The present study was carried out to describe the clinical picture of traumatic reticuloperitonitis TRP in water buffalo Bubalus bubalis and to evaluate the inflammatory and immunologic responses for this clinical condition. Twenty-two buffalo with acute local TRP were monitored in our study. Additionally, 10 clinically healthy buffalo were randomly selected and served as controls. Our findings suggest that the examined immunologic variables were helpful in documenting the inflammatory response in buffalo with TRP. However, their diagnostic usefulness only becomes apparent when considered in tandem with the clinical findings for any given animal, its anamnesis, and a subsequent USG assessment. Due to the frequent complications of TRP, more accurate indicators of its occurrence and severity would be useful.
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The datasets used and analysed for this study are available from the corresponding author on reasonable request. The study evaluated the results of clinical examination and haematological and serum biochemical analyses in cattle with traumatic reticuloperitonitis TRP.
In many cases, a diagnosis of TRP is not possible based on individual clinical or laboratory findings because even the most common abnormalities are not seen in all cattle with TRP. Traumatic reticuloperitonitis TRP remains one of the most important internal disorders of cattle in addition to abomasal displacement. Despite this decrease, the clinical implications remain the same.
Traumatic reticuloperitonitis most commonly results from perforation of the reticulum by metal objects such as nails or wire that have been accidently incorporated into feed and ingested [ 6 — 9 ]. This may lead to localised peritonitis, sometimes involving neighbouring organs, and in severe cases it results in generalised peritonitis.
Clinical signs of TRP have been described in a number of reference texts [ 6 , 8 , 9 ]. Acute disease usually results in distinct signs that include anorexia, decreased milk production, fever, ruminal atony and tympany, abdominal pain, arched back, abdominal guarding and tense abdomen [ 6 , 8 , 9 ].
The clinical signs in cattle with chronic disease on the other hand are often less apparent. A short audible grunt is considered characteristic of acute TRP and may be a spontaneous response to reticular contractions or changes in posture such as lying down and getting up [ 6 , 10 , 11 ]. There may be additional signs in cattle with sequelae such as traumatic pericarditis [ 12 ], liver abscesses [ 13 ] or cranial functional stenosis [ 6 , 9 ]. Cattle with acute localised peritonitis typically have neutrophilia with a regenerative left shift [ 9 ] and those with acute diffuse peritonitis have leukopenia with a degenerative left shift [ 9 ].
The most important biochemical findings are increased concentrations of total protein and fibrinogen. Tests for reticular foreign bodies may elicit a grunt, although other painful disorders of the thorax and abdomen may stimulate the same reaction [ 6 , 10 , 14 ]. Pinching of the withers, gradual application of pressure followed by sudden release of pressure on the area between the xiphoid and the umbilicus using a pole and percussion of the abdominal wall with a rubber hammer over the region of the reticulum are the most useful foreign body tests for TRP [ 15 ].
Others include the zone test developed by Kalchschmidt, leading the animal up and down a steep incline and ferroscopy to detect the presence of metal [ 15 ]. Other diagnostic tests include radiography and ultrasonography, which will be addressed in a separate paper. The clinical and laboratory findings in cattle with TRP have been thoroughly described in a number of standard texts.
However, the majority of information is largely based on empirical evidence, and systematic evaluation of the clinical and laboratory findings in cattle with a definitive diagnosis of TRP has not yet been done. In particular, the frequency of positive responses to foreign body tests, which are considered an essential part of a diagnostic work-up in cattle with TRP, has not been determined.
The goals of the present study were to describe the clinical and laboratory findings in cattle with TRP, to establish the frequency of positive responses to foreign body tests and to determine which foreign body test elicited the most positive responses. This was a retrospective study of cattle that had a main diagnosis of TRP, which meant that the clinical signs were attributable to TRP and not another concomitant disease or disorder. The cattle were all greater than 1 year of age and had been admitted to the Veterinary Teaching Hospital, University of Zurich, from January 1, to December 31, Cattle with TRP that had concomitant diseases causing anterior abdominal or caudal thoracic pain were excluded; this included 27 cows with bronchopneumonia and 24 cows with abomasal ulcers.
All cattle that had been part of previous reports were not included in the present study. Traumatic reticuloperitonitis was diagnosed based on radiographic evidence of a foreign body that penetrated or perforated the reticular wall or was seen outside of the reticulum in cattle and on ultrasonographic changes of the reticular wall in cattle. Foreign bodies that penetrated or perforated the reticular wall were removed during laparoruminotomy in cattle, and in 10 others, a reticular abscess was drained transcutaneously under ultrasonographic guidance.
