Today for clinics I had the large animal rotation, where we get a case, are given the presenting symptoms, and then we are supposed to come up with a list of differentials, a diagnosis, and a treatment plan. Basically, the point is to start training your brain to actually think like a vet, which isn't as easy as I thought it would be. It's so easy to jump ahead and skip steps and make assumptions that can cause you to miss a lot of important clues in what is actually wrong. Anyway, so we got this case and we were left alone to discuss as a group what we thought was going wrong. And even though it pains me to say this, this large animal case was so much better than the equine one.
Our case was about a 2 month old mixed breed beef calf. He was admitted for having a bilaterally distended abdomen and for appearing depressed. He had previously been admitted for calf diphtheria (I just had my exam on that one- yay for knowing Fusobacterium necrophorum!) and had been on antibiotics for a while. Now the thing about cows is their rumen is a pain in the butt. Anything wrong with the rumen is no good. Anything wrong with all the little microbes inside the rumen is no good. And what do antibiotics do? Wipe out all the little microbes in the rumen. So as we were discussing the case that was like a red flag to be aware of.
The attending clinician gave us the vitals from this calf (high heart rate and weak pulse), there was some pinging and splashing in the abdomen (a sign of gas, possibly bloat), absolutely no motility (ruminants should have a least a couple of gut sounds every 2 minutes), and told us that he was dehydrated as well as having some diarrhea. Then we were left to discuss our problem list, differentials, diagnostic procedures, diagnosis, and treatment.
Now, I don't pretend to know anything about cows. I really don't know anything. Mama cow was in the next pen over with a ridiculously fuzzy winter coat that made her look like a teddy bear, and I didn't even know cows grew winter coats. I don't know why they wouldn't, but it never occurred to me that they would, either. So that pretty much sums up my experience with cows.
So while the group is sitting around discussing, one of the first things said is a displaced abomasum. This is one of the only diseases that I actually know about it cattle, besides bloat. The abomasum is the "true stomach" of the cow's 4 chambered stomach, meaning it's the chamber that's like our own stomach. And normally it sits more on the right side of the abdomen, and it being displaced just means it's not sitting where it should be. I think we also came up with decreased vagal innervation (the vagus innervated the GI tract) as well as just all the little rumen bugs being wiped out. I was happy about this, because it meant I actually knew what was going on. I didn't really think it was a displaced abomasum though, because beef cattle almost never get them. That's apparently a dairy cow thing. I was told this by someone who knows a lot more about cows than I ever will (aka Jenn).
Eventually our clinician comes back and tells us that it actually IS a left displaced abomasum. And all the clinicians were so excited and told us we were the luckiest vet students in the entire world that we got to see this. I will take their word for it. But we did get to watch the clinicians ultrasound the calf, which was cool. usually when you ultrasound the rumen you can't see anything, because gas blocks the ultrasound waves and thanks to the rumen bugs the rumen is full of gas. But because all of the microbes in this calf had died we could see into the rumen, and we could also see the abomasum right where it shouldn't be, next to the rumen. Then we got to watch (and help) rock the calf. That's what they call it when you essentially flip the calf onto its back, grab it's feet and rock it from side to side. The idea is that reversing the orientation of the calf would move the gas in the stomach, and then by rocking the gas would kind of carry the abomasum back to where it should be. Unfortunately, probably because this calf had no gas on it's stomach, ultrasound confirmed that 2 attempts at rocking didn't work. That means the poor little guy is probably going to need surgery to fix it.
But I'm feeling pretty good about getting to witness something so rare (because apparently a left displaced abomasum in beef cattle are completely unheard of) and to see how to rock a calf. I'd say this is in the top 3 as far as productive clinic days go. =]
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