Methods of clinical examination of individual ailing animals including history taking

PHYSICAL EXAMINATION OF THE RUMINANT

Oral cavity and pharyngeal region

  • The normal ruminant will have the following
    • Saliva production- 100-190 L/day with a high concentration of sodium and bicarbonate
    • Mucous membranes- pale pink in cattle with a CRT < 2 seconds
    • Breath- no odor to slightly stale
    • Incisors- 8 lower incisors, they may be slightly loose
    • Tongue- long, firm with good tone, transverse fissure about halfway back
  • Abnormal findings upon examination include
    • Swellings- tongue, lymph nodes, pharyngeal region
    • Erosions or ulcerations
    • Blunted papillae
    • Teeth- loose or broken incisors or molars, retained deciduous caps, discoloration, abnormal wear
    • Mucous membranes- icterus, pallor, congestion
    • Breath- malodorous, ammoniacal, acidic
    • Motor function- absent or weakness in the lips, tongue, pharynx

Esophagus

  • The normal structures for the esophagus are
    • 110-125 cm long with striated muscle the entire length of the organ
    • Courses down the neck on the left side, the opening of the esophagus is dorsal to the larynx
    • Enters the stomach through the cardia at the level of the 8th intercostal space
  • Abnormal findings of the esophagus are
    • Mucosal lesions, intraluminal foreign bodies, mural lesions, extramural compression
  • Examination of the esophagus is conducted by
    • External palpation of the cervical esophagus, internal palpation via rumenotomy or pharynx, passage of a stomach tube, endoscopy, ultrasonography, radiology

Reticulum

  • The normal findings of the reticulum are
    • A sacculated structure originating from the dorsal sac of the rumen
    • Found primarily on the left side of the cow at the level of the 6th – 8th ribs on the abdominal floor
    • Reticulated (honeycomb) pattern
    • Contraction begins as the primary rumen contraction is initiated
  • Abnormal findings associated with the reticulum are 
    • Perforating foreign bodies, proliferative masses, epithelial erosions or ulcers
  • Examination of the reticulum can be performed
    • Indirectly by: Auscultation of reticular contractions (7th intercostal space at the costral-chondral junction), withers pinch test, xyphoid compression test
    • Directly by: Palpation via laparotomy or rumenotomy, radiography, ultrasonography

Rumen

  • The normal rumen contains about 140 L of ingesta, which is arranged in linear strata with the gas on top, particulate ingesta (long stem fibers) next, and small particles and fluid at the bottom
  • Contraction rate is 1-2/ minute
  • A combination of primary and secondary contractions occur
  • Primary contractions act to mix ingesta and include the reticulum
  • Secondary contractions depress the ingesta below the cardia to allow for eructation
  • Rumination is a voluntary action and occurs 4-24 times/ day and may last for up to 60 minutes
  • The entire left side of the abdomen should be filled by the rumen
  • Abnormal findings of the rumen are:
    • Altered motility, failure of ruminal-omasal transport, failure of eructation, epithelial lesions, loss of stratification, alterations of pH, alterations of bacterial or protozoal content
  • Examination is by
    • Distance observation of ruminal contractions and rumination, ballotment and succession, external palpation, auscultation, rectal examination, stomach tube recovery, rumenocentesis, laparotomy, rumenotomy
    • Factors that influence ruminal contractions in a stimulatory fashion are eating, buccal stimulation, low tension in the reticulum and abomasal acidity.
    • Factors that influence ruminal contractions in an inhibitory manner are high tension in the reticulum, bloat, pain, hypocalcemia, abomasal distention or depressants.

Omasum

  • The normal findings for the omasum are
    • 25 cm in diameter and very firm (“many folds” or “book”)
    • Right side of the abdomen at the level of the shoulder and between the 7th-9th intercostal spaces
    • Function is as a pump
    • Processes 100 L / day
    • Absorbs water, minerals and volatile fatty acids from ingesta prior to transport to abomasum
  • Abnormal findings of the omasum are failure of transport, mural lesions, epithelial lesions, impaction
  • Examination is by external percussion (questionable efficacy), laparotomy, rumenotomy (very long reach)

