Clinical and laboratory findings, treatment and outcome in 145 cows with type-2 abomasal ulcer

Anaemia in South American camelids - an overview of clinical and laboratory diagnostics

South American camelids (SACs) play an increasing role in veterinary care in Europe. Many alpacas or llamas presented to veterinarians suffer from anaemia, regularly with a packed cell volume (PCV) below 0.10 l/l, which is a life-threatening condition for the animals. This review article presents clinical and laboratory diagnostic tools for the diagnosis of anaemia in SACs. Clinical identification of anaemic animals can be performed by assessing the FAMACHA© score and the Body Condition Score (BCS), since anaemia in alpacas and llamas correlates with pale mucous membranes and a lowered BCS. Haematological examination of a blood sample can provide a more differentiated diagnosis of anaemia in SACs. A common finding is regenerative anaemia with an increased number of reticulocytes that is often caused by blood loss due to Haemonchus contortus. Changes in a blood smear from an alpaca or llama with regenerative anaemia may include normoblasts (nucleated red blood cells), anisocytosis, poikilocytosis, polychromasia, Howell-Jolly bodies or basophilic stippling. Furthermore, non-regenerative anaemia, often caused by trace element deficiency or cachexia, can also occur.

Small intestinal strangulation in 60 cattle - clinical, laboratory and ultrasonographic findings, treatment and outcome

BACKGROUND

Intestinal strangulation is constriction of the intestine by a band of tissue, ligament or blood vessel causing partial or complete intestinal obstruction. This retrospective study describes the clinical, laboratory and ultrasonographic findings, treatment and outcome of 60 cows with intestinal strangulation.

RESULTS

The general condition was abnormal in all cows (60/60), 23.3% (14/60) had nonspecific signs of pain, 40.0% (24/60) had signs of colic and 48.3% (29/60) had signs of somatic (parietal) pain. The most common digestive tract abnormalities were, in decreasing frequency, reduced or absent intestinal motility (100%, 60/60), reduced or absent faecal output (98.3%, 59/60), reduced or absent rumen motility (93.4%, 56/60), dilated small intestines on transrectal palpation (63.3%, 38/60), positive ballottement and swinging auscultation (BSA) and/or percussion and simultaneous auscultation (PSA) on the right side of the abdomen (58.3%, 35/60) and at least one positive foreign body test, most commonly the back grip, in 33.9% (20/59) of the cows. Other common findings were reduced skin surface temperature (67.8%, 40/59), reduced skin turgor (51.7%, 31/60), prolonged capillary refill time (49.2%, 29/59), enophthalmus (48.3%, 29/60) and moderate to severe scleral injection (46.6%, 27/58). The most common laboratory findings were hypokalaemia (58.3%, 35/60), haemoconcentration (57.6%, 34/59), base excess (51.1%, 24/47), hyperproteinaemia (45.8%, 27/59), hyperbilirubinaemia (43.3%, 26/60), acidosis (42.6%, 20/47) and azotaemia (38.3%, 23/60). The principal ultrasonographic findings were subjectively reduced or absent small intestinal motility and dilated small intestines, but the strangulation could not be visualised by ultrasonography. With one exception, all cows underwent a right flank laparotomy to resolve the strangulation by transection or resection of the impinging tissue. Forty-nine (81.7%) cows were discharged and 11 (18.3%) were euthanized before, during or after surgery.

CONCLUSIONS

Without laparotomy, intestinal strangulation could be clinically (transrectally) diagnosed in only 10% of the cows. A laparotomy is therefore essential for the correct diagnosis. The prognosis is good with prompt surgical treatment.

