ISRAEL JOURNAL OF
VETERINARY MEDICINE
Vol. 58 (2-3)
2003
COMPARATIVE EFFICACY OF DIAGNOSTIC TESTS
IN THE DIAGNOSIS OF TRAUMATIC
RETICULOPERITONITIS AND ALLIED
SYNDROMES IN CATTLE*
Ramprabhu, R., Dhanapalan, P. and Prathaban S.
Center of Advanced Studies in Veterinary Clinical Medicine and Therapeutics,
Madras Veterinary College, Chennai - 600 007, India.
Abstract
Clinical cases presented at the Veterinary College hospital with traumatic
reticuloperitonitis (TRP) and allied syndromes are divided into four groups and
subjected to clinical, special examination, haematology, biochemistry, metal
detector, radiography, ultrasonography and exploratory laparotomy. The overall
incidence of TRP and allied syndromes was 0.96%. Leukocytosis with left shift is
indicative of traumatic reticulopericarditis whereas neutrophilia in the absence of
leukocytosis is indicative of diffuse traumatic reticuloperitonitis. Higher values of
fibrinogen were recorded in traumatic pericarditis followed by traumatic
reticuloperitonitis. Sulkowitch and glutaraldehyde coagulation tests were positive in
23.88% and 16.48% of the cases. Radiography is able to detect metallic foreign
bodies but unable to detect any tissue reaction. Ultrasonography is excellent in
assessing reticular motility, fibrinous adhesions/deposits but foreign bodies could
not be visualized. Hence, both ultrasonography and radiography should be used
judiciously in diagnosing problems causing the foreign body syndrome in cattle.
*Part of the Ph.D., thesis submitted by the first author to Tamil Nadu Veterinary and Animal Sciences
University, Chennai - 51, India.
Introduction
Affections of the bovine forestomach due to ingested foreign bodies are the
subject of attention almost all over the world and of major economic importance due
to severe loss of production and production ability and some times death of the
animal. The disease presents considerable difficulty in diagnosis because ruminal
atony and abdominal discomfort may occur in other diseases. Previously, the
diagnosis of traumatic reticuloperitonitis was based on routine physical examination,
total and differential leukocyte count and radiography. With the advent of modern
diagnostic instruments in the diagnosis of ruminant disorders, more sophisticated
techniques have been developed - ultrasonography, ferroscopy and laparoscopy to
arrive at an early comfirmatory diagnosis. Most of the clinical cases brought to the
hospital are of chronic type. The total and differential leukocyte count alone cannot
be relied upon as a diagnostic aid for this condition, so the study was planned to
diagnose traumatic reticuloperitonitis in cattle sufficiently early, to minimize the
complications and restore production under field conditions and to compare the
efficacy of different diagnostic tests in making an early diagnosis.
Materials and Methods
Out of 7006 animals presented at the large animal clinic, 67 were affected with
the clinical symptoms of traumatic reticuloendometeritis.
The examinations were carried out on 67 animals (51 cows and 16 buffaloes) with
traumatic reticuloperitonitis and were classified in four groups as follows:
Group I
-
Traumatic reticuloperitonitis(localised)
(n1 = 19, n2 = 7)
Group II
-
Traumatic reticuloperitonitis (diffuse)
(n1 = 14, n2 - nil)
Group III
-
Traumatic pericarditis
(n1 = 16, n2 = 8)
Group IV
-
Diaphragmatic hernia
(n1 = 2, n2 = 1)
Group V
-
Control
(n1 = 6, n2 = 6)
n1 = Cow; n2 = Buffalo
Clinical Examination and Haematological and Biochemical Findings
All the cows underwent a clinical examination and special examination according
to the method of Rosenberger(1) and abdominocentesis. In addition, the haematocrit,
leukocyte count, blood biochemical profiles were performed and glutaraldehyde
coagulation test was performed as described by Braun et al., (2). Sulkowitch test on
urine was performed according to Hall(3).
Ferroscopy
A metal detector (ferroscope) was applied over the ventral and ventrolateral parts
of chest and abdomen to detect a ferromagnetic foreign body according to Riger (4).
Radiography of the reticulum
The reticulum was examined radiographically according to Nageli (5).
Ultrasonographic examination
The areas over the reticulum and the left and right sides of the thorax up to the
level to elbow joints were clipped. The remaining hair was removed with depilatory
cream, transmission gel was applied and the cows were examined
ultrasonographically with a 3.5 MHz linear array transducer ( Basic Scanner
vet.2005) with a radius of 40mm.
