case presentation (ruminant)
TRANSCRIPT
Kiatisak Jooypan, Chanon Kamta, Nattapol Seehawat,
Parach Ponium, Sirikorn Pamornsupornvichit
Case Presentation Group 2
Mahidol UniversityFaculty of Veterinary
Science
Case PresentationS
ign
alm
en
t • Species: Bovidae
• Breed: Holstein Friesian
• Sex: Female
• Age: 5 years
• Body condition score: 3/5
• Weight: 370 kgC
linic
al S
igns • Milk production
has decreased
• Lordosis posture
• Obtundent
Production • Mid lactation cow
Previous Medication
• Terramycin® (Oxytetracycline) 50 ml.
• Butasyl® (Phenylbutasone)
Vaccination profile
• FMD type O, A, Asia 1 and A-Sakolnakorn
Feed• Concentrate, Soybean meal, Cob &
Corn
Reproduction and
Production profiles
• Last AI
• 30th, May, 2012
• Day open
• > 105 days
History Taking
Physical ExaminationGeneral appearance: Obtundent and Lordosis posture
Heart rate: 78 bpm, Respiratory rate: 73 bpm
Rectal temperature: 102.4 F
Capillary refilling time: 2 seconds
Mucous membrane: Pale pink
Hydration status: < 5%
Rumen contraction rate: 3 times/2 minutes incomplete
• GI disease
• Hepatobiliary disease
• Mesenteric tension
• Musculoskeletal
• Internal organ rupture
• Pancreatic disease
• Reproductive problem
• Trauma
• Urinary problems
• Drugs and toxins
Abdominal pain
• GI problems
• Bloat
• Obstruction
• Bacterial overgrowth
• GI ulcer
• Hardware disease
• Non GI problems
• Pyrexia
• Stress
• Drug/toxin
RCR alteration
• Physiological causes
• Lower airway disorders
• Restrictive disorders
• Systemic and miscellaneous disorders
• Drugs/toxins
Panting with increase expiration sound
Initial Assessment
Complete blood count
Serum chemistry
• Serum renal profile
• BUN, Creatinine
• Serum liver profile
• Total protein, ALP, AST, ALT
Initial Plan
Physical ExaminationGeneral appearance: Obtundent and Lordosis posture
Heart rate: 80 bpm, normal heart sound
Respiratory rate: 80 bpm (abdominal breathing), increased expiration sound
Rectal temperature: 102 F
Capillary refilling time: 2 seconds
Mucous membrane: Pale pink, hydration status: < 5%
Rumen contraction rate: 1 times/2 minutes incomplete
Additional Tests
Left kidney enlargement
Bloody mucous stool
Rectal palpation
Negative
Metal detector
Complete blood count
Types Referenc
e
Results
WBCx10/mm3
(4-12) 57.3
Monocyte (80-850) 0
Neutrophil (600-5400) 53,289
Lymphocyte (1800-9000) 1,146
Eosinophil (0-2400) 573
Basophil (0-250) 0
Band Neu. (0-250) 2294
RBC x106/µl (5-10) 6.86
MCV [fl] (40-60) 45
MCH [pg] (13-18) 18.6
MCHC [g/dl] (30-36) 41.3
PLT x 103/µl (100-800) 138
Hb [g/dl] (8-15) 12.8
Hct% (24-46) 34
PLT [smear] adequate decreased
Morphology Normal
Results- Leukocytosis
- Netrophilia with left shift
- Monocytopenia
- Lymphocytopenia
Serum chemistry
Tests Referenc
e
Results
BUN (mg%) (10-20) 93.2
Creatinine (mg%) (1-1.6) >10
ALP (IU/L) (64-282) 218
AST (IU/L) (31-95) 141
ALT (IU/L) (3-41) 14.2
Total protein
(mg%)
(5.9-8.1) 4.8
Serum Chemistry
Results- Azotemia
- Hypoproteinemia
Complete blood count
Test Referenc
e
Result
WBCx10/mm3 (4-12) 24.3
Monocyte (80-850) 0
Neutrophil (600-5400) 17253
Lymphocyte (1800-9000) 1701
Eosinophil (0-2400) 0
Basophil (0-250) 0
Band Neu. (0-250) 5346
RBCx106/µl (5-10) 6.86
MCV [fl] (40-60) 45
MCH [pg] (13-18) 18.2
MCHC [g/dl] (30-36) 40.1
PLT x 103/µl (100-800) 111
Hb [g/dl] (8-15) 12.5
Hct% (24-46) 35
PLT [smear] adequate decreased
Fibrinogen (450-750) 400
Results- Leukocytosis
- Netrophilia with left shift
- Monocytopenia
- Lymphocytopenia
- Decreased fibrinogen
Serum ChemistrySerum chemistry
Test Referenc
e
Results
Glucose (mg%) (54-154) 131
BUN (mg%) (10-20) 125
Creatinine (mg%) (1-1.6) >10
ALP (IU/L) (64-282) 217
AST (IU/L) (31-95) 138
ALT (IU/L) (3-41) <5
Total protein
(mg%)
(5.9-8.1) 5.2Results- Azotemia
- Hypoproteinemia
- AST increased slightingly
ElectrolytesElectrolytes
Test Referenc
e
Result
s
Na+ (mmol/L) (132-152) 118
K+ (mmol/L) (3.9-5.8) 7.4
Ca2+ (mmol/L) (2.0-2.63) 0.79
Results- Hypernatremia
- Hyperkalemia
- Hypocalcemia
UrinalysisUrinalysis
Urine
source
Cystocentesis
Color Yellow-Green
Transparen
cy
Turbid
USG 1.020
pH 6.0
Protein 2+
Glucose Negative
Ketone 1+
Bilirubin Negative
Nitrate Negative
Blood/Hb Negative
Leukocytes 1+