Type 2 abomasal ulceration in cattle and buffalo: energy and lipid metabolic status, clinico-biochemical parameters, treatment, and prognostic indicators

Twenty nine animals (22 cattle and 7 buffaloes) having type 2 abomasal ulcer (AU2) were studied in this prospective investigation, along with a control group (n = 20). Signalment, history, clinical signs, and laboratory alterations were determined. Blood, rumen fluid, abomasal fluid, and fecal samples were collected at the time of presentation. Depressed behavior, anorexia, dehydration, melena, sparse feces, and mushy rumen with substantially reduced or nonexistent motility, tachycardia, and tachypnea were common clinical findings. Colic was observed in 58% of animals. While the neutrophil count was significantly greater, the mean of lymphocytes, hemoglobin, erythrocyte count, and hematocrit were all lower (p < 0.05) than the corresponding control values. In comparison to the control values, the levels of BHBA, NEFA, lactate, bilirubin, BUN, creatinine, LDH, CK, GGT, ALP, and AST were significantly higher but levels of proteins, cholesterol, Na, K, Cl, and calcium were lower (p < 0.05). In comparison to the control values, the other hemato-biochemical parameters did not differ substantially (p < 0.05). The rumen and abomasal pH were within the reference range while rumen chloride concentration was increased in majority of animals. Higher percentage (p < 0.05) of non-survivors showed left shift and toxic alterations in neutrophils than the survivors. As compared to the survivors, the non-survivors had higher (p < 0.05) BHBA, triglycerides, total bilirubin, AST, ALP, LDH, and lactate, and lower (p < 0.05) fibrinogen and calcium. The response to medical treatment was fair, long time survival rate was good, and there was no recurrence. The follow-up period was 28 months. After treatment, both the current and the subsequent lactation's milk production were unaffected.

[Frequency and diagnostic reliability of laboratory variables in cows with traumatic reticuloperitonitis and abomasal ulcers]

OBJECTIVE

A number of laboratory abnormalities occurs in cows with traumatic reticuloperitonitis (TRP) as well as in those with abomasal ulcers (U; classified as type 1 to 5). The goal of our study was to compare the frequency of individual laboratory variables of cows with traumatic reticuloperitonitis and cows with abomasal ulcers and determine the diagnostic significance of individual laboratory variables.

MATERIAL AND METHODS

The present study included 182 healthy control cows, 503 cows with TRP, 94 cows with U1, 145 cows with U2, 60 cows with U3, 87 cows with U4 and 14 cows with U5. Hematocrit, total leukocyte count, concentrations of total protein, fibrinogen, urea, potassium and chloride, base excess and rumen chloride concentration were analyzed. The frequency distributions of all variables for all groups of cows were compared and the diagnostic reliabilities (diagnostic sensitivities and specificities, predictive values, positive likelihood ratios [LR₊]) were calculated.

RESULTS

Values outside the reference interval occurred in 2 to 24 % of control cows (rumen chloride 2 %, urea 6 %, serum chloride 11 %, hematocrit 13 %, base excess 18 %, fibrinogen 20 %, total protein 21 %, total leukocyte count 22 % and potassium 24 %), which made differentiation of healthy and ill cows difficult. Therefore, the variables best suited for distinguishing healthy and affected cows were rumen chloride and blood urea concentration. This was also supported by an LR₊ of 14 to 27 for rumen chloride > 30 mmol/l and 6 to 15 for blood urea > 6.5 mmol/l in cows with abomasal ulcers. Urea also displayed a high diagnostic specificity and was suited for differentiation of healthy and diseased cows. The urea concentration was > 8.5 mmol/l in only 0.5 % of controls, and the LR₊ for a urea concentration > 8.5 mmol/l ranged from 11 in cows with TRP to 128 in cows with U2. Except for cows with TRP, azotemia was significantly more frequent in affected cows than in controls. Cows with U2 (70 %) had urea concentrations > 8.5 mmol/l significantly more frequently than cows of the other groups. Even though the groups of diseased cows differed significantly with respect to several variables, no variables were identified to reliably differentiate the various groups.

CONCLUSION

Different disorders in cows cannot be differentiated based on single laboratory variables.

CLINICAL RELEVANCE

For a definitive diagnosis the history, clinical findings and results of additional diagnostic techniques such as radiography of the reticulum, ultrasonography and abdominocentesis are required. In many cases, a definitive diagnosis can only be made via exploratory laparotomy and/or postmortem examination.

