case presentation (ruminant)

Kiatisak Jooypan, Chanon Kamta, Nattapol Seehawat,

Parach Ponium, Sirikorn Pamornsupornvichit

Case Presentation Group 2

Mahidol UniversityFaculty of Veterinary

Science

First day

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

Problems ListAbdominal pain

RCR alteration

Panting

Obtundent

• 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

Second

day

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


Electrolytes

Serum chemistry

• Serum renal profile

• Serum liver profile

Plan

Sadly, the owner

decided to take this

cow to slaughter.

Gross lesions

Abdominal cavity: Peritoneal effusion and

Fibrinosuppurative inflammation

Abdominal cavity: Fibrinosuppurative adhesion

and

Ecchymosis hemorrhage

Serosal surfaces: Diffuse hemorrhage

Heart: Petechial hemorrhage

Kidney: Small yellowish white cortical

abscesses

Kidney: Renal enlargement

Pyelonephritis: Suppurative inflammation

of kidney and the renal pelvis

Laboratory

Results

(Fist day)


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

Laboratory

Results

(Second day)


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

Gram Staining

Gram staining

Pus in pelvis Gram positive cocci

Peritoneal

fluid

Gram positive cocci

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

Kidney Histopathology

4X


10X

• Suppurative pyelonephritis with multiple abscesses

Histopathology


Microscopic finding

- Cellular

destruction

- Necrotic debris

- PMNs

40

X

Problems List

(new)

Renal enlargement Peritonitis

Panting Obtundent

Revised

Assessment

• Acute renal failure

• Acute pyelonephritis

• Hypertrophy

• Hydronephrosis

• Neoplasia

• Pyogranulomatousnephritis

• Renal cyst

• Abscessation

Renal enlargement

• GI disease

• Hepatobiliarydisease

• Mesenteric tension

• Musculoskeletal


• Pancreatic disease

• Reproductive problem

• Trauma


• 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


• Trauma


Abdominal pain

• Traumatic reticuloperitonitis

RCR alteration

Differential

Diagnosis

Renal diseases

• Acute pyelonephritis

GI diseases

• Intestinal ulcers


• 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

Special Thanks

Dr. Taweewan

Tansatit

Veterinary Pathologist

Thank you

For your

attention

Leptospirosis Test kit

Negative

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

Differential

Diagnosis

Renal diseases

• Acute renal failure

• Renal infection

GI diseases

• Bloat


Systemic diseases

• Infection

• Inflammation

case presentation (ruminant)

Education