Abomasal Disease (LDAs, RDAs, & Volvulus)

Left

(Left or right) displaced abomasums are more common

1. Abomasal hypomotility prerequisite

2. Ketosis, hypocalcemia, retained fetal membranes

3. Early postpartum dairy cows

LDAs are a multifactorial syndrome including what aspects?

1. Anorexia

2. Drop in milk production

3. Ketosis (predisposing or as a result)

4. Reduced manure output, soft

5. Rumination still likely occurring but reduced fill

6. Variable pitched ping on left

What are clinical signs of LDA? (6)

Tuber coxae, point of elbow

You should draw a line from _______________ to _______________ to ping on the left side

1. Metabolic alkalosis

2. Hypochloremia

3. Hypokalemia

What are the hallmark clinical pathology findings for LDA?

Liptak test

Abomasocentesis to compare to the abomasal pH versus the rumen pH

Burnt almonds/slightly acrid

The abomasocentesis from an LDA smells like what?

Less

For an LDA, the abomasum pH is (less or greater) than the rumen pH

Right

The normal position of the abomasum is (left or right) of the midline

Surgical correction

What is the treatment for LDA?

Roll and toggle

What is the blind technique for treating for LDA?

1. Omentopexy

2. Pyloropexy

3. Abomasopexy

What are the surgical (open) techniques for treating for LDA?

Right paramedian

The _______________ approach is good for emptying the abomasum

1. Short procedure

2. Minimal invasion of peritoneal cavity

3. Minimal equipment

4. Do not need to withhold feed or water (for most)

5. Economics

What are the advantages to the roll and toggle method for treating LDAs? (5)

1. Inability to confirm return of abomasum to normal position

2. Tack the wrong viscus

3. Abomasum needs to be freely moveable (NO adhesions or pathology)

4. Cannot assess the abdomen for abnormalities

5. Labor intensive and risk to handlers

What are disadvantages to the roll and toggle method for treating LDAs? (5)

B

T or F: The roll and toggle method can be used for right sided pings

Roll and toggle

If there is adhesions/pathology of the abomasum, which method of surgical correction for LDA should NOT be used?

1. Tacking the rumen

2. Tacking the pylorus without rumen or abomasum to normal position

3. Peritonitis

4. Fistula formation (importance of cutting suture 2 to 3 weeks post-op)

5. Thrombosis and cellulitis

What are the complications of roll and toggle to correct LDA? (5)

Right

To correct an LDA with omentopexy or pyloropexy you would use a (left or right) flank approach

1. Choose a site as close as possible to normal position of the pyloroduodenal junction without interfering with duodenal function

2. Distribute the pexy over as wide an area of omentum as possible

3. Incorporate peritoneum in the pexy

4. Use a suture that will last long enough for firm fibrous adhesion to form

What are the keys to stable omentopexy?

Your first layer of closure (peritoneum and transversus muscle)

For omentopexy you should hang the omentum like a curtain and incorporate it into what?

Simple continuous

What type of pattern should you use for omentopexy?

#2 or #3 monofilament nonabsorbable (ethilon, prolene)

What type of suture is ideal for omentopexy?

Make sure you are not too close to pyloric sphincter

What should you keep in mind with pyloropexy?

Left

To correct an LDA with abomasopexy you would use a (left or right) flank approach

A

T or F: Left sided abomasopexy is NOT indicated for right displacements/volvulus

Greater curvature

A standing, left sided abomasopexy gives access to the _____________ of the abomasum

Caudal of xiphoid (sternum) and slighlty right of midline

Where should you mark for a left sided abomasopexy?

Milk veins

You need to ensure not to hit _______________ when performing left sided abomasopexy

1. Medical stabilization (correct dehydration)

2. Treat hypocalcemia

3. Treat ketosis

4. Perioperative antibiotics

5. NSAIDs

Regardless of what surgical correction is used for LDA, what should be done afterwards? (5)

A

T or F: LDAs are not an emergency

B

T or F: Right sided pings suggestive of abomasal volvulus are not an emergency

A

T or F: You cannot distinguish a RDA from a volvulus ping characteristics

A

T or F: You should treat all RDAs as an emergency

Medial

The omentum is attached on the _______________ side of the abomasum

1. Similar signs of LDA

2. Dehydration

3. Complete lack of manure production

4. Tachycardia (predictive --> 100 bpm, poorer outcome)

5. Potential colic and evidence of shock

6. Right sided ping 10th to 13th ribs

What are clinical signs of RDA/AV? (6)

1. Ruminal tympany

2. Rumen collapse

3. LDA

4. Pneumoperitoneum

5. Pneumorectum

6. Abscesses

7. Physometra

What are things that can ping on the left? (7)

1. RDA/AV

2. Small intestine

3. Cecum

4. Spiral colon (very rare)

5. Severe ruminal tympany

6. Pneumoperitoneum

7. Pneumorectum

8. Abscesses

9. Physometra

What are things that can ping on the right? (9)

1. Displacement of liver from the body wall

2. Location of omasum shifted ventrally

What on ultrasound suggests RDA/AV?

1. Metabolic alkalosis

2. Hypochloremia

3. Hyponatremia

4. Hypokalemia

What are clinical pathology findings of RDA/AV?

Alkalosis, acidosis

RDA/AV starts as a metabolic _____________ and changes with metabolic ____________ with increased severity/ischemia

6

A L-lactate of > ___________ mmol/L is a poorer prognosis of RDA/AV

Counter clockwise

A vast majority of AV are ________________ in direction

B

T or F: You should remove gas before fluid when correcting an RDA/AV

1. Heart rate > 100 BPM

2. Dehydration > 6%

3. Hypochloremia (<79 mEq/L)

4. L-lactate > 6 mmol/L

5. Necrotic and thrombosis at surgery

What are poor prognostic indicators of RDA/AV? (5)

1. Abomasal perforation

2. Peritonitis

3. Septicemia

4. Omental tearing

5. Type III vagal indigestion (abomasal neuromuscular dysfunction)

What are complications of surgical correction of RDA/AV? (5)