1 Types of Ileus- Anamnesis and Clinical Signs of Ileus

Transcript

A warm Greetings to all,

This class is on Intestinal Ileus in cattle.

Why Intestinal Ileus has been taken as a separate topic, is to know that it is one of the most challenging cases in bovine medicine and most of the owners become frustrated and become nervous because they want to know whether this case will become all right or they are going to face a severe economic loss because of the death of the animal. In that context, these Intestinal Stasis has been taken as a separate topic and we are going to see why there is economic importance.

If the Intestinal Ileus is not properly approached, the animal can die. There will be a reduction in the production, namely the milk yield. Sometimes the whole animal may die, We are going to see this Intestinal Ileus in 5 chapters:

1. In the first chapter, we are going to see an anamnesis and its clinical sign,
2. In the second lesson, we are going to see the Clinical investigations that are going to perform on the animal,
3. In the third lesson, we are going to see Ultrasonography involving the thoracic diseases,
4. The fourth lesson involves Ultrasonography of abdominal diseases, and
5. In the fifth lesson, we are going to see the Management of Ileus and special emphasis on the pregnancy and pregnancy-associated Ileus.

Now we will go on to lesson one, where we are going to see the importance of Ileus and anamnesis. The Ileus is broadly classified into:

• Mechanical Ileus and
• Functional Ileus.

Mechanical Ileus: it has got a wide variety of causes, it can be luminous or extraluminal causes. Mechanical alias there are many important there are many causes, but the important diseases or syndrome that we need to focus on:

• Traumatic reticulitis or Traumatic Reticulo-peritonitis
• Right-sided displacement (RDA) of abomasum or volvulus
• Diaphragmatic hernia or Vagal indigestion
• Intestinal obstruction
• Mesenteric volvulus
• Caecal dilatation,

these are all on the Intestinal part, there are two more important things as far as the obstacle involvement is concerned;

• Uterine torsion
• Dystocia caused by the fetus

So, you have to rule out all these things and take appropriate measures to identify the Functional Ileus because by exclusion we have to rule out each Etiology then only we can approach the Functional cause. If you are not ruling out the Mechanical cause and going for treatment of the Functional cause, then there will be a metallic, that is why a Mechanical Ileus is being dealt with when you are going to deal with the functional Ileus.

Of the Functional Ileus; there is no exact Etiology so far it has been proved, but it is only hypothesized that these may cause a Functional Ileus. In Functional Ileus, there are no specific clinical signs, except for the reduction in the quantum of the dung produced.

The etiology can be:

• Dietary factors, for example, the owner would have changed the type of fodder or suddenly he would have gone for a change in the concentrate which would have caused Impaction and other things.
• It can be a parasitic infection or
• maybe because of peritonitis or
• it can be pregnancy-associated areas where the pregnant fetus presses onto the intestinal segments and causes Ileus or
• The mere electrolyte abnormality, namely hypercalcemia, a reduction in potassium and phosphorus can also be attributed to the functional Ileus.

Now we are going to see how we are approaching this Intestinal Ileus called the Intestinal Stasis in cattle. Firstly we will be taking up an Anamnesis or how far we are going to stress on the history, then we will go on to Clinical signs, then Clinical investigation, Laboratory analysis, Radiography, and Ultrasonography- how it is going to involve in the thoracic and abdominal cavity.

Anamnesis: In this stress has to be given whether the owner has changed the diet, because the proportion of the fodder and the concentrate plays an important role or whether he has given the excess fodder or irrational fodder, this can go on for the ruminal impaction, then, later on, develop into Intestinal Ileus or whether the importance has to be given to note on the dung, what are the parameters to be noticed on dung consistency whether it is hard or it is loose, whether it is accompanied by any other things may be mucus or blood or foreign material.

Please note the pregnancy status also, as in the advanced stage this can go for Functional Ileus due to pregnancy.

Then previous medication, whether it has been treated with an antibiotic or any anti[1]inflammatory or has been treated with any other diseases. so because these factors may go from hypermotility or atony of the rumen.

Clinical examination of the animal: invariably in all these cases the change in the dung is most conspicuous, what is that? There is a reduction in the quantity of the dung, maybe atony and the complete absence of the dung or change in the consistency of the dung may be hard, a little pasty like that.

The marked things he noticed here are Dehydration, Rumen atony, or hypomotility. In some cases like volvulus or mesentery, we may get Colic signs.

