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Clinical examination of the abdomen in adult

cattle

Article in In practice June 2004

DOI: 10.1136/inpract.26.6.304

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Peter Cockcroft
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Some common and economically

important conditions of the
abdomen, such as left displaced
Abomasum abomasum (shown here in posterior
transverse view at the level of the
13th rib) can be readily identified
on careful clinical examination and
cost-effectively corrected

Left

Clinical examination of the abdomen

in adult cattle PETER COCKCROFT PETER JACKSON AND

CLINICAL examination of the abdomen in adult cattle can be daunting due to the fractious nature
of infrequently handled animals and the lack of adequate restraint facilities on some farms. For many
veterinary surgeons, cattle have become an unfamiliar species which are only examined periodically. The
range of abdominal conditions which may occur in cattle is challenging and a careful cost-benefit analysis
is required before an investigative or treatment protocol in embarked upon. Nevertheless, much can be
achieved by using a methodical approach and many conditions may be successfully (and dramatically)
treated if the correct diagnosis is achieved. This article describes how to conduct a systematic clinical
Peter Cockcroft
graduated from examination of the bovine abdomen and outlines the abnormalities which may be found. In particular, it
Cambridge in 1980. considers the observation and examination of the patient and any further diagnostic investigations which
He is a senior lecturer
in farm animal may be useful. Where appropriate, specific conditions are used to illustrate the abnormalities which may
medicine at the be present. The urogenital system is not covered.
University of
Cambridge and
holds the RCVS
diploma in cattle
CLINICAL EXAMINATION OBSERVATION OF THE PATIENT
health and
production. The primary purpose of the clinical examination is to Useful information can often be derived by observing
identify the clinical abnormalities and the risk factors that cattle at a distance and this stage of the clinical examina-
determine the occurrence of disease in an individual or tion should not be rushed. Ideally, observation should be
population of animals. From this information, the most performed with the patient in its normal environment.
likely cause, the organs or systems involved, the location This enables its behaviour and activities to be monitored
of the lesion, the type of lesion present, the pathophysio- without restraint or excitement, and to be compared with
logical processes occurring, the severity of the disease those of other members of the group and accepted normal
and the epidemiology of the outbreak may be deduced. patterns. More often than not, however, sick animals have
The clinical examination should ideally proceed been separated from their group and assembled in collect-
through a number of steps (see box below). It is impor- ing yards or holding pens to await examination, and most
Peter Jackson tant to consider the findings of a specific topographical observations are made in this situation.
graduated from examination in the light of other components of the clini-
Edinburgh in 1960.
After 16 years in cal examination to avoid misinterpretation.
general practice, he
worked as a lecturer
in veterinary
obstetrics at the
Royal (Dick) School
of Veterinary Studies.
Appreach to th clinical
In 1980, he moved to exain affon
Cambridge veterinary
school as a university * Owner's complaint
physician. He retired
in 2002, but * History of the farm
maintains a keen * Signalment of the patient
interest in medicine
and obstetrics.
* History of the patient
* Examination of the environment
Observation of the patient
* Physical examination of the patient
* Further investigation
Observation is an important part of the clinical examination

304 In Practice * J U N E 2 0 04
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Cinkal signs of abdominal bease

Behavioural signs
* Kicking at the abdomen
* Reluctance to get up and down
* Movements made with care
* Grunting
* Grinding of the teeth
Abnormal posture
* Rocking horse posture: lower-
ing the back, stretching the fore-
legs forwards and the hindlegs
backwards (intussusception)
Faecal signs
* Presence or absence of faeces
(on the floor)
d_bb by observatlen
* Reduction or increase in the
quantity of faeces
* Changes in faecal composition
* Perineal staining (diarrhoea)
Other signs
* Dullness
* Straining in an attempt to
defecate (rectal tenesmus)
* Reduced eructation, regurgita-
tion and cudding rate
* Low body condition score
(chronic condition)
* Dropping of the cud (patholo-
gy involving the cardia or sub-
acute ruminal acidosis)
* Swishing of the tail (subacute
ruminal acidosis)
* Dyspnoea (bloat, pain)
e Sunken eyes (dehydration or
cachexia)
* Increased respiratory rate (com-
pensation for metabolic acidosis
or pain)
* Recumbency (due to weakness
or pain)
* Reduced appetite or anorexia
* Jaundice (of non-pigmented
areas of the skin such as the
udder)
* Neurological signs (hepatic
encephalopathy)

Points which should be assessed include feeding,
eating, urination, defecation, interactions between group
members and responses to external stimuli. In addition,
the patient should be made to rise and walk, allowing its
posture, contours and gait to be evaluated and any gross
clinical abnormalities to be detected.
Observations of the abdominal silhouette should be
made from a distance of several metres from behind the
animal to get an overall impression of its shape (see box
on the right and diagrams below). Viewing each side of
the animal from an oblique angle can be useful to high-
light changes in the lateral contours. The abdomen can
be split into four quadrants - left dorsal, left ventral,
right dorsal and right ventral. Abnormalities of the con-
tours within each quadrant should be noted.
PHYSICAL EXAMINATION OF THE PATIENT
RESTRAINT
Although it may be possible to examine a docile dairy
cow with little restraint, it is in the interests of the patient
and the examining veterinary surgeon to make use of any
restraint facilities available no matter how primitive.
This will optimise safety for the clinician and will usual-
ly increase the scope of the examination. Restraint facili-
ties may include the use of swing gates, artificial insemi-
nation stalls, races, the milking parlour, Wopa boxes
(Wopa, Harreveld, Netherlands) or crushes. An anti-kick
bar may be helpful when performing a peritoneal tap.
Ch__gms In the lte1ral
abd alima 0
* Sprung left costal arch (left displaced
abomasum)
* Distended left dorsal quadrant (ruminal bloat)
* Distension of the right dorsal quadrant (right
displaced abomasum)
* Distension of the left and right dorsal quadrants
(pneumoperitoneum)
* Distension of the left dorsal quadrant and the
right ventral quadrant, sometimes called the '10 to
four' or a 'papple' profile (vagal indigestion)
* Distension of the right and left ventral quad-
rants (hydrops uteri and accumulations of fluid in
the peritoneum such as uroperitoneum or ascites)
* Distension of the right ventral quadrant and,
to a lesser extent, the left ventral quadrant (late
pregnancy)

(A) (B) (C) (D)

Posterior views of (A) the normal silhouette of the lateral abdomen in cattle, (B) ruminal bloat causing distension of the left dorsal quadrant of the
abdomen, (C) vagal indigestion causing distension of the left dorsal and right ventral quadrants, (D) pneumoperitoneum causing distension of the
left and right dorsal quadrants

306 In Practice * JUNE 2004

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Cattle may be restrained for clinical examination using

(above) a crush or (left) a Wopa box

Regional anatomy
A good knowledge of the applied topographical anatomy of the bovine abdomen
is essential so that the clinician is aware of the underlying structures being evalu-
ated during the clinical examination.