Clinical, haemato-biochemical, and ultrasonographic findings of abomasal impaction and abomasal ulcers in buffaloes

The current study evaluated the clinical, ruminal, haemato-biochemical, and ultrasonographic findings of abomasal disorders' affected buffaloes grouped as abomasal impaction (n = 18) and abomasal ulcers (n = 15). The abomasal disorders' screening was based on clinical examination and confirmed by ultrasonography. The most common clinical findings of the buffaloes affected with abomasal disorders include depressed demeanour (96.97%), absence of rumination (87.88%), abdominal guarding (87.88%), sunken eye balls (81.82%), tachycardia (78.79%), tachypnea (72.73%), and kyphosis (63.64%). The average rumen motility, respiratory rate, and pulse rate for abomasal impaction and abomasal ulcers were 0.28, 33.37, and 83.44, and 0.33, 35.87, and 92.60, respectively. The faecal occult blood test (benzidine test) revealed the presence of melena in all the buffaloes diagnosed with abomasal ulcers (100%). The ultrasonographic examination of the abomasal impaction group revealed increased abomasal size with no movement of the abomasal contents. The ultrasonographic imaging of abomasal ulcer-affected buffaloes showed irregularity in the abomasal wall-outline with moderately echogenic abomasal contents and a layer of fibrin at the affected area. Nine buffaloes had ultrasonographic evidence of peritonitis. The abomasal contents of buffaloes with positive benzidine test (n = 15) were screened for Clostridium perfringens by a polymerase chain reaction and were found positive for cpa toxin yielding 900-bp length. The rumen protozoal count was higher in healthy buffaloes, while the sedimentation test, (time) methylene blue reduction test, (time) and chloride levels were higher (P < 0.01) in the buffaloes affected with abomasal disorders. Haematological findings revealed a higher haematocrit, total leucocyte count, neutrophils, and eosinophil proportion and lower haemoglobin, total erythrocyte count, and lymphocyte proportion without affecting the fractions of monocytes and basophils. Furthermore, the buffaloes affected with abomasal disorders showed lower albumin, phosphorus, and potassium and higher aspartate transaminase, blood urea nitrogen, creatinine kinase, creatinine, and chloride concentrations. The present study projects clinical signs, ruminal parameters, and haemato-biochemical parameters as better indicators of abomasal disorders; however, ultrasonography is the sole diagnostic aid for the confirmation of abomasal disorders in buffaloes.

Clinical, laboratory and ultrasonographic findings in 38 calves with type-4 abomasal ulcer

Background

Type-4 abomasal ulcers (U4) are perforated ulcers causing diffuse peritonitis. This retrospective study describes the clinical, laboratory and ultrasonographic findings in 38 calves with U4. The medical records of 38 calves aged three days to 20 weeks with U4 were scrutinised.

Results

The most common clinical findings were poor general health (95%), reduced skin elasticity (95%), rumen atony (91%), abdominal guarding (76%) and positive percussion auscultation and/or swinging auscultation on the right side of the abdomen (75%). The most frequent laboratory findings were increased numbers of segmented neutrophils (87%), eosinopenia (87%), acidosis (84%), azotaemia (79%) and hyponatraemia (79%). The most frequent abdominal ultrasonographic findings were intestinal atony (68%), fluid (67%) and fibrin deposits (58%) in the abdomen. Thirty-five calves were euthanased and three calves died spontaneously. All calves underwent pathological examination. Diffuse peritonitis caused by a transmural abomasal ulcer was the principal diagnosis in all calves.

Conclusions

Perforated abomasal ulcers cause severe illness, and a thorough clinical examination combined with ultrasonographic abdominal examination should lead to a tentative diagnosis.

