abnormal:

1. Dyspnoea (eg. open-mouth breathing with neck extended, nostrils flared and back arched with elbows abducted)

2. Noises (eg. coughing, sneezing, snuffling, wheezing)

3. Nasal discharge

Example: The RR is 12breaths/minute which is within the reference range of 10 - 30 brpm. She appears eupneic (no increased effort while breathing)

• The RR is 48 breaths per minute, which is above the reference range. Loud snuffling noises can be heard from the nose, loudest on inspiration,

T1: Temperature

• Normal

• Method

Normal: 38 - 39.3˚C (~38.5˚C)

Method: Insert thermometer all the way until the window and against the rectal mucosa to obtain an accurate reading

T2: Tail Tone, Anal Tone and Coccygeal Pulse

• Define tail tone

• Coccygeal pulse location

• Normal pulse rate

• Example normal description

Tail Tone: Level of resistance when grasping and elevating the tail (present/absent/weak/strong)

Coccygeal Pulse: Coccygeal artery in the ventral groove of the tail at the level of the vulva (present/absent/strong/weak/bounding)

Pulse: 48 - 84bpm

Example: The tail tone is strong and the pulse is palpable and as a regular rhythm

T3: Vulval Mucus Membranes

• Location

• 4 Features to assess

• Example normal description

Location: Beyond the mucocutaneous junction

Features:

1. Colour

2. Hydration

3. CRT

4. Discharge

Example: The vulval MM are shiny/slippery and a salmon pink colour with a CRT of 1 - 2 seconds

• Abnormal = Tacky, white, red, brown, yellow, blue, petechiae

T4: Supramammary Lymph Nodes and Udder Palpation

• Method

• 5 Features to assess

• Example normal description

Method: Keep head high and stoop slightly (never crouch or kneel)

• Can perform at end as some animals resent

• Palpate ventral surface and up lateral sides of ALL 4 quarters

Features:

1. Hardness or swelling

2. Lumps

3. Temperature (hot/cold)

4. Pain

5. Symmetry

Example: The cow is dry, all four quarters are soft, non-painful and relatively symmetrical. There are four teats, and the supramammary lymph nodes are not palpable

LHS1+10/RHS12+3: Visually Assess Limb and Claw

• Method

• 4 Features to assess for

• Example normal description

Method: Do NOT palpate

• If further exam required → Restrain leg with ropes AFTER full clinical exam

Features:

1. Swelling of joints, bones and tendons

2. Redness or lesions on skin

3. Muscle atrophy

4. Medial and lateral claws

Example: There is mud and debris along the lateral side of the left hindlimb, she is standing with the left foot slightly in front of the right

• vs. There is moderate swelling over the lateral aspect of the hock, the skin is missing over this swelling, the claws appear even

LHS2/RHS11: Visually Assess Lateral Udder and Ventral Abdomen

• Method

• 6 Features to assess

• Example normal description

Method: Do NOT get too close or crouch

Features:

1. Skin

2. Contour of abdomen

3. Milk vein for damage

4. Umbilical region for hernia

5. Prepuce in males

6. Udder: Symmetry and teat condition

Example: The skin appears smooth with an even ventral abdominal contour. The milk vein is not prominent in this dry cow. The udder is fairly symmetrical and empty. Teats are mildly dry.

LHS3/RHS10: Palpate Pre-Femoral Lymph Node

• Method/location

• 4 Features to assess for

• Example normal description

Method: Run hands caudal to cranial across flank in front of the quadriceps muscle

Location: Between the tuber coxae and stifle (slightly cranial and dorsal to stifle)

Features:

1. Texture

2. Mobility

3. Size

4. Pain

Example: The pre-femoral lymph node is smooth, freely moveable and 10 × 5cm (large in LATU cows due to fat coverage)

