[Frequency and diagnostic reliability of laboratory variables in cows with traumatic reticuloperitonitis and abomasal ulcers]. / Häufigkeit und diagnostische Zuverlässigkeit von Laborbefunden bei Kühen mit Reticuloperitonitis traumatica und Labmagengeschwüren.

OBJECTIVE: A number of laboratory abnormalities occurs in cows with traumatic reticuloperitonitis (TRP) as well as in those with abomasal ulcers (U; classified as type 1 to 5). The goal of our study was to compare the frequency of individual laboratory variables of cows with traumatic reticuloperitonitis and cows with abomasal ulcers and determine the diagnostic significance of individual laboratory variables. MATERIAL AND METHODS: The present study included 182 healthy control cows, 503 cows with TRP, 94 cows with U1, 145 cows with U2, 60 cows with U3, 87 cows with U4 and 14 cows with U5. Hematocrit, total leukocyte count, concentrations of total protein, fibrinogen, urea, potassium and chloride, base excess and rumen chloride concentration were analyzed. The frequency distributions of all variables for all groups of cows were compared and the diagnostic reliabilities (diagnostic sensitivities and specificities, predictive values, positive likelihood ratios [LR+]) were calculated. RESULTS: Values outside the reference interval occurred in 2 to 24 % of control cows (rumen chloride 2 %, urea 6 %, serum chloride 11 %, hematocrit 13 %, base excess 18 %, fibrinogen 20 %, total protein 21 %, total leukocyte count 22 % and potassium 24 %), which made differentiation of healthy and ill cows difficult. Therefore, the variables best suited for distinguishing healthy and affected cows were rumen chloride and blood urea concentration. This was also supported by an LR+ of 14 to 27 for rumen chloride > 30 mmol/l and 6 to 15 for blood urea > 6.5 mmol/l in cows with abomasal ulcers. Urea also displayed a high diagnostic specificity and was suited for differentiation of healthy and diseased cows. The urea concentration was > 8.5 mmol/l in only 0.5 % of controls, and the LR+ for a urea concentration > 8.5 mmol/l ranged from 11 in cows with TRP to 128 in cows with U2. Except for cows with TRP, azotemia was significantly more frequent in affected cows than in controls. Cows with U2 (70 %) had urea concentrations > 8.5 mmol/l significantly more frequently than cows of the other groups. Even though the groups of diseased cows differed significantly with respect to several variables, no variables were identified to reliably differentiate the various groups. CONCLUSION: Different disorders in cows cannot be differentiated based on single laboratory variables. CLINICAL RELEVANCE: For a definitive diagnosis the history, clinical findings and results of additional diagnostic techniques such as radiography of the reticulum, ultrasonography and abdominocentesis are required. In many cases, a definitive diagnosis can only be made via exploratory laparotomy and/or postmortem examination.

Diagnostic reliability of clinical signs in cows with traumatic reticuloperitonitis and abomasal ulcers.

BACKGROUND: Clinical signs of traumatic reticuloperitonitis and abomasal ulcer are often similar making the disorders difficult to differentiate. The goal of our study was to compare the frequency of individual clinical signs of cows with traumatic reticuloperitonitis and cows with abomasal ulcers and determine their diagnostic significance. The frequency of the findings "rectal temperature, heart rate, respiratory rate, demeanour, signs of colic, arched back, abdominal guarding, bruxism, scleral vessels, rumen motility, foreign body tests, percussion auscultation, swinging auscultation and faecal colour" of cows with traumatic reticuloperitonitis (TRP, n = 503) and cows with type 1 (U1, n = 94), type 2 (U2, n = 145), type 3 (U3, n = 60), type 4 (U4, n = 87) and type 5 (U5, n = 14) abomasal ulcer were compared, and the reliability indices "diagnostic sensitivity and specificity, positive and negative predictive values and positive likelihood ratio" were calculated. A total of 182 healthy cows served as controls (control group). RESULTS: None of the cows in the control group had colic, rumen atony or melena, 99% had no abnormalities in demeanor and appetite and did not have a rectal temperature of ≤38.6 or >  40.0 °C, a heart rate >  100 bpm or a respiratory rate >  55 breaths per min, and 95% did not have an arched back or bruxism. The control group was therefore ideal for comparative purposes. Many signs such as mild increase in rectal temperature, scleral congestion and positive foreign body test were non-diagnostic because they occurred in healthy as well as in ill cows. Likewise, differentiation of cows with TRP and abomasal ulcer was not possible based on single clinical variables; a detailed history and a comprehensive assessment of all clinical findings were required for this. CONCLUSIONS: The findings of the present study serve as a guide for the veterinarian in the differentiation of cows with traumatic reticuloperitonitis and abomasal ulcer.

Aetiology, diagnosis, treatment and outcome of traumatic reticuloperitonitis in cattle.

Traumatic reticuloperitonitis (TRP) in cattle is caused by ingested nails, pieces of wire, and other nonmetallic materials that injure the reticular wall. Clinical signs of acute TRP may include anorexia, fever, drop in milk production, rumen atony and tympany, abdominal pain, an arched back, a tucked up and "guarded" abdomen and spontaneous grunting, but may be obscure or absent in chronic cases. Haematological findings alone are not diagnostic, but total and differential white blood cell counts, the concentration of fibrinogen and total protein and the glutaraldehyde coagulation time may indicate inflammation associated with TRP. The clinical examination is aimed at eliciting a grunt in response to foreign body tests such as back grip, pole test or pain percussion. Inflammatory changes of the reticulum and adjacent organs and impairment of reticular motility are characteristic features of TRP and can be detected via ultrasonography. Radiography is the technique of choice for the visualisation of metallic foreign bodies and for monitoring the efficacy of a magnet. Treatment may be conservative or surgical, but in most cases initial treatment is conservative with administration of a magnet and antibiotics. If the cow fails to respond to medical treatment, surgical treatment is the next option other than euthanasia and ideally is carried out after imaging of the reticulum. If this is not feasible, a second magnet and continuation of antibiotic treatment is recommended.

