81st Western Veterinary Conference

V502
Abdominal Emergencies in Cattle
David C. Van Metre, DVM, DACVIM
Colorado State University, Fort Collins, CO, USA

OVERVIEW OF THE ISSUE

For this seminar, an abdominal emergency will be defined as a potentially fatal disorder within the
abdominal cavity that is characterized by acute clinical signs. In such cases, the attending veterinarian’s
ability to acquire important historical and examination data may be limited by the animal’s size and
behavior while in pain, as well as the potentially disjointed communication of relevant historical data by
the owner or caretaker during a crisis. Such conditions are conducive to an incomplete clinical
assessment. Therefore, the veterinarian must strive to acquire relevant data in a thorough, yet time-
efficient framework. This seminar will outline the differential diagnoses for an acute abdomen according
to age and production status of the animal. Physical examination clues to aid in establishing a diagnosis
and arriving at a decision for surgery will be reviewed as well.

OBJECTIVES OF THE PRESENTATION

ƒ To provide practitioners with a review of the differential diagnoses of an acute abdomen,
categorized by the age, gender, and production status of the animal.
ƒ Through a literature review, to provide practitioners with the salient physical examination findings
and clinical criteria that contribute to a diagnosis and a decision for surgery, respectively.

CLINICAL DIAGNOSTIC POINTS

ƒ In cases where a definitive diagnosis cannot be made by physical examination or common ancillary
diagnostic tests, monitoring the animal for clinical deterioration and progressive abdominal
distension may aid in arrival at a decision for surgery.
ƒ Progressive abdominal distension can be monitored by serial measurements of abdominal girth at a
predetermined anatomic landmark, e.g., at the edge of the last rib.

KEY THERAPEUTIC POINTS

ƒ For adult cattle with dehydration secondary to diarrhea or grain engorgement, alkalinizing fluids
are indicated. Such fluids include Lactated Ringer’s solution and similar polyionic fluids (e.g.,
Plasmalyte®).
ƒ Cattle with functional or mechanical obstructions of the gastrointestinal tract frequently need fluids
with relatively high sodium and chloride concentrations, such as isotonic or hypertonic sodium
chloride.

KEY PROGNOSTIC POINTS

ƒ A prognosis may be made in light of the most likely differential diagnoses and the expected
outcomes of treatment for each differential; data from the history, physical examination, and
ancillary diagnostic tests must be included to frame the prognosis in the context of the patient’s
current status.
ƒ Because of the ease with which exploratory laparotomy can be performed in adult cattle,
assignment of an accurate prognosis may require utilization of exploration as both a diagnostic and
prognostic tool.

ADDITIONAL DETAIL
Careful consideration of the signalment is a necessary first step in addressing abdominal emergencies,
simply because certain abdominal disorders occur at a greater frequency in animals of a certain age and
production status. For example, limited data to date indicate that hemorrhagic bowel syndrome tends to
occur in post-partum dairy cows within the first 3–4 months of lactation.1 The onset, duration, and
progression of the chief complaint(s) should be clarified in the history. The veterinarian should inquire if
similar diseases or signs of disease have been identified on the premises, and, more specifically, in the
same age or production group of the animal in question. An affirmative response may be indicative of a
problem rooted in nutrition, animal management, toxin exposure, or infectious causes, while a negative
response lends weight to consideration of more sporadic, spontaneous etiologies. Because of the central
role that changes in diet have in many acute gastrointestinal disorders, a specific query about this topic is
warranted; diet composition, quantity, frequency and mode of presentation, and changes in social
stratification of the group may be clues to a change in diet for the affected animal. A brief inspection of
feed is often informative. Treatments administered and the response to each should also be determined in
the history.
The veterinarian should next conduct the physical examination. Table 1 shows a list of diseases that
the practitioner should consider in the bovine patient with an acute abdomen, categorized by signalment.
Table 1. Acute abdominal diseases, by common signalment groups.
Calf (< 6 mo)
ƒ Rumen putrefaction
ƒ Rumen acidosis*
ƒ Left / right displaced abomasum, abomasal volvulus,* abomasitis / abomasal tympany
ƒ Enteritis, including enterotoxemia*
ƒ Intestinal obstruction:*
o Intussusception
o Volvulus
o Incarceration
o Volvulus of the mesenteric root
o Adhesions
ƒ Atresia jejuni / coli / ani
ƒ Peritonitis secondary to:
o Perforated abomasal ulcer*
o Rupture of infected umbilical structure