(above) The gastrointestinal tract. (right) Horizontal section through the thorax and
abdomen at the level of the proximal humerus

Diaph

Splee

ejunum Omasum
Reticulum /77 I
Abomasum
Left lateral view of the abdominal viscera in situ Right lateral view of the abdominal viscera in situ

In Practice * J UNE 2004 307

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EXAMINATION OF THE LEFT ABDOMEN
Examination of the left side of the abdomen involves
assessing the rumen and reticulum, and checking for evi-
dence of left displaced abomasum.
Palpation of the rumen
The rumen can be palpated through the abdominal wall
at the left sublumbar fossa. This can provide some idea
of the size and fullness of the rumen. In the normal ani-
mal, the contents of the upper part of the rumen have a
doughy consistency, but digital pressure should not leave
a lasting impression once palpation ceases. In cases
of vagal indigestion, there may be rumen overfill with
fibre and an impression of a fist pushed into the sublum-
bar fossa will remain following withdrawal of the fist.
Pneumoperitoneum caused by intraperitoneal gas may
cause mild to moderate distension of the right and left
sublumbar fossae. This may occur following abdominal
surgery when air is drawn into the peritoneal cavity by
diaphragmatic movements associated with breathing. It
is also sometimes produced in cases of generalised peri-
tonitis. The condition is confirmed by pushing inwards
at the distended left sublumbar fossa where the normal
rumen wall will be detected. The rumen is much reduced
in size in inappetent or cachectic animals. In some cattle
that have been anorexic for several days. the dorsal sac
of the rumen may collapse inwards and cannot be palpat-
ed; this can be confirmed by rectal examination.
Rumen movements
The adult pattern of ruminal movements is established
at between six and eight weeks of age. Ruminal move-
ments are controlled by the vagus nerve and have four
functions:
* Mixing ingesta (A cycle);
* Moving ingesta (A cycle);
* Eructation (B cycle);
* Regurgitation for rumination.
There are normally one or two ruminal movements
per minute. These can be detected at the left sublumbar
fossa by observation (in thin animals with a short coat),
palpation and auscultation using a stethoscope. The last
is the most sensitive of the three methods. Changes in
rumen motility are indicators of disease. Hypomotility
(less than one movement every two minutes) or rumeno-
stasis may cause free gas bloat and is associated with a
number of conditions, including milk fever, carbohydrate
engorgement (ruminal acidosis) and painful conditions of
A clenched fist can be pushed into the left sublumbar fossa
to assess rumen fill
308
Checklist for examination of the
left abdomen
distension of the
* Detailed examination of any
rumen
* Assessment of rumen contents by palpation
* Assessment of rumen motility by palpation or
auscultation
* Auscultation and percussion to check for left
displaced abomasum
* Rumen fluid collection and analysis, if required
* Tests for anterior abdominal pain
the abdomen. Hypermotility (more than five movements
every two minutes) is less common and is associated with
conditions such as frothy bloat. vagal indigestion, enteri-
tis anld Johne's disease.
Ruminal bloat and acidosis
A diagnosis of ruminal bloat can be made if hyper-
resonance is present on percussion and auscultation of the
distended left sublumbar fossa. Oesophageal obstruction
should be considered, particularly if accompanied by
excessive salivation. Decompression can be attempted
either by using a large 16 gauge, 5 cm needle inserted
into the tympanic dorsal sac of the rumen through the
flank or by passing an oral or intranasal stomach tube into
the rumen. It will be impossible to pass a stomach tube in
the presence of an oesophageal obstruction caused by a
foreign body. If a tube can be passed, free gas bloat can
be easily decompressed. Frothy bloat blocks the tube or
Auscultation is the most sensitive method for evaluating
ruminal movements
_~~~~~~~~~~~~~~~~~~~~~~~~
e~~~~~~~~~~~~~~~~~~~~~~ .
_S~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Iu~~~~~~~~~~~~~~~~~~~~~~~~
Palpation may be used to identify distension
of the left sublumbar fossa
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needle and decompression will not be achieved. In cases Rumen fluid

of ruminal acidosis, the fluid volume of the rumen When pyloric obstruction, ruminal acidosis or poor
increases due to osmosis into the hypertonic rumen. rumen function are suspected, rumen fluid collection and
Ballottement of the rumen may reveal splashing sounds analysis may provide useful additional information (see
caused by the excess fluid. later).