LHS4: Auscultate Rumen Contractions

• Method

• Normal rate of contraction

• Example normal description

Method: Listen over left paralumbar fossa for ≥1.5 - 2 minutes (hear length of time between two contraction)

• Left paralumbar fossa = Triangle created by the 13th rib cranially, tuber coxae caudally, transverse process of the lumbar vertebrae dorsally and the abdominal oblique muscles ventrally

Normal: ONCE every 30 - 90 seconds

Example: There were 3 strong contractions over 2 minutes

• vs. Only 1 rumen contraction was auscultated over 2 minutes and there is poor rumen fill

LHS5/RHS9: Percuss/Ballot/Succuss Rumen

• Method/definitions

• 3 Layers of the rumen

• Example normal description

Method:

• Percuss = Ping down left paralumbar fossa to assess layers of rumen and detect LDA

• Ballot = Punch down left paralumbar fossa to feel layers of rumen

• Succuss = Ballot with auscultation of layers (listen for splashes)

Layers:

1. Gas cap

2. Fibre mat

3. Fluid

Example: The fibre mat is doughy and extends up to here, and there is no splashing on succussion

LHS6/RHS8: Ping ribs 9 - 13

• Function

• Location

• Example normal description

Function: Detect LDA/RDA = High-pitched sound

Location: #1 location for LDA = Line from olecranon to tuber coxae

• Normal abomasum ventral, to the right of midline

Example: No high-pitched pings were auscultated and there is no evidence of an LDA

LHS7/RHS6: Auscultate Lung Fields

• Difficultly with cows

• Location

• Example normal description

Difficulty: Reduced auscultation field due to interference of noise from GI caudally, depth of thoracic process muscles dorsally, shoulder muscles cranially and heart ventrally

Location: Bordered by the caudal scapula/triceps cranially, line from rib 10 - 11 → olecranon caudoventrally and epaxial muscles dorsally

• Listen to dorsal, mid and ventral aspects

• Place stethoscope between triceps and chest wall to access more cranial regions = Important for right cranial lung lobe (1st lobe off tracheal bronchus)

Example: Soft bronchovesicular sounds are auscultated, no crackles or wheezes can be heard.

LHS8/RHS5: Auscultate Heart

• Location

• Normal heart rate

• 2 Features to assess for

• 4 Valves (+ location)

• Example normal description

Location: Under rib 3 - 6 (under elbow → move limb forwards)

Normal: 40 - 60bpm in paddock (48 - 84bpm during examination)

Features:

1. Arrhythmia

2. Murmur

Valves:

1. Pulmonic (3rd intercostal space LHS)

2. Aortic (4th intercostal space LHS)

3. Mitral (5th intercostal space LHS)

4. Tricuspid (5th intercostal space RHS)

Example: The heart rate is 68bpm, within the reference range of 48 - 84bpm. The beats are strong, regular, with no murmurs detected.

• OR The heart is difficult to hear, but the sounds are regular and the heart rate is 48bpm, within the reference range of 48 - 84 bpm.

LHS9: Wither’s Pinch Test

• Method

• Normal (negative response)

• Positive response

• 2 Alternative tests

  • Method

  • Result

Method: Lift skin behind wither’s off spine with both hands → Perform twice for interpretation

Normal: Dipping = Cow drops down

Positive Result: Cow does NOT dip after x2 tests → Indicates cranial abdominal or caudal thoracic pain

Alternatives:

1. William’s Test = Place right hand over left paralumbar fossa and stethoscope close to thoracic inlet → When rumen contraction occurs, vet can feel movement in paralumbar fossa and should listen for grunt in thoracic inlet = Positive for pain

2. Bar Test = Bar under abdomen at xyphoid process and lifted at each end → Grunt = Positive for pain

LHS11/RHS4: Palpate Pre-Scapular Lymph Node

• Method

• Normal size

Method: Place hands in middle of scapula with fingers towards head → Run hands cranially until you feel the end of the shoulder muscles → Even more cranial advancement to feel lymph node

