digrum 4 1 abomasum-2005(sinistra) ( dextra) torsion (cum torsione) reflux syndrome (regurgitatio...
Transcript of digrum 4 1 abomasum-2005(sinistra) ( dextra) torsion (cum torsione) reflux syndrome (regurgitatio...
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Internal medicineLectures for students, 7th semester
Digestive diseases of ruminants IV.Abomasal diseases
Dr. Vörös KárolyBelgyógyászati Tanszék és Klinika
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Diseases of the abomasum
Abomasal displacement Abomasal Abomasal obturation(dislocatio abomasi) (obturatio abomasi)
DA inflammation ulcer(abomasitis) (ulcus abomasi)
left sided right sided(sinistra) ( dextra)
torsion(cum torsione)
reflux syndrome(regurgitatio ingestae abomasi)
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Pathogenesis of abomasal displacement
Nutritional abnormality (++ grain, -- fiber)
Abomasal atony
Abomasal dilatation
Anatomical factors Mechanical factors
LDA RDA Abomasal torsion
accompanying dis. hypochloremia accumulation of fluidlocal complications hypokalemia within the abomasumreflux syndrome metab. alkalosis ischemia (necrosis)
+dehydration, (--) tissue perfusionhemoconcentration (++) lactate
metabolic acidosis
Other abomasal disord.Intercurrent diseases(endotoxins)
Fetus,move-ments
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Topography of the bovine abdominal
organs (Gyarmati 1954)
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Location of the abomasum
normal situation LDAdigvideo7
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Clinical signs of LDA I.
Occurence:mainly post partum within some days/weeks
Course:
subacute, chronic (often masked by intercurrent diseases)
General symptoms:
“only” depression, weight loss, (--) milk production
Basic clinical values:
T: n, P: n, R: n /(--) (shallow)(--) rumen movements
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Digestive symptoms:
(--), variable appetite, decreased ruminationthin-pasty feces+/- positive reticular pain probes
rumen: small, firm, decreased motility
abomasum: severe LDA: visible, palpable• percussion: oval, tympanic region• auscultation: spontaneous tinkling sounds (30- 40 % )
(bubbling sounds)• auscultation with ballotment: splashing sounds (50-60 %)• auscultation with percussion: metallic sounds (90-95%)
(steel band effect)
Clinical signs of LDA II.
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Degrees of LDA
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Clinical signs of LDA Spontaneous tinkling sounds
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Clinical signs of LDA
Auscultation with ballotment:
splashing sounds
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Clinical signs of LDA
Auscultation with percussion:
metallic sounds
(steel band effect)
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Clinical signs of LDA III.
Rectal examination: abomasum is not to be palpated (1:100 )medially displaced rumen
Signs of intercurrent diseases:mastitis, foot diseases, puerperal disorders
Symptoms of joint diseases and complications:secondary ketosis, fat mobilisation syndrome, reflux syndrome
Laboratory examinations:blood: (++) PCV, (--) Cl , (--) K, metab. alkalosis, (++) glucose, ketone in milk, urine
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Diagnostic work-up of LDA
DiagnosisMost important is the targeted examination of the abomasum !!!
(The finding can change ! Screening examination !)
Differential diagnosisA) diseases with anorexia and ruminal stasis
B) intercurrent diseases, joint diseases, complications
C) diseases with similar finding of auscultation + percussion (differentiation: localisation, probing, puncture )
D) other abomasal diseases
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Differential diagnosis of LDA during simultaneous auscultation and percussion
After Rebhun, 1991
Left sided abomasal displacementFree gas + fluid within the rumen(posterior funct. stenosis, acidosis)Pneumoperitoneum
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Surgical treatment of LDA I.(Utrecht method)
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Surgical treatment of LDA II.(Utrecht method)
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Surgical treatment of LDA III.(Utrecht method)
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Surgical treatment of LDA IV.(Utrecht method)
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Videos
Surgical treatment of LDA V.(Utrecht method)
digvideo7
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Surgical treatment of LDA.(Hannover method)
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Development of right sided abomasal displacement and abomasal torsion
RDA Abomasal torsion
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Clinical signs of RDA and abomasal torsion I.
Course: acute, subacute
General symptoms:
• after calving, within a few weeks• more severe, than those of the LDA; especially with torsion• serious deterioration, weakness, +/- good body condition• (moderate) abdominal pain
basic clinical values:T: n /(--), P: ++, R: variable
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Skin:dehydration (+ sunken eyes)
Mucous membranes:
dry, pale, dirty redCRT: prolonged
Circulatory organs:
signs of peripheral circulatory failure
Clinical signs of RDA and abomasal torsion II.