Left displaced abomasum

No physical examination of the left side of
the abdomen is complete without checking
for left displaced abomasum, which is a
common condition in the early postpartum
dairy cow. Milk yield and appetite are
depressed in affected cases. Ketosis is invari-
ably present and can be identified by a
'pear drops' smell on the breath or by test-
ing the urine, milk or saliva for ketones
using Rothera's test or reagent strips for
urinalysis (Multistix SG; Bayer Diagnostics).
Concurrent conditions, such as mastitis or
endometritis, often occur.
In cases of left displaced abomasum,
the fluid- and gas-filled displaced abomasum
is positioned between the left abdominal
wall and the rumen. Characteristic sounds
are produced by rising bubbles of gas and by
the gas/fluid interface within the displaced
abomasum. The musical tinkling sounds pro-
duced by escaping gas bubbles can some-
times be heard by simple auscultation using
a stethoscope. Gentle ballottement of the
abdomen using a clenched fist or by gentle
rocking may evoke these sounds. High-
pitched resonant 'pings' (which sound like a
basketball being bounced on a concrete floor
or a steel drum being hit) may be detected
by simultaneous percussion and auscultation
over the region of the displaced abomasum.
The position and size of the displaced
abdomen is variable. It is generally recom-
mended that clinical evaluation should be
focused along a line drawn from the left
elbow to the left tuber coxae, although it
can be found much higher or lower than
this. In general, clinical evaluation along this
line from ribs 9 to 13 is the most rewarding.
The resonance produced by the normal
gas cap within the rumen can sometimes
be confused with that produced by a left
displaced abomasum. This can usually be
discounted by passing a stomach tube into
the rumen and decompressing any gas that
may be present. The clinical evaluation is
then repeated. A collapsed dorsal sac of
the rumen can produce a ping with a lower
pitch. The rumen movements may be nor-
mal or reduced in intensity and frequency.
Passing an oral or intranasal stomach tube
into the rumen and blowing down the tube
produces a bubbling sound which is audible
when a stethoscope is placed over the left
sublumbar fossa. It is claimed that the bub-
bling sound cannot be heard when left dis-
placed abomasum is present, although this
is highly subjective.

Development of left displaced abomasum Line along which 'pings' are commonly elicited during auscultation and
percussion in animals with left displaced abomasum

Auscultation and percussion of a cow with left displaced abomasum Urine samples can be used to confirm ketosis

In Practice * J U N E 2 004 3 09
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Confirmation of left displaced abomasum

Abomasocentesis
Further confirmation of a left displaced abomasum
can be achieved by abomasocentesis although this
procedure is usually unnecessary. To perform abo-
masocentesis, the skin in the intercostal space over
the region in which pings are heard is aseptically
prepared and a lumbar spinal needle quickly insert-
ed. Following removal of the stylet, a sample of abo-
masal fluid is withdrawn using a syringe. The pH of
the sample can then be measured with pH indicator
paper. If the pH is in the range of 2 to 4, this is consis-
tent with the presence of a left displaced abomasum.
If it is impossible to obtain a fluid sample, damp pH
paper can be held close to the hub of the needle in An abomasal tap can be used to confirm left displaced
the stream of escaping gas from the abomasum. The abomasum
indicator paper should register a low pH if the abo-
masum has been punctured. identified by ultrasonography in the normal position
just to the right of the ventral midline, a diagnosis of
Ultrasonography left displaced abomasum can be ruled out.
Ultrasonography can be used to identify a displaced
abomasum as the folds of the abomasal mucosa Laparoscopy/laparotomy
contrast with the papilliform mucosa of the rumen. Laparoscopy or surgical laparotomy will allow direct
However, experience is required to differentiate these visualisation or palpation to establish whether or not
two structures. Alternatively, if the abomasum can be a left displaced abomasum is present.

EXAMINATION OF THE RIGHT ABDOMEN

Traumatic reticulitis Examination of the right side of the abdomen is per-
formed to the assess the liver. abomasumi intestines and
Cattle with traumatic reticulitis may be reluctant to
move and may stand with an arched back or may be
graxid uterus.
anorexic and pyrexic. Cases that have progressed to
Liver
traumatic reticulopericarditis may have cardiovascu-
Liver disease in cattle may be diagnosed by:
lar signs including those of congestive heart failure.
* Clinical signs:
The animal may grunt when it moves or breathes
* Palpation aind percussion:
due to pain induced by parietal peritoneal irritation.
* Clinical pathology (see later):
Physical tests (see box on the facing page) for
* Ultrasonography;
the anterior abdominal pain which is usually associ-
* Liver biopsy (see later).
ated with traumatic reticulitis are the:
Additional techniques include:
* Withers pinch test;
* Laparoscopy:
* Bar test;
* Exploratory laparotomy (see later).
* Knee/fist test;
Clinical signs of liver disease include weight loss, diar-
* Eric Williams test.
The sensitivity of these tests is increased by plac-
rhoea, haemorrhage, hepatic encephalopathy, photosensiti-
sation, ascites anid jaundice. Prehepatic causes of jaundice,
ing a stethoscope over the ventral trachea so that
such as haemolytic anaemiia are common in cattle.
normally inaudible grunts in response to pain can be
The liver cannot normally be palpated and lies beneath
detected.
the costal arch. If it is grossly enlarged or displaced pos-
Wing of ilium Right displaced
abomasum

Palpation behind the costal arch on the right-hand side may reveal Line along which abnormal pings identified by auscultation and percussion
liver enlargement in the presence of a right displaced abomasum and a distended caecum

310 In Practice * J U N E 2004

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teriorly, it may be palpated by pushing the fingers behind
the right costal arch. The liver may be enlarged in cases
of chronic liver fluke infection and congestive heart fail-
ure. The exact location of the liver can be confirmed by
either percussion with or without simultaneous ausculta-
tion using a stethoscope or ultrasonography. Ultrasound
examination can also help to establish the size, position
and consistency of the liver as well as confirm the pres-
ence of abscesses. The liver can be identified through
intercostal spaces 6 to 12 on the right-hand side. The cau-
dal vena cava may be examined between ribs I I and 12
and the gallbladder through the 9th, 10th or 11th inter-
costal space. The gallbladder lies on the caudal border of
the liver, but is seldom involved in pathology although it
may be enlarged in some cases of salmonellosis.
Abomasum, intestines and gravid uterus
Abnormal contours identified earlier should be explored
in detail. Distension of the right sublumbar fossa may be
seen with right-sided abomasal or caecal dilation and/or
torsion. However, a distended lower right flank is normal
in the last trimester of pregnancy. Other causes of
ruminal distension include vagal indigestion, omasal or
abomasal impaction and generalised peritonitis.

