K.VIGNESHKUMAR
(BVT 15058) Final Year student
Veterinary College and Research Institute (TANUVAS),
Tirunelveli, Tamilnadu – 627358 (India
Guide: Dr.S.Dharmaceelan, Professor and Head, Department of Veterinary Surgery and Radiology, Veterinary College and Research Institute, Tirunelveli
INTRODUCTION:
An overview of acute abdominal disorders published (vametre et al., 2005). Therapeutic decision in acute abdominal disorders of cow elaborately discussed (Ueli brawn, 2006). Acute abdomen is characterized by abrupt onset of severe abdominal pain that often requires immediate medical or surgical interventions. Typically, the veterinarian presented with cow having suddenly undergone illness with symptoms of stopping of feed intake, defecation, reduced milk production, distended abdomen. The dilated abdomen may be “papple” or “barrel or pear-shaped (Radostitis et al, 2000), occasionally had colic like symptoms, bruxism and arched back. An arched back position is the indication of parietal pain and sunken back indicative of visceral pain (Stober et al, 1987). A rapid diagnosis is paramount to avoid the irreparable organ damage (Ueli brawn, 2006). Here, the main objective of the practitioner is to localize the cause of pain and initiate the therapeutic plan based on the immediate diagnosis and economical value of the animal.
CURRENT SCENARIO OF ACUTE ABDOMEN
Nowadays, diagnostic tools are easily approachable in field conditions such as portable ultrasound helps to instant diagnosis of the acute abdomen like abomasal volvulus, intussusception. But rural and tribal areas ancillary test or laboratory analysis like CBC, Peritoneal fluid analysis, culture of samples is not feasible. Some practitioner initiates their diagnostic work with nearby local laboratories. Today’s practitioner developed their skills in physical examination and surgical management. Otherwise based on the severity of the condition patients referred to nearby referral clinics.
ECONOMIC LOSS TO ACUTE ABDOMEN:
Infield condition, prognosis of delayed cases acute abdominal disorders including intussusception, abomasal volvulus, and caecal torsion are grave. In these conditions sudden drop in milk production is inevitable. These disorders cause severe economical loss for the farmers. In case the animal undergoes surgical intervention laparotomy sutures are removed after 10-14 days. This also reduces the animal value if the condition persists even after surgery where they may not be accepted by the slaughterhouses. Even though the condition is corrected, the return of normal milk production is taking so much time which leads to the economic loss of producers. The source of abdominal disorders affects the culling capacity of animal-like septic peritonitis and the oncogenic condition of the abdomen may lead to the condemned carcass. In those conditions, the owner will not be received any profit by means of culling the animal.
DIAGNOSTIC PROCEDURE:
Obtain a history and physical examination more important diagnostic tool of field practitioner. They have clear knowledge about the anatomy of bovine and pathophysiology of abdominal pain. The signalment is an important part of history which helps to stabilize the animal prior to medical or surgical management.
Physical examination:
Based on the distance observation, clinical signs, percussion, Palpation and auscultation of abdomen will be helpful to diagnosis the source of pain. In distance examination, the contour of the abdomen gives an idea to diagnosis the abdominal disorders. Simultaneous percussion and auscultation of the abdomen to ping sound helps to localize the source of abdominal pain or affected organ. Rectal palpation also gives important diagnostic information like caecal dilation, intussusception by means of dilated loops of intestine.
Acute abdomen is classified into abdominal and extra-abdominal. Extra abdominal disorders contain the laminitis, myopathy. Abdominal disorders divided into intestinal (abomasal volvulus, intestinal volvulus, intussusception) and extra intestinal (Uterine torsion, pyelonephritis, bladder rupture). These conditions are always kept in mind by the practitioner while performing clinical examinations.
Complete blood count:
A sudden increase in the neutrophils will give the information of some inflammatory changes was occur in the animal body. Increased value of PCV was an indicator for those abdominal conditions. The hematological profile is more helpful to correct the hemodynamic changes.
