the material has been collected from the standard text books and internet

1. Dr Rekha Pathak and Dr Mahendra Priya

2. Ruminant Stomach
The oesophageal groove is present in newborn
ruminants. It is a channel taking milk from
the oesophagus into the abomasum, bypassing
the rumen, reticulum and omasum.

3. Continuation
First three parts regarded as
esophageal sacculations (non-
glandular) lined by stratified
sqamous epithelium.
Fourth part is true stomach(
glandular)
Esophagus open in between
rumen and reticulum i.e atrium
ventriculi.

4. Rumen Parietal and visceral
surface.
 long axis extend from point
opposite to ventral part of
7/8 ICS to almost pelvic
inlet.

5. Reticulum
• Lies between 6/7 intercostal surface on median line.
• Site of incision – equidistant from tubercoxae and last
rib begining 5cm ventral to lumbar transverse process.

6. Introduction TRP
 Perforation of wall of reticulum by a sharp foreign body
produce acute local peritonitis ,which may spread to cause
acute diffuse peritonitis or remain localised to cause
subsequent damage, including vagal indigestion and, in
rare cases diaphragmatic hernia
 The penetration of foreign body may proceed beyond the
peritoneum and cause involvement of other organs
resulting in pericarditis; cardiac tamponade; pneumonia;
pleurisy and mediastinitis; hepatic, splenic, or
diaphragmatic abscess.

7. Etiology
 Accidental ingestion of foreign body through feed or
while grazing on pasture
 Lack of oral discrimination
 Tendency to lick metallic object
 Greedy feeding
 The typical foreign body is a metallic object ,such as a
piece of wire or a nail, often greater then 2.5 cm in
length, or any sharp needle etc, that can cattle swallow
during grazing.

8. Epidemiology
 Adult dairy cattle are most affected because of their
more frequent exposure.
 Not very frequently seen in yearling, beef cattle, dairy
bull, sheep and goat.
 More common in cattle fed on prepared feed.
 Rarely seen in sheep and goats.
 Rare in Camels

9. Pathogenesis
 Lack of oral discrimination cause ingestion of foreign
body
 Reach to the reticulum
 Because of honey comb structure-- foreign body get
trapped here and penetrate through the wall of
reticulum
 Mostly in the lower part of the reticulum
 Acute local peritonitis develops within 24 hours after
penetration
 It leads to ruminal atony and abdominal pain

10.  Reticular contractions will be slower and less in
numbers
 Reticular abscesses are common complication
 Peritonitis leads to –
 Decrease ruminoreticular motility
 Inappetance to anorexia
 Capricious appetite(eat hay not concentrate)
 Chronic tympani
 Fever
 Pain on deep palpation

11.  Generalised peritonitis and extension occurs in cattle
that are forced to exercise during disease.

12. Common
sequelae
Uncommon
sequelae
perforation
Acute local
peritonitis
Recovery
Chronic local
peritonitis
Acute diffuse
peritonitis
Acute
pericarditis
Vagal indigestion Diaphragmatic
hernia
Death due
to CHF
Chronic
pericarditis
Rupture of left gastro
epiploeic artery
Splenic abscess, hepatic abscess,
diaphragmatic abscess, pleurisy
and pneumonia
Rupture of coronary
artery or cardiac
temponade

13. Clinical Finding
 Recurrent tympany is most common symptom
 Sudden complete anorexia
 Abducted elbows
 Marked drop in milk yield
 Sub acute abdominal pain
 Reluctant to move or slow walking particularly down hill is
often accompanied by grunting
 Arching of back(Animal appears ‘tucked up’)
 Defecation and urination cause pain it results in
constipation and retention of urine
 High rise of temperature

14. Video by Dr. Shridhar TRP
 Heart rate -80 beats /min
 Respiratory rate – 30/min, shallow breathing
 If pleural cavity penetrated then accompanied by
audible expiratory grunt.
 Rumination absent
 Free gas bloat
 Pain can be elicited by deep palpation of abdominal
wall just caudal to xiphisternum.
 In more severe cases brisket area can become
enlarged(due to excessive fluid)and inflammation can
appear

15.  Chronic local peritonitis-
 Poor body condition
 Scanty faeces with more undigested particle
 Persistent slightly elevated temperature but in some
cases temperature within normal range
 Gait may be slow and careful
 Occasionally grunting may occur during rumination