Tests for the detection of anterior abdominal pain

Withers pinch test Bar test

The withers pinch test is performed by grasping a
fold of skin over the withers. This will cause the ani-
mal to dip the spine. If there is a penetrating for-
eign body which causes irritation of the parietal
peritoneum during the test, the animal will resent
making this movement and will usually grunt.
The bar test involves applying upward pressure on the anterior abdomen to
check for discomfort and associated grunting. The test is best performed with
an operator standing on either side of the animal. A padded metal or wooden
bar is placed beneath the animal and positioned just behind the xiphisternum.
Each operator slowly raises the bar and then lowers it quickly. The veterinary
surgeon should place a stethoscope over the trachea in the ventral midline of
the neck and auscultate for a grunt. In an animal with acute traumatic reticuli-
tis, this sudden movement will often elicit discomfort and a grunt.

Knee/fist test Eric Williams test

The knee/fist test involves applying a sudden The Eric Williams test is a
upward force with the knee or fist in the area of more subtle technique for the
the xiphisternum. A grunt with resentment can be early detection of traumatic
expected if the animal has anterior abdominal pain. reticulitis. However, the test
cannot be performed if there
is ruminostasis. A stethoscope
is positioned over the trachea
and a hand placed on the
left sublumbar fossa to detect
ruminal movement. A quiet
and normally inaudible grunt
may be heard just prior to
the start of the ruminal com-
ponent of the A cycle. The
grunt is due to pain elicited
by the double reticular con-
traction which causes the
penetrating foreign body to
produce parietal peritoneal
irritation.

In Practice o JUNE 2004 31 1

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Ballottement of the abdomen may help to define the
character of an internal structure
Checklist for examination of the right abdomen
* Detailed examination of any contour abnormalities
* Palpation and auscultation of the right body wall for pings
* Auscultation and succussion to assess intestinal motility and content
* Ballottement to identify normal and abnormal structures
* Test for pain in the right ventral anterior quadrant
* Check for enlargement of the liver by palpation
* Assessment of the contents of the peritoneal cavity
The right hody vall should he examined by perCCLs-
sion a.nd aluseultation for pings along the dors.al and vell-
tral region ot a linc troim the clhow to the right tuha
cox.ae. Contditionis producing pings invclude abhomasal
dil,ation/torsion (anterior sublumbLIar. fossa). caecal dil -
tion/torsioll or01gs in the rectuLIm (posterior sublumblharl-
fossa) and pnCeimopei-itoneumil (dilated dorsal quadrant).
Normal intestinal sounds (borborygmil) mray be heard
intermittently in the rig,ht ventiral quadrant every 15 to 3))
seconds, but their ibsencce is tiot diagnm-lostic of an ahblom-
itl conbdition. Fi-equent peristaltic sounlds may indliclte
intestinal hy permotility. Splashing1 soulids caulsedt hb
excessixVe fILlid inl the initestines may be detected by hal-
lottement anid sucCussioi. Thesc sounlids imay be ideenti-
fled in association A ith enteritis, rumliinal acidosis or
intestin.al obstruCtioll. Ultrasonography of the small
intestines is possible and peristaltic mov ements can be
obserxved easilv in the normial aninial. The contncits of'
the intestines cian atlso be im-a,ged. Fibrin tags may he
idtentified if peritonlitis is present.
Checklist for rectal examination
* The quantity and composition of faeces should be noted
* Palpate the dorsal sac of the rumen to assess position, size and content
A Palpate the right side of the abdomen to check for:
- Dilated and distended loops of bowel (caecum, large and small intestine)
- A solid intussusception
- A dilated abomasum
- Abdominal masses
- An enlarged liver
- Fibrous adhesions or peritoneal roughness
312
- * w -
Succussion and auscultation may induce splashing sounds
if there are abnormal amounts of fluid in a viscus
Ballottemilenit ot the loNver flank in late preginiancy will
eaIusC thc letLIs to impact on i-choLiind on the ballotting
haiid. Somietimies lai-ge masscs ol tat arc presenlt in caIses
ol t'at necrosis, aInd impactions ot the abomalsU max
also be detccted in this Wx a.
Pain tests should be perfoi med on the anteiiol- xentral
quladrant ol the abdomienr by pressing, a knee or1 clenclhed
list quieckly and firmly into the abdomen. A pain responise
may indicate a Oeal peritonitis occurring secondirily to a
pertlorated abomsal ulcer. This usual ly oCCuL-s in high-
vieldine dairy cov s duriinc- earkl lactation.
EXAMINATION OF THE CONTENTS
OF THE PERITONEAL CAVITY
Detection ol excessix e flllid in the .Abdomen by physical
meatis is not CasV unless the aICCulaLtionls are laroe.
Gross distension ot the abdomileni duc to ascitcs is rare. A
Iluid thrill is difficult to identity by bcallottement becaLuse
of the fluid contenit of the ventral rumenL.
Abdomi nocelltesis and/or u It.rasonography are extieme-
ly useful fOr detecting aind characterising abnorm-ualities ot'
the peritoneal tiuid. 0n ultl-rsouInd examIIlinatioi, excessixe
peritoneal Iluid can bc scenI as non-echogenic IbLuid
imlalges. Floating leaxI\ es ot oedematouLs oImeCIntuLIm ImaV
be presenit W ith mioper-itOlICuLI. Per-itollitis mlay producc
hyperechogen ic tags of fihbriii. Peritonacal tILuid samples
obta.ined hy ahdomninoccritesis can be assessed by gross
examinii.ationl or senit 1or laiboratory .analysis aind hacterio-
IoWical CuLltllre (See later).
RECTAL EXAMINATION
Rectal examination can be used to identity coniditions
affecting the gastrointestinal and Lirogenital traicts. The
technique is usualIly limilted to cattle over 12 monithis
of ag,e and is performed last to av oid creating pneumLIo-
i-ectumii and tenlesmILIs which may confusc abdominal
auscultation and percussioin. Rectal examinaition is best
perforimled in the st(anding animal,; in the recumilbenit ani-
mal, the abdominial contents become displaced caiudally
wvhich makes palpation dift'iCult unless the animial is
placed in lateral recumbency (the safety' of the operator
should be conisidered if the animal is likelv to rise). A
rectal prolapse should haxe beein detected before this
point in the examination, either by observation or the
presence of tenesmIus. How ver, on liftintg the tail, a
rectal prolapse should bc obx ious. w ith lintlamed oedemia-
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Rectal examination can be used to detect and assess

