Ruminant Head and Neck

Name at least THREE speculum devices that are useful for the bovine examination.

1. Spool speculum

2. Wedge speculum

3. Hog speculum

True or False: Equine speculum devices work just as well in cattle.

False! They are NOT good for cows because they do not have upper incisors, amongst other reasons.

True or False: Actinobacillus lignierseii, a Gram-negative aerobic pleomorphic rod, is a normal part of the ruminant oral cavity.

True!

What disease is caused by Actinobacillus ligniersii?

Wooden tongue

What is the biggest cause of wooden tongue?

Break in mucosa/skin (eating stemmy feed)

True or False: The disease is sporadic in occurrence, but outbreaks can occur due to common risk factors such as stemmy forage or sharp objects frequented by the herd.

True!

Name at least THREE other areas of the body that can be impacted by wooden tongue and explain how.

1. Lips/cheeks/neck- granulomas or abscesses

2. Flank/limbs/udder- nonhealing, open sores

3. Esophagus/forestomach- bacteremia with organ spread

You are called out to a beef operation to look at a middle-aged cow. On examination, you notice drooling, protrusion of the tongue, gaunt appearance, weight loss, dysphagia, and pain while eating.

1. What is your top differential?

2. Given your top differential, what would you expect to palpate on the tongue/head of this cow?

3. What is one major rule out you can make on palpation, especially around the torus linguae?

1. Wooden tongue

2. The tongue is firm and meaty with some raised knots. Draining tracts might be seen and intermandibular area might be swollen. Sulfur granules are seen in variable amounts.

3. Foreign body (wire, sticks, etc.)

Name at least THREE major differentials for wooden tongue.

1. Actinomycosis (lumpy jaw)

2. Foreign body

3. Neoplasia

4. Other pyogranulomatous infections (Nocardia)

What is one major way to rule out lumpy jaw as a differential for wooden tongue?

Lumpy jaw: If the cow is not painful (unless also have dental dx or other pathology)

Wooden tongue: very painful

True or False: Wooden tongue is often diagnosed by physical exam findings alone, but can be made definitive by biopsy or culture from tissue or aspirated fluid.

True!

What are TWO pathologic findings on physical exam that would point you towards wooden tongue?

1. Club colonies

2. Sulfur granules

True or False: Masses associated with wooden tongue are multifocal, necrotic masses filled with nonodorous thick, white-yellow purulent material.

True!

What is the major treatment for wooden tongue?

What is the standard administration route and dose?

Sodium iodide 20%

20 mg/kg IV

You treat wooden tongue with sodium iodide 20% every 7 days 2-3x or until iodinism is observed.

What does this mean?

Mild signs of toxicity observed (excessive tearing, flaky skin, diarrhea, inappetence)

What kind of animals does the label for sodium iodide indicate not to use in?

Do we believe them?

What kind of cows should you really not give this to legally?

Pregnant cows (abortions)

Nah they'll be fine

Lactating cows

True or False: Wooden tongue is also sensitive to a number of antibiotics, including penicillin, sulfonamides, and oxytetracycline.

True!

What kind of prognosis does wooden tongue carry?

Good

There is currently on unknown MOA for why sodium iodide is used to treat cattle.

What is the proposed mechanism?

Penetrating granulation tissue or decrease immune response that causes granulation tissue

What would you tell an owner to prevent wooden tongue?

Avoid excessive stemmy forage and remove other risk factors in pasture

You get a call from a client that is worried about one of his bulls. He thinks that it has lumpy jaw.

He asks you how this bull could've gotten lumpy jaw. What do you tell him?

Should he be worried about systemic signs?

Normal flora that is commensal and enters via breaks in skin and invades deeper tissues, usually caused by stemmy feedstuff or sharp objects.

No, it is localized and proliferative but not highly invasive or spread systemically.

How does lumpy jaw most typically present?

Hard, immovable bony mass (osteromyelitis) on the mandible (more common) or maxilla (less common). Cow is non-painful.

True or False: Exudative lesions are rare, but like wooden tongue, exudate contains yellow-white particles called sulfur granules.

True!

You examine a cow that you presume to have lumpy jaw. This is a valuable show animal and the client wants to confirm your suspicion.

What TWO things are the best options to do?

What else is of value to confirm and also rule out neoplasia?

Tissue biopsy or fluid aspirate (culture)

Histopath

You have a cow that presents presumptively with lumpy jaw. You decide to perform a quick cytology to support your diagnosis. What do you see grossly and then upon Gram stain?

