This document describes left displaced abomasum (LDA) in cattle. LDA typically occurs in dairy cows within a month of calving, often due to nutritional management issues. The abomasum is displaced to the left side of the abdominal cavity due to atony from volatile fatty acids in the diet. Clinical signs include reduced appetite and milk production. Treatment involves surgical correction, usually using right flank omentopexy to fix the abomasum, along with supportive care like fluids and anti-inflammatories. Proper nutritional management can help prevent LDA.

1. NAME :AMEER HAMZA
CLASS# 01
DVM FINAL YEAR
(SEMESTER:09)
SEC:A
SESSION:2016-2020
MEDICINE CLINIC 3
ASSIGNMENT SUBMITTED TO :
DR HAQ AMAN ULLAH
Assignment No.3
Describe in detail the etiology, pathogenesis, and treatment
of following diseases:
Displacement of abomasum in cattle
LEFT DISPLACED ABOMASUM
Left displaced abomasum (LDA) typically occurs more commonly during the winter
housing period in dairy cows in the month following calving. Some association with
high-concentrate/low-fibre rations, previous episodes of hypocalcaemia, twinning
and endometritis have been reported. Increasingly, LDA is seen in recently calved
heifers, which may reflect poor nutritional management before entering the milking
herd. LDA is rarely seen in
beef cows or intensively fattened cattle.
ETIOLOGY

2. Displacement of the abomasum occurs to either the left or the right of the abdominal
cavity. Atony, secondary to highly volatile fatty acid concentrations from continued
fermentation of high carbohydrate rations within the abomasum, results in
accumulation of gas and displacement.
CLINICAL SIGNS:
The clinical signs are most severe when LDA occurs in conjunction with puerperal
metritis and associated toxaemia in the first week after calving.
The cow is often febrile (39.5–41°C), depressed and anorexic, with a reduced milk
yield. There is profuse, often fetid, diarrhoea.
However, most LDA cases occur more than 10 days after calving when there are
concurrent clinical signs of chronic endometritis and secondary ketosis. A typical case
presents 15–30 days post calving with a history of poor milk yield , reduced appetite
with chronic weight loss
The cow is slow to move and dull and has a dry staring coat. The rectal temperature is
normal and the cow is often constipated. A sprung rib cage may be obvious on the left
side with a severely distended abomasum present.
A hypochloraemic, hypokalaemic metabolic alkalosis can develop in chronic cases.
The distended abomasum occupies the craniodorsal area of the left side of the
abdominal cavity (under the rib cage) and auscultation and percussion reveal
high-pitched metallic ‘pinging’ sounds. Rumen movements can be heard caudally in
the sublumbar fossa. It is uncommon to be able to palpate the caudal edge of the
displaced abomasum on rectal examination.
DIFFERENTIAL DIAGNOSIS
Rumen void syndrome (i.e. a gap [vacuum]) formed between the left flank and the
shrunken dorsal sac of the rumen, which yields a ‘ping’ upon percussion; gas cap in
rumen associated with grain overload; pneumoperitoneum.
DIAGNOSIS

3. 1. clinical examination, remembering that more than one condition may exist at the
same time (i.e. metritis and LDA, secondary ketosis and LDA). A combination of
percussion and/or ballottement with simultaneous auscultation is normally diagnostic.
Diagnosis is confirmed at surgery.
2. Paracentesis of the displaced abomasum contents (aided by ultrasonography) would
reveal the presence of fluid with no protozoa and a PH of 2, but is rarely undertaken
or is necessary.
TREATMENT:
1. MANAGEMENT
The rolling technique takes time and requires three people and the LDA recurs in up
to 60% of cases. Surgical correction of LDA is the option preferred by most
practitioners. There are many surgical techniques, but right flank omentopexy is the
preferred method andhas largely replaced the bilateral flank approach. In many
practices, toggling (Grymer/Sterner method) is performed because of cost savings, but
this method is not without its problems and published reports describe an 85%
successrate.
A- Rolling technique
The cow is cast onto her right side (166) and may be hobbled to prevent injury to
attendants. The cow is then pulled onto her back and supported (167), while the left
flank is balloted to help the abomasum rise to the midline. Alternatively, the cow can
be gently rocked along her long axis. The cow is then quickly passed onto her left side
(168) so that the abomasum floats to its normal position on the right side. The hobbles
are removed and the cow is allowed to stand.
B- Right flank omentopexy approach
An intravenous NSAID such as ketoprofen or flunixin is administered preoperatively.
A right laparotomy is performed in the standing cow under distal paravertebral
analgesia without sedation (169). The surgeon’s left arm is directed initially towards