a displaced or enlarged viscus and to investigate the Analysis of faecal samples can help to establish a definitive
passage and consistency of faeces diagnosis

cally into a cowpat. Cattle faeces are usually the consis-

Li IQpLi
tency of a thick milkshake although it is always more
Finding(s) Condition meaningful to compare the faeces of a sick animal with
other healthy cows in the group.
Dorsal sac packed with fibre Vagal indigestion
Faecal samples can be collected for laboratory
Distended and tympanic dorsal sac Bloat analysis which may include bacteriology, virology and
Dorsal sac cannot be palpated Collapsed dorsal sac examination for parasitic gastroenteritis, fasciolosis and
coccidiosis.
Tense, gas-filled viscus at arm's length Right displaced/dilated
laterally on the right abomasum
Large, hard, sausage-shaped structure Intussusception FURTHER INVESTIGATION
on the right
Tense, gas-filled viscus, shaped like a Distended/dilated CLINICAL PATHOLOGY
long balloon with a blind end caudally, caecum Haematology, biochemistry and acid-base measurements
immediately on the right laterally
may provide useful additional clinical information. Meta-
Large focal mass(es) which may Fat necrosis bolic acidosis may be associated with carbohydrate
surround the intestines
engorgement or endotoxaemia. Metabolic alkalosis can
Thickened small intestines Johne's disease occur in animals with abomasal displacement (due to
(highly subjective)
sequestration of hydrogen ions) and urea poisoning.
Bicarbonate deficits can be estimated in the field using
the Harleco apparatus although this is now being super-
tous rectal mucosa protruding through the anus. In the seded by hand-held biochemical and acid-base analysers.
normal animal, it is possible to palpate the caudal surface
of the dorsal sac of the rumen to the left of the pelvic
1-11*V-11 0--- 1*
t-14:2 ... S

brim. Non-specific referred pain or focal pain responses

may be elicited on rectal examination. Referred pain may Faecal appearance Condition(s)
be due to peritonitis or traumatic reticulitis. Focal pain Dry, dark brown, ball-shaped, shiny Slow gut passage/dehydration
may be provoked on palpation of an intussusception. (covered in mucus)
Smears prepared by gently scraping the rectal mucosa Dark green colour Increased bile salt content
with a glass slide protectively held in an enclosed gloved (eg, haemolytic anaemia)
hand may be useful in confirming Johne's disease in
Pale olive-green colour Decreased bile salts
some suspected cases. (eg, anorexia)

EXAMINATION OF THE FAECES
Cattle generally pass some faeces every 1-5 to two hours,
producing 30 to 50 kg of faeces daily. The transit time is
1-5 to four days. The presence of faeces in the rectum or
voided onto the floor indicates active gut motility. An
absence of faeces for 24 hours is abnormal. The volume,
consistency, colour, fibre length (comminution), mucous
covering and odour of the faeces should be noted. The
comminution of undigested fibre in the faeces is an indi-
cation of the degree of mastication and rumen function.
Poor comminution indicates poor rumination or acceler-
ated passage through the forestomachs. Animals grazed
on fresh spring grass at tumout may have very watery
faeces while dry cows on a straw-based diet may have
very stiff faeces that will support a stick if placed verti-
Undigested grains in faeces
Dysenteric faeces. A mixture of undigested
bloody mucus and watery faeces, usually
with an offensive fetid smell and sometimes
with yellow-grey casts (fibrin)
Blood and sloughing mucosa
Melaenic (black) faeces
Frank blood or blood clots
Plentiful pasty faeces
Diarrhoea
Normal cattle fed on unprocessed grain
Salmonellosis, winter dysentery, mucosal disease
Intussusception (ischaemic necrosis)
Digested blood from the abomasum or the proximal
intestine. Consider abomasal ulceration, pharyngeal/
oesophageal tumours (bracken/papillomavirus) and
caudal vena cava syndrome. Dark faeces are also
seen in cases of lead poisoning
Coccidiosis or mucosa damaged during rectal
examination
Johne's disease
Enteritis or osmotic (ruminal acidosis)

