Abomasal Ulcers and Abomasitis

True or False: Abomasal ulcers can occur in any breed, signalment, and purpose of bovid, but the condition is more common in dairy calves, particular veal calves, feedlot animals, especially near the end of the finishing phase and high-producing lactating dairy cattle.

True!

Name and describe the FOUR types of abomasal ulcers.

Type I: non-penetrating (sub/non-clinical; does not breach basement membrane)

Type II: ulcers with profuse intraluminal hemorrhage (low PCV, melena)

Type III: perforation with localized peritonitis (visceral surface -> omental bursitis)

Type IV: perforation with generalized peritonitis

What kind of hemorrhage does Type I have, if present?

Mild

What portion of the abomasum is most associated with abomasal ulcers in adults? Calves?

Adults: fundic

Calves: pyloric

True or False: Duodenal ulcers without concurrent abomasal ulceration are extremely rare.

True!

What are FOUR classification of at-risk cattle for abomasal ulcers?

1. High-producing dairy cattle

2. Feedlot cattle

3. Veal calves

4. Beef calves

What type of abomasal ulcers depend on the class of cattle, but can be as high as 80% and is subclinical?

How are these often diagnosed and treated?

Type I

Diagnosis of exclusion and treated empirically

True or False: An animal with Type I abomasal ulcers might present with non-specific clinical signs, like reduced appetite, decreased weight gain, and altered rumen motility.

True!

Type II abomasal ulcers are often associated with ---, especially in mature dairy cattle.

Lymphoma

Types III and IV are considered (sporadic/intermittent/perpetual)

Sporadic

What are the TWO major clinical signs associated with Type II ulcers?

1. Melena

2. Anemia (whole blood losses- PCV and TS)

You are presented with a mature dairy cow with abdominal pain, bruxism, reduced appetite, and intermittent occult blood in the manure. Upon running a CBC, you noticed a low PCV and TS.

What abomasal ulcer type is your best differential?

Type II

What are the three biggest non-tumor associated ulcers in Type II?

1. Anemia with PCV <25% with regeneration

2. Colic

3. Acute death

Name FOUR of the five major clinical signs seen with lymphoma associated ulcers in Type II.

1. Abomasal displacement

2. Anorexia

3. Intraluminal hemorrhage

4. Dark loose stool

5. Pale mucus membranes

True or False: Lymphoma-associated ulcers in Type II are more variable in their extent of wall involvement and other organs affected than non-tumor associated ulcers.

True!

True or False: Lymphoma-associated ulcers in Type II is more likely to have a profoundly low PCV.

False! Lymphoma-associated ulcers in Type II is LESS likely to have a profoundly low PCV.

What are the FIVE other predilection sites for lymphoma?

1. Heart

2. Abomasum

3. Uterus

4. Lymph nodes

5. Spine

What are the major differences between Type III and IV?

III: SLOW perforation COVERED by omentum that is LOCALIZED

IV: ACUTE perforation NOT COVERED by omentum that is GENERALIZED

Type III abomasal ulcers are most associated with perforations of what TWO things?

1. LDAs

2. Omental bursa

What type of abomasal ulcers present similarly to TRP with walled-off infections and adhesion formation?

Type III

What is the development of peritonitis between the two layers of the greater omentum, whereby the ulcer perforates on the visceral surface (left wall) of the abomasum?

Omental bursitis

Omental bursitis is characterized by peritonitis with --- exudate, often --- in odor, and frequently with --- in the omental sac or between the two serosal layers of the bursa.

Suppurative

Fetid

Empyema

True or False: Cattle with abomasal ulcers and resultant localized peritonitis are usually febrile (103-105 F), anorexic, have reduced rumen motility or atony, and have signs of abdominal pain on deep palpation of the ventral abdomen to the right of midline.

True!

How would omental bursitis feel if it were held within the bursa versus if the bursa had perforated?

Intact (III): filled with pus; hard to appreciate; no peritonitis felt on rectal

Perforated (IV): saran wrap on arm rectal; adhesions; peritonitis appreciated

What kind of fluid is sequestered within the peritoneum with a type IV abomasal ulcer?

Protein-rich exudate

A cow presents with acute and complete anorexia, stasis of the rumen and intestinal tract, fever (103-107 F), poor peripheral perfusion with cool extremities, dehydration, reluctance to move, and audible groaning or grunts with expiration.