Exploratory laparotomy
Exploratory rumenotomy permitted a thorough check to be made of the amount,
composition, degree of comminution, odor, or color of the rumen contents and parts
of the rumen wall. Exploratory laparotomy was performed following the standard
procedure (6).
Statistical Analysis
The data obtained were statistically analyzed wherever applicable to study the
significance of group versus control for the two different species by least square
analysis(7).
Results
Traumatic reticuloperitonitis and allied syndrome were recorded in 76.12% of
dairy cows and 23.88% in buffaloes. Among the breeds, it was recorded in 47.76%
Jersey cross-bred cows, 17.91% in Holstein-Friesian cows, 8.96% in non-descript
and 1.49% in Sindhi cows and 23.88% in Murrah-cross buffaloes. The higher
incidence in Jersey crossbreds might be due to their higher prevalence in the city
and the breeding policy of the State Government. All the animals were over 4 years
old. Out of the 67animals, 39 (58.21%) animals were recently calved, 14 animals
(20.90%) were pregnant and 14 animals (20.90%) were non-pregnant. The major
clinical signs recorded in the various groups are given in Table 1.
Table 1. Clinical signs in traumatic reticuloperitoniti.
Sign
Group I
Group II
Group III
Group IV
Sudden
Anorexia
23.08
28.57
16.66
-
Drop in milk
yield
46.5
21.43
29.16
33.33
Regurgitation
15.38
21.42
-
33.33
Bruxism
42.31
57.81
37.55
33.33
Kyphosis
53.84
57.91
54.17
33.33
Abduction of
elbows
26.92
21.43
45.83
33.33
Pellety dung
38.46
57.14
66.67
100
Poorly digested
fibre
46.15
28.57
33.33
-
Recurrent bloat
45.83
33.33
16.67
33.33
Brisket edema /
muffling heart
sounds
-
-
87.5
-
The general behaviour and attitude of all the animals was unsettled. The rectal
temperature varied from 38.950C to 39.450C in cows and 38.43 to 39.500C in
buffaloes. The heart rate was between 44.90 and 89.00 in cows and 78.75 and 82.00
per minute in buffaloes and the respiratory rate varied between 32.64 and 39.45 in
cows and 30.14 and 39.50 per minute in buffaloes. Ruminal motility was reduced in
all cases. Out of the five grunt tests conducted, scootch test (70.15%), reticular grunt
(67.16%) and xiphisternum percussion (64.18%) were found to give highest positive
results in TRP and allied syndrome. In the haematological profile, a significant
increase in leukocyte count was noticed in group III (12131.25/ul ± 245.85,12137.50
± 401.37) compared to group 1 (11147.37 ± 478.92, 10350.00 ± 419.00) and control
(9150.00 ± 223.28, 8816.67 ± 153.93) cows and buffaloes. In the differential
leukocyte count, highly significant increase was observed in group III when
compared to groups I, II, IV and control. Highly significant increase in fibrinogen
level was observed in group III cows (13.13 g/1 ± 0.43) followed by groups II
(12.74 ± 0.55), I (10.34 ± 0.22) and IV (8.40 ± 0.14) when compared to the control
(5.33 ± 0.13). Maximum increase in fibrinogen values were recorded in group III
buffaloes (13.00 ± 0.62) followed by I(10.57 ± 0.28) and IV (9.50 ± 0.00). Group III
cows (4.68 ± 0.33 : 1) had lowest plasmaprotein:fibrinogen (PP:F) ratio followed by
groups II (4.89 ± 0.32:1), I(6.32 ± 1.19 : 1) and IV (6.46 ± 0.17 : 1). In
glutaraldehyde coagulation test reduced clotting time ((3 - 6 minutes) was noticed in
28.57% cases in group II cows, 37.5% in group III cows and 37.5% in group III
buffaloes. Animals which had more than 14.00 g/L fibrinogen were positive for
glutaraldhyde coagulation test.
In Sulkowitch test, out of the 67 animals with traumatic reticuloperitonitis and allied
syndrome, only 16 animals (23.88%) gave positive results and all these animals had
a low serum calcium level.
In peritoneal fluid analysis, highly significant increases in the total protein content
and neutrophil count were observed in different groups of cows and buffaloes when
compared to control. In metal detector (ferroscopy) in both cows and buffaloes
deflection was noted in most of the cases at sensitivity 2 (26.87%).
