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 عملية علاج قرحة وانزياح المنفحة بالصور

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مُساهمةموضوع: عملية علاج قرحة وانزياح المنفحة بالصور    الأحد سبتمبر 12, 2010 3:49 pm

ABOMASAL DISPLACEMENT AND ABOMASAL VOLVULUS


Overview of the Condition
Because cows live on a high fiber diet, they have a specialized digestive system that helps them process their food. Like all ruminants, cows have four distinct compartments to their stomachs- the rumen, reticulum, omasum, and abomasum. Much of the fiber in their diets is slowly broken down by bacteria in the rumen before it passes in to the remaining compartments. The abomasum is referred to as the “true” stomach of the cow; here, digestive juices help to extract as many of the remaining nutrients as possible.
The abomasum moves easily within the cow because it is suspended by loose attachments. Unfortunately, this means the abomasum can potentially move out of its normal position, resulting in bloating (filling up with gas) and even life threatening obstruction. Three types of abnormal position are commonly seen, including left abomasal displacement (LDA), right abomasal displacement (RDA), and “volvulus” (twisting) of the abomasum on the right side (RVA). Abomasal displacements typically occur in high production dairy cows, but also have been recognized infrequently in calves, dairy bulls, and beef cattle. Abomasal displacement to the left is by far the most common.
No one knows exactly what causes the abomasum to move out of its normal position. The majority of abomasal disorders occur in dairy cows during the first three months of lactation (milk production). It is possible that changes in diet, exercise, or amount of space in the belly, or problems such as inflammation in the mammary glands or uterus or fat build-up in the liver, could slow down normal movement in the stomach and intestines, resulting in bloating and subsequent change in the position of the abomasum.
Signs/Clinical Presentation/Diagnosis
Adult dairy cows with abomasal displacement or volvulus lose their appetites and produce less manure. Milk production also drops.
The classic diagnosis of LDA or RDA is made by performing simultaneous “auscultation and percussion” or “pinging” of the abdomen. This is done by “snapping” or thumping the abdomen with the thumb and third finger while listening with a stethoscope. A pinging noise is heard when there is a gas filled organ up against the body wall, such as a displaced abomasum. Other digestive organs can cause a ping in cattle, so it is important to carefully identify the area producing the noise. The classic left and right-sided DA ping is between the ninth and thirteenth rib (on the left and right side respectively), on a line angling between the tuber coxae (the pointy hip bone) and the elbow (Figure 1). If the diagnosis of displaced abomasum is still unclear there are other tests that can confirm, or help to confirm, the diagnosis including passage of a nasogastric tube (a tube through the nose into the stomach), testing the fluid from the rumen, and evaluating blood work for abnormalities.
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Figure 1: A typical area of ping outlined in a cow with an LDA
(Photo courtesy of Dr. T.J. Divers).
Differential Diagnosis
Other conditions that can cause signs similar to abomasal displacement include gas distension of the rumen, which causes air entrapment on the left side of the belly, or in the cecum or intestines, which causes air entrapment on the right side. These conditions are differentiated from abomasal disorders by the location of the ping and sometimes by rectal palpation. Animals with abomasal volvulus often have fluid collecting in the belly that can be detected on physical examination. If fever accompanies the signs of LDA, a perforating abomasal ulcer (Figure 2) could be present along with abomasal displacement.
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Figure 2: A perforating abomasal ulcer in a cow. A full thickness hole in the abomasum allowed food particles to leak into the abdomen. The hole will be sewn closed to prevent further leakage.
Treatment Options
Treatment goals for abomasal displacement or volvulus include moving the abomasum to a normal position, preventing it from ever displacing again, and keeping the procedure as inexpensive as possible for the owner. Abomasal displacements can be corrected by open (surgical) or closed (nonsurgical) techniques. Closed techniques are less expensive and relatively quick and simple to perform. They include rolling the cow to flip the abomasum back in place, or securing the abomasum to the body wall with a blind tack (a holding stitch in the abomasum that is placed without opening the belly) or a toggle pin (a special device to fix the abomasum in place). Rolling is not an effective long-term treatment because most cows will have a recurrence.
With the blind tack or toggle pin technique, the cow is rolled onto her back to help shift the abomasum back into place before it is tacked to the body wall by suture or toggle pin. Some surgeons may use a laparoscope during closed procedures, which helps them see into the cow’s belly while they are tacking the abomasum. Both blind tacking and toggle pin techniques prevent recurrence of the displacement but they can have very high complication rates, including infection or damage to internal organs. Closed techniques should not be used in cows that are having difficulty breathing or that are valuable to the herd.
With open techniques, an incision is made through the side or belly of the cow so that the surgeon can anchor the abomasum to the body wall internally (Figure 3). Whether the surgery is performed with the cow standing or lying down depends on the surgeon’s preference, temperament of the cow, its physical condition, and the surgery facilities that are available.
Before surgery can be performed, it may be necessary to stabilize the animal with fluid therapy, calcium and/or dextrose (sugar) solutions, and antimicrobials (i.e. antibiotics). Conditions such as mastitis (mammary gland inflammation or infection) and metritis (uterine inflammation or infection) must be treated as well.
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Figure 3: The abomasum being examined at surgery with the cow on her back.
Abomasal Volvulus
Once the abomasum starts to twist (abomasal volvulus), the cattle get much sicker, with rapid heart rates, greater amounts of gas and fluid collection on the right side, loss of appetite, scant manure production, and dehydration. These cows must undergo an open, surgical procedure to return the abomasum to its normal position and they may require temporary tube placement into the abomasum to empty it (Figure 4) before it can be repositioned.
[ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذه الصورة]
Figure 4: A stomach tube placed in the distended abomasum to empty it before returning the abomasum to the correct position. (Photo courtesy of Dr. D.F. Smith)
Because blood vessels can be damaged when the abomasum is twisted, the prognosis for abomasal volvulus is poorer than with a simple displacement and the cow will require more intensive therapy. Cows that are stressed and have increased heart rates (>100 beats/min.) may not do as well as those that are treated early in the disease.
Potential Complications of Surgery
In some animals, the fixation to the body wall may fail, or the cow may develop an infection at its incision site. Animals that have other illnesses or health problems such as respiratory (lung) disease or that are severely dehydrated are more likely to have complications after the surgery.
Aftercare
After surgery, cows are returned to the herd with no special post-operative management unless drugs were used that require a specific withdrawal time. It is necessary to monitor the surgical wound and, in rare instances, deal with an incisional complication. Additionally, cows may have other diseases such as mastitis that require specific treatment.
Prognosis and Prevention
Generally the outcome following surgery for abomasal displacement is quite favorable, regardless of the technique chosen. Short-term success rates are reported to be as high as 85-95%; how the cows will do long-term is not well known. The prognosis following abomasal volvulus is more guarded.
Unfortunately no one knows how to prevent the onset of abomasal displacements. Rapid changes in diet should be avoided. There has been some suggestion that heredity may play a role in development of abomasal displacement, so breeding lines should be examined closely


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