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Displaced abomasum

  1. Abomasal Displacement in Dairy Cows: Old to Recent Advances Dr. Mohamed Tharwat Prof. of Vet. Internal Medicine, Zagazig University
  2. Post Calving Metabolic Problems
  3. 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 Periods Month Freshening Body Stores Used for Milk Production Body Stores Regained for Next Lactation Dry Period Rumen Rehab Nutrient and Milk Yield Relationships in the Lactation and Gestation Cycle Dry Matter Intake
  4. Metabolic disorders often occur in a predictable sequence or cascade
  5. Significance of these Problems Reduced Milk Production Reduced Fertility Loss of Animal Post Calving Metabolic Problems
  6. What is happening to the cow post calving? • Milk production increases quicker than appetite • Cows lose weight • Cows adjusting to new diet • Stress levels increase • Combating Infection
  7. Post Metabolic Problems Primary Metabolic • Hypocalcaemia • Hypomagnesaemia • Post-Parturient Haemoglobinuria • Acetonaemia • Fatty Liver Syndrome Secondary Metabolic • Displaced Abomasum • Retained Membranes • Lactic Acidosis
  8. Displaced Abomasum
  9. Displaced Abomasum (DA) • Refers to repositioning of abomasum from the right ventral abdominal wall • Twisting and displacement slows or stops flow of digesta. • Leads to bloat appearance • “Pinging” detected with stethoscope by thumping the cow near the last rib and listening on the left flank. • Displacements may be left or right sided (RDA, LDA) • Most are left-sided.
  10. Displaced Abomasums • Left displaced abomasum (LDA) is most common in early lactation • Right displaced abomasum (RDA) occurs throughout lactation • Right torsion of the abomasum (RTA)
  11. Abomasum • True Stomach • Site of gastric juice production • Site of protein digestion and amino acid absorption • Breakdown to peptides and amino acids by the enzyme.
  12. Types of nutrients?
  13. Digestive Process Nonprotein N (NPN) Feed proteins FatsCarbohydrates Cellulose Starches Hemicellulose Sugars Microbial protein (essential AA) Volatile fatty acids (VFA’s) VFA’s RUMEN/ RETICULUM RUP Microbial protein Peptides OMASUM ABOMASUM SMALL INTESTINE Peptides Amino acids Fats Fatty acids & glycerol Glucose Glucose RUP LIVER Glucose = microbial action; = main site of absorption = some absorptionRDP = rumen degraded protein; RUP = rumen undegraded protein;
  14. Outline: Displaced Abomasum • History and Signalment • Pathophysiology • Diagnosis • Clinical signs, clin path, R/O’s • Treatment • Non-surgical • Surgical • Ancillary care (Fluids, …) • Risk Factors for LDA
  15. History of DA • Age: older lactating dairy cattle • Timing: 80% occur during first month after parturition • Nutrition: • Dry cow rations: inadequate fiber • Fresh cow: excess carbohydrates/ inadequate fiber Concurrent disease: 40% of DA’s have retained placenta, mastitis, or metritis
  16. Risk Factors for LDA • High-production Dairy Cows • High concentrate, low roughage diet • Large body size • Limited exercise • Post-partum • Abomasal atony
  17. Normal location of abomasum
  18. Digestive Tract Esophagus Rumen Omasum Reticulum Abomasum Pancreas Liver Gall bladder Cecum Small intestine Large intestine Rectum
  19. Left view bovine stomach
  20. Why does the abomasum displace? (1) Abomasal atony (2) Increased abomasal gas production (1) + (2) => abomasum moves (LDA,RDA) Normal position of abomasum Left displacement
  21. Displacing Abomasum In Action
  22. LDA
  23. Cross Section Abdominal Cavity A B C D B C D A Abomasum = A Rumen = B C = Omasum D = Liver
  24. A typical area of ping outlined in a cow with an LDA
  25. Why does abomasal atony occur? • Hypocalcaemia • Inadequate effective fiber • VFA’s reach abomasum => abomasal hypomotility => HCl refluxes back into rumen => systemic metabolic alkalosis • Endotoxemia • Released during mastitis/metritis
  26. RUMEN
  28. VFA pH Abomasal atony Growth Rate (all Bacteria) Fermentable CHO
  29. Taken from “Digestive Physiology of Herbivores”
  30. Why increased gas productn? Diet Type Gas volume (methane,O2,N2) Hay 800 ml/hr Concentrate 3 lb 1100 ml/hr Concentrate 15 lb 2200 ml/hr
  31. Clinical Pathology • Normal CBC • Metabolic alkalosis(slight) • Hypo • Ca • K • Cl • Ketosis (mild) • Dehydration • Hypoglycemia (maybe) • Hyperbilirubinemia
  32. Clinical Signs of DA’s • Normal TPR (most cases) • Partial anorexia (“off feed”) • Hypogalactia (“down in milk” ~ 5-10 lb/day) • Depression • Secondary ketosis • mild to moderate • Scant stool • firm/loose • undigested particles