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Digestive organs:
complete inappetence, (++) thirstfeces: scant, pasty, +/- olive greencomplete ruminal stasis, +/- pozitive reticular pain probes(--) liver dullness
Abomasum: •visible and palpable in severe cases•percussion: tympanic oval region, horizontal dullness (pain)•auscultation: spontaneous tinkling/bubbling sounds (20 %)•auscultation with ballotment: splashing sounds (60-70 %)•Auscultation with percussion: metallic sounds (90%)
Clinical signs of RDA and abomasal torsion III.
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Rectal examination:balloon-like, palpable abomasum(RDA: 60 %, + torsion: 90 %)firm rumen
Laboratory examinations:(++) PCV, (--) Cl , (--) Kmetabolic alkalosis acidosisleuko/neutropenia
Course:RDA torsion shock death
Clinical signs of RDA and abomasal torsion IV.
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Clinical signs of RDA and abomasal torsionAuscultation with percussion: metallic sounds
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Diagnostic work-up of RDA and abomasal torsion
Course: rapid
Diagnosis:based on the targeted examination
of the abomasum (including rectal finding !)
Differential diagnosis:
A) Diseases with similar auscultation + percussion(cecal torsion, small intestinal ileus, intestinal atony )
B) Diseases with abdominal pain
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after Rebhun, 1991
Differential diagnosis ofRDA
during simultaneousauscultation and
percussion
Right sided abomasal displacement
Cecal dilatation and torsionSmall intestinal ileus
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Differential diagnosis of RDA II. Cecal dilatation and torsion
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Differential diagnosis of RDA III.Ileus
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Surgical treatment of RDA I.
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Surgical treatment of RDA II.
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Fluid therapy using continuous drip infusion technique
The basics of fluid therapy and the rate of dehydration see at acute
rumen acidosis
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A calf can also have an abomasal displacement and even the veterinarian can suffer from an accident.
Instead of the final word:
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Abomasitis and abomasal ulcer(abomasitis, ulcus abomasi)
Forms: Primary Secondary
Occurence: rare more common
Cause:
stress other abomasal disease
grass, fertilizers, leukosis, GI helminths
herbicides VD, salmonellosis
calves: rough fodderfungi, hair balls
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Clinical signs:
Mild form:no symptoms / mild general symptoms, inappetence
Sever form: (bleeding ulcer)anaemia, dehydration, peripheral circulatory failuremelenarumen stasis, positive reticular pain probesabomasum:
pain during pressure (palpation)gas and fluid accumulationabomasocentesis: typical finding
Perforation:localised /diffuse peritonitisrapid death
Abomasitis and abomasal ulcer
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Abomasitis and abomasal ulcer in
cattle
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Diagnostic work-up:
Diagnosis: feces, local findings, abomasocentesis !
Differential diagnosis:other abomasal diseases, acute enteritisdiseases with acute blood-loosing anemia
Treatment:• diet, adstringents, mucoprotective drugs• blood transfusion, • H2 receptor blocking drugs? (e.g.. cimetidine)• alkalisers (MgO, Mg silicate) • surgery
Abomasitis and abomasal ulcer
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Abomasal obturationEtiology:
sand or rough, hard fodder + lack of drinking water(feedlot bulls, sheep)
Clinical signs:similar to abomasal ulcer, but other, characteristic local signs:
abomasum: firm, sand sack-like palpatory finding
Treatment: A) conservative: spasmolytics, laxatives
+ fluid and electrolyte replacement
B) surgery: rumenotomy or abomasotomy
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Surgical treatment ofabomasal obturation
(sand obturation)
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Pathogenesis of reflux syndromeAbomasal disorder
Back flow of the abomasal fluid
Rumen fluid Blood
(++) acidity by titration metabolic alkalosis(--) pH Cl- < 95 mmol/lCl- > 30 mmol/l hypokalemia(++) osmolality (++) PCV
Sequels
thin (watery) rumen fluid dehydration, (--) GFR
dilatation of the rumen extrarenal uremia
Dirksen, 1984 nyomán
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Clinical signs of of reflux syndromeAccumulation of abomasal fluid within the rumen
Dehydration Metabolic Rumen distensionalkalosis
Exsiccosis Uremia Respiration: (++) undulating rumen
skin, urine-like (--) resp. rate thin, sour-smellingeyes, breath, shallow breathing ruminal contentCRT, PCV (++) creatinine
+Characteristic clinical signs of the underlying abomasal disease
DA, abomasitis, abomasal ulcer, obturation, posterior functional stenosis
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Reflux syndrome in a cow
Hoflund syndrome, posterior functional stenosis
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Study of the compensation of metabolic alkalosiswith pneumotachography
Healthy cow
LDA + reflux syndrome
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Thank you for your attention.