Traumatic reticulitis or Traumatic reticulo-peritonitis: the animal may have Fever, Tachycardia, Arched back when you go for a Slope test, what is a Slope test- make the animal walk on an inclined plane, the animal will be a little bit comfortable when it walks up the hill but when it comes down the hill it has difficulty either it grunts or going for a mild groaning is there.

The next test is Pain Percussion, so if you go for deep pain percussion, the animal elicits pain or chronic. There will be Rumen atony or hypomotility, Rectal examination- inevitably there is scanty dung or absent dung.

Diaphragmatic hernia; here there is recurrent bloat and as a clinician, they are not able to pass the stomach tube, sometimes if they pass the stomach tube, the content is usually frothy and again the bloat occurs.

Next is Vagal indigestion: vagal indigestion as you see (Showing pictures in the slide) the abdomen from the end we get a papple-shaped abdomen. what is that left side is papple shape and right side of the abdomen is pear shape which is a significant as far as the vagal indigestion is concerned.

Displacement of abomasum: it can be Right or Left, usually Right causes a significant change as far as the Intestinal Ileus is concerned. In the Left side displacement of the abomasum, we get a ping sound, either on the left paralumbar fossa or a penultimate intercostal space. What we need to do is start the auscultation and combine the percussion from the left elbow to the paralumbar fossa. So we will be able to get a ping sound, so where we get the ping sound we are supposed to get the Liptack test. Introduce the needle, collect the fluid, and assess the pH, so that is going to confirm the left side displacement of the abomasum.

As far as the Clinical sign again Right side displacement of the abomasum, we are going to get a ping sound on the right side, what is the area, from the elbow to the paralumbar fossa? Do a combined auscultation percussion, we will get a ping sound. During a rectal examination we may get the caudal part as close as your pelvic inlet, the round viscous is palpable on the cranial right side of the abdomen.

Mesenteric Volvulus: here there is a rapid debilitation and progression to a moribund state and the Colic is often severe in this type of mesenteric volvulus. Rectal examination reveals multiple loops of the distended small and large intestine, the normal spatial arrangement of the viscera is usually not present.

Cecal dilatation: here it is on the right side there is abdominal distension and tympanic resonance is noticed on right paralumbar fossa to 1-4 rib spaces cranially. In the rectal examination, we find the dilated round apex of the cecum protruding into the pelvic inlet, and the small intestine of various segments are palpable. Uterine torsion and Dystocia can be easily assessed by vaginal examination and rectal examination and for those clinical signs, we have to see P1 P2 P3.

In Functional Ileus no specific clinical signs, except for a reduction in the dung quantity.

(Showing pictures in the slide1) On the left side, we can see the Rectal examination and the dung that is smeared on the hand which is in the case of a normal animal, and right side we can see the animal where the fodder is of a brown type of hay is being given. The left side is of the green folder, the right side is of the hay or other things.

(Showing pictures in slide2) here we can see on rectal examination, a reduction in the quantity and a slight change in the consistency.

(Showing pictures in the slide3) Rectal examination reveals dung which is having a near absence of dung, what you call an empty rectum, on the right side we are seeing the dung of dark color. We can say this is called a raspberry jam appearance.

(Showing pictures in the slide4) The appearance of the dung on the left side is a strawberry jam appearance, on the right side is a Raspberry jam appearance.

(Showing pictures in the slide5)This gives an important take-home lesson namely, jam-like appearance, what is it? The left side has a Strawberry jam-like appearance. We get frank bleeding as in the case of polyps or tumors which are from the rectum or the colon.

On the right side, we get a raspberry jam appearance which we notice in case of intussusception, so if we get a raspberry jam appearance or dark red colored dung, then we should immediately think of intussusception.

(Showing pictures in the slide6) There is a deviation from the previous slide, now we are going to see a blackberry jam appearance. Blackberry jam appearance is nothing but a dark-colored/ black color dung which we encountered in abomasal ulcer as appreciated from the right side slide.

The important Clinical tips to re-emphasize :

• if you get Strawberry jam appearance- it is a frank bleeding
• if you get Raspberry jam appearance it is indicative of intussusception
• if you get a Blackberry jam appearance it is an abomasal ulcer.

In this class, we have seen the various Etiologies that are responsible for Intestinal Ileus or Intestinal Stasis in cattle and we have elaborately seen Anamnesis and Rectal examinations. In the next class, we are going to see the Clinical Investigation we are going to undertake on Intestinal Ileus in cattle.

Thank you!