How do you know this is not wooden tongue based off this result?

Gross: sulfur granules

Gram: gram-positive pleomorphic rods

Wooden tongue in gram-negative

True or False: Unlike actinobacillosis, Actinomyces spp. are difficult to culture and require special culture techniques and sample handling.

True!

What diagnostic for lumpy jaw can be useful in confirming osteomyelitis (swiss cheese appearance of bone) and help differentiate from neoplasia, dental disease, and fractures?

Radiographs

What major difference does lumpy jaw have in prognosis, treatment, and long-term quality of life than is different than wooden tongue?

Prognosis: variable to very poor

Treatment: sodium iodide, but LONG-TERM abx (penicillin, LA200, Nuflor)

QOL: facial distortion from bones affected- can impact dental health (lesions do not reabsorb)

True or False: The dose and frequency of sodium iodide treatment of lumpy jaw is exactly the same as wooden tongue.

True!

You got a cow and it's got a weird lump on its face. You did an oral exam and confirmed it was not feed packing or a foreign body. What's the best way to try and quickly get some information on what it could be?

Aspirate

True or False: Proper restraint, effective drainage, and dilution of the site are key factors in lancing an abscess.

True!

Outside of balling gun injuries/magnet bolus and other pharyngeal traumas, what are TWO nontraumatic conditions that impact the pharynx?

1. Neoplasia causing pharyngeal collapse (abscessed retropharyngeal lymph nodes)

2. Neurological dysfunction (severe listeriosis, otitis interna)

You are called out to examine a cow in respiratory distress. Once you arrive, you notice it is dysphagic and has feedstuff coming from the nostrils. You also notice ptyalism, halitosis, and occasionally ruminal tympany. After talking to the producer, you learned that he placed a magnet in this cow a few days ago.

You go to examine the throat latch region. What would you expect to find?

Extensive swelling (cellulitis) with abscess formation that can extend all the way to thoracic inlet

What major finding related to pharyngeal trauma carries a poor prognosis?

Septic mediastinitis

Initial pharyngeal lacerations can wall off trapped debris and bacteria, creating —————, which can be large and palpable externally and cause pharyngeal collapse from extraluminal compression.

Retropharyngeal abscesses

Sometimes, an emergency —— +/- temporary rumenostomy must be placed to stabilized the animal with pharyngeal trauma and allow further diagnostic workup.

These animals would then be at risk for —— —-.

Tracheostomy

Aspiration pneumonia

When placing a tube through the pharynx of a cow, you must stay —- and —- like a horse when going through the nasal cavity to avoid the —-.

Why might you be passing a tube?

Ventral

Medial

Ethmoids

Relieve bloat

Why would you need to do an emergency trochar/rumenotomy on a cow with pharyngeal trauma?

Pharyngeal tissue could be occluding airflow and cow could be at risk of bloat if unable to eructate

How are the arytenoids of a cow different than a horse?

Much rounder

There are several diagnostic options available for pharyngeal trauma.

If available, an —- allows better visualization of lacerations and damage extent.

—- are useful for tracking the amount of soft tissue gas and fluid lines, including mediastinal involvement.

—- can determine the integrity of tracheal and esophageal walls and location(s) of abscesses.

Endoscopy

Radiographs

Ultrasound

True or False: If there is air in a space where there normally isn't, this can serve as a great breeding ground for bacteria.

True!

If you see a cow with dysphagia and lots of swelling, what should you check for?

Aspiration pneumonia

If available, an —- allows better visualization of lacerations and damage extent. —- are useful for tracking the amount of soft tissue gas and fluid lines- including mediastinal involvement. —- can determine the integrity of tracheal and esophageal walls and abscess locations.

Endoscopy

Radiographs

Ultrasound

Name TWO signs on ultrasound that are indicative of some kind of infectious process.

1. Comet tails

2. V lines

What FOUR major findings might you see on a CBC/Chem with retropharyngeal abscess?

CBC: inflammatory leukogram; high fibrinogen

Chem: electrolyte derangements; protein loss

True or False: Prognosis of balling gun injuries is variable and depends on severity of trauma and comorbidities seen.

True!

What can occur with irreparable damage to the vagus nerve?

Bloat

How long should you treat with antibiotics for balling gun injuries?

What major abx might be warranted?

1. Beta-lactams (first line of defense)

2. Tetracyclines; sulfonamides; florfenicol

Name TWO of the three anti-inflammatories that might be used in treating balling gun injuries.