4. the cow’s tail head over the dorsal sac of the rumen, then around behind the omentum
into the left sublumbar fossa. The abomasum is football sized and lies high up on the
left side under the costal arch, buoyed by its gas content. The abomasum is punctured
and deflated using a 14 gauge needle connected to a flutter valve or suction pump.
The needle is guarded by the surgeon’s hand when passed through the abdominal
cavity.
Release of gas causes the abomasum to sink towards the ventral midline, pulled by its
liquid contents. The surgeon’s hand is now directed forward from the incision site
alongside the lower right flank wall towards the ventral midline just caudal to the
xiphisternum. Near the midline the greater omentum is grasped with the left hand and
slowly pulled up to the ventral margin of the incision. The ‘sow’s ear’ (170),
abomasum (171) and pylorus can be readily identified. An
omentopexy is performed whereby a continuous suture taking four 3 cm bites of
omentum is used to close the peritoneum and transversus muscle layer, picking up a
deep bite of omentum with each needle pass such that the omentum is fixed along the
whole length of the closure. Some surgeons elect to perform a pyloropexy, but this
may necessitate considerable pressure to hold the pylorus at the level of the flank
incision. Rolling the cow immediately prior to right flank omentopexy can make the
surgery simpler because the abomasum will be found repositioned in the lower right
abdomen when the surgeon enters the abdominal cavity. The laparotomy wound is
then closed routinely.
Administration of large volumes of oral fluids is recommended by some practitioners
to distend the rumen and prevent potential re-displacement, but cows often begin
eating immediately after surgery. Animals, especially those where the LDA was not
detected early (172) and those with secondary ketosis, take several weeks to fully
recover their appetite and milk yield.
C- Grymer/Sterner method
Recently, toggling of the abomasum (Grymer/Sterner method) through the ventral
abdominal wall overlying the tympanitic abomasum has been described as a more
cost effective procedure than right flank omentopexy. The cow is cast into dorsal
recumbency with the abomasum restored to its normal midline position. The

5. abomasum is locatedas quickly as possible by percussion and two toggles with nylon
sutures are introduced into the abomasum through wide-bore trocars approximately
5–10 cm apart. The trocars are removed and the nylon sutures tied together. Failure
accurately to locate the abomasum may result in toggling the omentum or other
viscera, although this method is reported to be about 85% effective.
D- Right ventral paramedian abomasopexy
In this technique the cow is sedated and cast in dorsal recumbency. A right
paramedian incision is made after local analgesia, the abomasum, which will have
floated back into the midline, is identified and an abomasopexy anchors it to the
ventral body wall. While this method is preferred by some surgeons, it carries risks
associated with sedation and casting in dorsal recumbency, and a greater risk of
wound breakdown.
2- Supportive therapy
A- Concurrent puerperal metritis is treated for three consecutive days with
oxytetracycline
B- NSAID (e.g. ketoprofen @0.3mg/kg or flunixin
@1.1-2.2 mg/kg administered for 2 days ).
C- Fifty per cent dextrose (400 ml i/v) is used to treat secondary acetonaemia and
propylene glycol can also be administered (p/o q12h).
E- Oral potassium chloride administered as a drench may be indicated in some cases
and will hasten recovery when weakness due to hypokalaemia is present.
Prevention/control measures
High concentrate levels must be avoided immediately following calving. Sufficient
long fibre (e.g. hay orchopped straw) should be provided during the early
post partum period. There must be prompt treatment of retained placenta and early
cases of puerperal metritis.
Control measures for hypocalcaemia, including use of acidifying diets during the dry
period, should be instituted. Overconditioning of dry cows must be prevented. The
increasing prevalence of LDA in heifers is a concern and a review of their late
gestation nutrition, calving management and introduction into the milking herd is
indicated.
DILATION/RIGHT-SIDED DISPLACEMENT
OF THE ABOMASUM

6. Dilation and right-sided displacement of the abomasum (RDA) occurs occasionally in
dairy cows during early lactation, but it is much less common than LDA.two-thirds of
the way up the right flank just cranial to the right sublumbar fossa.
DIFFERENTIAL DIAGNOSIS
Gas may accumulate in the caecum and spiral colon, causing high pitched metallic
sounds on percussion in the right caudal abdomen. Abomasal volvulus leads to pings
over a much larger (>60 cm diameter) area, and more severe systemic signs.
DIAGNOSIS
Diagnosis is based on clinical findings and elimination of
other potential causes of poor appetite and milk yield.
TREATMENT:
Reported treatment for abomasal dilation includes 40% calcium borogluconate (400
ml i/v).
substituting some concentrates with hay for 3–5 days
oral and intravenous fluids as necessary.
Hyoscine or metaclopromide have been reported to be useful for abomasal dilatation,
but there is little supporting evidence. Most cases of uncomplicated RDA resolve
spontaneously within several days.
Right flank laparotomy accompanied by decompression and drainage of the
abomasum (often as a last resort) may relieve the problem, but why such surgery
should be successful remains uncertain.
A similar aetiology as for LDA is suspected for RDA, therefore similar husbandry and
dietary control measures apply. RDA is not a major disease concern in dairy cattle.