Normal: 2 - 3cm x 6 - 8cm

LHS12/RHS2: Examine Brisket

• 3 Features to assess for

• How to ID oedema

Features:

1. Oedema

2. Masses

3. Trauma

Oedema: Pitting

LHS13/RHS1: Evaluate Jugular Fill and Pulse

• Normal pulse

• Abnormal pulse

• How to assess jugular fill

• How to differentiate pathological from physiological jugular distension

• 3 DDx

Normal: Jugular pulse seen from level of thoracic inlet to <1/2 neck height

Abnormal: Jugular pulse >1/2 up neck

• NORMAL to extend further when head down

• Jugular cording

Fill: Hold off jugular vein at thoracic inlet to observe jugular fill (assess central venous pressure and volaemic status)

Differentiation: Hold off jugular vein at head and wipe blood into heart → Assess if jugular pulse returns

DDx:

1. RCHF (eg. endocarditis)

2. Traumatic reticuopericarditis

3. Johne’s disease

LHS14: Evaluate Hydration

• 4 Ways to assess hydration

  • Normal

  • Dehydrated

1. Skin tent (neck or upper eyelid)

   • Normal: Skin elastic and will return to normal position after 1 second

   • Dehydrated: Tent remains as skin elasticity reduces

2. Eye position

   • Normal: Eyes are not sunken and no gap between eyeball and eyelids

   • Dehydrated: Enophthalmos and skin surrounding eye shows tension on underlying bones

3. Viscosity of saliva

   • Normal: Saliva with viscosity of canola oil = Well-formed bubbles observed

   • Dehydrated: Saliva sticky and of thicker viscosity, fewer bubbles form

4. Jugular fill

H1: Symmetry

• Additional feature to assess

• Example normal description

• 4 DDx for head tilt

Feature: Length of horns, shape and direction of growth

Example: The cow’s face is symmetrical. The ears are moving freely, the eyes are both open and comfortable. There is no heat tilt present.

• vs. The left ear and left eyelids appear to be drooping on one side, the nose appears to be deviated to the right of midline slightly

Head Tilt:

1. Otitis media/interna (eg. Mycoplasma bovis)

2. Listeriosis

3. Thromboembolic meningoencephalitis (TEME, Histophilus somni)

4. Trauma

H3: Examine Eyes

• Importance

• Example normal description

• 8 Abnormalities

• How to assess the 3rd eyelid

Importance: Detect SCC early to improve welfare and longevity

Example: Open, comfortable with clear, bright and visual corneas

Abnormalities:

1. Discharge or epiphora (excessive tear production)

2. Swelling

3. Blepharospasm

4. Corneal opacity, neovascularisation, hyperaemia

5. Foreign body

6. Growths

7. Corneal discolouration

8. Entropion, ectopic cilia

3rd Eyelid: Place thumb on upper eyelid and gently press through skin onto globe to regress the eyeball into the eye socket slightly

• Use other forefinger to gently pull lower eyelid down so the 3rd eyelid is exposed/visible

Provide descriptions for the following images

A: 3 x 5mm raised, irregular yellow to pink mass on the lower lateral limbus of the right eye. A second area of thickened, pink to yellow mass in the region of the 3rd eyelid involving all visible tissue

B: Focal 2 x 2mm slightly raised, pink to red lesion on the dorsal aspect of the cornea around 1 - 2 o’clock, surrounded by corneal opacity extending about 1.5 - 2cm in diameter on the left eye. Enlarged scleral vessels on the dorsal limbus and scleral region on the bulbar conjunctiva

H4: Examine Nostrils and Nasal Planum

• Method

• 7 Abnormalities

• Example normal description

Method: Use finger to gently palpate inside each nostril for foreign bodies

Abnormal:

