Hi, today I'm going to go through some of the challenges that we face when we are considering farm animal emergencies. Now, what this, webinar is not going to be is to tell you how you should go about doing caesareans or doing, displaced abema, but rather to think about some of the challenges that we face, particularly when we're facing things that are not familiar to us. And One of those big challenges is we see a wide range of, differentials and differing physical exam findings, particularly when we're comparing between commercial stock and, farm animals that are kept as pets.

And the other problem we have compared to maybe companion animals is we often get a very poor or a vague history as to what those presenting signs are. Sometimes we're faced with animals that are challenging to examine or that there are poor handling facilities, and then the value of diagnostic tests available to us varies. So I thought I'd start doing some sort of theory about thinking about clinical reasoning and thinking about this quizzical triangle.

When we come to approach a clinical case, we often need some form of methodology to try and label a disease and obtain a diagnosis. Now in lots of scenarios, it's actually the pathology rather than the particular pathogen and that's important when we're thinking about identification of clinical signs, disease outcome and designing that therapeutic plan. But the downside of thinking about disease from a differential or a pathogen identification mindset is that sometimes we miss things and therefore we need to try and use, particularly in those perhaps unfamiliar scenarios, a purposeful.

A more thoughtful physical exam, very strategic ancillary testing, and then use all of those findings to try and inform us of, the sort of treatment and prognosis arms of the triangle or square as it becomes. And this is what this quizzical triangle looks like. We're trying to get a diagnosis, we're then trying to come up with a treatment and, and prognostic plan, and then built into that sometimes prevention's gonna be very important, particularly in a group or a herd scenario.

So many of us get calls to go and see animals and we sort of disease label. You get into the car on your way to see an animal and you think that you're probably gonna be faced with X. And the problem with this sort of disease labelling is that it presumes all the disease presentations of a particular disease are going to present the same.

And it also restricts that clinician's ability to consider disease variation and deviation in health, productivity of that disease manifestation, and also how that disease might manifest in different production environments. And also, more importantly, it depends what you know about the disease. So this calf that's displayed on the right hand side, many of you without a history would be able to look at this and see that it's got cardinal signs consistent with malignantaral fever.

But if you're not familiar with this disease or you have never encountered it before, that might not be something that you would pick up from just looking at that picture. So when we're thinking about approaches to cases, there are sort of two basic approaches. We've got pattern recognition and we've got problem, problem oriented, .

we've got problem-oriented approaches. When we're thinking about pattern recognition, we often need case experience and local knowledge in order for that to be effective. We need to understand, and have the correct patterns.

And the big advantage to pattern recognition is that it's very speedy and effective. The biggest problem comes is when you try and patent recognise something that you don't know or that it's in a species or a production system that you're unfamiliar with and you then end up doing 2 + 2 and getting 64 instead of 4. When we think about problem-orientated approaches, it's often really good for diseases that you don't know or species or production systems that you are not, that you're not familiar with.

And one of the great things with problem-oriented approaches is it's been shown in both human And veterinary medicine to enhance effectiveness in economy and enjoyment of that approach because it develops that experience and knowledge base to allow you ultimately when you've seen more than one of them, to be able to move to pattern recognition. So when we're thinking about this approach, what we want to do is we want to define and refine the clinical problems. We want to find the problems that are gonna have the highest diagnostic return, and then we're gonna want to answer key questions related to that problem.

So we're gonna want to know what organ systems likely to be affected, what the differential diagnosis or diagnoses are, what tests you're gonna do in order to try and confirm your diagnosis. And fundamentally, if you're going to use this approach, you do need a complete and relevant problem list. And one of the cool things about using this approach is actually for any species, there are a finite number of observable clinical problems that you have to master.

For example, if we were small animal vets, vomiting would be one of those problems, whereas actually that's not the case in ruminants because vomiting is in fact pretty rare. And by using this approach, we acknowledge that each case has a unique combination of observable abnormalities, and then we can tailor what we're gonna do to that case, both diagnostically and therapeutically, and then come up with a likely prognostic estimate and how we might prevent that in the future. So let's think about some of those common presenting problems or emergencies that we see in everyday practise.

Some of those presenting signs are really specific like coughs, and others are not so like pyrexia or milk drop in dairy cattle. And it's really important when you're selecting a problem to try and pick the one you're most likely to get a diagnostic return on. So things like changes in appetite, weight loss, reduction in production and pyrexia.

