Acute Abdomen in Ruminants

1. Hemorrhagic bowel syndrome (HBS)

2. Duodenal outflow obstruction

3. Trichobezoar, phytobezoar, enterolith

4. Fat necrosis

What are examples of obstructive non-strangulating lesions of the small intestine in ruminants?

1. Intussusception

2. Segmental small intestinal volvulus

3. Torsion of mesenteric root

What are examples of strangulating lesions of the small intestine of ruminants?

Caudal right abdomen

Small intestinal fluid distention will ping where?

1. Root of mesentery

2. Jejunoileal flange

Torsion of small intestine commonly occurs where?

Mature dairy cattle

Hemorrhagic bowel syndrome is a disease of what?

A

T or F: HBS has a high case fatality rate

Hemorrhagic bowel syndrome (HBS)

Massive hemorrhage within lumen of jejunum, in dairy cattle

1. Clostridium perfringens type A

2. Hindgut acidosis, nutritional problem

What are speculated causes for HBS?

First 3 to 4 months

HBS occurs in lactating dairy cattle typically in the ________________ of lactation

1. Peracute death

2. Severe hemorrhage - down, hemorrhagic shock

3. Intraluminal obstruction - colic, weakness, abdominal distention

4. Melena (scant, tarry feces with casts/clots of blood)

5. Positive succussion right abdomen

6. +/- SI distention on rectal

What are clinical signs of HBS? (6)

1. Tachycardia

2. Tachypnea

3. Pale MM

4. Cool extremities

5. Down

What are the components of hemorrhagic shock? (5)

1. Dilated loops of SI

2. Clotted blood within lumen

3. Free abdominal fluid (effusion) and fibrin

What may you see on ultrasound to suggest HBS?

1. Intussusception

2. Small intestinal volvulus

3. Severe functional ileus

What are differentials for HBS?

Exploratory

How do you reach diagnosis of HBS?

1. Resection and anastomosis

2. Enterotomy

3. Manual massage

What are your options when surgically treating HBS with a standing right flank laparotomy?

1. Ration management

2. Transition health

3. C. perfringens Type A vaccine in problem herds

4. Feed supplements (mycotoxin binding agents)

How do you prevent HBS?

1. Foreign body

2. Ulceration and stricture

3. Iatrogenic (recent pyloropexy)

4. Extraluminal compression

What can cause a duodenal obstruction?

Sporadic and rare

Duodenal obstruction is a _____________________ condition

Surgical correction (FB - enterotomy & stricture - side to side anastomosis)

How do you treat duodenal obstructions?

1. Ectoparasites and shedding of hair coat

2. Low roughage diet

Why do trichobezoars occur?

1. Poor appetite, weight gain, vagal indigestion

2. Colic and abdominal distention, lack of manure

What are clinical signs of trichobezoars?

1. Rumenotomy

2. Abomasotomy

3. Enterotomy

How do you surgically remove trichobezoars?

Fescue toxicosis

________________ increases herd prevalence of fat necrosis

Fat necrosis

Necrosis of mesenteric, abdominal and retroperitoneal fat leading to intra- and extraluminal compression

Neoplasia and abscesses

What are DDx for fat necrosis?

1. Jejunum into jejunum or ileum

2. Ileum into cecum/colon

3. Cecum/colon

4. Colon into colon

What are the 4 types of intussusception?

Jejunum into jejunum or ileum

Which type of intussusception is most common?

Small intestine

Intussusception is most commonly involving the _____________ in cattle

1. Colic

2. Peritonitis, septic shock

3. Abdominal distention

4. Fecal production often zero beyond 24 hours

5. Passage of blood/mucus

What are clinical signs of intussusception? (5)

1. Abdominal ultrasound

2. Abdominocentesis

How do you diagnose intussusception?

Right

You should perform a (left or right) paralumbar fossa laparotomy for intussusception?

A

T or F: Manual reduction ("pulling it apart") is contraindicated for intussusceptions

Mass ligation

Fatty mesentery makes vasculature difficult to see for resection and anastomosis, for this reason you should perform _______________

End to end or side to side with suture (not stapling devices or ligasure electrocautery)

What is the best way to perform a resection and anastomosis?

Intestinal volvulus

Rotation of intestine about mesenteric attachment

Root of the mesentery

Volvulus of the ___________________ leads to the entire SI being involved

Cardiovascular shock

Intestinal volvulus of the root of the mesentery leads to ____________________

Acute obstruction

Intestinal volvulus of the jejunal flange leads to ___________________

Marked distention of SI

What will you feel on rectal for an intestinal volvulus?

Distended amotile loops (stacked Olympic rings)

What will you see on ultrasound for intestinal volvulus?

1. Immediate surgical correction

2. Standing right paralumbar fossa

3. Detorsion of twist (R&A if indicated)

How do you treat intestinal volvulus?

B

T or F: There is better survivability of root of mesentery intestinal volvulus compared to jejunal flange intestinal volvulus

Pelvis

The blind end (apex) or the cecum points towards the ____________

Proximal loop of ascending colon

Dorsally, the cecum is attached to the ______________________

Ileum

Ventrally, the cecum is attached to the _______________

1. Right paralumbar ping and positive succussion

2. Tense dome shaped hollow viscus in pelvic canal on rectal

What are important findings that suggest cecal dilation?

1. Tachycardia

2. Colic

3. Abdominal distention

4. Larger ping area

What are clinical signs of cecal volvulus?

1. Fluids, NSAIDs, off feed for ~24 hours

2. Surgery if deterioration

If there is only cecal dilation and the cow is still passing feces, what is the treatment?

1. Standing right flank laparotomy

2. Typhlotomy

How do you treat cecal dilation/volvulus?

A

T or F: Resection is NOT indicated for the first surgical procedure when correcting cecal dilation/volvulus

Axial

The normal anatomic position of the cecum is the spiral loop ascending colon is ____________ to the cecum and proximal loop of ascending colon

Salvage procedure

If there is atresia ani, what should be done?

Euthanasia

If there is atresia coli, what should be done?

A

T or F: Meconium impactions are NOT common in calves

1. Sedation and epidural

2. Abdominal pressure to find bulge

3. Remove skin (~quarter size where rectum should be)

4. Blunt dissection down to "balloon" and around to free up rectal pouch

5. Place stay sutures

6. Full thickness simple interrupted sutures

Describe the salvage procedure to atresia ani (6)

Vaginal prolapse

ID prolapse

Cervical prolapse

ID prolapse

Uterine prolapse

ID prolapse

Rectal prolapse

ID prolapse

Increase in abdominal pressure or inadequate sphincter tone

Rectal prolapse occurs due to what?

1. Too short tail dockings

2. Enteritis

3. Chronic coughing

4. Straining from cystitis, dystocia

What are causes of rectal prolapse?

I

Anatomical classification of rectal prolapse: rectal mucosa only; small intermittent

II

Anatomical classification of rectal prolapse: all layers (mucosa to serosa) of rectum, variable length

III

Anatomical classification of rectal prolapse: all layers of rectum and prolapse of large colon

IV

Anatomical classification of rectal prolapse: sphincter intact with intussusception of colon and rectum through anus (palpable trench)

I

Extent of injury from rectal prolapse classification: mucosa and submucosa only

II

Extent of injury from rectal prolapse classification: disruption of muscular layers (diverticulum)

III

Extent of injury from rectal prolapse classification: serosa intact

IV

Extent of injury from rectal prolapse classification: al layers torn

1. Sugar

2. Hypertonic saline

3. Compression

What can be used to help correct rectal prolapse?