Peripartum heifer / cow

ƒ Traumatic reticulitis / reticuloperitonitis*
ƒ Dystocia / abortion / uterine torsion
ƒ Ileus caused by metabolic disorders (e.g., hypocalcemia)*
ƒ Acute bloat associated with:*
o Rumen acidosis
o Esophageal obstruction
o Froth
o Indigestion of late pregnancy

Postpartum or non-pregnant heifer / cow

ƒ Peritonitis secondary to:
o Uterine rupture during parturition
o Breeding injury
ƒ Pyelonephritis*
ƒ Indigestion /pseudo-obstruction / prodromal enteritis*
ƒ Hemorrhagic bowel syndrome (HBS)*
ƒ Cecal dilatation / volvulus*
Steer / bull
ƒ Urolithiasis
ƒ Inguinal hernia
*Present in signalment groups to the right as well.

The decision to perform a laparotomy in cattle with abdominal disease involves integration of the
signalment, history, physical examination findings, and, if available, ancillary diagnostic tests. This
decision may be influenced by such factors as available facilities, the veterinarian’s expertise, and the
animal’s physical status. Referral to a hospital with optimal facilities is often necessary for more
complicated surgical procedures, or if extensive pre- or post-operative medical management is
anticipated. In addition, particularly if surgery of the small intestine is anticipated, an assistant may be
needed for optimal surgical hygiene and tissue handling. If the clinical signs do not clearly indicate the
need for prompt surgical intervention, or if medical treatment is to be attempted first, the veterinarian
should clearly outline to the owners or caretakers those changes in patient status that will indicate a
positive response to medical treatment.
Parameters to evaluate include attitude, appetite (if feed and water are to be offered), fecal
production, abdominal contour, presence of tympany or fluid on ballottement, heart and respiratory
rates, rectal temperature, hydration status, membrane color, and abdominal distension. The degree of
abdominal distension can be monitored over time by serial measurement of the abdominal girth. A tape
measure or a strip of bandage tape with marks made to denote serial measurements can be used for this
purpose. The abdominal girth should be measured at the same location each time. The space between the
second and third lumbar vertebrae is a potential site for girth measurement, as is the caudal edge of the
13th ribs on each side. Progressive abdominal distension indicates that gas, fluid, and/or ingesta are
accumulating in the gastrointestinal tract or abdominal cavity. In such cases, surgical intervention is
usually prompted by these findings unless there is a clear cause for the distension that can be addressed
with medical management. If economic limitations do not allow surgical intervention, euthanasia should
be performed at the point in time when the animal’s status reaches the point where surgical correction is
necessary to limit suffering. Tables 2–4 show disease conditions that usually necessitate surgical
intervention. In cases for which no specific diagnosis can be made, if the gastrointestinal disease process
is characterized by accumulation of gas, fluid, or ingesta, progressive shock, and/or colic, surgical
exploration should be considered.2,3 Implicit to both tables is the stipulation that the patient’s economic or
sentimental value is sufficient to warrant the cost of surgery.
Table 2. Abdominal conditions that typically warrant surgical intervention in calves
Disease Findings / rationale for surgical intervention

Severe, acute rumen Severe dehydration and tachycardia, severe fluid distension of rumen, rumen pH < 5.
acidosis Rumenotomy may not benefit patient much if profuse diarrhea is present (+/- with
offending feed visible) as this indicates that a substantial fraction of the offending
feedstuffs have moved into the lower parts of the digestive tract.

Left / right displaced Displaced abomasum commonly results in abomasal ulceration (+/- perforation) in calves.
abomasum Affected calves show a typical tympanic resonance with fluid. Distended organ may create
visible bulge over caudal rib area and paralumbar fossa. Delaying surgery may prompt
ulceration and formation of adhesions.