16. Clinical Pathology
 In acute local peritonitis
 A neutrophilia and left shift is common (mature
neutrophils above 4000 cells/µl and immature cells
above 200 cells/µl
 Neutrophils increase by day 1 and last for day 3 in
uncomplicated cases
 In chronic cases level do not return to normal
 In acute diffuse peritonitis
 Leukopenia (total count below 4000 cells/µl)with a
greater absolute number of immature neutrophils
(degenerative left shift occurs)

17.  Plasma protein level –
 Plasma protein level increased by 88±13 g/l (normal-
77±12 g/l)
 Increased serum amyloid A and hapt0globulins
 Prolonged prothrombin time, thrombin time, activated
partial thromboplastin time and thrombocytopenia
 Increased nitric oxide concentration in serum
 Albumin level decreased by 28.57 in acute case and
30.78 in chronic case(normal-32.51)
 Globulin level increased by 45.82 in acute case and 51.38
in chronic case (normal-37.95)
 A/G ratio – (normal-0.857) in acute-0.624,in chronic-
0.599

18.  Acute phase proteins-
 Occurs during stressful conditions
 Secreted from liver and aim of these agents is to isolate
and destroy the infectious agent, prevent tissue damage
and restore homeostasis
 Secretion of APPs are regulated by the pro inflammatory
cytokines
 APPs for determination of cattle diseases are fibrinogen,
haptoglobulin, serum amyloid A, α-1 acid glycoprotein
 In TRP fibrinogen and haptoglobulin level significantly
increases

19. Protein Normal TRP
Fibrinogen (ηg/ml) 101.1±17.6 205.1±18.1
Haptoglobulin(mg/ml) 0.03±0.01 1.19±0.37
Serum amyloid A(µg/ml) 67.9±34 165±63
Α-1 acid
glycoprotein(µg/ml)
663±121 1069±280

20.  Abdominocentesis and peritoneal fluid-
 Site :- 10-12 cm caudal to xiphisternum and 10-15 cm
lateral to the midline
 Prepare the site aseptically
 Give a stab incision on the prepared site
 A blunt ended teat cannula or 16-18 gauge 5 cm long
hypodermic needle can be used to insert through the
incision
 Fluid will come out or we can aspirate it with the help of
syringe

21.  If fluid not obtained then a trocar and cannula 80 mm
long and 4 mm diameter is used
 Trocar is inserted along with the cannula then remove
the trocar
 A 80 cm 10 french gauge infant feeding tube is inserted
through cannula leaving 10-20 cm outside
 From here we can get peritoneal fluid

23. Metal detectors
 These metal detectors can be used to detect metal
foreign body but not very useful
 Laparoscopy- right flank laparoscopy using a flexible
fibre optic laparoscope 14 mm in diameter and 1.1 m in
working length can be used to visualize the reticulum
and other organs

24. Tests to Diagnosis Wither’s test-
 Pinch the cows wither and observe the reaction
 Healthy cow – nudge /pinch(move downward)
 Sick cow-stay still(downward movement cause pain)
 Grunt test-
 Apply upward pressure to the sternal region (Pole test)
 Healthy cow - not react
 Sick cow – grunts, kicks or acts uncomfortable

25. Necropsy fimdings

26. Treatment
 C0nservative therapy-
 Immobilization of animal
 Antimicrobial therapy – penicillin or broad spectrum
antibiotics should be administered parenterally for 3-5
days
 Anti-inflammatory should be given parenterally
 Oral administration of magnets to immobilize the
foreign body

27.  Surgical treatment-
 Rumenotomy – a left flank laparotomy and ruminotomy are
perform
 Standing position
 Equidistant from tubercoxae and last rib—5cm ventral to the
lumbar transverse process
 Weingarths rumenotomy ring is applied
 Frame of the ring is fixed to the dorsal wound by thumb
screw
 Part of rumen is out and rumen foreceps is fixed to the dorsal
part of the rumen wall –hooked into dorsal eye of the frame
 Similarly on the ventral part
 Incise the rumen—rumen hooks are placed into the cut edges
of the rumen wall . Incise the rumen
 The spillage into the abdominal cavity is prevented
 The mature abscesses can be drained inside the lumen of the
organs

28. https://www.youtube.com/watch?
v=OXk21Lx_XZg
Rumenotomy by D K
singh

30. Removal of penetrated linear metallic foreign body from the reticulum

31. Cleaning with normal saline Cusing suture Lembert suture
Rumen closure with No 2 chronic catgut
Before rumen closure transfaunation done

32. Muscle suturing-simple continuous
Pattern using No .2 catgut
Skin closure-interrupted
Horizontal mattress

33. Post Operative Care
 Routine dressing of the cutaneous wound .
 Administration of antibiotics and analgesics.
 Fluid therapy up to normal feed and water intake.
 After 7-10 day remove the skin suture.