1. Foreign body (pruritis = nasal catarrh)

2. Unilateral airflow

3. Ozena

4. Abnormal discharge (eg. mucoid, purulent, haemorrhagic)

5. Photosensitisation

6. Nodular mucosa

7. Snuffling

Example: Beads of sweat, bilateral airflow and symmetrical with no foul odours

• vs. Loud snuffling is heard on examination, the nares appear oedematous, roughened and hyperaemic bilaterally. There is mild mucopurulent nasal discharge from the left side, which also has reduced airflow

H5: Examine Muzzle, Open Mouth and Palpate Tongue

• Method

• 5 Features to assess for

Method:

1. Place one hand gently into the corner of the cow's mouth with the palm of the hand facing upwards

2. Gently apply pressure to the roof of the cow's mouth with fingers

3. Grab tongue with free hand and pull away from body

4. Rest hand grasping tongue gently against corner of mouth

Features:

1. Oral ulceration

2. Odour

3. Food

4. MM colour

5. Missing/worn/erupting incisors

H6: Palpate Submandibular Tissue and Lymph Nodes

• Method

• Example normal description

• 4 DDx for enlarged submandibular lymph nodes

Method:

1. Place hand on corner of ramus

2. Run hands down towards the chin to feel for masses/swelling

3. Repeat on other side

Example: Submandibular lymph node is the size of a mandarin, soft and freely movable with no pain

• Parotid and retropharyngeal lymph nodes not palpable if healthy

Enlarged Submandibular Lymph Nodes:

1. Woody tongue

2. Lumpy jaw

3. TB

4. Enzootic bovine leukosis

5 DDx for submandibular swellings (+ description on palpation)

Extra fat	Soft, non-painful, body temperature, does not pit when squeezed
SC oedema	Soft, non-painful, pits when squeezed
Actinomycosis (lumpy jaw)	Hard, immobile swelling on the jaw bone
Abscess	Firm, painful, hot
Enlarged submandibular lymph nodes	Moveable lumps which may be tender and does not pit when squeezed

Describe the significance of the following ear tags

Right Ear = Herd number (#143)

Left Ear = Calf tag (123rd calf born in 2014 in CCRK herd of origin)

Vaginal Examination

• Method

• Indication

• Normal discharge

• Abnormal discharge

Method:

1. Perform BEFORE rectal exam to reduce risk of faecal contamination introduced into vagina

2. Clean and dry vulva of gross contamination

3. Lube hand and pass through vulva (MM should be smooth)

4. Palpate cervix and assess tone and size of os

5. Scoop along vaginal floor to collect discharge to visual and olfactory assessment

Indication: Calving and post-calving

Normal: Clear and odourless

Abnormal: White, cloudy, yellow, mucoid, haemorrhagic, foetid

Urine Sample

• Method of collection

• 3 Features to assess

• Example description

Method: Rub perineum region directly under vulva to stimulate urination females

• Do NOT hold tail → Clamping

• Not possible in male

Features:

1. Colour

2. Clarity

3. Ketones (ketostix)

Example: The urine is dark yellow, clear, voided in a strong stream and has a strong odour

Faecal Sample

• 3 Pieces of information it provides

• 5 Features to assess

Information:

1. Diet

2. Hydration

3. GI function

Features:

1. Amount/Volume = Depends on nutrition, hydration, rate of passage of ingesta, obstructions, infectious agents

   • Absent OR present (+ to ++++)

2. Consistency = Depends on nutrition (long stem fibre vs. soluble CHO), hydration and GI function

   • Numerical scale OR description (eg. liquid, firm, dry, formed)

   • Normal: Some fibre present after squeezing out liquid component = Remnants of cereal grain husks

3. Colour = Depends on nutrition, hydration, GI function and hepatic function

   • Green, olive green, brown, yellow, orange, grey, black

4. Additional Components = Depends on disease

   • eg. Ulcers, Salmonella, rumen acidosis, rumenitis

   • Melaena, haematochezia, mucus.fibrin, gravel/sand, palm kernel husks, undigested feed, bubbles/foam