In Practice e J U N E 2 004 3 13
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Electrolyte measurements may reveal hypochloraemia
and hypokalaemia which may be present in animals with
left displaced abomasum. A low packed cell volume
(PCV) may indicate a haemorrhaging abomasal ulcer
while a raised PCV may suggest dehydration. Leuco-
cytosis with relative neutrophilia may indicate an inflam-
matory process. Conversely, leucopenia and neutropenia
may be found in severe cases due to sequestration. Hypo-
proteinaemia may be a feature of a protein-losing
enteropathy, such as Johne's disease, or a reduction in
hepatic production. A high concentration of fibrinogen is
a useful indicator of inflammation.
The bromosulphophthalein clearance test and the
gluconeogenic test using propionic acid can be used to
assess liver function, but are rarely performed nowadays.
Clinical pathology may be used to identify liver disease.
Biochemical changes, such as hypoproteinaemia, occur
in some types of liver disease. The liver enzyme aspar-
tate aminotransferase (AST) may be elevated in cases
of liver disease, but it is also produced by other tissues,
including cardiac and skeletal muscle. Sorbitol dehydro-
genase and glutamate dehydrogenase are liver specific
and are elevated in the acute phase of liver disease.
Gamma glutamyltransferase is a reliable indicator of bile
duct damage and is raised in cattle with fasciolosis. Bile
salts may be elevated in animals with hepatic pathology.
Conjugated bilirubin increases with bile duct obstruction
and unconjugated bilirubin rises in the presence of
haemolytic anaemia. Indirect measures of liver function
in cows with fatty liver syndrome include evaluating
levels of non-esterified fatty acids, glucose and AST.
Ru _mm flwid
S cellectM
A sample of rumen fluid may be obtained using a nasogastric or oral stomach tube
or by performing rumenocentesis. The use of a nasogastric tube avoids the dan-
gers of placing a mouth gag while rumenocentesis avoids the risk of contaminat-
ing the sample with saliva. The sample should be kept relatively warm by placing
it close to the body and analysis is best performed within an hour of collection.
To perform rumenocentesis, a small area of skin in the left ventral quadrant of
the abdomen is surgically prepared. A tail kinch or anti-kick bar can be used in
order to protect the operator. An 18 gaUge, 9 cm lumbar spinal needle with a
stylet in place is thrust up to the hilt through the skin of the prepared site into the
fluid contained within the ventral sac. The stylet is removed and a syringe is
attached to the needle and a sample withdrawn. The needle can sometimes get
blocked by solid material and may have to be cleared by injecting air. Once a
sample has been obtained, the needle is withdrawn.
314
RUMEN FLUID ANALYSIS
Rumen samples should be collected with care as saliva
contamination increases the pH of samples (see box
below). The sample should be evaluated as soon as pos-
sible as cooling and exposure to air alters protozoan and
bacterial activity.
Colour and pH
Normal rumen fluid is usually olive-green or greenish-
brown. In animals with ruminal acidosis, the fluid may
appear milky grey. The pH of rumen fluid can be mea-
sured in the field using pH indicator paper and can range
from 3 to 9. The pH is normally 6 to 7 in cattle on
roughage-based diets, and 5 5 to 6-5 in cattle on concen-
trate-based diets. In cases of ruminal acidosis (carbohy-
drate engorgement), the pH will be 5 or less. In anorexic
cattle, the pH will be alkaline, usually in the range of 7 5
to 8, because of the constant production of saliva which
has an alkaline pH and due to a lack of substrate for the
rumen flora to produce volatile fatty acids. Higher pH
values may be seen in animals with urea poisoning.
Sedimentation/flotation
The sedimentation/flotation test is an indirect measure of
the activity of the microflora within the rumen. To pro-
vide an accurate measure of this activity, the test must be
performed within a short time of collecting the rumen
fluid sample. This should be placed in a measuring
cylinder and the time taken for complete sedimentation
and flotation of solid particles noted. Fine, dense parti-
cles sink while coarse particles float supported by gas
In Practice e J UNE 2004
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bubbles due to fermentation. In healthy cattle, the nor-
mal time for sedimentation and flotation is four to eight
minutes. Inactive microflora result in rapid sedimenta-
tion with little floating material which is seen in chroni-
cally anorexic cattle.
Redox potential
Redox potential (methylene blue reduction time) is a
measure of the reduction-oxidation activity of ruminal
microflora and reflects anaerobic fermentation by rumen
bacteria. This test must be performed within a short time
of collecting the sample to produce an accurate result. It
is carried out by mixing I ml of 0 03 per cent methylene
blue with 20 ml of rumen fluid and comparing the colour
with that of a control sample of rumen fluid only. The
time taken to decolourise the methylene blue is measured.
Rumen fluid from healthy cattle on a concentrate and hay
diet will decolourise methylene blue in three minutes or
less while rumen fluid from cattle fed hay only will
decolourise the dye in three to six minutes. Poor micro-
bial activity is indicated if decolourisation of methylene
blue takes 15 minutes.
Protozoal activity
Rumen fluid from normal healthy cattle contains high
numbers of large and small protozoa with ciliate and fla-
gellate forms, all of which are highly active. The sample
should be agitated to resuspend the organisms and a drop
of the sample placed on a warm glass slide and covered
with a coverslip. The protozoan activity can be observed
using a low power (x 10) objective lens on a microscope.
Large protozoa are more sensitive to abnormal changes
in rumen fluid composition. All protozoa are killed when
the pH drops below 5. There are reduced numbers of
protozoa in samples with low fermentation activity.
Gram staining
Gram-stained smears can be prepared from rumen fluid
samples. There are mainly Gram-negative bacteria in
normal rumen fluid but, in cases of ruminal acidosis,
Gram-positive streptococci and lactobacilli predominate.
Left-sided laparotomy
In Practice * JUNE 2004
Chloride concentration
Rumen fluid chloride concentration can be measured
by most laboratories on request. In healthy cattle, rumen
fluid has a chloride concentration of less than 30
mmol/litre. Concentrations above this level are consid-
ered abnormal and may be caused by a reflux of abo-
masal ingesta into the rumen. High levels also occur in
cases of ruminal acidosis and severe anorexia.
EXPLORATORY LAPAROTOMY
AND RUMENOTOMY
An exploratory laparotomy can be extremely useful
