Ultrasound as a decision-making tool in abdominal surgery in cows

Blood Inflammatory, Hydro-Electrolytes and Acid-Base Changes in Belgian Blue Cows Developing Parietal Fibrinous Peritonitis or Generalised Peritonitis after Caesarean Section

This study aimed to describe the inflammation, hydro-electrolyte and acid-base imbalances caused by generalised peritonitis (GP) and parietal fibrinous peritonitis (PFP) after caesarean section. After clinical examination, blood was sampled from 11 cows with PFP, 30 with GP and 14 healthy cows. Serum and plasma refractometry and glutaraldehyde tests were used to evaluate the inflammation level, while hydro-electrolytes and acid-base parameters were assessed using an EPOC® device. In addition to clinical signs of dehydration (>10%), blood analysis showed a high fibrinogen concentration (PFP: 8.64 ± 8.82 g/L; GP: 7.83 ± 2.45 g/L) and fast glutaraldehyde coagulation (<3 min) indicative of severe inflammation in both diseases compared to the control group (p < 0.05). Moreover, a severe decrease in electrolytes concentration (Na+: 126.93 ± 5.79 mmol/L; K+: 3.7 ± 1.3 mmol/L; Ca++: 0.89 ± 0.12 mmol/L; Cl−: 82.38 ± 6.45 mmol/L) and a significant increase in bicarbonate (30.87 ± 8.16 mmol/L), base excess (5.71 ± 7.42 mmol/l), L-lactate (8.1 ± 4.85 mmol/L) and creatinine (3.53 ± 2.30 mg/dL) were observed in cows with GP compared to the control group (p < 0.05). In contrast, few major perturbations were noticed in PFP, where only K+ (3.64 ± 0.25 mmol/L) and Ca++ (1.06 ± 0.09 mmol/L) were significantly modified (p < 0.05). In conclusion, a high dehydration and severe inflammation are induced by PFP and GP. Nevertheless, GP causes more electrolytes and acid-base disturbances than PFP.

Description of Plasma Penicillin G Concentrations after Intramuscular Injection in Double-Muscled Cows to Optimize the Timing of Antibiotherapy for Caesarean Section

In order to improve the efficacy of penicillin injection during caesarean section, we aimed to identify the optimal timing of its preoperative administration. A study was conducted in 12 adult, non-pregnant Belgian Blue cows. To evaluate the plasma penicillin concentrations, blood samples were taken from the jugular vein at −5, 15, 30, 45, 60, 120, 240, 480 min relative to the intramuscular (IM) injection of 21,000 IU/kg of body weight of penicillin G. Results showed that plasma concentrations at 15 min after IM injection (668.3 ± 73.7 ng/mL) largely exceeded the minimal inhibitory concentration (MIC) of penicillin-sensitive bacteria (MIC < 125 ng/mL). With increasing time, plasma concentrations continued to rise, attaining an increasing proportion of moderately sensitive bacteria (250 ng/mL > MIC < 2000 ng/mL). The maximal concentration was reached between 1 and 4 h (average: 1.495.1 ± 181.7 ng/mL) after IM injection in the majority of cows, and decreased non-significantly to 1002.1 ± 93.2 ng/mL at 8 h. In conclusion, plasma penicillin concentrations at 15 min after an IM injection inhibit penicillin-sensitive bacteria. However, in order to obtain the maximal protective effect of the antibiotherapy, surgery should be started at 1 to 2 h after IM penicillin injection.

Parietal fibrinous peritonitis in cattle: A literature review

BACKGROUND

Parietal fibrinous peritonitis (PFP) is a complication of laparotomy in cattle, consisting of fluid and fibrin accumulation within a fibrous capsule between the parietal peritoneum and the abdominal muscles. Since scientific information on PFP is scarce, we aim to collect available information to help practitioners in its diagnosis and treatment, and to formulate research perspectives.

METHODS

PubMed and GoogleScholar databases were scanned using "cattle" or "bovine", and one of the following keywords: "seroma", "parietal fibrinous peritonitis", "retroperitoneal abscess", or "wound infection".