Sediment 50/hpf WBC
1-5/hpf RBC
Results- Hypersthenuria
- Aciduria
- Proteinuria
- Ketonuria
- Neutrophils in urine
Peritoneal Fluid
AnalysisPeritoneal fluid analysis
Color Pale-Red
Transparenc
y
Turbid
Protein 40 g/dl
Specific
gravity
1.030
Cytology Numerous PMNs
Moderate RBCs
Few epithelial cells
Results- Modified transudate
SummaryComplete blood count
• Leukocytosis
• Netrophilia with left shift
• Monocytopenia
• Lymphocytopenia
• Decreased fibrinogen
Electrolytes
• Hypernatremia
• Hyperkalemia
• Hypocalcemia
Serum chemistry
• Azotemia
• Hypoproteinemia
Urinalysis
• Hypersthenuria
• Aciduria
• Proteinuria
• Ketonuria
• WBCs in urine
• Suppurative pyelonephritis with multiple abscesses
Histopathology
Kidney Histopathology
Microscopic finding
- Cellular
destruction
- Necrotic debris
- PMNs
40
X
Revised
Assessment
• Acute renal failure
• Acute pyelonephritis
• Hypertrophy
• Hydronephrosis
• Neoplasia
• Pyogranulomatousnephritis
• Renal cyst
• Abscessation
Renal enlargement
• GI disease
• Hepatobiliarydisease
• Mesenteric tension
• Musculoskeletal
• Internal organ rupture
• Pancreatic disease
• Reproductive problem
• Trauma
• Urinary problems
• Drugs and toxins
Abdominal pain
• GI problems
• Bloat
• Obstruction
• Bacterial overgrowth
• GI ulcer
• Hardware disease
• Non GI problems
• Pyrexia
• Stress
• Drug/toxin
RCR alteration
• Physiological causes
• Lower airway disorders
• Restrictive disorders
• Systemic and miscellaneous disorders
• Drugs/toxins
Panting with increase expiration sound
Revised
Assessment
• Pyelonephritis
• Abscessation
Renal enlargement
• GI disease
• Internal organ rupture
• Trauma
• Urinary problems
Abdominal pain
• Traumatic reticuloperitonitis
RCR alteration
Differential
Diagnosis
Renal diseases
• Acute pyelonephritis
GI diseases
• Intestinal ulcers
• Traumatic reticuloperitonitis
• Suppurative inflammation of kidney and
the renal pelvis caused by bacterial
infection
Risk factors
- After parturition
- Multiparous cows
Pyelonephriti
s
Possible causative agents
• Pyogenic gram positive coccibacteria
• Staphylococci (skin flora)
• Streptococci
• Other
Infection routes
• Ascending infection
• Hematogenous infection (descending)
Triggers
• The stresses of parturition
• Traumatic insult
• Peak lactation
• High-protein diet
• Reflux of urine
• Tail switching
Pathogenes
is
Possible causative agents
• Pyogenic gram positive cocci bacteria
• Staphylococcus spp.
• Streptococcus spp.
Gram staining
Pus in pelvis Gram positive cocci
Peritoneal
fluid
Gram positive cocci
Gram Staining
Pathophysiolog
y Renal abscesses
Pyelonephritis
Abdominal
cavity
Peritonitis(Fibrinosuppurative
adhesion)
Intestinal serosa damages
Septicemi
a
Peritoneal effusion(Modified transudate)
• Penicillin G (22,000 IU/kg, IM, bid) +
Trimethoprim-sulfadoxine (16 mg
combined/kg, IM, bid) for ≥ 3 wks
Treatme
nt
• Fluid therapy
– Fluid rate = dehydration x B.W.
– Maintenance fluid
• Anti-inflammatory drugs
• Analgesic drugs
– NSAIDs
• Reduced protein feed
Supportive
Treatment
Environment hygiene
Protein component in feeds
Parturition management
AI has been associated with a reduction in the number of cases
Affected animals should be isolated
Prevention &
Control
USG evaluation in
cattleIsosthenuric range
• 1.006-1.014
Hypersthenuric range <1.022
• Renal diseases
Hypersthenuric range >1.022
• Dehydration
Ruminal Content
AnalysisRuminal content analysis
pH 7
Gram stain Gram negative bacilli
Gram negative cocci
Fecal ExaminationFecal examination
Gross Mucous stool
Direct smear NF
Simple floatation NF
Simple
sedimentation
NF
Protein in FeedFeed types
Weight
kg)%DM %CP DM (kg) %
Protein
intake (%)
Soybean
meal100.00 88.50 47.00 88.50 10.17 4.78
Wheat germ 200.00 87.50 16.30 175.00 20.11 3.28
Bran extract 200.00 88.90 17.30 177.80 20.43 3.53
Cassava 200.00 89.80 2.30 179.60 20.63 0.47
Palm meal 90.00 93.30 15.70 83.97 9.65 1.51
Coconut meal 140.00 92.30 17.10 129.22 14.85 2.54
Bone meal 20.00 96.40 7.10 19.28 2.22 0.16
Salt 15.00100.0
015.00 1.72 0.00
Premix 2.00100.0
02.00 0.23 0.00
967.00 92.97 870.37100.0
016.28
kg/cow/day %CP %DM DM (kg) % Protein (%)
Concentrate 7.00 16.28 92.97 6.51 55.94 9.11
Soybean