Abomasal volvulus, Rapid, progressive debilitation and hypovolemic shock. Minimal fecal output. Right-sided
abomasitis / abomasal large tympanic viscus with fluid. Ventral percutaneous abdominocentesis may resolve
tympany simple cases of tympany. Volvulus is suspected if distension recurs following ventral
percutaneous abdominocentesis. Treatment should include measures against C. perfringens
invasion of abomasal wall.

Intestinal obstruction Rapid and progressive debilitation and hypovolemic shock. Distended intestinal loops
Intussusception, may be evident through the skin of the flank or with abdominal ultrasonography. Fluid
Volvulus, Incarceration resuscitation does not result in resolution of abdominal distension nor restore fecal
Volvulus of the production, as is expected with most cases of enteritis accompanied by abdominal
mesenteric root distension and/or colic.
Adhesions

Cecal dilatation / See above. May be difficult to differentiate from abomasal displacement / volvulus in
volvulus calves.

Atresia ani Relatively simple surgical repair if mild and if the anus is the sole atretic segment of the GI
tract. Atresia of intestine or colon is difficult to repair.

Table 3. Abdominal conditions that typically warrant surgical intervention in adult cattle
Disease Findings / rationale for immediate surgical intervention

Urolithiasis Complete urethral obstruction typically prompts surgical intervention; ; if incomplete,

surgical correction may still be elected to ensure most prompt resolution.

Severe, acute rumen Severe dehydration and tachycardia, severe fluid distension of rumen, rumen pH < 5,
acidosis heart rate > 100. Rumenotomy may not benefit patient much if profuse diarrhea is
present.

Free gas bloat Poor response to passage of orogastric tube; trocarization or rumenotomy indicated

Frothy bloat Poor response to medical treatment

Traumatic reticulitis Poor response to medical treatment

/reticuloperitonitis

Right displaced May undergo volvulus if not repaired promptly.

abomasum

Abomasal volvulus Devitalization of abomasum will occur if surgery is delayed. Differentiation from right
displaced abomasum not always clear-cut during physical examination.

Hemorrhagic bowel Casts of dark blood or melena in feces. Progressive abdominal distension and shock.
syndrome (jejunal Rectal palpation may or may not reveal intestinal distension. High case fatality rate
hemorrhage syndrome) may prompt euthanasia in many cases.

Intestinal obstruction Detection of obstruction by rectal palpation, ultrasonography, or abdominocentesis

Intussusception, may prompt surgery. The animal’s physical status may be highly suggestive of a
Volvulus, strangulating lesion. Fluid resuscitation does not result in resolution of abdominal
Incarceration distension nor restore fecal production (fluid resuscitation and correction of mineral /
Volvulus of the electrolyte imbalances typically does restore fecal output and resolve distension in
mesenteric root cases of pseudoobstruction, a.k.a. prodromal enteritis, enteritis w/ colic).
Adhesions

Cecal volvulus Distended base of cecum, spiral colon, and small intestine often detectable on rectal
examination. Scant or absent fecal production (cases of cecal dilatation typically
continue to pass liquid feces and apex of cecum is palpable per rectum).

