Abomasal Displacement (1).pptx

A complete guide to etiology, diagnosis and treatment of Left displacement of abomasum

1. Displaced Abomasum Ali Asad

2. Outline Introduction Risk Factors Clinical Signs Diagnosis Treatment 1/1/2023 Displaced Abomasum 2

3. Introduction Gaseous distention and displacement of abomasum either toward left or side of abdomen between rumen and abdominal wall. May be due to abomasal atony or decreased filling capacity of rumen LDA is most common and occur mostly during early lactation while RDA occur throughout lactation. RDA is more serious as some degree of volvulus is always present. Mostly affect High producing animals. Also occur in calves. 1/1/2023 Abomasal Displacement 3

4. Relative Anatomy 1/3/2023 Displaced Abomasum 4

5. Risk Factors Dietary Risk Factors: Dietary Crude Fiber: Crude fiber concentration less than 16-17% is associated with LDA. High level grain feeding increases flow of ruminal ingesta to abomasum which cause an increase in VFA’s conc. which can inhibit abomasal motility This inhibits flow of digesta from abomasum to duodenum. Thus, lead to large volume of methane and Carbon dioxide being trapped and causing it’s distention & displacement. 1/3/2023 Abomasal Displacement 5

6. Risk Factors Breed and age of cow : LDA occurs predominantly in Holestein-Fresian and Jersey cows. Late pregnancy: During late pregnancy rumen is lifted from the abdominal floor b the expanding uterus and abomasum is pushed forward and to the left under rumen. Following parturation, the rumen subsides trapping the abomasum, especially if its atonic or distended with feed. 1/3/2023 Abomasal Displacement 6

7. Risk Factors Concurrent Diseases: Cows with LDA are more likely to have had retained placenta, ketosis, still-born calf, metritis or parturient paresis. Hypocalcemia: Blood calcium level affect abomasal motility. Value below 1.2mmol total calcium /L suggest absence of abomasal motility. 1/3/2023 Abomasal Displacement 7

8. Risk Factors Miscellaneous animal Risk Factors : Unusual activity, including jumping on other cows during estrus. 1/3/2023 Abomasal Displacement 8

9. Clinical Findings Inapetence or complete anorexia Drop in milk production Ketosis Diarrhea Pasty feces Normal TRP Clinical signs for LDA and RDA are almost similar. 1/2/2023 ABOMASAL DISPLACEMENT 9

10. Diagnosis Clinical History: Ping on percussion : A metallic sound can be heard on percussion over an area between upper third of 9 th – 13 th rib in case of LDA & 10 th -13 th rib in case of RDA and 12 th & 13 th rib in case of abomasal volvulus. Succussion : Diagnostic procedure that require shaking of a part of body to elicit splashing sounds in a cavity or cavities. Abomasal Fluids: Color :Khaki-brown(Abomasum) Greenish(Rumen) Smell: Sour odor Consistency : Watery 1/2/2023 ABOMASAL DISPLACEMENT 10

11. Diagnosis Liptek test: Based on difference in pH of rumen and abomasum. Abomasal pH : 2-4 Rumen pH: 6-7 Ultrasound Examination : Abomasum is seen between rumen and body wall. It contain fluid ingesta ventrally and a agas cap dorsally . Rectal Examination : On RP a sense of emptiness in right upper abdomen. The rumen is usually smaller and rarely distended abomasum may be palpated . 1/2/2023 ABOMASAL DISPLACEMENT 11

12. Diagnosis Atrial Fibrillation : Due metabolic alkalosis & disappear following surgery . Clinical Pathology: Beta-hydroxybutyrate value between 1-1.6 mmol/L (N:0.35-0.47mmol/L)is associated with LDA, 1/2/2023 ABOMASAL DISPLACEMENT 12

13. Treatment Medical Technique: Neostigmine@ 0.5 mg/kg Metclopramide(0.1-1 mg/kg), Hyoscin N-butyl bromide Lipotropic drugs(Kaolin, Niacin) Calcium Borogluconate Fluid Therapy 1/3/2023 ABOMASAL DISPLACEMENT 13

14. Treatment Non-Surgical: Place cow in lateral recumbency, tie it’s feet and roll the animal from side to side while animal is in dorsal recumbency. Massaging the abdomen while rolling helps in normal repositioning of the abomasum. It is important to finally roll animal on left side and allow it to get up from this position 1/3/2023 DISPLACED ABOMASUM 14