Are much less likely to be helpful to us than nasal discharge, cough, changes in abdominal contour, changes in urination or GI motility, which are gonna be much more specific to a body system. So let's have a think about a case. This was a 5 day old Holstein Friesian heifer calf that presented recumbent offsock and with diarrhoea.

And in an ideal world, we'd want to refine that in more detail, to think about what its percentage fluid deficit might be and how we were going to replace that fluid deficit in order to improve its clinical size. Now based on a pattern recognition approach, we have got an animal that's likely to have neonatal. Diarrhoea and the pathogen is probably gonna be predictable based on farm history and the age of the cough.

So let's say it's likely to be E. Coli. Now we may or may not be right about that pattern recognition, that's gonna depend a lot upon our previous knowledge.

So let's think about this from a problem-based approach. We've sort of got 3 problems. We've got recumbency, we've got anorexia, and we've got diarrhoea.

And then we can split that into some of the, some of the signs. That we've got. Now as I'm sure most of you would agree, recumbency and anorexia are gonna be much lower hitters in terms of us coming to a definitive diagnosis based on the problems we're presented with than the diarrhoea itself.

So when we look at that, we can think about, it can be very difficult, but we need to pick that problem that's got the highest diagnostic return. So let's think about another case. So this time it's a Belgian blue ball that presents with a two day history of anorexia and rapid breathing.

Physical exam reveals a marked tachypnea, increased respiratory effort, and a mild left hand side abdominal distention. So again, when we think of our differentials, we've got anorexia, we've got tachypnea, we've got increased respiratory effort, we've got no cudding, we've got this change in shape. So when we think about our priority for investigation, we're probably gonna start with the things that are most likely to be life threatening, so the significant respiratory signs, but also they're gonna be the highest yield in terms of us trying to obtain a definitive diagnosis.

And one of the key things to a problem-based approach is, that actually it's not species-specific, so it lets us apply that to whatever of the species combinations that we work with, which is farm bets, is often, often multiple species from multiple, from multiple, rearing systems and, and including pets. So we've got which body system do we think is involved and which part of that body system is affected, and then do we think the involvement of that body system is primary or secondary, physical or functional? And then thinking about what the pathology in that part of the body system is.

So let's try and apply that to our Belgian blue bull that's got rapid breathing, marked tachypnea, and increased respiratory efforts. So based on these clinical, the more specific clinical signs that we've got, it's likely that this is, that the primary body system that's affected is respiratory. And what we're then gonna want to know is, do we think this is likely sympathetic stimulation, i.e., is it pain or another reason, which is pretty unlikely, not reported here, but actually this fall is a largely normal heart rate.

We then want to think about which part of the respiratory cycle is affected. And it's likely to be inspiratory with, further information to give you from that physical exam that the bullet got flared nostrils, extra movement of the ribs and diaphragm. And the third part is, does the respiratory effort seem to localise to the respiratory tract?

And the answer is, it seems to, well, it's trying to get in more air, has got its neck extended and has got its elbows abducted. So our conclusion is that it's probably got primary respiratory disease and that the abdominal signs that we're seeing are probably secondary. So then we want to know what part of the body's system, i.e.

The respiratory tract, is affected. And there is no evidence of a cough in this animal. There's no evidence of a nasal discharge or lymphadenopathies, but, there.

And there's not particularly any evidence of upper respiratory tract noise and there doesn't seem to be altered airflow in the upper airway. But there does appear to . The altered respiratory function when we palpate the larynx, where the animal seems to develop more significant inspiratory noise and increased inspiratory effort.

So because of that last finding that we've got there, the likelihood is this animal's got an inspiratory and dyspnea that's compatible with extra thoracic disease, because as we've said, we've not got a cough or a bilateral nasal discharge. And that change in respiratory function with palpation of the larynx is very strongly suggestive of laryngeal disease. So we then need to work out is that laryngeal involvement primary or secondary, physical or functional.

And, it is altered when we palpate it, and it is altered when the animal is mildly and stressed and certainly looks to have more significant respiratory signs when, the, the animal's asked to move around. So it's suggested there may well be some dynamic laryngeal function, maybe paresis or paralysis of that larynx. So then we move to, well, what's the likely pathology?

