Food Animal Medicine- Intestinal Diseases of Ruminants

wilsbach's version from 2016-02-12 20:39

Intro, Hemorrhagic Bowel Syndrome

Question Answer
(read over) list of the intestinal dzs to keep in mindHemorrhagic Bowel Syndrome, Mesenteric Fat Necrosis, Intussusception, Mesenteric Volvulus, Cecal Dilation and Volvulus, Rectal Prolapse, Atresia Coli/Ani
Hemorrhagic Bowel Syndrome is aka?Jejunal Hemorrhage Syndrome
how much should you be concerned about HBS?ER!! highly fatal
HBS is characterized by...intraluminal GI hge
what causes HBS?cause is unclear, they possibly suspect Clostridium perfringens Type A or perhaps Aspergillus spp.?
what food can put cattle at higher risk for HBS?Feeding silage, TMR(total mixed ration), finely ground corn
when during parturition/lactation is a dairy cow more prone to HBS?First 120 days of lactation, esp if there is high level of production going on
what is a supplement given to cattle which can cause/ help mediate HBS?bovine somatotropin (given to inc production)
what is the onset of HBS like? What are the clinical signs?Usually sporatic dz (outbreaks rare) with a peracute onset (very acute and violent). It leads to rapid debilitation and a sharp decrease in production, along with hypovolemic shock (see tachycradia, tachypnea, cool extremities) and of course you will see Scant bloody, tarry feces
where would you find a ping with HBS?Right side (see last set of cards for exact location pic)
how is the abd going to appear/sound with HBS?you will see Abdominal distension, Right sided ping, and will only hear Minimal ruminal or intestinal motility
what might you find on rectal exam with HBS?Might feel distended loops of SI, Might feel nothing (loops are heavy and full of blood instead of gas so can sink ventrally)
what might you find the the CBC of a cow with HBS?Neutrophilia and leukocytosis common. Also possibly anemia, depending on how soon we found them
what will be the chem abnormalities you will see with HBS?Hypochloremic metabolic alkalosis! (because sm int is damaged, not absorbing the Cl and H from the abomasum like it should be), Hypokalemia (not eating or not absorbing nutrients from food properly), azotemia, hyperglycemia (stress inc glucose release by the liver, also stress=steroids=dec sensitivity to insulin)
dx--> what might you see on US with HBS?Many distended loops of small intestine. >5 cm diameter strongly suggests mechanical obstruction
when US the sm int, a diameter of >_?_ strongly suggests a MECHANICAL obstruction>5cm (mechanical obstruction can be a huge blood clot i suppose)
what are you looking at / what is going on here? this is a U/S of the sm int. they are grossly enlarged. The red star is pointing out a very echogenic substance in the lumen of the int, which is most likely clotted blood (HBS)
If you do a R flank laparotomy and HBS is suspected, what do you expect to find?You will see Multiple inflamed segments of jejunum (Ileum and duodenum less commonly), the Serosa is dark purple and Blood clots can be palpated intraluminally
what are your sx options for managing the blood clots stuck in the jejunum in HBS? (3) (which is preferred?)(1) Manual clot massage without opening the GI tract (preferred) (2) Enterotomy and emptying GI tract (3) Resection and anastomosis
what drug can you give if you are concerned about endotoxemia?flunixin meglumine
what is some IV fluid therapy you can consider for the HBS cows?Fluid replacement (+/- blood), help replace electrolytes (low Cl, low H, low K), can add flunixin for their endotoxemia
which antimicrobial and at which dose would you consider for HBS, and why?If we are to assume that the HBS is possibly caused by the clostridium perfringens type a, we will want an antimicrobial. And if you think it's clostridium, you will want to reach for penicillin at a HIGH dose (also do antiinflammatory therapy!!)
why/which antitoxin(s) would you consider for HBS?Clostridium perfringens type C and D antitoxin (Even tho she thinks it is caused by type A? Idk. maybe these are the only ones avail or sthing)
what is the prognosis of HBS?GUARDED: High mortality (77-100%)
what can you do to inc survival rate of HBS?Survival rate is beTTer with surgical management (~60%) ((as opposed to 77-100% dying lol)
what is a post-op complication you need to be mindful of?Risk of re obstruction postoperatively
Prevention of HBS is difficult since pathogenesis is unknown, but what are some things you can recommend?Evaluate transition cow management to improve general disease resistance and proper nutrition, Ensure proper silage management, Clostridium perfringens vaccination

SI obstruction causes

Question Answer
aside from HBS, what are 3 other things which can cause SI obstruction?Mesenteric Fat Necrosis, Intussusception, Mesenteric Volvulus
Mesenteric Fat Necrosis--> are there particular breeds affected? Age?Affects older, usually fat cattle... Angus and Jersey cattle more commonly
how does BCS affect mesenteric fat necrosis?fatter= more at risk
what is the pathogenesis of mesenteric fat necrosisit is unclear lol
how is mesenteric fat necrosis related to SI obstruction?Occasionally fat necrosis can cause extraluminal GI obstruction (basically the fat gets in the way)
what are CSs lik for mesenteric fat necrosis?Clinical signs are consistent with those of small intestinal obstruction --- Subclinical discovered on rectal exam
what would intraoperative findings be like for mesenteric fat necrosis?Intraoperative findings include hard irregularly-shaped masses encompassing bowel
how do you tx mesenteric fat necrosis?tx not recc
what is the severity of colic signs in cows with intussusception?Cause of mild-moderate colic signs
WHO is intussusception more common in?Occurs more commonly in juveniles
If there is an adult with intussusception, where do you think it is?adults= jejunum
if there is a calf <2mo old, where do you think the intussusception is?calves <2mo= LARGE OR SMALL INT
what are 3 things you can do to try to dx intuss?Distended SI on rectal, Bulls-eye lesion on ultrasound exam, Abdominocentesis
if there is a intuss, if you wanna fix it, what are you gonna have to try to do? what is the survival rate?will need sx intervention, Survival 35% :(
who is more prone to getting mesenteric root volvulus?can affect all ages and breeds, but neonates most prone
what are presenting clinical signs of a calf/cow with mesenteric root volvulus?there MARKED abdominal distension and pain, so you will def see Severe tachycardia and tachypnea. RAPID deterioration ensues
what will Mesenteric Root Volvulus be like with rectal exam?Distended small intestine
if the mesenteric root volvulus has a strangulating lesion, what must you know?SX ER!
prog of mesenteric root volvulus?guarded.....earlier tx the better

