PE of Bovine Abdomen, Abomasal Displacement, and Ulcers

What organ(s) are you listening to when auscultating the left abdomen of a cow?

Rumen only

Where do you assess for rumenal contractions?

L paralumbar fossa

What organ(s) are you listening to when auscultating the right abdomen of a cow?

• Abomasum

• Jejunum

• Ileum

• Cecum

• Descending duodenum

What is the purpose of percussion?

To ID areas of gas or gas-fluid distention of the viscera

What is the purpose of sucussion?

To determine AMOUNT of relative fluid present

Where do you sucuss?

BELOW the area of the ping you found

ID indications for left sided pings

• LDA

• Rumen gas cap

• Pneumoperitoneum

ID indications for right sided pings

• RDA ± volvulus

• Cecal dilatation ± volvulus

• Spiral colon

• Pneumoperitoneum

• Pneumorectum

Which abomasal displacement (left vs. right) is more common and when is peak occurrence?

LDA is more common, especially during the first 6 weeks of lactation

List the four risk factors for abomasal displacement

1. XS VFA production caused by highly acidic feeds (e.g. high-moisture corn, corn silage, grain) → leads to motility issues/stasis

2. GI stasis 2º to metabolic (hypocalcemia, ketosis) or infectious (metritis, mastitis, enteritis) disease

3. Twins or large calf → leaves void in abdomen

4. Genetics → deeper bodied cows

Clinical signs + biochemical abnormalities of an LDA/RDA cow

PE

• Off-feed and decreased milk production

• Dull, mild dehydrationn

• Vitals WNL

• Decreased strength and/or frequency of rumen contractions

• High pitched ‘ping’ on side

• Variable degrees of succusible fluid (RDAs will have more dramatic fluid than LDAs)

Chemistry

• Hypochloremia

• Hypokalemia

• Metabolic alkalosis

Medical tx options for LDA

1. Treat primary disease (ketosis, hypocalcemia, hypokalemia, etc.)

2. Oral laxatives (mag sulfate) → stimulate GI evacuations

3. Encourage hay consumption to fill rumen with roughage

Sx approaches for correcting LDA (and indicate (*) the 2 most common)

• Right flank omentopexy (*)

• Right flank pyloro-omentopexy (*)

• Left flank abomasopexy

• Right paramedian abomasopexy

• Roll and toggle - blind tack abomasopexy (highest complication risk)

Why is an RDA an emergency?

Much more emergent than LDA due to risk of twisting and becoming ischemic

Clinical signs of volvulus after RDA

• Acute, dramatic appetite decrease and decreased milk production

• Scant feces

• Severely depressed or colicky

• Systemic compromise: severe dehydration, poor peripheral perfusion, rumen stasis

• Tachycardic and tachypneic ± atrial fibrilation due to electrolyte abnormalities

• Often palpable on rectal exam

What are three complications of abomasal volvulus?

1. Damage to the vagal nerve → vagal indigestion

2. Vascular thrombosis along lesser curvature

3. Abomasal outflow obstruction 4-5 days post-op

• Abdominal distension

• Dehydration

• Bradycardia

• Decreased appetite and fecal production

Risk factors for abomasal ulceration for adult cattle

• Highly acidie diets (e.g. grain, corn silage)

• Early lactation (4-6 weeks) → stress, diet change, housing change, peak milk production

• NSAIDS

• Lymphosarcoma

• Abomasal displacement

Risk factors for abomasal ulceration for pre-weaned calves

• Stress → weaning, dehorning

• Concurrent diseases - BRD, scours

• NSAIDS

• Inconsistencies in milk feeding

• Clostridium perfringes type A → acute hemorrhagic ulcers in calves

Describe the 5 classifications of abomasal ulcers

Type 1: non-perforated ulcer, minimal hemorrhage

• ± Melena, intermittent hyporexia/anorexia

Type 2: Bleeding ulcer

• Melena, complete anorexia, hemorrhagic shock

Type 3: Perforated ulcer with local peritonitis

• Leakage of abomasal contents, walled off by omentum and fibrinous adhesions

  • Febrile, rumen hypomotility/stasis, reluctant to move

Type 4: Perforated ulcer with diffuse peritonitis

• Massive leakage of abomasal contents prevents localization of infx

  • Complete inappetence, dehydration, stasis, fever, tachycardic, endotoxemia → sepsis → death

Type 5: Perforated ulcer causing peritonitis limited to the omental bursa

• Clinical signs similar to Type 4

• Either found dead of alive, recumbent w/abdominal distention and respiratory distress

Describe the general treatment of abomasal ulcers

• Discontinue NSAIDS/corticosteroids

• Dietary change

• ± Gastric coating agents?

• Pantoprazole (proton-pump inhibitor) → $$$

Describe the general treatment specific to Type 2 abomasal ulcers

• ± Whole blood transfusions

• Aminocaproic acid (antifibrinolytic) for hospitalized, hemorrhaging patients

Describe the general treatment specific to Type 3 abomasal ulcers

• Stall rest and minimize stress

• Broad-spectrum abx for 1-2 weeks

• Supportive care (IV fluids, Ca, K)

Describe the general treatment specific to Type 4 and 5 abomasal ulcers

• ± Humane euth

• For highly valuable Ps

  • Referral for IV abx and supportive care

  • Likely for weeks to months

Important to consider decreased performance if P survives

What is the common signalment for Type 5 perforated ulcers?

Calves >>> adult cattle

What comorbitiy are abomaasal lymphosarcomas typically associated with? What other predilection sites may you find lymphosarcomas?

Bovine Leukemia Virus