1. Dexamethasone

2. Flunixin meglumine

3. Meloxicam

What TWO surgical interventions might be needed for balling gun injuries?

1. ER tracheostomy

2. Rumenostomy

Name THREE other additional treatments/managements of balling gun injuries.

1. Oral fluids (combat salivary losses)

2. Nutritional (alfalfa meal slurry; Chaff hay; soft and palatable)

3. Rumen fluid transfaunation

What is the most common reason to see a camelid outside of parasites?

Dental disease

True or False: Any tooth can be involved, and mandibular teeth are most impacted.

True!

You see a 5 year old alpaca who presents to you with feed dropping, excessive salivation, packing of cud in cheeks, oral pain, head shyness, and visible malocclusion. He has also recently decreased in BCS. He has a firm swelling over his lower left mandible.

You are most concerned about dental disease. What are at least FOUR differentials for this?

1. Soft tissue infection

2. Abscess

3. Mandibular osteomyelitis without tooth involvement

4. Salivary mucocele

5. Neoplasia

Would lumpy jaw be a differential for dental disease in camelids?

No, it is not reported in camelids.

————- is the diagnostic for dental disease in camelids. And, if feasible, ———- with contrast, performed under sedation, would be ideal to allow for a more thorough examination (primarily if surgical).

Skull radiographs

CT

True or False: Medical and surgical treatment of dental disease in camelids is comparable prognostically.

False! Medical treatment alone has VARIABLE success, while surgery is usually CURATIVE with a GOOD prognosis.

What are the TWO classifications of drugs used to medically manage dental disease in camelids and how long are they given?

1. Antibiotics (4-6 weeks)

2. Anti-inflammatories (1-2 weeks)

You can use several antibiotics for dental disease in camelids, including ceftiofur, penicillin, and isoniazid.

What drug is often given SQ every other day for 10 days and can wreck havoc on the GI tract, where you should expect diarrhea or GI upset?

Florfenicol (Nuflor)

Why must you be careful with NSAID use in camelids?

They hang on to them -> require much lower doses or prolonged, small intervals

What do most cases involve for true treatment of dental disease?

Extraction (under GA)

What are the THREE approaches for dental extrractions used in camelids?

1. Ventrolateral buccal approach

2. Retropulsion (not for mandibular)

3. Oral extraction (only for extremely loose teeth)

What salivary gland spans from the jugular to the base of the ear with a duct in the superficial masseter muscle?

What nerve is within this gland?

Parotid gland

Facial n (CN VII)

What salivary gland spans the medial angle of the mandible and is deep to the parotid gland, intimate with the common carotid arteries?

Mandibular gland

How much saliva is produced daily in a mature bovine?

>50 L

Saliva is essential for digestion, where 80 mEq/L of —- and there are often significant —- losses. These are often seen in low amounts if a cow is unable to swallow saliva.

HCO3

K+

True or False: Congenital atresia or agenesis of salivary ducts can result in fluid-filled swellings that are non-painful and do not pose a risk to the animal and can go untreated.

True!

Why is lancing and draining of congenital atresia/agenesis of salivary glands discouraged?

Does not address problem and leads to secondary infections with severe metabolic acidosis (loss of bicarb)

What is the major sequelae of traumatic laceration/rupture of salivary gland disease?

Sialocele (mucocele) -> ascending infection

What are TWO non-surgical ways you can manage a traumatic laceration of a salivary gland?

1. Kill off glandular tissue with caustic injection or duct ligation (simplest treatment)

2. Marsupialization of duct proximal to laceration

What agent can be injected into the salivary gland? (2)

Which one of these should you avoid using in food-producing species, as this would be no bueno for human consumption?

1. Lugol's iodine

2. Formalin

Formalin

Name TWO reasons why surgical repair of a lacerated salivary duct can be challenging.

1. Risky to patient; lengthy surgical time

2. Catheterization can be difficult

Name THREE etiologies of sialoadenitis (swollen salivary gland) and THREE ways to treat it.

1. Infections

2. Penetrating wounds

3. Plant awns/foreign body

1. Drain (if abscessed)

2. Antibiotics

3. Anti-inflammatories

What is the major difference between goiter and milk goiter?

Goiter: thyroid pathologic enlargement

Milk goiter: Extra thymic tissue; spontaneously regress

Everything else on this powerpoint she said was supplemental!

Thank God holy shit