Large int obstruction

Question Answer
(list) 4 main things that can happen to lg int to cause obstructionCecal dilatation and volvulus, Atresia coli, Rectal prolapse, Atresia ani
Cecal Dilatation and Volvulus--> uuh, why is the cecum dilating and rotating and stuff?gas accumulation, pathophys similar to displaced abomasum (so more gas= more mobile= can flip)
what are clinical signs like for cecal dilation and what would you find on PE?you'd see Mild signs of colic (such as Mild tachycardia, Inappetence), and on PE you would get a Ping in caudal PLF (paralumbar fossa), and the apex of the cecum will be palpabale on rectal exam
where will there be a ping with cecal dilation/volvulus?(right) caudal paralumbar fossa
what will clinical signs for cecal volvulus be?Signs similar to those of abomasal volvulus...but you wont really have as much of a hypochloremic metabolic alkalosis bc the sm int in front of the cecum is absorbing the H and Cl, but there is still a hypokalemia bc they arent eating
how will the rectal exam vary between a cecal dilation and a cecal volvulus?Dilation= apex of cecum palpable. volvulus= BODY of cecum palpable
what would you do to treat cecal dilation?Should respond to medical management- can provide fluids (Ca+ if needed), can provide analgesia (NSAIDs), and you can add fiber to the diet.
If cecal dilation is a recurrent problem, what are some things you can consider for tx?consider long-term high fiber diet or elective typhlectomy
how do you treat a Cecal Volvulus?SX- Decompress/empty cecum and Replace to normal position
prog of cecal volvulus? what might it depend on?Guarded, Dependent on degree of ischemic injury
cecal dilation and volvulus both occur most often WHEN?Both of these problems occur most often in first 60 days of lactation ie "fresh cattle"
what are some preventative strategies you can use to avoid cecal dilation/ volvulus(similar to those for displaced abomasum) NUTRITION MANAGEMENT!!! you need a good transition to high concentrates, and you still need enough fiber!~ you should also Monitor for concurrent disease, and Prevent hypocalcemia
how does hypocalcemia tie in with cecal dilation/volvulus?hypocalcemia is a common problem in fresh cows (first 60d of lactation= highest risk) and hypocalcemia leads to dec motility which in turn can lead to the dilation, gas accumulation, and volvulus
what is the typical presentation of atresia coli?NORMAL AT BIRTH, and healthy for 1-3 days. Then there is an abrupt onset of inappetance, abdominal distension, and a lack of fecal production with mucus and blood in the rectum
how do calves get atresia coli?it is a Congenital lesion which might be hereditary (higher indices in holstein calves)
is there a breed prone to atresia coli?holsteins
in what ways can the atresia coli defect vary?It can be just a Imperforate membrane, there can be a Cord-like remnant, or it can be a blind-ended dilation
how would atresia coli appear on US and rads?US: Ultrasonography indicates lack of intestines in caudal abdomen. RADS: Radiography indicates distended bowel (Could consider contrast study to confirm)
how would you treat atresia coli?you can consider surgical management, but it is expensive and frequently unsuccessful. Success might depend on degree of atresia
how can you help prevent atresia coli? (2)(1) dont breed dams with affected offspring (2) Early rectal palpation (<42d gestation) may predispose
what is hx/CSs like for atresia ANI?very similar to coli (NORMAL AT BIRTH, and healthy for 1-3 days. Then there is an abrupt onset of inappetance, abdominal distension, and a lack of fecal production)
who is prone to getting atresia ANI?just like atresia coli, it is congenital, they suspect it is hereditary, and holsteins seem predisposed
If you have a young sick calf, always check to make sure it anus!
how do you treat atresia ani?Rectum and atretic anus often separated by a membrane. So, Perforate the membrane, Suture to skin to create a new anus (prog fair to good, much better than atresia coli)
what is the FIRST thing you should think of when you see a rectal prolapse?IT IS REPRESENTATIVE OF AN UNDERLYING PROBLEM- need to figure out WHY it happened, or it is going to recur
what are some possible underlying causes of rectal prolapse?Diarrhea, Intestinal parasitism, Dystocia, Urolithiasis, Bloat, Late-term gestation, Pneumonia(apparently you can cough so much you prolapse your rectum. well damn), Docking tail too short (sheep)
why is docking the tail too short in sheep a risk factor for prolapsed rectum?if too short, can affect neuro supply to perineum, lose tone
how do you treat a rectal prolapse?do a Sacrococcygeal epidural (low or caudal epidural), clean the prolapse (massage with warm water and mild soap), Apply sugar or glycerin to draw out edema, and then replace the prolapse. THEN place a purse string suture, and ensure feces can pass. (if tissue is necrotic, resection/amputation might be necessary)
what should you be careful of when placing a purse string to treat the prolapsed rectum?DONT ENTER THE LUMEN and make sure they can till pass feces
best way to prevent rectal prolapses is..ID THE UNDERLYING CAUSE! do a fecal exam, thoracic rads, eval other animals in the herd