Treatment of 503 cattle with traumatic reticuloperitonitis.

BACKGROUND: The treatment of traumatic reticuloperitonitis (TRP) in cattle has a long and impressive history that goes back more than 100 years. This study describes treatment for TRP in 503 cattle. Initial treatment was based on radiographic findings; cattle with a foreign body attached to a magnet were treated conservatively using antibiotics, anti-inflammatory drugs and intravenous fluids. Cattle with a foreign body lying on the ventral aspect of the reticulum or penetrating or perforating the reticulum received a magnet in addition to medical treatment. Cattle were radiographed again the next day. When the foreign body was completely attached to the magnet, medical treatment was continued. When the foreign body was not attached or still penetrated/perforated the reticulum, a rumenotomy was carried out. RESULTS: Of the 503 cattle, 232 were treated conservatively, 206 underwent surgery, 61 were slaughtered or euthanased and four were treated after discharge at home with a magnet and antibiotics. Surgical treatment was significantly more successful than conservative treatment; 90% of 206 operated and 82% of 232 medically-treated cattle were discharged. CONCLUSIONS: For practical purposes, cattle suspected of having traumatic reticuloperitonitis should initially be treated with a magnet and antibiotics and re-evaluated, ideally radiographically, when response to treatment does not occur within 3 or 4 days. Surgery is limited to cases in which the foreign body fails to completely attach to the magnet.

Ultrasonographic and radiographic findings in 503 cattle with traumatic reticuloperitonitis.

This study involved 503 cattle with traumatic reticuloperitonitis (TRP), 494 of which underwent ultrasonographic and 484 radiographic examination of the reticulum. Ultrasonography revealed changes in the reticulum and/or peritoneum suggestive of peritonitis in 403 (83%) cattle, a decrease in the amplitude of reticular contractions in 244 (54%) and reduced or absent reticular motility in 173 (37%). A total of 536 foreign bodies were seen on 465 (96%) radiographs and a magnet was seen on 311 (64%) radiographs. Of the 536 foreign bodies, 300 (56%) were not attached to a magnet and 236 (44%) were attached. Of 300 radiographs showing foreign bodies not attached to a magnet, the foreign body was lying flat on the floor of the reticulum on 98 (18%) radiographs, was at an angle of greater than 30 degrees to the ventral aspect of the reticulum on 54 (10%), had penetrated the dorsal reticular wall on 76 (14%), had perforated the reticulum on 64 (12%) and was completely outside of the reticulum on 8 (1%) radiographs. Ultrasonography provides information about the scale and localisation of inflammatory changes of the peritoneum, and radiography allows the visualisation of ferromagnetic foreign bodies and magnets.

Clinical and laboratory findings in 503 cattle with traumatic reticuloperitonitis.

BACKGROUND: The study evaluated the results of clinical examination and haematological and serum biochemical analyses in 503 cattle with traumatic reticuloperitonitis (TRP). RESULTS: The most common clinical findings were abnormal demeanour and general condition (87%), decreased rumen motility (72%), poorly digested faeces (57%), decreased rumen fill (49%), fever (43%) and tachycardia (26%). In 58% of the cattle, at least one of three tests for reticular foreign bodies (pinching of the withers, pressure on the xiphoid and percussion of the abdominal wall) was positive, and in 42% all three tests were negative. The most common haematological findings were decreased haematocrit in 45% of cattle and leukocytosis in 42%. An increase in the concentration of fibrinogen in 69% of cattle and total protein in 64% were the main biochemical findings. The glutaraldehyde test time was decreased with coagulation occurring within 6 min in 75% of cattle. CONCLUSIONS: In many cases, a diagnosis of TRP is not possible based on individual clinical or laboratory findings because even the most common abnormalities are not seen in all cattle with TRP.

Case report: clinical and postmortem findings in four cows with rib fracture.

BACKGROUND: Published reports of rib fractures in adult cattle are limited to the occurrence of chronic rib swellings caused by calluses, which are unremarkable from a clinical standpoint, whereas studies identifying clinical signs of rib fractures were not found in a literature search. This report describes the clinical and postmortem findings in four cows with rib fractures. CASE PRESENTATION: The 13th rib was fractured in three cows and the 11th rib in the remaining cow; three fractures were on the right and one on the left side. Clinical and postmortem findings varied considerably, and percussion of the rib cage elicited a pain response in only one cow. One cow had generalised peritonitis because of perforation of the rumen by the fractured rib. One cow was recumbent because of pain and became a downer cow, and two other cows had bronchopneumonia, which was a sequel to osteomyelitis of the fracture site in one. In the absence of a history of trauma, the diagnosis of rib fracture based on clinical signs alone is difficult. CONCLUSIONS: Although rib fractures undoubtedly are very painful, the four cases described in this report suggest that they are difficult to diagnose in cattle because associated clinical signs are nonspecific.