RESULTS

Although scientific information is often anecdotal, two recent larger studies shed more light on PFP symptoms, diagnosis and treatment. Symptoms vary according to the cavity's localisation and size, and include anorexia, weight loss and an inflammatory status. Rectal palpation is strongly indicative, but the definitive diagnosis is made by ultrasound. Trueperella pyogenes and Escherichia coli are frequently isolated germs, although it remains unclear whether they are primary or secondary agents. Good survival rates were reported after surgical drainage.

CONCLUSION

Although the diagnosis and treatment seem clear, the exact pathogenesis of PFP should be the focus of ongoing research. This can be achieved by epidemiological data analysis focusing on risk factors like surgery technique, housing and ration.

Comparison between generalised peritonitis and parietal fibrinous peritonitis in cows after caesarean section

BACKGROUND

Parietal fibrinous peritonitis (PFP) and generalised peritonitis (GP) are two postoperative complications in cows, characterised by fluid and fibrin accumulation throughout the peritoneum (GP) or in an encapsulated cavity (PFP). Unlike GP, PFP is scarcely documented.

METHODS

Twenty-one GP cases and 12 PFP cases were confirmed by ultrasound in cows referred to the Veterinary Clinic (Liège University) for complications after caesarean section. All cows underwent a standardised examination protocol. Blood samples were analysed for metabolic and inflammatory markers. Bacteriology was performed on peritoneal fluid samples. Treatment consisted of surgical drainage of the abdominal cavity (GP) or the encapsulated cavity (PFP). Variables concerning anamnesis, clinical findings and treatment outcomes were compared.

RESULTS

Perioperative complications had occurred in 9/21 GP cows but 0/12 PFP cows (P<0.05). Biochemical analysis indicated pronounced inflammation and did not differ between groups. Peritoneal fluid samples of both groups were contaminated and contained similar bacteria (Trueperella pyogenes and Escherichia coli). While 11/12 PFP cows were discharged, all patients with GP died or were euthanased (P<0.05).

CONCLUSIONS

We hypothesise that PFP and GP are two different manifestations of perioperative peritoneal contamination. The severity and spread of the contamination determine the clinical presentation and the prognosis.

Diagnostic performance of ultrasonography in clinical management of dairy cattle identified with left-sided ping sounds

Objectives:

Left displaced abomasum (LDA) is a common postparturient condition of high yielding dairy cattle. The diagnosis of LDA is challenging and has historically been based on findings that are not specific to the condition. The objective of the current study was to investigate the diagnostic performance of ultrasonography (USG) in the clinical management of dairy cows identified with left-sided ping sound postpartum.

Materials and methods:

Cows with reduced appetite postpartum and had audible left-sided ping sounds on abdominal auscultation were eligible to be prospectively recruited onto the study. The results of clinical findings and abdominal USG were recorded along with milk β-hydroxybutyrate levels, pH levels of abomaso/rumenocentesis samples, and findings on exploratory laparotomy. The diagnostic performance of USG and other clinical investigations was assessed by calculating the test sensitivity and specificity using exploratory laparotomy as a gold standard test.

Results:

A definitive diagnosis of LDA was made in 23 cows, 8 cows were diagnosed with peritonitis, and 4 cows with frothy tympany. The USG findings that were consistent with LDA were present in all cattle diagnosed with LDA at exploratory laparotomy. The USG findings over the past three intercostal space characteristics of LDA, however, were also present in five cases subsequently diagnosed with peritonitis and in all cases diagnosed with frothy tympany on exploratory laparotomy. The pH of abdomaso/rumenocentesis samples yielded the highest diagnostic accuracy (97.14%) as a single test in the current study.

Conclusions:

USG over the left abdominal wall despite being a highly sensitive test for the diagnosis of LDA has limitations as a diagnostic tool due to suboptimal specificity.

Indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle: 95 cases (1999-2011)

OBJECTIVE

To evaluate indications for and factors relating to outcome after rumenotomy or rumenostomy in cattle.

DESIGN

Retrospective case series.

ANIMALS

95 cattle that underwent rumenotomy or rumenostomy.

PROCEDURES

Medical records for 95 cattle that underwent either rumenostomy or rumenotomy at 2 veterinary teaching hospitals in 1999 through 2011 were analyzed. Reasons for the procedures were noted. Long-term outcome was determined during telephone interviews with owners.

