Differential diagnosis of right sided pings in cattle Flashcards Preview

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Flashcards in Differential diagnosis of right sided pings in cattle Deck (27):
1

DDx of left sided pings - 7

-RDA and volvulus
-caecal dilatation and volvulus
-pneuomoperitoneum
-pneumorectum
-distension of proximal colon
-peritonitis
-omental bursitis

2

Is LDA or RDA more acute?

RDA most acute. Always consider potentially fatal. Don't let the sun go down on an RDA!

3

Aetiology - RDA

Abomasal atony factors (high concentrate/low fibre rations, periparturient disease and genetic selection) but it is a complex process - progression from simple dilattaion to dilatation and displacement and finally volvulus (complete occulsion of organ and BVs). This is therefore a more serious life-threatening metabolic condition, which requires prompt treatment

4

Signs of right dilatation and displacement

sudden onset anorexia and milk drop, no rumination, sprung last rib (RHS), intial scour (maybe) followed by reduced pasty faeces with a rancid odour

5

Signs - of following volvulus

Cessation of faecal output, normal-low temperature, HR (brady to tachycardia 60-110), dehydration with sinking of eyes, normal/reduced resp rate, cool extremities, death

6

Prognosis - RDA

Pyrexia and inter-current disease such as metritis indicate a poor prognosis

7

Diagnosis - RDA and volvulus - 3

-Auscultate/percuss - ping, extends cranially to 9th ICS (differentiates it from gas in proximal colon or caecum). Tinkle on ballotment.
-Rectal - distended organ may be palpable
-Clinical path - severe hypochloraemic, hypokalaemic metabolic acidosis (i.e. same as LDA). The lower the chloride levels, the more severe the prognosis (esp. <75mMol/l carry a poor prognosis). Ketosis and hypocalcaemia may also be present.

8

Treatment - RDA

Medical or surgical
Medical = metoxlopramide or buscopan compositum
Surgical = right flank correction and omentopexy,

9

Fluid therapy - RDA

Isotonic saline 30L via IV is beneficial if dehydrated
Continue with oral fluids 20-40L with 100g potassium chloride BID

10

Post-op care RDA

Generally slower to recover than LDAs. Keep on hay or silage only for 7d before introducing concentrate

11

Complications of RDA? 2
Success rate?

Volvulus --> vascular thrombosis (along greater curvature), vagal indigestion (wait 4d before offering prognosis after surgery).
Success rates usually around 40% (30-80%)

12

What is caecal dilatation and volvulus a form of?

Segmental ileus

13

Aetiology - caecal dilatation and volvulus?
Mechanism of this problem?

Factors causing abomasal atony (high concentrate/low fibre rations, periparturient disease, genetic selection). Most commonly present in early lactation in cows on a high concentrate diet or on lush pasture. Fermentation occurs and gas formed dilates the ccaecum, looses stability, apex rises, free distal end not supported by mesentery so rotates causing a volvulus. Vascular compromise and necrosis follow. Rarely, intraluminal haemorrhage may occur

14

Signs -caecal dilatation and volvulus? 5

Rapid onset anorexia and milk drop
decreased faecal output
TPR normal
filling of the right paralumbar fossa
absence of rumination

15

Signs - as volvulus occurs

Colic, dehyrdation and sinking of eyes, tachycardia (80-100)

16

Diagnosis - RDA

-Auscultation/percussion - ring in right caudal abdomen, extends forward no further than first three caudal rib spaces. Ballotment often results in a tinkle.

-Rectal examination - large distended gas filled 'sausage' may be palpated filling the pelvic cavity. Occasionally free end of ceacum is deflected ventrally, cranial to pubic brim,. so only gas filled base may be palpable. Free end may also be displaced dorsally and cranially.

-Clinical pathology - mild metabolic alkalosis

17

Treatment - RDA -2 When are each indicated?

Medical or surgical:

-Medical (if normal HR, not total anorexia, some faeces passed and dehydration is absent/mild) - take off concentrate (5-7d), buscopan (30mls IV,2 doses, 12 hour intervals) Also neostigmine (unlicensed - cow)

-Surgical (if raised HR, total anorexia and no faecal output, dehydration and colic). Administer IV fluids with flunixin meglumine and correct surgically (right flank laparotomy)

18

Recurrence rate of caecal dilatation and volvulus after right flank laparotomy

10-20% cases

19

Post-op care (right flank laparotomy)

keep on roughage and laxatives before introducing concentrate feed after 5-7 days.

20

Aetiology - pneumoperitoneum

Ruptured abomasal ulcer (usually)
tearing of uterine wall at calving

21

Sings - pneumonperitoneum

Bilateral abdominal distension
Dull ping high in abdominal cavity on both sides
Perforated ulcer may --> abdominal pain, fever etc.

22

Pneumorectum = sign, not illness. Diagnosis

Always auscultate before performing a rectal exam or you will hear a ping on RHS, which must be differentiated forma caecal distension. Some cows will rectovaginal tears may suck in air spontaneously

23

Distension of proximal colon - signs

right sided ping tucked into the costal arch in the paralumbar fossa. Ping doesn't extend cranially to 9th rib (vs RDA), and a distended caecum will not be palpable per rectum. This reflects intestinal stasis. You must find out cause of this.

24

Signs of peritonits

Accompanying ileus will result in multiple ping sover the right flank due to gas pockets forming in loops of intestine.

25

What is omental bursitis a sequel to?

Ruptured abomasal ulcer on the lesser curvature and filling of the omental recess with pus and fluid. Leads to massive low abdominal swelling and compression of viscera.

26

Diagnosis - omental bursitis

Multiple pings on right abdomen.
laparotomy - a firm viscus is palpable in the ventral abdomen
strings of fibrin throughout the omental recess
viscus = pus formed between the two layers of the omentum

27

Treatment and prognosis - omental bursitis

Drainage of the omental pocket via a ventral abdominal approach.

Poor prognosis