  33. Clinical Signs (continued) • Paralumbar fossa: • “Slab-sided” abdomen • Visualize / Palpate • Rectal palpation (can’t) • Mild colic • Mild hypocalcemia • Hypotonic rumen • Cold ears, widely dilated pupils
  34. Clinical Signs (continued) • LDA: Ping & Splash • Ascult and percuss • Ping high pitched • Ballottement for splash of fluid • All pings are not created equal – rumen ping Note: ~15% of LDA’s DO NOT PING or ping sporadically
  35. Differential Diagnosis • LDA • Ketosis (non-pinging LDA) • Rumen ping • RDA • Ketosis (non-pinging RDA) • Other Right-sided pings: • Uterus, cecum, peritoneum, colon, rectum • “Off feed” ping
  36. Right-sided pings
  37. Treatment of Displaced Abomasum
  38. Therapeutic Goals • Return abomasum to proper position • Create a permanent attachment • Correct electrolyte, acid-base, & hydration deficits • Treat other concurrent diseases
  39. Rolling • The cow is cast and laid on her back, then rolled vigorously to the right and the roll stopped abruptly in the hope that the abomasum will free itself. • Bring the cow to sternal position & allow to stand • Auscultate the left thorax to ensure LDA is relieved • Starvation and water restriction for 2 days before rolling may be advisable.
  40. Rolling Technique • Advantages • Quick & easy technique • No invasive surgery • Disadvantages • >50% redisplace • If RDA or RTA are present, can exacerbate problems
  41. Surgical correction Left abomasal displacement
  42. Left abomasal displacement 1) Left flank approach.
  43. Left flank approach. Left abomasal displacement
  44. Left flank approach. Left abomasal displacement
  45. Left flank approach. Left abomasal displacement
  46. • Left flank approach. • Left Para costal incision as for exploratory laparotomy or rumenotomy but to a slightly lower site. • With along thread 1.5 m length of non- absorbable suture material (polyamide no. 3- 4) with straight long triangular needle 5-6 continuous ford interlocking sutures are made in the greater omentum and wall of abomasum. • Evacuate the gas from the abomasum with needle connected to a plastic tube. Left abomasal displacement
  47. •The abomasum is repositioned in its normal position. •The two ends of the thread are passes through the ventral abdominal wall slightly to the right of midline by two needles. •The two ends are then tied together. •The flank incision is closed. •The abomaso-omental skin suture is removed after two weeks Left abomasal displacement
  48. Right flank approach
  49. Percutaneous fixation (toggle or bar suture) Left abomasal displacement
  50. Percutaneous fixation (toggle or bar suture)
  51. Percutaneous fixation (toggle or bar suture)
  52. Percutaneous fixation (toggle or bar suture)
  53. • Percutaneous fixation (toggle or bar suture) • The lower abdominal wall is prepared aseptically • The animal is turned into dorsal recumbancy. • The surgeon confirms the presence of tympanic abomasum ventrally. • Trocar and cannula are inserted firmly through the abdominal wall and abomasum caudal to the xiphoid and right to the midline. • The trocar is pulled out and toggle is inserted. • The cannula is removed and another toggle is applied by the same way caudal to the first. • The two are tied together. Left abomasal displacement
  54. • Its incidence is 1:8 to left displacement. • The same steps for diagnosis for left displacement except that it is done of course on the right. • Corrective surgery of RDA is generally more difficult and the patient progress is guarded to unfavorable. • Longstanding cases is not indicated for surgery specially with abomasal volvulus (RTA). • Corrected through: • Right paralumbar approach. • Ventral abdominal approach (open surgery). Right abomasal displacement
  55. Paramedian approach
  56. Replacement Fluids • Isotonic Saline, Lactated Ringer’s IV to replace deficit • K, Ca salts as needed to correct electrolyte imbalances • Free-choice oral fluids with NaCl, KCl
  57. Bad prognostic indicators • Chloride level equal to or below 79mEq/l. • Pulse rate equal to or greater than 100. • Base excess. • Tachycardia and decreased temperature. • Anion gap of equal to or over 30 mEq/l. • Large abomasal fluid volume. • Blue abomasal color at surgery. • Decreased GI motility post surgery.
  58. Control • Feeding large quantity of forages at late pregnancy. • Ensure daily exercise. • Minimize dietary alterations near parturition. • Decease the amount of grain and corn silage fed prepartum, while other forages are fed ad libitum.
  59. Questions are welcome?