34. Traumatic pericarditis
 Acute, subacute or chronic inflammation of the
pericardium often recorded in buffaloes and cattle as a
result of penetration of the pericardium by a sharp FB
 Constrictive pericarditis: characterised by symptoms
of toxemia and CHF
 Incidence in bovine is higher esp in pregnant or
recently calved due to increased intra abdominal
pressure—piercing the pericardium at one to two
places

35.  It may fall back into reticulum and rarely may come
out with faeces or may get disintegrated.
 Trauma to pericardium—inflammation—exudation—
adhesions/ infection may spread if the FB is
contaminated
 Cardiac tamponade : The pericardial sac which is fluid
accumulated or adhesions will impair the heart to act
as a pump
 Right sided heat failure is more common –thinner
than the left ventricular wall
 Toxemia due to absorption of bacterial toxins

36. Symptoms:
 Complete anorexia
 Dropped milk yield
 Reluctance to walk
 Short steps and stiffer gait, arched back, abducted
elbows, grunting, brisket edema, edema of the jaw,
dewlap and ventral abdominal region extending upto
the udder
 Engorged jugular veins
 Pericardial frictions sounds heard on auscultations
 Sometimes the upward and backward displacement of
heart in extreme cases make cardiac sounds audible in
level with the shoulder

37. Diagnosis
 Clinical signs, Pericardiocentesis and radiological
observation,
 hematology, biochemical and ECG changes reflect the
severity of the disease
 Pericardiocentesis: Through 5th or 6th intercostal space
shows offensive odour fluid in suppurtive pericarditis

38.  Low PCV, Hb, and leucocytosis, neutrophillia with
shift to left and elevated ESR
 Acidic urine and albuminuria, increased globulins,
decreased sodium and potassium, serum oxaloacetic
tranaminase is increased due to tissue damage
 Right ventricular failure: This results in increased right
ventricular diastolic pressure along with increased
right atrial and systemic venous pressure. Visible veins,
especially jugular get distended and becomes pulsatile

39.  The circulation time is prolonged
and cardiac output is decreased
 Radiographs: right or left lateral of
cardiac and reticular areas with
animal in lateral / dorsal
recumbency to see the presence and
position of the FB
 The cardiac shadow may increase
with disappearance of phrenico-
cardiac-pulmonary triangle in
positive cases
 In advanced cases calcification areas
in pericardium

40.  Differentiate from pleurisy, congenital cardiac defects,
DH
 In pleurisy: Friction rub and muffling of the heart
sounds present but are synchronised with respiratory
movements
 Respiratory distress is not evident in cases of TRP
 Pericardiocentesis helps to differentiate
 Contrast radiography of the reticulum and
differentiate with DH/ plane radiographs

41.  Treatment: Conservative/ surgical
 Diuretics, antimicrobial therapy, elevate the forelimbs
 Pericardiocentesis, pericardiotomy, pericardiectomy
with or with out pericardial graft
 Centesis : drain fluid from the sac and inject
antibiotics and proteolytic enzymes
 Not useful if adhesions between pericardium and
epicardium present
 Forelimbs are drawn forward and a large bore needle
inserted between the 4th or 5th i/c space above the
external thoracic vein to a depth of six cm
 Pericardiotomy: Laparorumenotomy first
 FB removed, in advance cases the prognosis is poor

42.  Isotonic saline/ dextrose.
 Pericardiotomy: The incision should be of sufficient length
to allow the hand inside the pericardial sac. Removal of
fibrinous exudates, FB is removed, irrigate the cavity with
warm sterile isotonic saline sol with antibiotics,

43.  closed with absobable suture, continuous. Drainage
tube may be fixed for lavage with mild antiseptic sol.
Containing the proteolytic enzymes
 Pericardiectomy: Removal of pericardium. Indicated
in constrictive pericarditis in which mediastinal
adhesions are thick and rigid pericardium and
epicardium interfere with cardiac filling. So there may
partial removal of pericardium---rarely practiced in
clinical situation