In all 61 cattle that were euthanased because of a poor prognosis, TRP was confirmed during postmortem examination. In all cattle, the diagnosis of TRP was based on more than one criterion. The results of ultrasonography, radiography, surgical treatment and postmortem examination as well as the outcome of treatment were described in a dissertation [ 16 ].
There were females and 7 males, which ranged in age from 1. There were no significant differences between the other reproductive stages. Of the cattle, 58 had received no treatment before referral, 50 had been treated with an antibiotic, 88 had received a magnet and had received an antibiotic and a magnet. A non-steroidal anti-inflammatory drug or metamizole was used in addition to other treatments in cattle or exclusively in 11 cattle.
The cattle underwent a thorough clinical examination [ 17 ]. The general health condition was evaluated by determining demeanour, appearance of hair coat and muzzle, skin elasticity, position of the eyes in relation to the sockets and skin surface temperature.
Each animal was observed for signs of pain such as spontaneous grunting and bruxism. The general health condition was considered to be mildly to moderately abnormal when appetite and degree of alertness were decreased and severely abnormal when there was anorexia and apathy or constant bruxism or grunting. The rumen was assessed for degree of fill, number and intensity of contractions and layering of contents. Sensitivity in the reticular region was assessed by preventing the animal from breathing for a short period by placing a plastic rectal sleeve over the mouth and nose and listening for grunting during the following deep breath.
This was followed by the foreign body tests, which included the pole test, pinching of the withers and percussion of the abdominal wall over the region of the reticulum with a rubber hammer. Each test was carried out four times, and the reaction of the animal was observed each time. A test was considered positive when it elicited a short grunt three out of four times.
The response to a test was considered questionable when it elicited a grunt two out of four times and negative when the animal did not grunt or grunted only once. Swinging and percussion auscultation as well as a rectal examination were also carried out. Faeces were assessed for colour, consistency, amount, fibre particle length and abnormal contents.
In cattle, a urine sample was collected during spontaneous micturition, but in 33 cases catheterisation of the bladder was carried out. The colour and transparency of the urine were assessed macroscopically, and the specific gravity was determined using a refractometer HRMT 18, A.
In addition, a methylene blue reduction time and the concentration of chloride were determined. Haematological analysis included the determination of PCV, total leukocyte count and the concentrations of fibrinogen and total protein using an automated blood analyzer CELL-Dyn , Abbott Diagnostics Division, Baar. Results were compared to reference intervals recently reported [ 18 ]. Frequencies were determined for each clinical and laboratory variable.
The Wilk-Shapiro test was used to test the data for normality. Differences in seasonal incidence of TRP and differences in occurrence at various reproductive stages were analysed using a one-way analysis of variance and the post hoc Bonferroni test. Over the year-study period, cattle with TRP constituted a yearly average of 7. The rectal temperature varied from Rectal temperature and heart and respiratory rates in cattle with traumatic reticuloperitonitis. Twenty-three cattle had both arching of the back and bruxism.
Walking on a lead rope elicited grunting in another five cattle. The pH of rumen fluid was greater than 7. Haematological and blood biochemical findings in cattle with traumatic reticuloperitonitis. The results of the present study showed that the yearly incidence of TRP as 7. Traumatic reticuloperitonitis occurred more often in the months of December to April and there was a marked decrease in cases during the summer months, similar to the results of other studies [ 6 , 20 ], although one study found no association with time of year [ 21 ].
There is a lower risk of ingestion of a foreign body during the summer when cattle are grazing than in the winter when they are fed prepared feed. Traumatic reticuloperitonitis is extremely rare in cattle that are kept on pasture year-round [ 9 ] because they are more likely to detect foreign bodies in grass than in hay [ 22 ].
Contamination of feed with metal foreign bodies is greater with preparation and storage of hay than in fresh forage, although wire is no longer used to tie hay bales. There were no differences among the stages of pregnancy, which was similar to the findings of one study [ 20 ] but contrasted the results of one other in which TRP was observed more often in the last trimester of pregnancy [ 6 ]. Differentiation of acute and chronic TRP was deliberately omitted for two reasons.
Firstly, the definitions of acute and chronic TRP vary considerably depending on which author is cited, and secondly, reliable differentiation is not possible based on history and clinical examination alone. Reliable differentiation of cattle with acute and chronic TRP can only be determined with a post-mortem examination, which was only carried out in 61 of cattle.
