Unit 2 - Forestomach and Abomasum Part 3

Question 1

What are the fates of a nail or another metal object inside of a cow?

Answer 1

Attachment to a previously administered magnet with no clinical disease
Penetration of reticular wall without entry into peritoneal cavity
Perforation of reticular wall and entry into peritoneal cavity
Perforation of reticular wall and entrance into peritoneal or thoracic cavity

Question 2

What disease will a metal object cause if it penetrates the reticular wall without entry into the peritoneal cavity?

Answer 2

Localized/focal reticulitis and mild disease

Question 3

What disease will a metal object cause if it perforates the reticular wall and enters into the peritoneal cavity?

Answer 3

Localized traumatic reticuloperitonitis (TRP)

Question 4

What disease will a metal object cause if it perforates the reticular wall and enters into the peritoneal or thoracic cavity?

Answer 4

Pericarditis, myocarditis, abscesses, adhesions and vagal indigestion

Question 5

What history is commonly associated with acute cases of TRP?

Answer 5

Clinical signs occur within 24 hours - anorexia, profound drop in milk production, reluctance to move, and anxiousness

Question 6

Uncomplicated cases of TRP may resolve within ___ - ____ days.

Answer 6

3-5

Question 7

What possible history is associated with complicated cases of TRP?

Answer 7

It lasts days to weeks and progression may be due to failure to localize peritonitis or organ involvement
Decreased feed intake, milk production, and fecal output
Development of ‘vagal’ appearance or become gaunt

Question 8

T/F: TRP is the most common cause of cranial abdominal pain in mature cattlle.

Answer 8

true

Question 9

What will you find on PE in a patient with TRP?

Answer 9

Fever, anorexia, decreased rumen motility, cranial abdominal pain, tachypnea, and abducted elbows
+/- peritonitis, pleuritis, pericarditis
+/- papple shape

Question 10

What behaviors are associated with cranial abdominal pain in cattle?

Answer 10

Absent ventroflexion with pressure applied to the withers
Grunt with pressure applied to the withers
Grunt with dorsal pressure applied to the xyphoid
Reluctance to move
Arched back when standing
Forelimbs held in an abducted position

Question 11

What ancillary diagnostics can be done for TRP?

Answer 11

CBC and fibrinogen
Total protein
Abdominocentisis

Question 12

What will your CBC and fibrinogen results be in patients with TRP?

Answer 12

Neutrophilia and hyperfibrinogenemia

Question 13

What will the total protein be in a patient with TRP?

Answer 13

High - but absence of a high total protein doesn’t rule it out

Question 14

What will the abdominocentesis results show in patients with TRP?

Answer 14

TNCC > 6000 cells/ul
TP >3 g/dL
Neutrophils > 40% consistent with peritonitis

Question 15

If you are able to take radiographs for a possible TRP patient, where anatomically should you take the radiograph? What will you see?

Answer 15

Cranial abdomen

Will see a metallic foreign body and likelihood of penetration of the reticular wall

Question 16

What will you seen on ultrasound in a patient with TRP?

Answer 16

Abnormal motility due to peri-reticular adhesions
Peri-reticular abscesses
Peritoneal, thoracic, and pericardial effusions

Question 17

How is TRP treated?

Answer 17

Magnet
Broad-spectrum antibiotics
NSAIDs
Fluid resuscitation
Rumenotomy

Question 18

What causes an LDA?

Answer 18

It is unknown, but it is a multifactorial syndrome - Abomasal hypomotility prerequisite
Ketosis, hypocalcemia, RFM

Question 19

Is an LDA or an RDA more common?

Answer 19

LDA

Question 20

What clinical signs are associated with an LDA?

Answer 20

Anorexia
Drop in milk production
Ketosis
Reduced manure output, soft
Rumination, but reduced fill
Variable pitched ping on the left

Question 21

What will an abomasocentesis show in a patient with an LDA?

Answer 21

The pH will be <4.5 and will smell like burnt almonds

Question 22

What will you see on ultrasound in a patient with an LDA?

Answer 22

The pylorus is not living where it normally should

The fluid filled viscus looks different from the normal rumen wall

Question 23

What will you see on clin path in a patient with an LDA?

Answer 23

Metabolic alkalosis, hypochloremia, and a mild increase in HCO3
Increased liver enzymes if concurrent ketosis

Question 24

What causes hypokalemia in patients with an LDA?

Answer 24

Shifts in H-K due to acid-base status

Question 25

What causes the hypocalcemia and hypophosphatemia in patients with an LDA?

Answer 25

Reduced feed intake

Question 26

What is the goal for treatment of an LDA?

Answer 26

Create an attachment to prevent recurrence

Question 27

What are the types of techniques that can be used to treat an LDA?

Answer 27

Blind techniques, open surgical techniques, right paramedian approach, and laparoscopic

Question 28

What blind technique can be used to correct an LDA?

Answer 28

Roll and toggle

Question 29

What open surgical techniques can be used to correct an LDA?

Answer 29

Omentopexy, pyloropexy, and abomasopexy

Question 30

What are the advantages to the roll and toggle?

