Abomasal Disease (LDAs, RDAs, & Volvulus)

(Left or right) displaced abomasums are more common

Left

LDAs are a multifactorial syndrome including what aspects?

1. Abomasal hypomotility prerequisite

2. Ketosis, hypocalcemia, retained fetal membranes

3. Early postpartum dairy cows

What are clinical signs of LDA? (6)

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

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

Tuber coxae, point of elbow

What are the hallmark clinical pathology findings for LDA?

1. Metabolic alkalosis

2. Hypochloremia

3. Hypokalemia

Abomasocentesis to compare to the abomasal pH versus the rumen pH

Liptak test

The abomasocentesis from an LDA smells like what?

Burnt almonds/slightly acrid

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

Less

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

Right

What is the treatment for LDA?

Surgical correction

What is the blind technique for treating for LDA?

Roll and toggle

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

1. Omentopexy

2. Pyloropexy

3. Abomasopexy

The _______________ approach is good for emptying the abomasum

Right paramedian

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

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 disadvantages 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

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

B

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

Roll and toggle

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

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

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

Right

What are the keys to stable omentopexy?

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

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

Your first layer of closure (peritoneum and transversus muscle)

What type of pattern should you use for omentopexy?

Simple continuous

What type of suture is ideal for omentopexy?

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

What should you keep in mind with pyloropexy?

Make sure you are not too close to pyloric sphincter

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

Left

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

A

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

Greater curvature

Where should you mark for a left sided abomasopexy?

Caudal of xiphoid (sternum) and slighlty right of midline

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

Milk veins

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

1. Medical stabilization (correct dehydration)

2. Treat hypocalcemia

3. Treat ketosis

4. Perioperative antibiotics

5. NSAIDs

T or F: LDAs are not an emergency

A

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

B

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

A

The omentum is attached on the _______________ side of the abomasum

Medial

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

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 things that can ping on the left? (7)

1. Ruminal tympany

2. Rumen collapse

3. LDA

4. Pneumoperitoneum

5. Pneumorectum

6. Abscesses

7. Physometra

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

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 on ultrasound suggests RDA/AV?

1. Displacement of liver from the body wall

2. Location of omasum shifted ventrally

What are clinical pathology findings of RDA/AV?

1. Metabolic alkalosis

2. Hypochloremia

3. Hyponatremia

4. Hypokalemia

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

Alkalosis, acidosis

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

6

A vast majority of AV are ________________ in direction

Counter clockwise

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

B

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

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

1. Abomasal perforation

2. Peritonitis

3. Septicemia

4. Omental tearing

5. Type III vagal indigestion (abomasal neuromuscular dysfunction)