Acute Abdomen

Question 1

What are the differnetials for an acute abdomen? (5)

Answer 1

• Acute/chronic & local/diffuse peritonitis
• Right torsion abomasum*
• Caecal torsion*A
• Bloat: primary/secondary*
• Photosensitive dermatitis?

Question 2

What is the diagnostic plan for an acute abdomen (6)

Answer 2

• History taking
• Clinical exam
• Exploratory laparotomy
• Ultrasonography
  
  • Assess extent, localisation and character, allows guided abdominocentesis
• Peritoneal tap?
• Biochemistry/Haematology?

Question 3

What is seen on clinical examination of an acute abdomen? (6)

Answer 3

• Reduced feed intake, drop in milk
• Pyrexia (24-36h)
• Hypovolaemia, toxaemia, shock (acute)
• Reduced rumen activity/intensity, GI stasis, scant feces, abdominal distension
• Rectal exam
  
  • Fibrinous adhesions abdomen
  • Distended SI on rectal examination
• Signs of abdominal pain
  
  • Reluctance to move, arched back, grunt, treading hind legs, kicking abdomen, recumbency, pain tests
  • ­HR/RR

Question 4

What is peritonitis often secondary to?

Answer 4

Diffuse:

• Urethral obstruction (URI2)
• Acute acidosis/rumenitis (GI2)
• Toxic mastitis (Repro2)
• Postpartum metritis (Repro2)
• Perforated abomasal ulcer (GI2)

Local:

• LDA/RDA (GI2)
• Caecal torsion
• TRP (GI2)
• Uterine torsion/rupture, dystocia, caesarean, vaginal tear (Repro2)
• Intestinal obstruction, volvulus, strangulation, intussusception, perforation (iatrogenic)
• Splenic/Hepatic/Umbilical abscess (GI2)
• Post surgical complications

Question 5

Which cow type does a caecal torsion affect?

Answer 5

Earlt lactation dairy cows - Hypocalcaemia

Question 6

How common is dilation in caecal torsion?

How common is a torsion?

Answer 6

Dilation - common

Torsion - rare

Question 7

What are the differentials?

Answer 7

RTA/RDA (more cranial position)

Caecal dilation/torsion

Question 8

How can you treat a caecal torsion?

Answer 8

Surgical

Right flank laparotomy, externalise and empty caecum using purse string suture, reposition, administer oral fluids, Calcium borogluconate, NSAIDs (2 days, i.e. ketoprofen), antibiotics (3 days, Procaine benzylpenicillin)

Question 9

How can you treat a gastric dilation?

Answer 9

Surgical or conservative: calcium borogluconate, NSAIDs, spasmolytics

Question 10

What is a strangulation and how common is it?

Answer 10

• Prolapse of SI through mesenteric tear
• Persistent urachus

= RARE

Question 11

What is a volvulus?

and how common is it?

Answer 11

Torsion of the root of the mesentery

= RARE

Question 12

How common is an intussusception?

Answer 12

RARE

Question 13

How common is an intestinal obstruction?

Answer 13

RARE

Question 14

How can you surgically treat Intestinal obstruction, volvulus, strangulation, intussusception, perforation (iatrogenic)?

Answer 14

• Right flank approach
• Principles as for other species

Question 15

What is the terminology issue of bloat?

Answer 15

•“bloat” can mean ruminal dilatation
or just abdominal distension

•the rumen is most commonly responsible

Question 16

What are the 2 aetiologies of ruminal bloat?

Answer 16

–Frothy (primary bloat); often herd problem

–Free gas (secondary bloat); failure to eructate; often individual animals

Question 17

What is frothy bloat?

Answer 17

• High protein grass = ↑viscosity of ruminal fluid
  
  • Early grazing season, especially legumes such as alfalfa, high clover pasture
• Forms “froth” – prevents eructation
• Can pass stomach tube but doesn’t decompress

Question 18

How can you treat frothy bloat?

Answer 18

–Anti-foaming agents (e.g. Mineral oil, poloxalene – “BloatGuard”)

–If severe; decompress by rumenotomy initially (prognosis?)

–Diet management: take off pasture, late morning grazing, strip graze, feed hay before going onto grass

Question 19

Name causes of obstructive bloat(7)

Answer 19

• Obstruction: foreign body (may be palpable)
• Hypocalcaemia
• Prolonged lateral recumbency
• Vagal nerve damage
• Tetanus (rigidity, protrusion 3rd eyelid, hyperesthesia)
• Actinobacillus
• Outside pressure (carcinoma, papilloma, EBL, bTB)

Question 20

What does vagal nerve damage cause?
What is it secondary to?

Answer 20

• ‘vagus indigestion’: enlarged rumen>bloat
• Secondary to hardware disease, actinobacillosis (rumen/reticulum)

Question 21

What is a common cause of obstruction in cattle?

Answer 21

• Large quantities of feed, rapid intakes
• Root crops

–Potatoes, turnips, apples, fodder beet etc

Question 22

What are the signs obstruction “choke”?

Answer 22

• Distress, extended neck, coughing
• Obstruction at certain sites

–Oropharynx, thoracic inlet, heart base

–May palpate if cervical/Passage of a stomach tube

Question 23

How do you diagnose choke?

Answer 23

History and clinical appearance

Question 24

How can you treat obstruction (Choke)

Answer 24

• Relieve rumen tympany if severe
  
  • Knife/Trocar and cannula in left paralumbar fossa
• Administer spasmolytic IV/IM (some analgesic properties)
  
  • Butylscopolamine bromide and metamizole
  • Buscopan Compositum http://www.noahcompendium.co.uk
  • (!indication, withdrawal, lactation, pregnancy!)
• Attempt removal using fingers or gentle pressure with stomach tube (using paraffin/cooking oil or lubricant)
• Leave to macerate if rumen trocar/red devil is present

Question 25

What are the possible causes of abomasal bloat (3)

Answer 25

* dietary changes (feeding routine) * poor milk clot formation * Clostridia?

Question 26

What are the clinical signs of abomasal bloat (4)

Answer 26

* acute abdominal distension and pain * rapid dehydration * usually young calves (pre-weaning) * not relieved with stomach tube

Question 27

How do you manage abomasal bloat? (2)

Answer 27

* Deflate using needle (various techniques) * Manage metabolic consequences (e.g. dehydration)

Question 28

When does calves get ruminal bloat?

Answer 28

–Usually slightly older calves •Poor oesophageal groove closure –Often just after weaning –Causes not well understood •Related to poor rumen development

Question 29

What are the clinical signs of ruminal bloat in calves? (3)

Answer 29

–Much more chronic –Often recurrent –May follow concentrate feeding

Question 30

How can we manage ruminal bloat in calves?

Answer 30

–Can create fistula or use long-term trocar (“Red Devil”) if necessary