And do we have any evidence of systemic inflammation? We don't, it doesn't mean there isn't any, but there certainly isn't. And then can we find a relationship between the anorexia and not chewing the cud?

And laryngeal dysfunction. And there does appear to be normal ruminal motility, so it's probably not likely, . It's not likely to be having a significant impact on the gastrointestinal tract, but it may not be chewing the cod because in order for us to, for that, that movement to happen, we need laryngeal function because they need to be able to inspire against a closed glottis.

So then what are we gonna do next to try and get to the bottom of the pathology? Well, if we think it's an upper airway abnormality, what we would ideally do is we would, we would want to do endoscopy, and an endoscopy, we found that there was. That there was a, a narrowing of the laryngeal lumen and a bilaterally enlarged atenoid cartilage.

So our tentative diagnosis based on the diagnostics that we performed was an Carotenoid chondritis and we know that that's usually got an underlying bacterial cause. So treatment was tried with antimicrobials and anti-inflammatories, but as the ball didn't respond, a permanent tracheostomy was a thought. So I think what that last case really shows us is when we're doing these emergencies, how important it is to do a detailed and accurate physical exam, not just about the numbers, but really paying attention to the body systems and for many experienced.

Clinicians, you often have a feel that something isn't right beyond always being able to explain what that something isn't right is, but it certainly is definitely beyond TPR but much more and looking for that attention to detail and picking up all those problems. And I'm not gonna go through these sort of physical exam slides, but really thinking about ensuring we examine the whole, the whole animal, and not missing anything that might well be an important problem down the line, or, That that would have helped us narrow down some of these very non-specific signs that we're presented with. Same goes with with sheep really making sure sheep and goats, really making sure that we pay close attention to detail on our physical exam, which can be very hard sometimes when we've got excessive amounts of wool.

Again, similar true with the llamas and alpacas, large amounts of fibre, not always the best handling facilities, really getting to grips with those. And then we moved to the pig, in many commercial units. Individual physical examination may not be performed, but with the pet pigs, this can sometimes be a significant challenge.

And if it isn't a significant challenge, these animals are either very well handled or they are very, very sick. So then I thought we'd come back to thinking about the tools that we need for thinking about anatomical localization and, and then moving on to getting to that ultimate diagnosis. And we can sort of split our.

Approaches in these emergency cases into sort of 5 parts. We've got the value of physical exam and many of us are very reliant on physical exam in our in our emergency patients. We've then got haematology, which is often not as useful in ruminants as we would like it to be.

Then we've got other forms of clinical pathology and some things such as arterial blood gas analysis can be so useful to us but are not always available. And then we've got imaging, and again, sometimes our access to imaging is. Pretty limited, particularly with endoscopy and radiography, but really trying to do more and more work using ultrasound, not only for reproductive work and really getting the most out of the ultrasound machine.

And then we've got some specific ancillary diagnostics that can be valuable to us depending on what body system we have anatomically localised our disease process to. So things such as transtracheal wash and bronchoalveolar lavage for. Respiratory problems, rheum fluid analysis, rheum chloride, abdominocentesis, for GI problems, and then urinalysis, specific gravity, maybe sediment exams or stains for some of our urinary problems.

When we're defining looking for tools for organ dysfunction, however, many of those things stay the same, but some others get added in as well. So white cell counts may be useful to us when we're thinking about looking for dysfunction, but the white cell counting ruminants doesn't always do what we would like it to compared to what we might see in small animals. We certainly can add in value of looking at serum proteins and acute phase proteins such as serum amyloid A and fibrinogen to try and help us look for that dysfunction.

And then ultimately what we're gonna want to do is tools that are gonna identify pathology to us. And again, many of the things we've already talked about are on that list, but now we've got things like liver biopsy, we thought we've got liver disease problems or abdominocentesis to really help us get to the bottom of what we're faced with. So the next part of this, of this webinar is going to be largely case-based.

So I've got some production animal cases first, and then we'll move on to some of the, perhaps slightly more unusual and more cases we really need to use that problem oriented approach for with some of the, sort of pet, or small holding and ruminants and pigs. So I came up with a list of some of the common diseases that we see in commercial stock, and because they're common, they're often things that we're very, very good at pattern recognising based on history and or sometimes very limited physical exam findings. And then we've got some other things on this list that perhaps we don't see quite as often, but we might be more likely to need that lesion oriented approach for in order to get the diagnosis that we, that we want.