5. Odour

   • Normal: Fermented grass

   • Abnormal: Sour or dead tissue

List 6 additional diagnostic tests to perform on-farm

1. More specific examination → Sedated oral exam, ophthalmic exam, otic exam

2. Blood tests → CBC/biochemistry or BVD Ag ELISA, Johne’s ELISA

3. FNA → Contents, cytology and culture

4. Swab → Culture

5. Biopsy → Histology or staining

6. Imaging → U/S, radiographs, CT/MRI

5 DDx for jaundice

1. Theileriosis

2. Leptospirosis

3. Post-parturient haemoglobinuria

4. Onion/brassica toxicity

5. Facial eczema

What 3 other organs can be pinged in the right paralumbar fossa?

1. Abomasum (RDA)

2. Small intestine

3. Caecum

What types of disease may cause enlargement of the popliteal lymph node?

Foot infections / lesions

1. Foot rot (Fusobacterium necrophorum)

2. Digital dermatitis (Treponema spp.)

3. Sole abscesses or penetrating wounds

Trauma/cellulitis of distal hindlimb

Abscess

Large regions of non-pigmented skin with alopecia, erythema and crusting/flaking with ulcerative to erosive scabbed lesions with large area of necrotic epidermis

4 DDx?

1. Facial eczema

2. Spring eczema (no liver damage)

3. Drug reaction (eg. tetracycline)

4. Crops (eg. brassicas)

Consider season

Landmarks of the pelvis

1. Tuber coxae (hook)

2. Greater trochanter

3. Ischiatic tuberosity (pin bones)

8 Components of gross lesion description

1. Location

2. Arrangement (multifocal/diffuse/coalescing)

3. Number (eg. miliary = too many to count)

4. Size

5. Shape

6. Colour

7. Consistency (soft/gritty/pitting/rubbery/wrinkled/crusty/smooth/moist)

8. Odour

*Not ALL may be applicable

Top DDx for the following images

1. Bloat = L paralumbar fossa (distension above hips) → Backward D on LHS → Double D due to ruminal distension

2. Late-term pregnancy = Abdominal swelling BELOW hips (R = Uterus and L = Full rumen)

3. Late-term pregnancy with empty rumen

4. Vagal indigestion = Papple

List DDx for the following jaw swellings

Requirements for transport of cancer eye

1. Confined to eye and eyelid (no spread to lymph nodes)

2. Smaller than $1 coin (3cm)

3. Not flyblown, discharging or bleeding

Sheep Reproduction

• Cycle length

• Overt oestrus length

• Gestation length

Cycle: 17d

Overt Oestrus: 24hr

• Longer for MA and shorter for hoggets (4hr)

• Maiden hoggets do NOT seek the ram → Higher ram:ewe ratio

Gestation: 152d

Sheep Breeding Calendar

1. Mating/Breeding season

   • Mid-March/mid-April (MA)

   • Mate hoggets early-May

2. Pregnancy scan - June/July

   • 40-45 days (MA) or 60 days (hogget) after ram removal

3. Lambing - Late-July/early-October (depends on mating season)

4. Docking - November (1 month of age)

   • Rings = weeks after birth (earlier)

5. Weaning - December (weaned at same time)

• Ram preparation/soundness

• NZ sheep are highly seasonal (short-day)

  • First = silent ovulation (not detected by ram

  • More fertile + higher OR @ 2nd and 3rd ovulation

• Breeding too early/too later affects fertility AND fecundity

• Teaser advances and synchronise mating period (get through first, silent ovulation)

  • 17 days BEFORE ram

  • Ensures ewes are overtly oestrus with entire ram on 2nd cycle

  • Mating at same time, and shorten lambing spread

• Mating early

  • Regional variation (dry early on)

  • Meet Christmas market

• Mating later - Avoid poor weather conditions