3. Gastrointestinal Disease III: Abomasal Disease

What are the sources of rumen fluid collection for transfaunation?

C
A
O

• cannulated cow

• animal at slaughter

• oral collection (pass a tube)

When should collected rumen fluid be used?

as soon as possible

Can collected rumen fluid be stored? What happens if this occurs?

yes, for ~1 day; decreased microbial viability

True or false: The transfaunation of as little as 1 L of rumen fluid caused significant improvement in the activity of rumen flora in cows with indigestion.

true

Abomsasal displacements are a ________ etiology.

multifactorial

What are some etiologies behind abomasal displacements?

H
P
D
K

• hypomotility or atony of the abomasum

• possible concurrent diseases (mastitis, metritis, etc)

• deficiencies in nutrition or management

• ketotic cattle (days 3-5 post calving)

With abomasal displacements, ________ sided disorders are more common than ________ sided disorders, but ________ sided disorders have more complications.

left; right; right

What is the presentation for a displaced abomasum?

C
D
S
D
O
U
T

• complete or partial anorexia (tucked up)

• dehydrated

• scanty’pasty feces

• decreased milk production

• off-feed (not just grain)

• usually ketotic

• TPR may be normal or elevated

When do most displaced abomasum occur?

shortly after calving

Displaced abomasums are much more common in ________ than ________ cattle.

dairy; beef

In what age range of cattle are displaced abomasums more common?

older (> 2 years)

What is thought to contribute to displaced abomasums?

stress and nutrition

What are displaced abomasums commonly associated with?

mastitis or metritis

Left displaced abomasum is a disorder of ________ ________, about ____ ________ in ________.

early lactation; <30 days; milk

What are the clinical signs of a left displaced abomasum?

A
M
F
R

• appetite decreased

• milk production decreased

• fecal output decreased

• rumination possibly decreased

With a left displaced abomasum, there are variable levels of ________. A ________ can identify gas under pressure in an area of suspicion.

ketosis; ping

How do you diagnose left displaced abomasum?

A
B
P

• ausculatation (ping the abdomen)

• bloodwork

• pH of aspirated fluid (<4.5)

Where should you listen for pings with a left displaced abomasum?

mid thorax from the point of the elbow to the hip

Where can you hear pings from the rumen? What might it indicate?

the rumen gas cap (dorsal area over the last few ribs, paralumbar fossa, and hip); tympany (bloat) or empty (void)

Why else might you hear pings?

F
U
C

• free gas in the abdomen (pneumoperitoneum)

• uterine gas (physometra)

• cecal dilation/displacement

With a left displaced abomasum, what is sequestered in the abomasum?

chloride (HCl)

What are serum chemistry findings associated with displaced abomasum?

H
H
M
P

• hypochloremia

• hypokalemia (±)

• metabolic alkalosis

• possible hypophosphatemia

What are the treatments for left displaced abomasum?

P
A

• pexy (return the abomasum to normal anatomic location)

• address metabolic disorders

What are the types of pexy procedures that can be done in left displaced abomasum?

R
R
L
V
R
L

• right abomasopexy

• right ometopexy (COMMON)

• left ometopexy (more difficult)

• ventral paramedian abomasopexy (more secure but more involved)

• roll and tack/toggle

• laparoscopic correction

What is one of the more common pexy techniques in treating left displaced abomasum?

right ometopexy

A right displaced abomasum can be ________ or ________(________).

simple; complex (volvulus)

A right displaced abomasum is ________ frequent than a left displaced abomasum.

less

What are the clinical signs associated with right displaced abomasum?

S
P

• similar to left displaced abomasum

• potentially palpable on rectal examination

True or false: A right displaced abomasum is an emergency.

true

What are the differentials for right sided pings?

R
A
C
P
S
R
P

• right displaced abomasum

• abomasal volvulus

• cecal distention (can have a torsion component)

• physometra

• spiral colon gas

• rectal gas (after rectal palpation)

• pneumoperitopneum

Where do you hear pings if due to right displaced abomasum?

usually cranial to 8th rib and more cranial than left displaced abomasum ping

What is the initial presentation of right abomasum torsion/volvulus similar to?

right displaced abomasum

On further exam of right abomasum torsion, how are the clinical signs? What are they?

T
D
M
A
P

clinical presentation is more severe

• tachycardia (100+ bpm)

• decreased/absent rumen motility

• minimal to no fecal output

• advanced cases can have a ping with an arched dorsal border

• possible splashes with succession behind last rib

What are the differential diagnoses when it comes to right abomasum torsion?

I
T
C

• intestinal obstruction

• torsion of the mesenteric root

• cecal torsion

What can help differentiate right abomasum torsion?

rectal palpation

What is seen on clinical pathology with right displaced abomasum?

D
H
H
M
P
P

• dehydration/hypovolemia can lead to hemoconcentration

• hypochloremia

• hypokalemia (±)

• metabolic alkalosis

• possible hypophosphatemia

• paradoxic aciduria

What can develop in right displaced abomasum? Why? What type of prognosis does this cause?

metabolic acidosis; reduced perfusion; poor

What is an important component of the clinical pathology seen with right displaced abomasum? What is it?

paradoxic aciduria; conservation of Na, Cl, and K results in excretion of H+ to maintain electroneutrality

Why do cattle become alkalotic with displaced abomasums?

F
E
D
E

• first sequestration of Cl- (little leaves the abomasum to distal GI tract where it is absorbed)

• elevated pH and elevated HCO3

• dehydration leads to renal retention of Na

• excessive H+ ion loss via kidney (paradoxic aciduria)

What is the pathophysiology behind right displaced abomasum leading to torsion/volvulus?