And again, got some of these other, other diseases here that we, depending what sort of cases we work with, we may or may not be and more or less familiar with. So I think when we're thinking about commercial stock, as many of us know, history is often scant and that the presenting signs are often very, very non-specific on what we would call pretty low yielding, yielding, factors for us to try to come up with, a problem list, and then, a differential, a useful differential diagnosis list. .

Sheep are likely to present in more advanced stages of disease perhaps than than cattle and goats that are kept in very different commercial systems. One of the things we often do get good histories with is parity when they were last bred, which is likely to change differentials or when they're carved, what the TV status is, which is very important in certain parts of the country. Vaccines that are used and what their schedule is, but because this is going to give us often limited amounts of help, it then all becomes about the physical exam and really attention to detail on that physical exam so that we can find that high yielding problem.

So the first case that I've got is a six year old Holstein that presents with those non-specific signs of weight loss and milk drop. And the physical exam by the first vet that saw it didn't really find very much except for muffled heart sounds. So the problem is that we've got here are muffled heart sounds, and based on that history, we're probably gonna be thinking about cardiac, maybe, maybe the animal has got, some more solid fluid in its chest or it's got some form of pericardial effusion.

So I suppose going to see this case, my likely body system and pathology was very much centred around the cardiovascular system. So other things to note for this case were. The case had a negative bar test and with this pinch.

It had an increased fibrinogen and high normal white cell and neutrophil count. And actually when I got there, the cow had a relatively normal heart rate of around 80 beats per minute and did not have a pericardial effusion and the heart sounded OK. It doesn't mean it hadn't done previously, but certainly that was what it found.

So again, that sort of clean path and haematology we've got there, they are pretty non-specific signs of what we would expect from many sick adult cattle. So at this point, the decision was made that this animal had likely got a site of sepsis, and it was then trying to work out where that site of sepsis was. The animal didn't have any respiratory signs, normal respiratory rate, normal respiratory efforts.

So the starting point for this cow was very much looking in its abdomen. And this is an image taken from the left, cranial ventral . A section of the abdomen just caudal to the heart.

And what you can see on this screen is that we have got a white line that that represents the reticulum and then above that, hopefully you can all appreciate that there appears to be a spherical structure that's got a hypoechoic centre with a more hypoechoic wall. This is an image also taken slightly more ventrally in that cranio ventral portion, and here we can see the wall of the reticulum in the far field, and then we've got, fluid, which does appear hypoechoic, but in cattle that can definitely lead you astray. And then we can see some strand-like structures that appear to be connecting with the surface of the reticulum.

And the reason that I suppose I started in that site was that common things are common, and although the animal had got a a negative bar test and with this pinch, I wanted to rule out . A wire and peritonitis before I went on looking for anything else. And it certainly did appear that this animal had got a reticular abscess and had got some fluid peritonitis associated with that.

And, the thoughts were that perhaps the bar test with this pinch was negative because the, the wire had perhaps poked through and caused the abscess to form, maybe wasn't present sitting causing continued pain, and movement in that having penetrated that particular wall. I'm hypothesising, I don't know. So the, farmer was very reluctant to, cull this cow.

So the decision got made, that we would, the 4 weeks of antibiotics would be administered. We felt we needed a pretty prolonged course if we were going to be successful because it was going to need to, penetrate that abscess and I'm afraid I didn't have very much, confidence that this was going to improve. However, within about 10 days, the weight loss improved in this cow, milk production was apparently increased to better than it had been previously, about 3 weeks into the antimicrobial course.

And by the end of the antimicrobial course, the blood work was pretty normal and 6 months on, the cow was OK. This is one of those cases where you would look at these findings prognostically and say she probably didn't have a great prognosis and that somebody wanted to persevere and was successful. So the next case is a 4 year old, high yield in Halstein Friesian, again presents with very non-specific signs, pyrexic, anorexic milk drop, and it's 4 weeks post-calving.

So, I mean, body system and pathology based on that history is anyone's guess. You might go with reproductive, and, and or for me would be GI. Does this animal have, have a, have a display ever mason.

On physical exam, there was decreased ruminal contractility. Again, negative bar testing with a pinch, but the cow was really arched and appeared to be in pain, that had not responded, to, Flinnexin. And again, blood work was very, very unhelpful in many ways other than, confirming that we'd probably got some form of an infection with this inflammatory, .