RESULTS

42 (44%) bovids underwent rumenostomy and 53 (56%) bovids underwent rumenotomy. Among the 42 animals undergoing rumenostomy, 18 (43%) had rumen cannulas placed during elective procedures. Other indications for rumenostomy included ruminal tympany (bloat [n = 20]), esophageal obstruction (choke [1]), grain overload (1), and provision of access for administration of enteral nutrition (2). Indications for rumenotomy included traumatic reticuloperitonitis (n = 31), bloat (9), foreign body (6), choke (5), and other (2). Long-term follow-up data were available for 31 of 42 (74%) bovids that underwent rumenostomy. Of those 31 animals, 17 (55%) were still in the herd, 4 (13%) had been culled, and 10 (32%) had died or were euthanized. Long-term follow-up data were available for 38 of 53 (72%) bovids that underwent rumenotomy. Of those 38 animals, 13 (34%) were still in the herd, 14 (37%) had been culled, and 11 (29%) had died or been euthanized.

CONCLUSIONS AND CLINICAL RELEVANCE

Results indicated that rumenotomy and rumenostomy can be effective in treating or relieving complications secondary to forestomach disorders in cattle. Bovids undergoing rumen surgery had a favorable prognosis for survival and a fair prognosis for potential return to production.

Ultrasonographic evaluation of abdominal distension in 52 camels (Camelus dromedarius)

The purpose of this study was to assess the diagnostic value of ultrasonography in the evaluation of abdominal distension in 52 camels (Camelus dromedarius). The conditions included trypanosomiasis (n=35), intestinal obstruction (n=12) and ruptured urinary bladder (n=5). Fifteen clinically normal camels were included as controls. Transabdominal and transrectal ultrasonography was carried out on all camels. In animals with trypanosomiasis, ultrasonographic findings included accumulation of massive amounts of hypoechoic abdominal fluids where liver, intestine, kidney, spleen and urinary bladder were imaged floating. Except in two cases of bile duct calcification and one of hepatic abscessation, no detectable abnormal sonographic lesions were detected while imaging the hepatic and renal parenchyma, and the heart and its valves and major blood vessels. In camels with intestinal obstruction, ultrasonographic findings included distended intestinal loops with markedly reduced or absent motility. In one camel, the intestinal lumen contained localised hyperechoic material that was consistent with a foreign body. Hypoechoic fluid with or without fibrin was seen between intestinal loops. In camels with ruptured urinary bladder, ultrasonographic findings included collapsed and perforated bladder, echogenic blood clots within the urinary bladder and peritoneal cavity, increased thickness of the bladder wall, floating intestines in hypoechogenic fluid and echogenic calculi within the urethra. Ultrasonography was considered a useful tool for the evaluation of dromedary camels with abdominal distension.

Usefulness and limitation of ultrasonography in the diagnosis of intestinal intussusception in cows

The present study was conducted on 6 chronically ill Jersey/Red Sindhi cross-bred cows, which were suspected for intestinal obstruction on the basis of history and clinical signs. These cows were ultimately diagnosed with intestinal intussusception based on a combination of clinical, ultrasonographic and surgical examinations. “Bull's eye lesion” was the most prominent ultrasonographic finding, diagnostic for intussusception either trans-abdominally or transrectally. Dilated intestinal loops greater than 3.1 cm (mean ± SE, 4.41 ± 0.25) were imaged in the lower flank and the 12th intercostal space on the right side. Ultrasonography proved to be a useful tool in supplementing and substantiating the transrectal findings in cases of the bovine intestinal intussusception. However, ultrasonography was not significantly helpful where transrectal examination of the cows did not reveal any suspected intestinal mass.