The mean rectal temperature at the time of admission was In a clinical study of cattle with acute TRP, the mean rectal temperature was A recently published reference text states that the rectal temperature is A persistent mild increase in rectal temperature is characteristic of chronic inflammation [ 9 ]. The mean heart rate in a clinical study of cattle with acute TRP was slightly higher at The mean respiratory rate was 28 breaths per minute, which was in the upper range of the reference interval.
Constable et al. Cattle with TRP do not inhale as deeply as normal in an effort to mitigate pain elicited by movement of the fully-expanded lungs and the diaphragm. An increase in respiratory rate is a compensatory mechanism, which sometimes is misdiagnosed as bronchopneumonia. In cattle with tachypnoea that do not respond to antibiotic therapy, a differential diagnosis should include TRP and other diseases.
Rumen motility is often decreased or absent in cattle with TRP [ 6 , 9 ]. However, decreased rumen motility is a non-specific finding seen in many other diseases of the gastrointestinal tract as well as in systemic disorders. Cattle with TRP often have increased fibre particle length in the faeces [ 6 , 11 , 25 ] because of dysfunction of the sorting mechanisms between the reticulum and omasum, which leads to the movement of incompletely digested feed into the omasum.
Fibre particle length is an important indicator of disease of the reticulum, but an increase in length can also be due to dental disease or an increase in the speed of passage of ingesta through the gastrointestinal tract, such as occurs in diarrhoea [ 17 ]. Abdominal pain is a cardinal sign of TRP [ 6 , 9 — 11 , 14 ] and may manifest as arching of the back, grunting or bruxism, which may occur spontaneously or be elicited via foreign body tests.
Arching of the back is a sign of parietal pain, and spontaneous grunting is a response to pain caused by reticular contractions. Bruxism is a sign of pain associated with many diseases and is uncommon in cattle with TRP [ 6 ]. The pole test, pinching of the withers and pain percussion were considered by several authors to be the most important part of the clinical examination in cattle suspected of having TRP [ 6 , 28 — 30 ].
However, there are few studies that have investigated the response to foreign body testing and the presence of a foreign body in the reticulum [ 23 , 31 ]. These are sobering results but one must remember that to elicit grunting in cattle with chronic TRP, considerable strength may be required when conducting foreign body tests [ 6 ] and in cows with chronic localised peritonitis, the grunt test may be positive, negative or equivocal [ 9 ]. Positive swinging and percussion auscultation on the left side was the result of concurrent left displacement of the abomasum in 13 cattle and ruminal atony in another On the right side, positive swinging and percussion auscultation was attributable to intestinal atony or diarrhoea in 82, right displacement of the abomasum in three and caecal dilation in two.
The loss of negative pressure in 21 cattle and crepitus in 8 were considered to be signs of peritonitis. The leukogram and the plasma protein and fibrinogen concentrations are an aid in the diagnosis of TRP in cattle [ 8 ]. Acute cases are typically characterised by neutrophilia with a left shift and hyperfibrinogenaemia; however, the leukocyte count may vary in inflammatory disease from severely decreased to severely increased [ 32 ]. Leukocyte numbers vary with species and reflect the balance between production and release from the bone marrow and consumption [ 32 ].
In contrast to dogs, which have a rapid regenerative capacity and a relatively high bone marrow reserve of neutrophils, cattle have a slow regenerative capacity and a relatively low reserve.
Thus dogs with chronic infection usually have persistent neutrophilia, whereas cattle may have normal neutrophil numbers and a normal differential cell count, or even neutropenia with a left shift because of a slow regenerative response.
Traumatic reticuloperitonitis develops as a consequence of perforation of the reticulum. It is important as a differential diagnosis of other diseases marked by stasis of the GI tract, because it causes similar signs. Traumatic reticuloperitonitis is most common in mature dairy cattle, occasionally seen in beef cattle, and rarely reported in other ruminants. Cattle commonly ingest foreign objects, because they do not discriminate against metal materials in feed and do not completely masticate feed before swallowing. The disease is common when green chop, silage, and hay are made from fields that contain old rusting fences or baling wire, or when pastures are on areas or sites where buildings have recently been constructed, burned, or torn down. The grain ration may also be a source because of accidental addition of metal. Swallowed metallic objects, such as nails or pieces of wire, fall directly into the reticulum or pass into the rumen and are subsequently carried over the ruminoreticular fold into the cranioventral part of the reticulum by ruminal contractions.
Clinical and laboratory findings in 503 cattle with traumatic reticuloperitonitis