C
D
A

• counterclockwise torsion of abomasum and omasum from right to rear

• duodenum pulled medially to the body of the omasum

• abomasal blood vessels and ventral vagal trunk compromised (torsion near site where duodenum wraps around omasum causing functional pyloric stenosis/failure of abomasal outflow)

Where is the most common twist associated with right displaced abomasum torsion?

between the omasum and the abomasum

What is the treatment for right displaced abomasum/torsion?

S
T
P
N

• surgical correction (right sided or ventral paramedian)

• treat underlying metabolic deficiencies (hypokalemia, hypochloremia, alkalosis, and dehydration)

• possible antibiotics

• NSAIDs

What is the prognosis for right displaced abomasum? When is the prognosis poor?

good if simple, guarded with volvulus; if HR > 100 and if dark discoloration, severely distended, necrosis, and thrombosis of the gastric veins

What is the main prevention of displaced abomasum?

reducing forestomach atony caused by high concentrate diets

How can you reduce forestomach atony caused by high concentrate diets?

S
I
M
P

• slow introduction of concentrates

• increasing fiber length and particle size (check with particle separator)

• maintain serum calcium levels

• prevent ketosis

True or false: Displaced abomasums are not just seen in dairy cattle, but also in beef calves, sheep, goats, and girraffes.

true

An abdominal fistula is most commonly a ________ from a ________ ________. It can also be a result from ________ ________.

complication; ventral abomasopexy; other surgeries

What is this showing?

abdominal fistula

What are abdominal ulcers caused by?

stress and high starch diets

What are the 4 types of abomasal ulcers?

1. N

2. N

3. P

4. P

1. non-perforating

2. non-perforating and bleeding

3. perforating with localized peritonitis

4. perforating with diffuse peritonitis

What is a type I ulcer?

erosion or ulcer without hemorrhage

What is a type II ulcer?

hemorrhage

What is a type III ulcer?

perforation with acute localized peritonitis

What is a type IV ulcer?

perforated with acute diffuse peritonitis

What is a type V ulcer?

perforated with peritonitis within the omental bursa

What type of ulcer is this?

type I

What type of ulcer is this?

type II

What type of ulcer is this?

type III

What type of ulcer is this?

type IV

What type of ulcer is this?

type IV

How do you diagnose abomasal ulcers?

P
F
U
A
B

• physical exam (bruxxism)

• fecal occult blood (looking for digested blood in the feces)

• ultrasound

• abdominocentesis

• bloodwork

What are the clinical signs associated with abomasal ulcers?

V
I
B
D
S
P

• vague

• inappetence

• bruxxism

• dietary preference (will sort out forage instead of grain)

• salivation (excessive)

• poor thrift

What are the causes of abomasal ulcers in calves?

A
B
N
B
S
N

• abrasion theory

• bacterial and fungal agents

• NSAIDs

• BVD or IBR

• stress

• nutritional deficiencies (copper and selenium-vitamin E)

What is this showing?

abomasal ulcer

What is this showing?

abomasal ulcer

What is the treatment for abomasal ulcers?

R
B
A
M

• remove starch (rapidly fermentable and ground carbohydrates → grain)

• blood transfusion possible

• antibiotics possible

• mucosal protectants

What are the several different classes of gastroprotectant therapies for ruminants?

C
S
A
S
H
P

• coating agents

• sucralfate

• alkalinizing agents

• synthetic prostaglandins

• H2 antagonists

• proton pump inhibitors

There are limited gastroprotectant therapies for ________ ruminants.

adult

What are local agent gastroprotectants?

B
S
A

• bismuth subsalicylate

• sucralfate

• aloe vera juice

True or false: Bismuth subsalicylate is GRAS and needs frequent administration. Sucralfate has multiple mechanisms of action and is deactivated by rumen flora. Aloe vera juice is described in organic references and comparative human data.

true

What group of gastroprotectants are effective acid suppressing agents? How do they work?

H2 antagonists; work far upstream

What are examples of H2 antagonists?

F
R

• famotidine

• ranitidine

How is the efficacy of H2 antagonists described in ruminants?

limited to no oral efficacy in ruminants

What are the adverse effects associated with H2 antagonists?

E
D

• electrolyte disorders

• drug interactions

What is the most effective group of acid suppressors? How do they work?

proton pump inhibitors; directly on ATPase pump

What are examples of proton pump inhibitors?

O
P

• omeprazole

• pantoprazole

How is the efficacy of proton pump inhibitors described in ruminants?

limited to no oral efficacy in mature ruminants

What are the adverse effects of proton pump inhibitors in people?

N
E
A
H

• neutropenia

• electrolyte disorders

• anaphylaxis

• hepatotoxicity

When it comes to abomasal ulcers, do not forget about ________.

neoplasia

Abomasal impactions are usually a ________ cow problem.

beef

Surgery is usually ________ in abomasal impactions.

unrewarding

What is the treatment for abomasal impactions? What are specifics?

L
D
F

medical management

• laxatives

• detergents (DSS)

• fluids

True or false: Abomasal impactions cab be more than just feed. They can be due to gravel, phytobezars, trochobezats, placenta, and sand.

true

What is this showing?

abomasal impaction

What is a common neoplasia in cattle? What is it due to?

lymphoma; BLV

What does a BLV status indicate?

only indicates infection with the virus and does not mean they will have tumors

What is this showing?

lymphoma

Abomasal emptying disease is a recognized disease of what species only?

Suffolk sheep

Suffolk sheep can suffer from what disease?

abomasal emptying disease

What is the cause of abomasal emptying disease?

unknown but suspect dysautonomia

What are the clinical signs associated with abomasal emptying disease?

A
W
R

• anorexia

• wasting

• right abdominal distention

Treatment for abomasal emptying disease is ________.

unrewarding