Abomasum

  • The normal findings of the abomasum are the fundus lies in the xiphoid region predominately on the left side of midline, the pyloric region is to the right of the midline at the level of the 1st-2nd lumbar vertebra. The pH is acidic ranging from 2-4.5 and the abomasum will secretes about 35 L /day
  • Abnormal findings are displacements (left or right), torsion or volvulus (almost always when displaced on the right side), failure of transport, abomasitis, ulceration
  • Examination of the abomasum is via external palpation in small ruminants and calves, auscultation with simultaneous percussion (ping), rectal examination, succussion, aspiration of normal abomasum should be accomplished from insertion of needle 4” caudal to xyphoid and 4” right of midline. Aspiration of abomasal fluid may be obtained from the left side during displacement by insertion of needle and syringe below the level of the “ping”. Acid content of abomasum should be easily demonstrated by pH paper with appropriate comparison to the rumen contents. This technique or process is called the Liptack test.

Intestines

  • The normal intestines are found entirely on the right side of the ruminant within the omental curtain.
  • Bowel is responsible for digestion and absorption of nutrients just as in the monogastric species.
  • Abnormal findings include mechanical displacements, inflammation, congenital defects, malabsorption, maldigestion
  • Examination is performed by auscultation, percussion, succussion, rectal, abdominocentesis or Laparotomy.

Peritoneal cavity

  • The normal cavity contains the GI system with very small quantities of fluid (except pregnancy). Absorption of fluids occurs through diaphragmatic lymphatics. The cavity should be of a round contour with symmetrical ventral bulge.
  • Abnormal findings include inflammation (chemical or septic), transudation of fluid, distention or neoplasia.
  • Examination is performed by ballotment, auscultation, abdominocentesis (normal will have < 5 mg/dl protein, < 10,000 WBC, will clot (use EDTA for analysis)). To obtain a sample insert needles or teat tube in rumino-reticular recess (3-4 cm medial and 5-7 cm cranial to foramen of left milk vein) or ultrasonography.
  • Rectal palpation is used as an adjunct to external examination of the large ruminant this technique allows for examination of internal structures. Deep structures should be examined first and the reproductive tract last.
  • A normal bovine will produce fecal amounts up to 30-50 kg/day with 10-25 defecations. Bovine feces is 75-80% water and may appear formed or cowpie. Dry feces indicate dehydration or constipation, mucous covered fecal material indicates slow transit in bowel and tenacious or sticky feces indicate slow transit in forestomachs. Contents will be fiber, (should not exceed 2.5 cm in length) and grain (this will obviously vary with diet). Color is normally brown to green. Dark, tarry feces indicates bleeding in upper GI tract, plum colored indicates bleeding in ileum or cecum and reddish indicates bleeding in colon or rectum. Fecal odor should not be foul.

Pelvic cavity palpation

  • Cecal torsion will palpate as a blind sac filled with gas that may fill the entire pelvic cavity. The examiner should attempt to localize the origin to the upper right abdomen.
  • Abdominal fat necrosis will palpate with masses will that vary in size with firm, sharp edges.
  • Pelvic inflammation or abscesses may be so large that they preclude any further palpation.
  • Lymphosarcoma associated with increased size of internal lymph nodes such as the sub-iliac nodes. These may be the only enlargements noted on examination.
  • Hydrops will palpate as the entire anterior pelvis filled with fluid that can be localized to the uterus but the examiner may be unable to palpate fetus or cotyledons.
  • Bladder is found ventral to uterus and is usually not palpable in cows. If it is identified the bladder may have thickened wall in the case of cystitis or if markedly enlarged it may indicate obstruction.

Left Abdomen

  • Bloat will have tense rumen with displacement posterior and medial and the longitudinal groove will not be distinct. Rumen impaction the contents of the rumen will be firm with minimal gas cap. Rumen atony the contents will palpate as increased fluid and the rumen may have an L shape.
  • Left displaced abomasum is usually not palpable but it’s presence may displace rumen medially

Right abdomen

  • Cecal torsion will be most common. Impacted cecum is rare in bovines.
  • Intestinal torsion may occur but this is infrequent due to omental sling in the bovine.
  • Right displaced abomasum is most frequently palpable if volvulus is present
  • Intussusception is palpable in about 40% of cases. These will usually palpates as a firm tubular structure in unusual places. Bowel loops are distended by not turgid.
  • Inguinal hernia is usually on the left side in bulls. Make sure to palpate for these in animals with abdominal pain.

Tumors of the abdomen

  • Lymphosarcoma, Uterine adenocarcinoma, Mesothelioma
Last modified: Monday, 11 October 2010, 9:29 AM