Radiographic
findings
The position of
the reticulum was
normal in 34.62%
cases in group 1,
28.57% cases in
group II and
33.33% in group
III. No clear
position was seen
in 65.38% in
group 1, 71.43%
in group II and
66.66% in group
III. Radiography
of the reticular
contents showed
metallic foreign
bodies in 65.38%
cases in group 1,
Fig. 1 Hyperechoic deposits noticed adjacent to the reticular wall
suggestive of fibrin deposit.
14.29% cases in
Fig. 2 Hyperechoic well demarked lesion with clear cut boundries
group II and
41.69% cases in
group III. Sandy
material was
noted in 15.83%
cases in group I
and 14.29 % cases
in group II. Fluid
shadow was noted
in 14.29% cases in
group I and
37.50% cases in
group III.
Ultrasonographic
Findings
Visualization
Reticulum was
clearly visible in
84.61% in group
I, 28.57% in
group II and
83.33% in group
III. Visualization
of the reticulum
was poor in
71.43% cases in
group I.
Reticulum was
displaced dorsally
in 11.54% in
group I, 21.43%
in group II and
16.64% in group
III. No reticular
motility was
noticed in 30.77%
in group I,
71.43% in group
II and 45.83% in
group III.
Morphological
changes
Deposits of
various
echogenicities
were noticed on
the reticular
serosa in 73.07%
in group I,
85.71% in group
II and 16.66% in
group III (fig. 1).
Well demarcated
hyperechogenic
lesions with clear
cut boundaries
were seen in
46.15% in group
I, 21.43% group II
and 41.67% in
group III (fig.2).
Extensive fluid
accumulation of
an anechoic or
hypoechoic nature
was seen in
71.43% in group
III.
Homogeneously
echogenic fluid
accumulation was
noticed in 28.77%
in group III
(fig.3).
Exploratory
laparotomy
Exploratory
laparotomy was
performed in
46.95% cases in
group I, 28.57%
in group II and
33.33% in group
IV. Thoracotomy
was performed in
28.57% cases in
group III. Metallic
foreign bodies
varying in size
and number were
removed from the
reticulum of
animals of group I
and II. Eight
animals with
percarditis died
during the study
period and
postmortem
examinations
were carried out.
These revealed the
presence of strawcolored fluid
accumulation in
the pericardial
sac. Fibrin
deposits were seen
in the pericardium
and presence of
metallic foreign
bodies also noted.
In few cases,
metallic foreign
bodies were
present also in the
reticulum.
Fig. 3 Poor visualization of the reticulum with extensive fluid
accumulation..
Discussion
Traumatic reticuloperitonitis and allied syndromes are one of the most commonly
occurring diseases of the digestive tract of cattle. They result from injury or
perforation of the reticulum by a sharp foreign body. A tentative diagnosis can be
made on the basis of the results of a clinical examination but in difficult cases
additional diagnostic aids are required. The clinical examination of the animals is an
important procedure in the diagnosis of traumatic reticuloperitonitis in cattle. The
typical signs included an arched back, a tucked up or tense abdomen, a rectal
temperature above 390C, abnormal ruminal findings such as reduced or absent
ruminal motility or ruminal tympany, positive pain response tests, faeces containing
poorly digested material and a shorter than normal glutaraldehyde test(2) . The
probability that a cow has a condition increases as the number of typical clinical
signs displayed increases. In the haematological profile, leukocytosis with left shift
was indicative of traumatic reticulo-pericarditis and localised reticuloperitonitis.
Neutrophilia in the absence of leukocytosis was indicative of diffuse traumatic
reticuloperitonitis. The haematological observations concurred with the findings
from previous studies (8, 9).
Highly significant increase in globulin and fibrinogen levels and decreases in
albumin and plasma protein:fibrinogen ratio (PP:F) were noticed. This was in
agreement with previous findings (10,11,12). The changes in haematological values
and biochemical parameters such as elevation of fibrinogen, aspartate
aminotransferase and alkaline phosphatase were suggestive of inflammtory changes
in the body not only traumatic reticulo-peritonitis/pericarditis. They can provide
important clues for the presence of inflammatory changes. The diagnosis of bovine
traumatic reticuloperitonitis and allied syndrome was based on clinical signs and
haematological findings, however neither results in the confirmation of the disease.