Profile. Now based on this, she's got decreased ruminal activity, and she didn't appear to have a ping, so that made a, a left sided display havema less likely. But I still am not sure it necessarily helps us in terms of what body system or pathology is likely to be going on other than we've probably got a site of sepsis somewhere.

So because of this, I, I suppose my default with, with adult cattle is always to start with the gastrointestinal tract and then. And then move forward. So this is an ultrasound image taken from the left 10th intercostal space, and what you can see on this image is you can see an intercostal muscles in the, in the near field.

Then we've got the spleen which does not appear normal, and then we've got the room and the wall. And what you can see if you look closely into this spleen is that we've got a sort of spherical structure that has got some hypoechoic bits in the centre. So we saw this, and I mean, differentials for this would be abscess, granuloma, neoplasia.

And the cow did not come from a farm that was, that had TB as a particular problem. So 72 hours after starting antimicrobial and anti-inflammatory and analgesic therapy, the cow really didn't look any better. So the decision was made to perform a standing, left flank approach and remove the spleen.

This is a technique that was described in the 1950s and as long as. You tie off the splenic artery effectively, and it's a relatively straightforward surgery and can certainly be quicker than doing a DA and 18 months later his care was absolutely fine. And the cause of that splenic abscess, which is no big surprise to anyone, was a wire and presumably they had migrated from the fibre mat into the spleen.

The third case is a 4 year old Holstein Friesian cow that was found collapsed in a barn and breathing hard with flared nostrils in late gestation. And again, thoughts on the body system and the pathology and causes here and respiratory is gonna be pretty high on the list, could be cardiac, and it's certainly. Oh, and ultimately with that sort of hard breathing and flared nostrils could be any form of other causes of, of pain.

And in fact, this cow turned out to have To have a, a pericardial effusion and that the animal had gone into heart failure and had got, had got pulmonary edoema. And when you look closely on physical exam, there was sort of evidence of frothy fluid sitting at the, at the near in this in this animal. The next case, again, 5 year old Holstein Friesian from a again, pretty high yielding cow, presents 4 weeks post calving, again, usually non-specific signs, as we've said before, might be reproductive, might be GI, could be anything based on those signs.

Rectal exam revealed that there was an unusual mass in the right cordo dorsal abdomen. So in that position where we've got the secum, but we've also got the kidneys. Now, initially, the idea that the animal had got urinary tract disease was discounted because the urine looked grossly normal, but when a dipstick got done on that, on that urine, there was in fact 3+ protein and 3 + blood.

And based on that, the next steps were in order to try and identify the pathology, were to perform ultrasound of the bladder and also of the kidneys, which we can do both perectum and transcutaneously. And this is what the image looked like taken from the 12th intercostal space. So we've got these loculations that you can see here, you can see this is down to a 30 centimetre screen.

So this is a pretty large large structure which we assumed was a kidney. It's, you can see. It's got ecogenic material in it.

And from a prognostic point of view, ultrasounding that kidney is gonna give you a pretty good idea that it's got little functional tissue left and therefore, antimicrobials, even ones that will concentrate in the urine, are unlikely to be very effective. We could see some normal renal tissue a little bit further cranially as well. Again, the urine contained 90% degenerate neutrophils, and culture unsurprisingly revealed E.

Coli. And because of the structure of that kidney, actually trying antibiotics was going to be a fairly fruitless, experience. So discussions with the farmer, we talked about surgery time was likely to be similar, if not a little bit longer than it would be for a DA.

A standing nephrectomy got. Performed and within about 36 to 48 hours, this cow looked much better. And here's the kidney coming out of that abdomen.

It weighed about 7 kg, and they were just bags of pus where there should have been those normal lobules of kidney and that's what it looked like on a cross section. And here she is, one of the few er large patients that we've had that managed to make hypothermic during that surgery on a very cold day. The next case was a, a cow, a 2 year old cow that calved three months ago and had just been diagnosed in calf, found to have a milk drop and was dull and on physical exam, heart rate was 100.

36, temperature 38, and she's got reduced ruminal contractions. So, again, quite a difficult case to, to work with in an emergency and not that uncommon. So, is it a primary GI problem?