For adult cattle with dehydration secondary to diarrhea or grain engorgement, alkalinizing fluids are
indicated.4 Such fluids include Lactated Ringer’s solution and similar polyionic fluids (e.g., Plasmalyte®).
In contrast, hypovolemic cattle with functional or mechanical obstructions of the gastrointestinal tract
frequently need fluids with high sodium and chloride concentration, such as isotonic or hypertonic
sodium chloride.4 Potassium supplementation of intravenous fluids is often indicated.4 Cattle dehydrated
by the metabolic consequences of urinary tract obstruction also frequently benefit from sodium- and
chloride-rich fluids delivered orally or parenterally. In contrast, however, potassium supplementation
should be performed only when hypokalemia is confirmed, as the potential for hyperkalemia with
urinary tract obstruction is always lurking.
 Hypertonic saline, at a dosage of 4–5 ml/kg of 7.2% sodium chloride IV rapidly, provides rapid and
convenient volume expansion for cattle.5 This treatment should be followed by allowing the patient
access to water to drink or by orogastric intubation of water. However, excess water ingestion may result
in rumen volume expansion that can hamper surgical exploration of the abdomen, particularly if
significant abdominal distension already exists. Further, if sedation and recumbency or general
anesthesia is anticipated, oral water loading will increase the risk of regurgitation. In such cases,
following hypertonic saline with parenteral isotonic fluids is a safer choice.
Preoperative flunixin meglumine (1.1–2.2 mg/kg IV) has been used by the author and others6 for
analgesia during standing surgery, with inconsistent results. Xylazine (0.02 mg/kg IV) or detomidine
(0.01 mg/kg IV) can be administered with or without butorphanol (0.05 mg/kg IV) to achieve sedation
for approximately 30–60 minutes without causing standing cows to become recumbent; no surgical
procedure was performed on the animals of that study, however.7 In a study of standing surgical
correction of LDA or abomasal volvulus in dairy cows, xylazine (0.02 mg/kg IV) was used alone or in
combination with butorphanol (0.05 or 0.07 mg/kg IV).8 Preoperative administration of xylazine and
butorphanol reduced the volume of 2% lidocaine necessary for paralumbar celiotomy; however, local
anesthetic was still needed for complete anesthesia.8 In the author’s experience, the risk for a standing
cow to lay down during surgery is correlated with extensive manipulation of the intestine. When
available, assistance should be sought when extensive bowel handling is anticipated. It is often helpful to
tie the animal’s head with a halter pulled toward the side of the surgical approach. If the animal lies
down during the procedure, it will usually end up with the surgical (left) side facing upwards. For
debilitated animals, securing the animal in lateral recumbency at the onset of surgery may limit the
disruption that occurs when the standing animal lies down. To facilitate closure of a flank laparotomy
incision in an animal in lateral recumbency, pillows or padding can be placed under the down-side
shoulder and down-side hip to induce concavity in the up-side flank. Pre-operative antimicrobial therapy
is indicated if bowel incision is anticipated, if surgical time is anticipated to be prolonged, or if concurrent
infection exists.

SUMMARY
ƒ Consideration of differential diagnoses by patient signalment may aid the practitioner in
establishing a differential diagnosis.
ƒ In adult cattle, abdominal exploration has value as a diagnostic, prognostic, and therapeutic course
of action.

REFERENCES
1. Berghaus RD, McCluskey BJ, Callan RJ (2005). Risk factors associated with hemorrhagic bowel syndrome in
dairy cattle. J Am Vet Med Assoc 226: 1700–06.
2. Radostits OM (2000). Clinical examination of the alimentary system–ruminants. In: Radostits OM, Mayhew IG,
Houston DM, editors. Veterinary Clinical Examination and Diagnosis. London: WB Saunders, pp. 409–468.
3. Fubini SL (1990). Surgical management of gastrointestinal obstruction in calves. Comp Cont Ed Pract Vet 12(4):
591–598.
4. Roussel AJ, Cohen ND, Holland PS, et al (1998). Alterations in acid-base balance and serum electrolyte
concentrations in cattle: 632 cases (1984–1994). J Am Vet Med Assoc 212(11):1769–75.
5. Constable PD (1999). Hypertonic saline. Vet Clin N Amer: Food An Pract 15(3): 559–585.
6. Rebhun WC (1995). Abdominal diseases. In: Diseases of Dairy Cattle. Media, PA: Williams and Wilkins, pp. 106–
154.
7. Lin HC, Riddell MG (2003). Preliminary study of the effects of xylazine or detomidine with or without
butorphanol for standing sedation in dairy cattle. Vet Ther 4(3): 285–291.
8. Levine HD, Dodman NH, Court MH, et al (1992). Evaluation of xylazine-butorphanol combination for use
during standing laparotomy in dairy cattle. Ag Pract 13(7): 19–23.