15. Roll-and-Toggle Pin Suture Cast the cow. In dorsal recumbency abomasum should float to its normal position. Identify the abomasum by pinging and apply two toggles after deflating abomasum. 1/2/2023 ABOMASAL DISPLACEMENT 15

16. Surgical Techniques 1 2 3 4 5 1/3/2023 Displaced Abomasum 16

17. Anesthesia and Surgical Preparation Right paramedian abomasopexy is performed in dorsal recumbency. Animal is sedated, casted. it’s legs are tied and it’s body is supported by a tough frame. Surgery can be performed either on local lignocaine infiltration or general anesthesia. Xylazine: 0.12-0.15mg/kg(I/M or I/V) Xylazine 0.1mg/kg + Ketamine 0.5 mg/kg 1/3/2023 ABOMASAL DISPLACEMENT 17

18. Right Paramedian Abomasopexy 20-cm incision between the midline and right subcutaneous abdominal vein about 8cm behind xiphoid process ending immediately cranial to umbilicus In most cases abomasum will have returned to normal position during casting process. Lateral aspect of greater curvature of abomasum is incorporated with peritoneum and internal rectus sheath in a simple continuous manner Care must be taken to not penetrate the abomasal mucosa Close external rectus sheath and then skin 1/2/2023 ABOMASAL DISPLACEMENT 18

19. Right Paramedian Abomasopexy 1/3/2023 ABOMASAL DISPLACEMENT 19

20. Right Paramedian Abomasopexy Advantages: Abomasum brought into position more easily, Instantaneous reposition, Abomasum easily viewed, Examination for ulcers etc. Disadvantages: Not performed in standing position, Require more assistance, Abomasal fistula. 1/2/2023 ABOMASAL DISPLACEMENT 20

21. Anesthetic Protocol Left and right flank omentopexies and abomasopexies are performed with animal in standing position Local anesthesia is instituted by performing a paravertebral block, inverted L block, or a line block. Paravertebral:T13, L1, L2 Epidural 1/2/2023 ABOMASAL DISPLACEMENT 21

22. Left Flank Omentopexy 20 cm long vertical incision in left paralumbar fossa. Usually abomasum lies under the incision. Attachment of greater omentum along abomasum Place a 7cm long suture on omentum using 8m non-absorbable suture material. About a meter of suture material should extend on each side of suture line 1/3/2023 PRESENTATION TITLE 22

23. Left Flank Omentopexy Deflate and reposition abomasum. Attach a cutting edge needle to cranial end of suture and carry it ventral abdomen Force needle through ventral midline and attach a second cutting needle to caudal end of suture and pierce similarly through ventral midline about 8-12cm caudal to cranial suture Tie the two suture ends outside the body 1/3/2023 23

24. Left Flank Omentopexy 1/3/2023 PRESENTATION TITLE 24

25. Left and right Flank abomasopexy The procedure is basically similar except the suture is laced in simple continuous fashion in musculature of greater curvature of abomasum Left Flank approach for LDA and right flank for RDA. 1/3/2023 PRESENTATION TITLE 25

26. Right-flank Omentopexy Can be performed for both LDA and RDA After abomasum is decompressed and reposition grasp the omentum distal to pylorus and pull through abdominal incision Place two mattress suture of heavy catgut, one each cranial and caudal to incision line. Suture peritoneum and transverse abdominal muscle while also incorporating omentum in the ventral two third of incision 1/3/2023 26

27. Right-flank Omentopexy 1/2/2023 ABOMASAL DISPLACEMENT 27

28. Right-flank Omentopexy 1/3/2023 Abomasal Displacement 28

29. Right-flank Omentopexy Advantages: Can be performed in standing position Disadvantages: Abomasum not easily accessible. 1/3/2023 ABOMASAL DISPLACEMENT 29

30. Postoperative care General wound care Monitor patient for clinical signs, milk production etc. 0.9% sodium Chloride Therapy supplemented with potassium chloride. Neostigmine 1/3/2023 PRESENTATION TITLE 30

31. Complications Recurrence Abomasal Fistula Acute wound dehiscence with evisceration 1/3/2023 PRESENTATION TITLE 31

32. Thank you