Is the heart rate and respirate related to cardiorespiratory disease, or do they relate to hypovolemia and pain, . And pain themselves. So it can be very difficult and it's all about that attention, that attention to detail as to where you would go next with the case.

And as I've said before, the thoughts for me would be that I would start with the, the GI tract because common things are common, and then I would move on to the cardio respiratory system. Again, another case with this very non-specific history, decreased faecal output this time half two months ago, trying to work out likely body systems or pathology, really very difficult, although that decreased faecal output might relate to decreased, decreased intake or might be we've got a primary GI problem. And in this case, negative bar test increase stool side fibrinogens, suggesting some form of inflammatory process and really not very much on physical exam other than a slightly increased heart rate.

So as I've said, for me in a cow, I'm gonna start with the, with the GI tract and I came for ultrasound in this case, this is an image taken. From the right Cao ventral abdomen, and here we can see we've got these loculations of this of this structure, we've got this sort of spider's web appearance, the fluid here was actually very hyperchoic, suggestive of a fairly ongoing peritonitis. Here are some loops of small intestine that were all sort of stuck together, and not.

And not really very motile. And so the likelihood in this case is we've got a generalised peritonitis, and you would look at these findings. This is a significant amount of fibrinous material that's been going on, very unlikely that we're going to be able to revert that disease process back to something normal, particularly when we've got adhesions between pieces of the GI tract.

So prognostically, this cow never really had a great chance, but the, farmer wanted to try antibiotics, anti-inflammatories. We did try locally, lavaging this, abdomen, but it's often very unsuccessful when you get these sort of, pockets of, of fluid that have been loculated and closer. The cow didn't improve and was euthanized, and again, no obvious cause at postmortem examination.

I think this is the last case in my sort of emergency commercial, cattle section. This was a 4 month old beef calf with poor weight gain. It had been intermittently pyrexic and was now dull and off sock.

It was known it had had an umbilical hernia that the farmer had been able to initially reduce, but it was pretty big. But at admission that umbilical hernia was not reducible and was approximately orange size. So, although we've got a pretty poor, very general history, the sort of change in that umbilical hernia to me made it most likely that we've got some form of gastrointestinal disease, possibly an obstruction, and that that pathology might relate to strangulation within that, within that hernia.

So we scanned the hernia sac, I don't know if this video's gonna play, but within that hernial sac, we could see these loops of small intestine that was sort of very slightly motile. So, spoke to the to the farmer regarding this case. The the case either was gonna require likely euthanasia or we could try and see whether we could we, we could see exactly what was going on within that hernia sac, would we be able to reduce it, what did the intestines look like, etc.

And in fact, the, it was worse than we'd expected. It'd probably been going on much longer than perhaps we'd anticipated, but the, the intestine had adhered to that internal surface of the hernia and had partially strangulated. And in fact, we were able to resect about 30 centimetres of small intestine and anastomosis.

And the calf actually did very well post-surgery, got, got 5 days of antibiotics and some analgesics and got very little else, went back to its mother. And in fact, it's, it's weight gain, It was pretty normal in the sort of 6 weeks post-surgery and it, it made slaughter weight with the other animals in its group, and this is what it looked like at surgery we've just . Just opened up that hernia sac to see if there was anything that we could do and there really wasn't.

It was all really very much adhered together. So then opened up the abdomen in order to try and access the small intestine and remove that affected segment. So I'm now gonna move on to the sort of pets, the ruminants or the ruminants that are kept by small holders and think about, actually we end up with a very different differential list, these animals, some of which we're very familiar with and Some of which, some of which perhaps we are less so.

Some of them are the same, but some of them are definitely different, both because of the species that we see, but also because of the environments and the random things that some of these animals get that. So the first case that I was gonna talk to you about was, it was a small herd of 6 reindeer. They lived in a paddock on grass and concrete, and 1 had died within the last 4 days, and nothing had been found on postmortem examination.

There were now 2 reindeer with diarrhoea that were lying down and that were off feed, and one of them did in fact appear to be centrally blind. The owner had, got Clostridial vaccine, but had not actually administered it to the animals, and they had been dewormed with an ivermectin bolus, 12 months ago, but he didn't want to bolus them again. On worm egg count from the animal that had died, there were 50 tricustrongylus eggs.