Comparison of radiography and ultrasonography for diagnosis of diaphragmatic hernia in bovines

The present study was conducted on 101 animals suffering from thoracoabdominal disorders; out of which twenty seven animals (twenty six buffaloes and one cow) were diagnosed with diaphragmatic hernia based on clinical signs, radiography, ultrasonography, and left flank laparorumenotomy. Radiography alone confirmed diaphragmatic hernia in 18 cases (66.67%) with a sac-like structure cranial to the diaphragm. In 15 animals the sac contained metallic densities while in three cases a sac-like structure with no metallic densities was present. Ultrasonography was helpful in confirming diaphragmatic hernia in 23 cases (85.18%) and ultrasonographically reticular motility was evident at the level of 4th/5th intercostal space in all the animals. B+M mode ultrasonography was used for the first time for diagnosis of diaphragmatic hernia in bovines and the results suggested that ultrasonography was a reliable diagnostic modality for diaphragmatic hernia in bovines.

Surgery of the bovine large intestine

Cecal dilatation in cows and large intestinal atresia in neonatal calves are the most important diseases of the bovine large intestine amenable to surgical correction under field conditions. Clinical symptoms, diagnostic steps, surgical and medical treatment, etiopathogenesis, and prognosis are discussed. Surgery for correction of cecal dilatation, with and without retroflexion or torsion, can be performed under field conditions. In contrast, only anal reconstruction after atresia ani or colostomy in the case of atresia coli are amenable to field surgery; more complicated bypass procedures with anastomosis for atresia coli are best performed in hospital settings. Correcting intestinal atresia is not recommended because of animal welfare and breeding hygiene issues; it should be undertaken for salvage purposes only.

Ultrasonographic characterization of the urinary bladder in sows with and without urinary tract infection

The urinary bladders of sows (n=10) without urinary tract infection (UTI) were longitudinally transrectally scanned after emptying and refilling with 200, 400, 600 and 800mL saline, and a volume dependence was found for bladder depth (BD), dorsal (dWT) and ventral wall thicknesses (vWT), wall regularity (WR) and mucosal wall surface (mWS). When another 31 sows without and 15 with UTI (as defined on the basis of high bacterial count and macroscopic/biochemical urine abnormalities) were compared for these parameters using BD as volume equivalent, no differences were found. Sows with UTI more often had moderate to high amounts of sediment than animals without UTI. Ultrasonographic assessment of dWT, vWT, WR and mWS of the urinary bladder of sows requires knowledge of bladder volume, and BD may be used as a volume equivalent. However, the parameters are inappropriate for the diagnosis of UTI as defined in this study, while moderate/high amounts of sediment seem to be indicative. Sediment can be visualized by transrectal scanning, but this is also possible using the transcutaneous route.

Ultrasonographic evaluation of the omasum in cows and buffaloes

The study was conducted to establish the ultrasonographic features of the healthy and impacted omasum in cows and buffaloes. Scanning was done using a 3.5 MHz microconvex transducer. In healthy buffaloes, the omasum could be scanned at the eighth to ninth intercostal space as a round or oval structure having thick echogenic wall with echogenic leaves. Gradual slow movements of omasal leaves could also be seen in real-time B-mode. The omasum appeared to be very clear, large, and close to the transducer at the start of the omasal contraction, and as the contraction progressed the omasum retracted away from the transducer and became very small. In healthy cows the omasum was seen as a crescent-shaped structure with an echogenic wall. The contents of the omasum or omasal leaves could not be visualized. Omasal contractility was not as prominent as in buffaloes. In buffaloes, the impacted omasum appeared amotile, the omasal leaves were not visible, and the omasum as a whole gave a prominent distal acoustic shadow. In cows, the impaction could be diagnosed based on amotile omasum covering a large area on the right side. Ultrasonography was found to be helpful in subjective assessment of omasal impaction but could not aid in diagnosing the severity of impaction.

Diagnostic ultrasonography in ruminants

The use of diagnostic ultrasound equipment is becoming widespread within various sectors of veterinary practice. Ultrasonographic examination has several advantages over other imaging modalities and it can be applied in hospital and ambulatory settings. It has the potential for widespread use in the diagnosis of disorders of several body systems in food animal species. This article describes its application to gastrointestinal, hepatobiliary, cardiothoracic, urogenital, and umbilical disorders. Normal and abnormal findings are portrayed and discussed. Accurate and timely use of this diagnostic modality requires a modest amount of training and practice, but it allows for relatively rapid, inexpensive, and noninvasive acquisition of clinically relevant data.