Although the haematological examination was of considerable value as a diagnostic
aid in TRP, these alterations were non-specific and were seen in association with
other bacterial infections following severe stress (13). In the glutaraldehyde
coagulation test, positive results were obtained only from those animals having more
than 14.00. g/L fibrinogen. Clotting of blood did not occur in the rest of the cases
which might be due to less concentration of critical substances released by the
massive exudation, plasma protein and plasma fibrinogen(2). In Sulkowitch test
animals having lowered calcium were detected positive for TRP. However, Hall(3)
opined that even normal animals during the winter season produced positive results.
The metal detector detected the presence of metallic foreign bodies in all the
animals but some normal animals showed deflection during examination. Even
though a metal detector could be used to detect and confirm the presence of foreign
bodies in suspected cases of foreign body syndrome, these instruments were of
limited usefulness because it also detected no problem causing foreign bodies in
normal animals.
Radiography was best suited for visualization of metallic foreign bodies in and
outside the reticulum and the position of the foreign body was not a reliable
indicator of the condition. Radiography is the best method for visualizing them and
for obtaining accurate information about their position and nature (5,14).
Ultrasonographic examination revealed the presence of fibrinous changes or
abscesses that could not be visualized by radiography. The major advantage of
ultrasonography overcomes the problem of locating the lesion but also its size and
extent. In contrast,ultrasonography failed to identify any metallic objects including
magnets. This was in agreement with earlier findings (2). All the three techniques,
namely, ultrasonography, radiography and metal detector failed to detect the
presence of non-metallic foreign bodies like polythene bags which are a major
environmental pollutant.
Although radiography or ultrasonography alone provide a limited amount of
information the two techniques complement one another well. Thus radiographic
examination of the animal provided information regarding visualization of the
foreign body. But ultrasonography provided excellent data about reticular motility,
fibrinous deposits and abscesses. Thus, it is concluded that the judicious use of
radiography and ultrasonography, the problem causing foreign bodies can be
differentiated from other neutral foreign bodies, which are routinely found in the
rumen and a decision on rumenotomy can be taken.
LINKS TO OTHER ARTICLES IN THIS ISSUE
References
1. 1. Rosenberger, G: Clinical Examination of Cattle. Ist edition, Verlag Paul Parey, Berlin and
Hamburg, 1979.
2. Braun, U., Pusteria, N. and Auliker, H.: Ultrasonographic findings in three cows with peritonitis in
the left flank. Vet. Rec.142: 338-340, 1998.
3. Hall, S.A.: Diagnosis of reticulitis. Vet. Rec. 68: 88,1956.
4. Riger, H.: Quoted by Jamkhedkar, P.P and P.E. Kulkarni (1965). In: Utility of a metal detector in
the diagnosis of foreign body syndrome in bovines. Indian Vet.J.42: 441-450, 1956.
5. Nageli., F.: Diss. Vet.-Med. Zurich. 1991.
6. McGavin, M.D. and Morril, J.C.: Dissection technique for examination of the bovine
ruminoreticulum. J. Anim. Sci. 42: 535-538, 1976.
7. Snedecor , G.W. and. Cochran, W.G.: Statistical methods. Oxford and I.B.H. Publishing company,
Calcutta, 1989.
8. Misra, S.S. and Angelo, S.J.: An experimental study on traumatic reticuloperitonitis in bovines
with particular reference to diagnosis. Indian Vet. J. 51: 282-290, 1974.
9. Schilling, V.: The blood picture and its clinical significance. Translated and edited by E.B.H.
Gradwohl. The C.V.Mosby Co., St.Louis, 1929.
10. Ramakrishana, O., Nigam, J.M. and Krishnamoorthy, D.: Biochemical observations on cows with
traumatic pericarditis . Indian Vet. J. 56: 1044-1047, 1979.
11. Dimopoullous, G.T.: Plasma proteins.In Clinical Biochemistry of domestic animals. Vol.1, 2nd
edn. Academic press, New York and London, 1970.
12. Prathaban, S.: Study on plasma fibrinogen level in health and disease of cattle. M.V.Sc., thesis
submitted to Tamilnadu Agriculture University, Coimbatore , India, 1983.
13. Benjamin, M.M: Outline of Veterinary Clinical Pathology. 3rd Ed. Kalyan publishers, New
Delhi. p.291, 1985.
14. Braun, U., Fluckiger,M. and Nageli, F.: Radiography as an aid in the diagnosis of traumatic
reticulo-peritonitis in cattle. Vet. Rec. 132: 103-109, 1993.