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
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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.
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4. Relative Anatomy
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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.
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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.
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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.
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8. Risk Factors
• Miscellaneous animal Risk Factors: Unusual activity, including
jumping on other cows during estrus.
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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.
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10. Diagnosis
• Clinical History:
• Ping on percussion: A metallic sound can be heard on percussion over an area between upper
third of 9th – 13th rib in case of LDA & 10th -13th rib in case of RDA and 12th & 13th 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
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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.
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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,
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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
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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
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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.
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16. Surgical Techniques
Right
Paramedian
Abomasopex
Left-Flank
Omentopexy
Left-Flank
Abomasopex
Right-Flank
Abomasopex
Right-Flank
Omentopexy
1 2 3 4 5
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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
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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
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19. Right Paramedian Abomasopexy
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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.
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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
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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
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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
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24. Left Flank Omentopexy
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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.
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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
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27. Right-flank Omentopexy
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28. Right-flank Omentopexy
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29. Right-flank Omentopexy
• Advantages: Can be performed in standing position
• Disadvantages: Abomasum not easily accessible.
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30. Postoperative care
• General wound care
• Monitor patient for clinical signs, milk production etc.
• 0.9% sodium Chloride Therapy supplemented with potassium
chloride.
• Neostigmine
•
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31. Complications
• Recurrence
• Abomasal Fistula
• Acute wound dehiscence with evisceration
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32. Thank you