5 How to treat these cases?

Transcript

Hi! Everyone,

In the last module, we have seen the various modes of Diagnosing Traumatic Reticulo[1]peritonitis and Pericarditis.

In this module, we will see How to Treat these cases, that is what we will see in. Before going to this presentation, the first and foremost thing is:

1. Where the Foreign material is located and
2. What are all the facilities, we have
3. Again, the foremost thing is whether the economy is suitable for the therapy or not.

So, these are the three things you have to decide, what are all the facilities, whether the economy is suitable, and where the foreign material is located. So, these are the three things you have to decide and go through it before going through the therapy.

See before initiating any therapeutic approach, we have to go for medical management and before approaching Surgical management. Generally, Medical management is initiated if the medical management is failed, then we can go for Surgical corrections. Generally, it needs a long-time approach, and particularly long-time antibiotic is required. So, the goals of the therapy are antimicrobial therapy, Anti-inflammatory therapy, Management of fluid and electrolytes, and Pain management, these are the four things we need to keep in our mind. These are the goals of any animal which is suffering from Traumatic Reticulo-peritonitis and Pericarditis.

Generally, Traumatic Reticulo-peritonitis and Pericarditis animals have adhesions, as I told in the previous modules, when these adhesions are there, they generally inhibit the gut motility once the gut motility is inhibited there will be a development of ileus, so this alias needs to be kept in our mind always before treating the animal and this ileus always needs to be treated with prokinetic drugs if warrant in these animals. Because of the toxin’s signs, once the adhesion is developing, it is always better to maintain the animal, or it is always better to restrict the movement of the animal to promote the adhesions. see if there is breakage of the adhesions there will be extensive diffuse peritonitis used to develop, so we don’t want that because of that we always promote the adhesion formation. Once the adhesion formation is there, particularly in acute conditions, I told in the previous module’s adhesions formed within 72 hours, once these additions are formed and the inflammation is isolated, these animals generally recover within 3-5 days. And for these things two things are required:

1. Restricting the movement of the animal, then
2. Elevation of the four-quarter, see always the four-quarter should be elevated like this, that is the four-quarter and hindquarter should be 25 centimeters at least a difference. see the four quarters should be elevated and hindquarters should be below that, so we need to restrict the further movement of the foreign bodies.

Then some of the Pharmacological options are:

Generally, Tetracyclines and Beta-lactam antibiotics are used, and most commonly the steroid drugs and or NSAIDs non-steroidal anti-inflammatory drugs are warranted here. Again, if required you can go for anti-inflammatory drugs, as you can administer these drugs over a period, particularly by using these drugs in CRI infusion, and generally these drugs and anti-inflammatory drugs along with antimicrobial drugs. The minimum is at least required for about a period of five days.

Then Administration of Magnets, so magnets need to be administered on day one, when you diagnose the case as having Traumatic Reticulo-peritonitis, immediately you administer the Magnet. So, keep in mind, this magnet length should be more than >3 inches, and if the magnet is situated in an upright position, so it is very ideal for capturing the penetrating foreign bodies… So generally, if the magnet does not retrieve the penetrating foreign bodies, at least it should not allow the penetrating foreign bodies to progress further so that is how it will help. If not retrieved back at least it will prevent the progression of the foreign material penetrating foreign material further.

(Showing pictures in the slide) These are all the magnets that are administered to the reticulum of an animal and if you see this picture, this is after post-mortem they identified these magnets which are having penetrating foreign bodies around them and

The next one is Fluid therapy: Generally, I told diffuse peritonitis always has a Hypovolemic shock, so once Hypovolemic shocks are there, these patients require a large quantum of fluids, generally, these patients are vulnerable to Hypochloremia and Hypokalemia, so metabolic alkalosis is suspected in these patients. So, Hypochloremic, Hypokalemic, and metabolic alkalosis are suspected in these patients so that is why the best fluid is Isotonic saline’s. Along with that, generally we used to think about whether we can go for oral fluids or not. So here when you suspect an animal is having Traumatic Reticulo-peritonitis or Pericarditis, the oral fluid efficacy is not much, so that is why oral fluid therapy is not indicated particularly when the animal is in diffuse peritonitis, it is not indicated. Along with the normal Isotonic saline, if we want, we can add Potassium and Magnesium to that fluids and we can go for fluid therapy which is containing Potassium and Magnesium-rich fluids.

Then Rumenotomy: so, Rumenotomy, you know it Rumenotomy is generally done at the left flank.

And the Indications for Rumenotomy are Perotonitis, Peri-reticular/rumen adhesions, Peri[1]reticular abscess, and retrieving the foreign materials in the intraluminal space.

And suppose if a peri-reticular abscess is there so we want to lance it again we can go for Rumenotomy.

(Showing pictures in the slide) So this is the Rumenotomy, you know it very well, and see once the material is removed and we have to lance it properly, lavage it, then again, we have to close this surgical site in a proper way. This is the material recovered from Rumenotomy.

Then Thoracotomy: two things are done in Thoracotomy

1. Pericardiectomy
2. Pericardiotomy

So, both things can be done in Traumatic Reticulo-peritonitis and Pericarditis cases. So, the main indication is Septic pleuritis, Pyothorax, and Pericarditis, so these three are the main indications where Thoracotomy is indicated.

Generally, the fifth and sixth rib section is indicated for Thoracotomy and once Thoracotomy is done the outcome, particularly for unilateral Pyothoraxand and unilateral Septic pleuritis cases, the outcome will be good when compared to the other cases.

(Showing video in the slide) And if you see this tube attachment in the Thoracocentesis cases and there will be draining of the septic material from the Pericardium.

(Showing video in the slide) So this is the Ultrasonographic examination, after drip, you see this there is the quantum of fluid accumulated in the pericardial space, this is after therapy after seven days, particularly with the tube Thoracocentesis and generally, when you do the Thoracocentesis it should be done in a slow manner, you should not drain as quickly as possible, that is not indicated and generally the second-intention healing is always advisable, majority of the cases the second-intention healing will take a bit long time.

In a summary, in nutshell, so the penetration of the foreign body occurs mostly in the cranio[1]ventral regions which is one of the main places where the foreign material penetrates. So, the incidence of Traumatic Reticulo-peritonitis and Pericarditis is 14% particularly, in the forestomach disorders in India.

And there are 4 types of Pathogenesis: Acute peritonitis, Chronic local peritonitis, Diffuse peritonitis, and Sudden death, particularly in Traumatic Reticulo-peritonitis cases.

And there are 3 different types of Pericarditis: Effusive pericarditis, Fibrinous pericarditis, Constitutive pericarditis.

And the suspected Clinical signs are Grunting and Bruxism, whenever an animal is having bruxism and grunting you have to suspect the animal may have Traumatic Reticulo-peritonitis and Pericarditis.

So, the Multimodal Diagnostic approach needs to be carried out, it depends upon the availability of the facilities in your locality. Generally, the Prognosis is unrewarding in Traumatic Reticulo-peritonitis and Pericarditis Cases.

Thank you!