So when we think about this from a problem oriented approach, again, we've got some quite non-specific signs, but we certainly have got clinical signs of diarrhoea which are suggestive that we have got a gastrointestinal or an intestinal, problem that may or may not be primary, although with the anorexia, those two things go together, making us think that the GI tract is the likely sign. And then we moved to that worm egg camp. Well that worm egg count probably wouldn't be significant if we were dealing with that in a commercial room, but knowing what we know about reindeer is that they are a migratory species and they have a very tolerance for any forms of parasites.

And one of the reasons why reindeers are often kept kept on concrete in captivity and, in parks, etc. Is in order to try and combat that lack of tolerance. So the central blindness was Was interesting, but also quite relevant to this likely being a gastrointestinal abnormality.

We were able to measure ammonia in this case, and in fact the animal had a very, very high ammonia, which when we Looked at the rest of the biochemistry with electrolytes being largely normal and, and liver damage indicators and bile acids being normal was suggested that it was probably, gastrointestinally related due to changes in GI flora. So knowing what we know about them being a migratory species, we did in fact, Decide this was a primary parasite problem, and although that count would not have been significant in other species, it was in this one. They all got treated with, parental ivermectin.

Doramectin doesn't seem to work in reindeer, which is a very specific thing. They all had some parental steroids to try and reduce the, inflammatory response in the gastrointestinal tract, and then we advised that these animals were kept on concrete that could be washed down. The next case I've got in this series was Lulu.

She was a seven year old female potbellied pig that had been lying in lateral recumbency, unwilling to move, disinterested in feed, and breathing very hard. She was a pig that lived in both the house and the garden, and she was house trained and the owners, said she'd been normal in the morning and had had breakfast but was recumbent when they got home from work. So the animal was in lateral recumbency and didn't respond to stimulation, and for me in a pig that's very, very bad.

And temperature was normal. She had an increased pulse, and very thready pulse quality in her, ecular arteries. He mucous membranes, no abnormalities were detected on, cardiac consultation.

Respirate was 50, skin tent was probably normal, although the temperature of her extremities was cold, and she had no GI or Britney on the right or left side. So we've got an animal that looks like it's in . Is in hypovolemic shock, and the lack of Brigme is more suggestive that she has got some form of gastrointestinal.

Abnormality. So I, actually it was orogastric, not nasogastric. An orogastric tube got passed and gas and, and 2 litres of foetid yellow fluids got released, and abdominocentesis recovered, a large amount of straw coloured fluid with a slightly increased total.

But there certainly weren't large numbers of neutrophils that would have been suggestive of peritonitis. So the findings that we've got here are suggestive that the animal's got ileus, perhaps it's got an obstruction, but the abdominocentesis suggests that that obstruction is probably non-strangulating. We scanned the pig's abdomen, often needs large amounts of gel and time for it to soak in if you're going to get really good quality images.

And there were distended loops of small intestines, some of which had got quite thick walls. There was very poor gastrointestinal motility on ultrasound, but the liver, kidney, and spleen were normal. There was lots of free fluid in the abdomen, and no obvious enlarged lymph nodes, and there was an intact bladder.

And this is the sort of image we've got. We've got these varying descended loops of small intestine, and you can see that there are small. That there might well be an obstruction.

And this pig in fact went for an exploratory laparotomy and she had eaten several of these . Of these, cotton reels, large, large reels of, of cotton. There were no needles that we found attached to them, and they caused an obstruction sitting in her small intestine.

The next case is, George, a 6 month old pet pygmy goat, and this is one of those cases that I've put in really, to really make us think that actually, you know, we don't always get weird and wonderful things that we're not able to patent recognise from. Anyway, he was non-weight bearing after playing in the garden and a railway sleeper had fallen on his, right behind him. He was insured with, with Exotics Direct, which will insure just about any form of animal if you request it.

And I've got no other reported problems. 2, so, you know, the thoughts here are this is likely to be a musculoskeletal problem, and he's either going to have a fracture or there's going to be some form of soft tissue damage or a combination of those things. So, we usually, we could palpate the fracture and we confirmed what that fracture was using two views with radiography after he received some IV diazepam.

And what we know about young ruminants compared to probably other species is that their bones heal very, very well, almost despite what we what we do. There's various things that we could consider, but the simplest. It's going to be to cast that limb, which is exactly what we did.

Radiographed it after the cast. We've managed to reduce that Solta Harris fracture very effectively, and within 6 weeks, that fracture healed, the cast come off, and, all was well with hip. The next case is another case probably that we can have a pretty good go at pattern recognising with it.