Diagnostic reliability of clinical signs in cows with traumatic reticuloperitonitis and abomasal ulcers

Background

Clinical signs of traumatic reticuloperitonitis and abomasal ulcer are often similar making the disorders difficult to differentiate. The goal of our study was to compare the frequency of individual clinical signs of cows with traumatic reticuloperitonitis and cows with abomasal ulcers and determine their diagnostic significance. The frequency of the findings “rectal temperature, heart rate, respiratory rate, demeanour, signs of colic, arched back, abdominal guarding, bruxism, scleral vessels, rumen motility, foreign body tests, percussion auscultation, swinging auscultation and faecal colour” of cows with traumatic reticuloperitonitis (TRP, n = 503) and cows with type 1 (U1, n = 94), type 2 (U2, n = 145), type 3 (U3, n = 60), type 4 (U4, n = 87) and type 5 (U5, n = 14) abomasal ulcer were compared, and the reliability indices “diagnostic sensitivity and specificity, positive and negative predictive values and positive likelihood ratio” were calculated. A total of 182 healthy cows served as controls (control group).

Results

None of the cows in the control group had colic, rumen atony or melena, 99% had no abnormalities in demeanor and appetite and did not have a rectal temperature of ≤38.6 or >  40.0 °C, a heart rate >  100 bpm or a respiratory rate >  55 breaths per min, and 95% did not have an arched back or bruxism. The control group was therefore ideal for comparative purposes. Many signs such as mild increase in rectal temperature, scleral congestion and positive foreign body test were non-diagnostic because they occurred in healthy as well as in ill cows. Likewise, differentiation of cows with TRP and abomasal ulcer was not possible based on single clinical variables; a detailed history and a comprehensive assessment of all clinical findings were required for this.

Conclusions

The findings of the present study serve as a guide for the veterinarian in the differentiation of cows with traumatic reticuloperitonitis and abomasal ulcer.

Ultrasonographic documentation of type-3 abomasal ulcer in a cow with left displacement of the abomasum

Background

Ultrasonographic documentation of perforated abomasal ulcer has not been published till now. This report describes the clinical, ultrasonographic and postmortem findings in a Jersey cow with type-3 abomasal ulcer and left displacement of the abomasum (LDA).

Case report

The main clinical findings were abnormal demeanour, rumen atony and tympany, positive foreign body tests, positive auscultation and simultaneous ballottement on the left side, abdominal guarding and loss of negative pressure in the abdominal cavity. The tentative diagnosis was peritonitis and LDA. Abdominal ultrasonography produced images typical of LDA, and in one location between the abdominal wall and abomasum there was a layer of fibrin, a fibrin clot, a break in the abomasal contour, suggestive of a perforated ulcer, and partial obstruction of this gap with fibrin. The diagnosis of perforated abomasal ulcer with subsequent peritonitis was confirmed during postmortem examination.

Conclusions

The examination of this case shows that under certain circumstances, ultrasonographic imaging of a perforated abomasal ulcer in a cow is possible. Antemortem diagnosis of type-3 abomasal ulcer is preferable to relying on exploratory laparotomy and/or post-mortem examination.

Type-5 abomasal ulcer and omental bursitis in 14 cows

BACKGROUND

Type-5 abomasal ulcer (U5) is a perforated ulcer that causes peritonitis limited to the omental bursa. This retrospective study describes the clinical and laboratory findings in 14 cattle with omental bursitis due to U5. The medical records of 14 cows aged 2.5 to 14.6 years (5.4 ± 3.1 years) with U5 were scrutinised.

RESULTS

The most common clinical findings were partial or complete anorexia (100%), abdominal guarding (100%), obtunded demeanour (93%), congested scleral vessels (79%), tachypnoea (71%), rumen atony (64%), diminished faecal output (64%), reduced skin surface temperature (64%) and fever (46%). Four (29%) cows had between one and four concomitant diseases. The most common abnormal laboratory findings were hypokalemia (71%), haemoconcentration (57%), metabolic acidosis (57%) and azotaemia (43%). All cows were euthanased; five immediately after the initial examination, one after exploratory laparotomy and eight after unsuccessful treatment. A diagnosis of U5 was made in all cows during postmortem examination.

CONCLUSIONS

There is a need for improvement of the antemortem diagnosis of U5 because reliable differentiation of this disease from other conditions with a similar clinical presentation is currently not feasible.