in confirming and correcting some conditions of the
abdomen. Laparotomies are either carried out on the
right or left side, or the midline, depending on which
conditions are suspected. A left-sided laparotomy
enables the rumen, reticulum, spleen, left border of the
liver, part of the diaphragm, apical beat of the heart, left
kidney through to peritoneal fat, the path of the ureters,
the bladder, uterus, right and left ovaries and descending
colon to be palpated. Adhesions of the reticulum to
the parietal peritoneum may be palpable in cases of trau-
matic reticulitis. Left displaced abomasum can also be
confirmed.
A rumenotomy can be performed during a left-sided
laparotomy and can confirm the presence of obstructive
foreign bodies such as ingested plastic bags or hay nets.
The reticulum, rumen, oesophageal groove, reticulo-
omasal orifice and cardia can be examined. The reticu-
lum should be very carefully examined for penetrating
foreign objects, abscesses and Actinobacillus species
infections of the oesophageal groove.
A right-sided laparotomy gives access to the omasum,
abomasum, spiral colon, duodenum, jejunum, ileum, cae-
cum, liver and gallbladder. Surgery will enable confirma-
tion of a dilated caecum or torsion of the caecum, right
displaced abomasum, intussusception and torsion of the
root of the mesentery.
ABDOMINOC ENTESIS
Abdominocentesis (peritoneal tap, paracentesis) is useful
for diagnosing:
* Peritonitis in conditions such as traumatic reticulitis,
abomasal ulceration and intussusception;
A Weingart Rumenotomy Set
(Kruuse UK) can be used to
exteriorise and fix the rumen
wall when performing a
rumenotomy in order to
avoid contamination of the
peritoneal cavity by spillage
of the rumen contents
315
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A 19 gauge, 5 cm needle is
used for abdominocentesis
and the samples are
collected into a plain
tube and an EDTA tube 'Il
A common site for abdominocentesis is midway between
the xiphisternum and the umbilicus in the midline which
avoids the milk vein
* Ulopetitoleoml1 in conditioins sLuch as hladdlti- t-LIptLleC
01o tI-eteC-.ldt LrptLrIeC:
GLut conltenltS in the periton1eCimI1 CatiLsed hN, intestinal
rnUpttL e-:
* Hlaeiorrhagl illto the pei itotneniLII CaLised hy atbdomili-
Mial tLilMii -S, hiepattic and spleniic I-niptnrl-es. aniid aiscitcs
caIsed hV tright-sided heart failure.
Abdomlmillocentesis is eaLy aInd inexpensive to pefolrill
andICI r-eCjniL-Cs little CeqLnipmllelnt. In norimal he1alths ca-ttlc,
thel-C is LsialIlNd o1n1N 15 to 20 ml of peritoneal 1I-id i the
pCIritoie'al easvity. As aI coinseqlellnC, ai s.aLIMple is liot
alwslavs obhtained .and thc lack ol a s.Ample should tIot he
ilet pletedacl s ahnorn-imal. The onl\ exception to this is
dIuing1l latc pregnancy when the N0olnmeC of fILlid in1I-ereas-
es ilar-kedly. Abnorima.l pcr-itoneal IlUid, pa-tiCularIx-V iI
eases of locaLl peritonitis, may be confilled to a1 smmall atrea
ol tthe petitonICe1111 and imay not alsdays he samtilpled dcii-
iL, abdomillocentesis.
Thel-e aIrc sccl-.ll potential sites for Lbdomillocente-
sis. A comimilloni site is oni the xventt al aintcrior- ahdomncn
midway betwsecu the xiplisterl-numLI1 arnd the umllbilCIes in
the midlinc. This sitc is CeAsy to identi'y.IsadcICatrries o10
-isk ol accidentally puLIctuLing the milk veim. An alteinal-
tiv e site onl the anterior ahdomen is 5 Cmil CalUdal to the
xiphistetI-ImLI id 5 em to the left or ri,ht of the iidlille;
ill this ealse, care. is requtlirled to ensuIr-C thalt the milk %cili
is not pUIn1CtUt-el. Othet- sites aite oni the left ot tight pos-
tetnot atbdoliln just ainte-io to the attaLchimietit of the
man-imary gklnd to thie body ss ll
Peritoneal fluid samples from (left to right) a normal animal
(amber-coloured fluid) and cases of peritonitis (turbid fluid),
intussusception (serosanguineous fluid) and perforated
abomasal ulcer (particulate matter). Picture, from Radostits
(2000), reproduced with permission from W. B Saurnders
316
The site just anterior to the mammary gland attachment to
the body wall enables peritoneal fluid from the posterior
abdomen to be sampled
The pieparatotio aniid piocedLurle is the saime for ea.Ach
site. Ideally hair should be clipped ot shaIxed att the site
ailnd the skin .aseptically pr-cparcd. Restrainlt LIsinI.t a kitich
oit an anti-kick hbat xwill imllprox O)pCeraltOr- sa-ifety A 19
ca.u,ce.5 cci necdlc is gently pushed inlto the peritoteical
caxVitY ol the ahdomi-etn thl-ough thc skin. mutIscuaL.tn-re
aind patrict.al peritolletim. lfIi pet itoIteal tiLid is obtalincd.
the necdlc cain be r-otaIted aind the degt-ee of penetr-ation
imct el-alset. In xenitrtal sites the mmciel is somS0etimlies pelle-
ti-ated and a d-rk gritty sampic obtained. It no saniple
is obtaLined, a- nIe site shoLtld he selected. Attachine a
sytringc to the bairr-el of thc needle andcl applying gentlestLe-
tio mn ay be uLsefuIl. Sam11ples should bc collccted into plain
tubes fir bacteriology and EDTA tubes t'ot Cyttolog
PERITONEAL FLUID ANALYSIS
Saniples cain be sent off to the laborators lot detailed
aLnals sis. bLut uIseltil il lot m-a11tion C1,111 be obtalilnel iiesx-
peilsix el f-oti ,omgoss examiinationi of the saiple aiid
simliple Illict oseop CGi-oss examiination maxtV icluCILide
aXSSeSIsmeCnlt of thc coloLur-. o0ue11C, ViSCositO', tUIbidits
and clotting of tthe saIllple as w edl as its capacity to tot m
a stable Irothw head w hen shaken. Sim-iple imnictoseopy
enables bacteta and cLlut conitenits to be x isLalised.
Prepati-ations ol hilnlt1m l smeair-s on a (glass slide fol-
losed by Diff-Quik stailingwl xxill cnabletacalCilitati\!c alnd
seIm1iqctantItitaltix\assesscIseIlt
e of tthe CeliLlati- conitenit.
A miiorc dctaLiled latboratorly antily sis milaly include
cytology to estaiblish cell Ilnliimbet s aLind type. specil'ie
gras,ity proteiin coinceiitt atioti Cand the pt eparatioti of
statined smie.tars for- baIcterilal CultLil-te.
Colour and volume
Nortiial peritonleall ftluid is clear-. sti-as-coloured ot- yel-
loss The xolnrn1e of a saJmple obtained froti0 tioriial
healths calttle rianlges fromil () to 5 nml.
Laboratory analysis
Microscopy m-ay indicate the prescicc of paIrticulaIte
food matcri-al fromi011 a Iptuited bosel. A hig,hl specific
grXias its alid high proteiii conitetit suecests vx asC1lat11
datniage ssith Icakagte of plastiia proteiiis, peritoniitis or
ischatelmic tlecrosis ol thie bossel. Cy tology ti-ialy r-ex calatil
inciceased xxhite blood cell CoLIltt in thc peritoneial fIluid
xith iitcierased poly mior-phoniuclecar cells (PMNs). \shich
itidiclates intlan-iniation (stet ile or iltfectioLs); the pres-
ciec of cle(elncirattc PMNs. xxhich itiiplies itil'ectioti: atid
In Practice * J U N E 2 0 0 4
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S S S S S S SI_