What type of abomasal ulceration is this most consistent with?

Type IV

True or False: Type IV can be very peracute, leading to death within a few hours or more protracted at 36 to 72 hours. The prognosis is grave, and body temperature will drop prior to death.

True!

Are adults or calves more likely to develop diffuse peritonitis in Type IV?

Calves

What TWO major diagnostics are used to help determine the presence of peritonitis and its extent?

1. Abdominal ultrasound

2. Abdominocentesis

What THREE things might you expect with peritonitis on a Chemistry?

1. Hypokalemia

2. Hypochloremia

3. Metabolic alkalosis

Which of the following would NOT be well-detecting using ultrasound as a diagnostic for perforating ulcers:

-fibrin

-effusion

-abscesses

-adhesions

Adhesions

What would you expect on CBC with a perforating ulcer?

Leukocytosis with left shift and neutrophilia

What are the FIVE major pillars of treating abomasal ulcers?

1. Reduce stress

2. Treat concurrent disease

3. Address dietary issues

4. Blood transfusions (if severe bleeding)

5. Broad-spectrum antibiotics (if peritonitis)

What are the FOUR common anti-ulcer medications often given for abomasal ulcers?

1. Antacids (Mg hydroxide)

2. Coating agents (Sucralfate)

3. H2 antagonists (cimetidine, ranitidine)

4. Proton pump inhibitors (omeprazole, pantoprazole)

In what type of abomasal ulcers is surgical intervention not indicated? If fact, nothing is indicated for treatment? Why?

Type II- grave prognosis with lymphoma

What is the proton pump inhibitor that is preferred in mature ruminants? Calves?

Mature: pantoprazole

Calves: omeprazole (more closely related to monogastrics)

Where do ulcerations typically occur in camelids, although they can have ulcers in other compartments due to things like rumenitis and grain voerload?

C3

What is the major suspected pathogenesis for ulcers in camelids?

Stress- transport, fighting, parturition

What portion of the abomasum secrete HCl in camelids?

Caudal 1/3

True or False: The caudal flexure, pylorus, proximal duodenum, and greater curvature all play a role in HCl production.

True!

True or False: Ulcers in camelids can have bleeding and perforating types just like cattle, except they experience melena LESS than cattle.

True!

When would be TWO major times to expect melena in a camelid?

1. Gastric masses

2. Copper toxicosis

The diagnosis of camelid ulcers is often ---.

Speculative

How do you treat ulcers in camelids?

treat underlying cause (septicemia, enteritis) and give pantoprazole

Name the THREE most speculated causative agents of abomasitis and tympany in neonates in order from most to least likely.

C. Perf Type A -> Sarcinia spp -> E. coli

What are the THREE major risk factors of abomasitis?

1. Milk volume and frequency

2. Rapidly growing, well-doing calf

3. Problem herds

What are FOUR major clinical signs of abomasitis in a neonate?

1. Depressed to recumbent

2. Abdominal distention- abomasum gas and fluid filled

3. Bruxism, kicking at belly

4. Death can be very quick

You are presented an incredibly painful calf that is stilted and not wanting to walk. Shortly upon arrival, the cow goes down. It looks like it has bloat, as it has marked distention of the abdomen, and kicks at his belly.

What is your major differential?

Abomasitis

What are the FOUR major treatments of abomasitis?

1. Penicillin (parenteral, oral)

2. Deflate abomasum with catheter (dorsal recumbency)

3. IV fluids and supportive care

4. Antitoxin for Type C and T (in case its not Type A)

True or False: In abomasitis, the disease course is often peracute and sudden death may be the only presenting sign. Case fatality can be 100% without immediate treatment and high mortality is observed in spite of prompt and aggressive therapy.

True!

True or False: Vaccination is a crucial player of prevention of abomasitis, as Clostridium Type A is protective in a standard 7 or 8-way vaccine.

False! Clostridium Type A is NOT found in these vaccines and you should give ANY susceptible patient C. Perf A toxoid as prevention.

What are THREE necropsy findings of abomasitis?

1. Abomasal edema

2. Emphysema

3. Necrosis

What are the THREE major ways to test for C. Perf?

1. Culture

2. Toxin testing

3. Rapid growth postmortem

Name TWO major differentials for abomasitis in neonate cattle.

1. Salmonellosis

2. Coccidiosis

3. Gastric ulcers

4. Surgical lesions (hairball, intussusception)

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