Answer 30

``` Short procedure Minimal invasion of peritoneal cavity Minimal equipment Most don't need to withhold feed or water Economics ```

Question 31

What are the disadvantages to the roll and toggle?

Answer 31

Inability to confirm return of abomasum to normal position Tack the wrong viscus NOT to be used with R sided pings Abomasum needs to be freely moveable Cannot assess the abomasum and abdomen for abnormalities Labor intensive and risk to handlers

Question 32

What complications are associated with the roll and toggle?

Answer 32

``` Tacking the rumen Tacking the pylorus without return of the abomasum to normal position Peritonitis Fistula formation Thrombosis and cellulitis ```

Question 33

What surgical procedures can be done with the standing, right flank approach when repairing a LDA?

Answer 33

Omentopexy and pyloropexy

Question 34

In a nutshell, what is the standing right flank approach?

Answer 34

Block the R paralumbar fossa, cut your way in, deflate the abomasum, bring it under the rumen and back to normal position, bring the pylorus up to the incision, create a pexy of your choosing

Question 35

How do you deflate the abomasum?

Answer 35

With IV simplex tubing and teat cannula Protect the needle with your palm on the way in Go south first and then head north Poke the abomasum once at the highest point and push down with steady pressure

Question 36

Once the abomasum is deflated, what should you do next?

Answer 36

Push and sweep it under the rumen by laying your forearm and left arm on top of it

Question 37

What are the keys to a stable omentopexy?

Answer 37

Choose a site as close as possible to the normal position of the pyloroduodenal juncture without interfering with duodenal function Distribute the pexy over as wide an area of omentum as possible Incorporate peritoneum into the pexy Use a suture that will last long enough for firm fibrous adhesion to form

Question 38

Describe your first step of the omentopexy.

Answer 38

Hang the omentum like a curtain and incorporate it into your first layer of the closure - use a simple continuous with generous bites through the omentum

Question 39

When doing a pyloropexy, what anatomical landmarks do you need to be aware of?

Answer 39

The pyloric sphincter - be at least 5 cm orad to the pyloric sphincter within the antrum

Question 40

What is the suggested way to perform the pyloropexy?

Answer 40

Use 2 or 3 suture with 2 or 3 horizontal mattresses. Begin cranial to the incision. Start on the outside of the internal abdominal oblique, through the transversus, into the abdomen, through (not full thickness) the pylorus, back through the muscle, and tie knot on the outside of the muscle

Question 41

A standing, left sided abomasopexy is not indicated for what?

Answer 41

Right displacements/volvulus

Question 42

A standing, left sided abomasopexy gives you access to the greater curvature of the abomasum, what can that cause?

Answer 42

ulcers and adhesions

Question 43

Regardless of the surgical correction performed, what medical stabilization needs to be done for LDA patients?

Answer 43

``` Fluids Address hypocalcemia Treat ketosis Perioperative Abx NSAIDs ```

Question 44

Clinical signs of a RDA are similar to an LDA. What more severe signs do RDA/AV (abomasal volvulus) patients have?

Answer 44

Dehydration, complete lack of manure production, tachycardia, potential colic, and evidence of shock

Question 45

Where will you hear a ping with a RDA?

Answer 45

On the right side between the 10th and 13th ribs along the line from hip to elbow

Question 46

What will you see on ultrasound in patients with RDA/AV?

Answer 46

Displacement of the liver from the body wall and the omasum is shifted ventrally

Question 47

What clin path signs are associated with a RDA/AV?

Answer 47

Metabolic alkalosis, hypochloremia, hyponatremia, hypokalemia

Question 48

What clin path findings will you see in severe cases of RDA/AV?

Answer 48

Metabolic acidosis (due to ischemia)

Question 49

T/F: An L-lactate of >6 mmol/L is a better prognosis than of <2 mmol/L.

Answer 49

False - >6 is a worse prognosis

Question 50

A vast majority of RDA/AV are turned in what direction?

Answer 50

Counter-clockwise direction around the axis of the lesser omentum

Question 51

How is a RDA/AV treated?

Answer 51

Decompression and draining - place a purse string, drain with a stomach tube, tighten w/ tube removal

Question 52

What pexy's can be done for an RDA/AV?

Answer 52

Pyloropexy, omentopexy

Question 53

What post-operative care is needed for a RDA/AV?

Answer 53

``` The same for LDAs: Fluids Address hypocalcemia Treat ketosis Perioperative Abx NSAIDs ```

Question 54

What complications are associated with RDA/AV?

Answer 54

``` Abomasal perforation Peritonitis Septicemia Omental tearing Abomasal neuromuscular dysfunction (type III indigestion) ```

Question 55

What are some poor prognostic indicators for a RDA/AV?

Answer 55

``` HR > 100 bpm Dehydration > 6% Hypochloremia <79 mEq/L L-lactate > 6mmol/L Nectrotic and thrombosis at sx ```

Question 56

Is an LDA or a RDA/AV more emergent?

Answer 56

RDA/AV