Serum biochemistry profile:
In acute abdominal disorders shows the hypochloremia, hypokalemia, hypocalcemia occurred due to lack of gastrointestinal function which affected the abomasal absorption. It also helps therapeutic management for correction of electrolyte imbalance.
Abdominocentesis and Peritoneal fluid analysis:
During septic peritonitis abnormal volume of peritoneal fluid was collected. Normally peritoneal fluid was clear, specific density <1.016, limited volume, less than 1000 nucleated cells per Micro litre, with a majority of macrophages, rarely neutrophils were seen.
Ultrasound and Radiographic examination:
Ultrasound is the best diagnostic tool in veterinary practitioners which easily delineated the lesions in the abdomen which needs the prominent skills in clinical anatomy. By using ultrasound abomasal volvulus, intussusception conditions were easily diagnosable.
Radiographic examination is not possible in the field condition because cost of Radiographic machine, but it may help to diagnosis of traumatic reticuloperitonitis cases?
Exploratory laparotomy:
When the clinical examination and laboratory analysis do not help to elucidate the specific cause of abdominal pain at the time Exploratory laparotomy was ideal to the diagnosis of the cause of acute abdomen.
THERAPEUTIC PROCEDURE:
Based on the immediate diagnosis and economical value of the animal the therapeutic management is planned. The following protocol as listed below for medically managing the acute abdomen.
- Fluid therapy
- Pain management
- Antimicrobial therapy
- Laxatives or motility modifiers
Fluid therapy:
Fluid therapy to animal is necessary to hydrate the animal to replace that fluid loss and improve the circulation. Intravenous administration of large volume of fluid in the field condition is not feasible (i.e. 20L isotonic saline administration 60 – 90 minutes) due to the time constrain and unaffordable by the farmer. A hypertonic saline 4-5ml/kg can be administered to hydrate the animal (e.g. 500 kg weighed animal requires 2L IV administration of hypertonic saline). (Constable, 1999).
GI tract disorders patients affected with hypochloremia, hypokalemia with metabolic alkalosis due to abomasal absorption was interrupted during the acute abdomen. So Administration of Ringer’s Lactate is essential to maintain the electrolyte balance. Hypocalcemia must be corrected due to calcium maintains the intestinal smooth muscle contractibility by means enhancing the intestinal motility.
Pain management:
Pain control is more important to save the animal by means of administration of Analgesics and anti-inflammatory drugs. Administration of NSAIDs leads to worsening the condition due to inducing the abomasal ulcers. But Flunixin provides more efficient visceral Analgesia (Anderson and Muir, 2005). Some literature says flunixin and ketoprofen helps to control the visceral pain in acute abdominal disorders more efficiently (Fecteau, 2008). Sedatives like Xylazine, Detomidine also used for good pain management in bovine colic cases.
Antimicrobial therapy:
Administration of broad-spectrum antibiotics has to be started when bacterial translocation of GI tract was suspected and can be administered prior to surgical intervention. Hematological profile analysis helps to administration of antibiotics.
Laxatives or motility modifiers:
Laxative such as magnesium hydroxide used for intestinal obstruction and ileus patients. But continuous use of these products in colic patients leads to metabolic alkalosis, increased rumen pH, decreased rumen microbial activity. But motility modifiers, such as metoclopramide neostigmine are not beneficial in cases of intestinal torsion or intestinal obstruction.
Surgical management:
If the acute abdomen conditions are not manageable medically, the practitioner must think and go for surgical intervention. Surgical correction is recommended immediately in conditions such as Abomasal volvulus and intestinal volvulus. Before going to surgical correction field practitioners consult about the severity of the condition, prognosis and economical outcome with the animal owners.
CONCLUSION:
“When to cut and when to wait” is the most challenging million-dollar question in front of the practitioner. In that condition of acute abdomen, practitioners taking more concerned about the economic advantage of the owner. In the prevention aspect, farmers were taken more concentration of feeding and hygienic management of farming unit.