Abnormality Interpretation
Fluid volume in excess of 10 ml Pathological process or late pregnancy
Green Gut contents in the peritoneal cavity from gut rupture/perforation
(+/- particulate matter) or iatrogenic puncture of the gut during the sampling procedure
Vivid orange Rupture of the bile duct (rare)
Pink/red Presence of haemoglobin and/or red blood cells which may
indicate iatrogenic penetration of a blood vessel, gut infarction
or perforation
Red/brown Necrosis of the gut wall (eg, intussusception)
Blood Haemorrhage into the peritoneum (haemoperitoneum) which
may be pathological, but may be iatrogenic due to puncturing
of a blood vessel during abdominocentesis
Stable head of froth on shaking Increase in protein content (inflammation)
Increased viscosity Increase in protein content (inflammation)
Clotting Presence of an inflammatory process
Turbid Inflammatory products such as increased protein and cellular
Ultrasonography can be used to evaluate the peritoneal (sometimes with fibrin tags) content, and fibrin
fluid as well as various internal structures of the abdomen

increased monocytes, which suggests the pre sence of a

chronic inflammatory process.

RADIOGRAPHY
Radiography of the anterior abdomen may be useful for
the diagnosis of traumatic reticulitis caused by a pene-
trating wire. However, powerful machines aire required
and these are usually only available in referral centres.
Acknowledgements
The authors would like to thank
METAL DETECTORS AND COMPASSES Miss Melanie Balasingham
Metal detectors have been used to identify th.e presence for her assistance with the
photographs and the University
of metal in the anterior abdomen. However, mr any normal Objects retrieved from the reticulum of a cow with Farm, Cambridge, for the use
cattle give positive results due to harmless Xmetal frag- traumatic reticulitis caused by a wire (also pictured) of its cows and facilities. The
penetrating the anterior wall line diagrams in this article
ments present in the reticulum. Items such as the ends of are reproduced from Jackson
anthelmintic boluses, and nuts and bolts have b een found. and Cockcroft (2002), with
A compass can be used to detect the presenm ce of a pro- A liver biopsy is conducted using 10 per cent permission from Blackwell
Science.
phylactic magnet in the reticulum. This is indiicated by a buffered formalin, a Tru-Cut biopsy trocar, local anaes-
movement of the compass needle and suggest s traumatic thetic, a scalpel blade, syringe, needle, antiseptic and Further reading
reticulitis is less likely to be the cause of the ill]ness. alcohol. The site of the biopsy is 15 cm below the trans- BRIGHTLING, P. (1995) The
verse processes in the 11th right intercostal space. It is examination of a sick cow.
Proceedings No 78 of the
LIVER BIOPSY also defined by imaginary lines from the wing of the Postgraduate Committee in
Liver biopsy can be useful to characterise liv er patholo- ilium to the point of the elbow and the point of the Veterinary Science, University
gies such as fatty liver syndrome and ragwort poisoning shoulder; the site of the biopsy is the area of the 11th of Sydney. pp 393-423
DIRKSON, G. (1979) Digestive
or for trace element analysis (eg, copper). T]he risks of intercostal space which is enclosed by these lines. The system. In Clinical Examination
severe iatrogenic haemorrhage during and foil lowing this hair is clipped and aseptically prepared. Local anaesthet- of Cattle. Ed G. Rosenberger.
Berlin, Paul Parey Verlag.
procedure must be taken into account. T]he admin- ic is infiltrated subcutaneously and more deeply into the pp 184-258
istration of prophylactic antibiosis and tetanuIs antitoxin intercostal muscles beneath. A stab incision is made HOUSE, J. K., SMITH, B. P.,
FECTEAU, G. & VANMETRE,
should be considered. Checking the prothroml bin/clotting through the skin at this site and the biopsy needle is D. C. (1992) Assessment of
time before proceeding may be a wise precautiion. pushed through the incision in the direction of the oppo- the ruminant digestive system.
site elbow. The needle is then pushed into the stroma Veterinary Clinics of North
America: Food Animal Practice
of the liver. Ultrasonography can be used to guide the 8, 189-202
placement of the biopsy needle. The passage of the HOUSE, J. K., SMITH, B. P.,
VANMETRE, D. C., FECTEAU,
needle through the edge of the diaphragm and the liver G., CRAYCHEE, T. & NERVES,
produces a slight grating sensation. A biopsy is taken J. (1992) Ancillary test for the
assessment of the ruminant
I//I and the needle withdrawn. The sample is then placed in digestive system. Veterinary
10 per cent formol saline for histopathology or the fresh Clinics of North America: Food
Animal Practice 8, 203-232
sample is used for measurement of specific gravity and JACKSON, P. G. G. &
chemical analysis to assess lipid content. COCKCROFT, P. D. (2002)
Clinical examination of the
e-o
I7- gastrointestinal system. In
Clinical Examination of Farm
1-
SUMMARY Animals. Oxford, Blackwell
Science. pp 81-112
RADOSTITS, 0. M. (2000)
It should be borne in mind that more mistakes are made Clinical examination of the
alimentary system: ruminants.
by not looking than by not knowing. Without a profi- In Veterinary Clinical
cient clinical examination, an accurate diagnosis is Examination and Diagnosis. Eds
A Tru-Cut biopsy needle is used to obtain a liver biopsy 0. M. Radostits, I. G. J. Mayhew
sample which may be placed in 10 per cent formol saline for unlikely and errors may be made in the treatment, con- and D. M. Houston. London,
histopathology or kept refrigerated for chemical analysis trol and prognosis of the disease. W. B. Saunders. pp 409-468

In Practice * JUNE 2004 3317

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Clinical examination of the abdomen in adult

cattle
Peter Cockcroft and Peter Jackson

In Practice 2004 26: 304-317

doi: 10.1136/inpract.26.6.304

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http://inpractice.bmj.com/content/26/6/304

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