[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.

Type-5 abomasal ulcer and omental bursitis in 14 cows.

BACKGROUND: Type-5 abomasal ulcer (U5) is a perforated ulcer that causes peritonitis limited to the omental bursa. This retrospective study describes the clinical and laboratory findings in 14 cattle with omental bursitis due to U5. The medical records of 14 cows aged 2.5 to 14.6 years (5.4 ± 3.1 years) with U5 were scrutinised. RESULTS: The most common clinical findings were partial or complete anorexia (100%), abdominal guarding (100%), obtunded demeanour (93%), congested scleral vessels (79%), tachypnoea (71%), rumen atony (64%), diminished faecal output (64%), reduced skin surface temperature (64%) and fever (46%). Four (29%) cows had between one and four concomitant diseases. The most common abnormal laboratory findings were hypokalemia (71%), haemoconcentration (57%), metabolic acidosis (57%) and azotaemia (43%). All cows were euthanased; five immediately after the initial examination, one after exploratory laparotomy and eight after unsuccessful treatment. A diagnosis of U5 was made in all cows during postmortem examination. CONCLUSIONS: There is a need for improvement of the antemortem diagnosis of U5 because reliable differentiation of this disease from other conditions with a similar clinical presentation is currently not feasible.

Clinical and laboratory findings, treatment and outcome in 145 cows with type-2 abomasal ulcer.

This study involved 145 cows with type-2 abomasal ulcer. The most common clinical signs were, in decreasing order of frequency, depressed demeanour (100%), partial or complete anorexia (93%), rumen atony (91%), tachycardia (90%), dark or black manure (80%), prolonged capillary refill time (71%), pale mucous membranes (69%) and tachypnoea (62%). The most common abnormal laboratory findings were azotaemia (89%), low haematocrit (82%), hypokalaemia (81%), hypoproteinaemia (74%) and metabolic acidosis (61%). Ten cows were euthanased immediately after, or died during, the initial examination, and treatment was started (day 0) in 135 cows. Treatment included blood transfusion, sodium chloride/glucose solution, calcium borogluconate, vitamin C and metamizole. Fourteen cows also underwent right-flank laparotomy because of displaced abomasum (n = 7) or to rule out other causes of gastrointestinal haemorrhage (n = 7). The mean heart rate decreased significantly from 108 bpm on day 0 to 88 bpm on day 3. The haematocrit decreased significantly in cows that did not receive blood and increased significantly in the transfused cows during this period. The plasma protein concentration also increased significantly in transfused cows. Ninety-one (67%) of the 135 treated cows recovered and were discharged after a mean hospitalisation period of nine days, and 44 cows (33%) failed to respond to treatment and were euthanased or died. Aggressive treatment, which should include blood transfusion when indicated, is warranted in valuable cows because >50% can be expected to return to full production in the long term.

Clinical, laboratory and ultrasonographic findings in 87 cows with type-4 abomasal ulcer.

BACKGROUND: This study evaluated the clinical, laboratory, ultrasonographic and pathological findings in 87 cows aged 2 to 10 years (4.5 ± 1.5 years) with type-4 abomasal ulcer. RESULTS: The most common clinical findings were in decreasing order compromised health status accompanied by partial or complete anorexia (100%), abdominal guarding (81%), congested scleral vessels (77%), ruminal atony (73%), tachycardia (68%), tachypnoea (65%), positive foreign body tests (58%), decreased skin surface temperature (53%), fever (49%), reduction in negative intraabdominal pressure assessed transrectally (39%), poorly subdivided plant fragments in faeces (35%) and arched back (28%). The principal haematological abnormalities were hypokalaemia (72%), haemoconcentration (69%), azotaemia (56%), metabolic acidosis (49%), hyperfibrinogenaemia (45%), leukopenia (35%) and hypoproteinaemia (29%). Other abnormalities were aciduria (56%), haematuria (44%), increased chloride concentration in rumen fluid (34%) and abnormal peritoneal fluid (98%). Of 75 examined cows, 65 (87%) had ultrasonographic evidence of local or generalised peritonitis. On postmortem examination all cows had a type-4 abomasal ulcer and generalised peritonitis. In addition, 36 cows had type-1 ulcers, 6 had type-2 ulcers and one cow had a type-3 ulcer. DISCUSSION: The clinical signs in cows with type-4 abomasal ulcer are associated with generalised peritonitis. An increased haematocrit, indicating shock-induced haemoconcentration is characteristic in contrast to cows with traumatic reticuloperitonitis. Ultrasonography is useful for visualising and assessing generalised peritonitis. CONCLUSIONS: The diagnosis of type-4 abomasal ulcer based on clinical signs alone is difficult and therefore requires additional diagnostic procedures including the determination of the haematocrit and plasma protein concentration, abdominal ultrasonography and analysis of peritoneal fluid. In most cases, these steps lead to a correct diagnosis and allow timely euthanasia of the cow to prevent further suffering and unnecessary treatment costs. METHODS: The cows underwent a clinical, laboratory, ultrasonographic and postmortem examination.