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FARM ANIMAL > 11.3.4: Abdominal pain > Flashcards

11.3.4: Abdominal pain Flashcards

1
Q

Differentials for acute abdominal crisis

A

Gastrointestinal disease
* Abomasal volvulus
* Abomasal displacement
* Haemorrhagic jejunitis
* Caecal torsion
* Primary/ secondary bloat
* Intestinal torsion/ intussusception
* Mesenteric torsion
* Peritonitis

Non-GI diseases
* Uroliths
* Uterine torsion
* Pyelonephritis

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2
Q

History questions to ask for the animal in the acute abdominal crisis

A
  • Age
  • Sex
  • Breed
  • Stage of production
  • Nutrition
  • Management system
  • Stage in reproductive cycle
  • Previous surgery
  • Previous treatment
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3
Q

What aspects of your clinical exam should you pay particular attention to in the ruminant with the acute abdominal crisis? What findings would you expect?

A
  • Cardiovascular status: HR elevated, mm tacky, CRT prolonged, prolonged skin tent
  • Abdominal silhouette: assess rear and side for abdominal distension, assess back position (flat or arched)
  • Abdominal examination: reduced rumen contractility, listen for pings, listen for splashing on succussion
  • Look for signs of pain: bruxism, abducted elbows, reluctance to dip on wither’s pinch indicates cranial abdo pain
  • Assess viscera on rectal palpation
  • Assess faecal output, check for frank blood, melena, fibrin and mucus
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4
Q

What additional diagnostic tests could you employ in the ruminant with the acute abdominal crisis?

A
  • Abdominocentesis and peritoneal fluid analysis
  • Imaging: ultrasonography
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5
Q

What aspects of peritoneal fluid will you analyse?

A
  • Colour
  • Volume
  • Turbidity
  • Odour
  • Protein content
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6
Q

How will you ultrasound the abdomen and what should you see?

A

Use 7.5 MHz transrectal probe to identify the presence of fluid.

  • Look for reticular contractions on ultrasound
  • Located left of the midline, caudal to the xiphoid
  • Rumen and reticulum contract in “seagull-like” contractions
  • Can also assess for adhesions, abscess, fluid accumulation
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7
Q

A

A

Reticulum

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8
Q

B

A

Rumen

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9
Q

What is indicated by 4?

A

4 = free fluid. This is abnormal.

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10
Q

Aetiology and clinical presentation of peritonitis

A

Aetiology
Primary: associated with systemic infection
Secondary: after abdominal surgery

Clinical presentation
* Acute: abdominal discomfort, pyrexia, ± toxaemia, altered faecal output
* Chronic: non-specific clinical signs (“off-colour cow”, reduced production)

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11
Q

Causes of diffuse peritonitis

A
  • Urethral obstruction
  • Acute acidosis/ rumenitis
  • Toxic mastitis
  • Postpartum metritis
  • Perforated abomasal ulcer
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12
Q

Causes of local peritonitis

A
  • LDA/ RDA
  • Caecal torsion
  • TRP
  • Uterine torsion/ rupture, dystocia, caesarean, vaginal tear
  • Intestinal obstruction, volvulus strangulation, intussusception, perforation
  • Splenic/ hepatic/ umbilical abscess
  • Fat necrosis
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13
Q

Diagnostics for acute peritonitis

A
  • Wither’s test
  • Eric Williams test
  • Rectal palpation
  • Clinical pathology
  • Abdominocentesis
  • Exploratory laparotomy
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14
Q

Diagnostics for acute peritonitis

1-6

A

EW test = listen over trachea

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15
Q

Treatment of acute peritonitis

A
  • Oral fluids or IVFT - lactated ringers/0.9% saline/ Hartmann’s
  • NSAIDs e.g. meloxicam SC
  • Antibiotics: amoxicillin or oxytetracycline (long course; consider licensing)
  • Surgery: debridement, lavage and drainage. Cows wall off infection well.
  • PTS if v severe adhesions and peritonitis
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16
Q

Signalment for caecal torsion

A
  • Usually early lactation dairy cows
17
Q

Aetiology of caecal torsion

A
  • Poorly understood
  • Possibly increased VFAs in the intestines -> atony and dilatation -> if the free end kinks over then torsion
18
Q

What is abnormal and what are your differentials?

A

Abnormalities
* High end of HR, RR
* Distended right upper quadrant, R-sided ping
* Prolonged skin tent
* Scant faeces with some blood and mucus
* Tense distended viscus on upper R flank on rectal

Ddx: RTA/RDA (would expect more cranial position), caecal dilatation/ torsion

19
Q

Treatment of caecal torsion

A
  • Surgical: R flank laparotomy, empty caecum using purse string suture and reposition
  • Oral fluids
  • Calcium borogluconate IV
  • NSAIDs e.g. ketoprofen for 2 days
  • Antibiotics e.g. procaine penicillin for 3 days

Measure the fluid that comes out; more fluid = worse prognosis

20
Q

Signalment of Haemorrhagic jejunitis (Haemorrhagic bowel syndrome)

A
  • Usually but not always early lactation
  • Unusual in UK
  • Typically diagnosed at PM
21
Q

Aetiology and clinical signs of haemorrhagic jejunitis (haemorrhagic bowel syndrome)

A

Aetiology: unknown, possible link with Clostridium perfringens Type A

Clinical signs
* Haemorrhage in small intestine causes massive clots
* Clots -> obstruction -> colic
* Red to dark black blood in faeces (“raspberry jam”)
* Often fatal

22
Q

Treatment of haemorrhagic jejunitis

A
  • Usually fatal
  • Some reports of surgery to remove clots
  • Otherwise supportive care: oral or IV fluids, NSAIDs, deep straw bed, no competition for food and water
23
Q

How common are strangulations, intussuceptions and intestinal obstructions in cows? How will they present?

A
  • These are rare.
  • Will present with severe abdominal pain, circulatory compromise, abdominal bloat, and death in hours.
  • Lack of faecal output = very bad sign
24
Q

How will you diagnose and treat strangulations, volvuluses, intussusceptions, and intestinal obstructions?

A
  • Diagnosis on rectal palpation and exploratory laparotomy
  • Treatment = surgery, right flank approach
25
Q

History for TRP

A
  • Tyres used to hold down silage
  • Non-specific history: off-colour cow with milk drop, reduced appetite, change in behaviour
26
Q

Clinical signs of acute TRP

A
  • Severe CV compromise
  • Cardiac tamponade
  • Pain
  • Tachycardia
  • Pyrexia
  • Associated BRD signs
27
Q

Clinical signs of chronic TRP

A
  • Jugular distension
  • Ventral oedema
  • Tachycardia
  • Dyspnoea
  • Injected scleral vessels
  • Muffled heart sounds
28
Q

Clinical pathology findings with TRP

A

Non-specific findings:
* Leukocytosis
* Hyperfibrinogenaemia
* Elevated total protein
* Neutrophilia
* Elevated liver enzymes due to hepatic congestion if congestive heart failure

29
Q

Treatment of TRP

A
  • Early stages: bolus with magnet and give broad spectrum antibiotics (amoxicillin, oxytetracycline IM), give NSAIDs (meloxicam SC)
  • Late stages: PTS

FARM ANIMAL (53 decks)

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