Bertie was a 3 year old male pet pet pygmy goat. He had a distended abdomen, was bleeding, and had been straining for 4 hours. He'd been given by your colleagues some flinicine and scarpan compositant.

And the goat is obviously in a reasonable amount of discomfort during the examination, temperature's normal, increased pulse, increased respiratory rates, normal, extremity temperature has still got some ruminal contractions and no fluid wave on the allotment of the abdomen. So, with common things being common, a urine, a urethral obstruction's gonna be pretty high on our list with a pet goat of this age with these clinical signs. Many of these animals will often present with concurrent bloats because of sympathetic stimulation and reduction in the, in gastrointestinal bore rigme, but that didn't, wasn't in fact the case, with him.

And we used abdominal ultrasound to have have a really good look at what we were dealing with. So we could see that the rest of the gastrointestinal tract was fine. There was a small amount of free fluid in the abdomen, but not a significant amount, and we looked like we've got a nice round intact bladder.

What looks to be wall thinning on that top image is in fact just an ultrasound artefact. But what was of note was that this animal had got a dilated . Renal pelvis, and because it got hydronephrosis, because this has presumably been going on for some time.

And it's always worth knowing that because it might change the likely prognosis in that case. And in fact, this animal had its urethral process removed which didn't, fix the urethral obstruction. And then with discussions with the owner, this was not a house-trained goat.

A decision was made to perform a bladder marsupialization. I did talk to the owners about the risk of, secondary and ongoing, renal dysfunction because of that, hydronephrosis, but they wanted to continue with surgery. The goat did very well after surgery, and in fact, that hydronephrosis, resolved.

The next case is one we perhaps are less able to pattern recognise with. Esmeralda was a nine year old son and goat that had a smelly discharging wound from one side of her mammary gland, and that mammary gland had been getting much larger over the previous few months. The owner had been putting arnica and aloe vera creams on it and it had no effect, and the goat had not been as bright and had basically not been eating for the previous week, which was why you got called.

Physical exam and basic blood work didn't really reveal any abnormalities. Fibrinogen was an increased at 7 grammes per litre and milk couldn't be extruded from the mammary glands. Now, although she was not a lactating goat.

It didn't certainly rule out mastitis or chronic mastitis, but perhaps with this history might make us think of of other abnormalities that might be going on, particularly with her age, considering she may have a granuloitous or neoplastic process. So we ultrasounded this mammary gland, pockets of hypoechoic fluids, areas of, relatively homogeneous normal mammary glands, but then these really abnormal he heterogeneous areas, that extended into the, into the normal areas in not a particularly nice way. And that within the abnormal areas, there was evidence of some shadowing suspected calcification.

And the abnormal areas had no obvious capsule, but the unaffected side appeared normal. So we were then concerned that maybe this was a neoplasm and that that neoplasm was likely to be malignant rather than benign. We went hunting to see if there was, were any other abnormalities that we could note, and there weren't.

We could see nothing on, abdominal ultrasound, nothing on thoracic radiography. So the decision was made to perform a, we could have done a hemi mastectomy in this, in this goat, but decided to perform a total mastectomy as, she wasn't a milking goat and was unlikely to be bred again, and the mammary gland got removed and, she had a, a very successful recovery. And then the next case was a A Shetland sheep, a 10 year old female Shetland sheep that presented with a distended abdomen and was anorexic.

And with that history, we would certainly be, I was certainly considering that this was likely to be a primary gastrointestinal disease. The sheep had been losing muscle mass over the last few months, but her abdomen had been getting larger. And she did live with some other sheep and some other goats in a large back garden that were largely normal.

Compared to some of these pet animals, she was fed a relatively normal diet, and she was wormed regularly and worm-egg Kent did get performed on all animals. On examination, she's got a very high pulse and with pale mucous membranes and had got a very significant fluid wave on the of the abdomen. So making us think perhaps that fluid was extra gastrointestinal rather than necessarily within the GI tract.

And again had a very high fibrinogen which for me would be suggestive of obviously a significant inflammatory process, but when it gets to be. That high, I'm always thinking more of neoplastic processes rather than infectious processes. So we put a scanner onto her abdomen to see exactly what that fluid was, and what you can see on this image is you can see an artefact on the image with those sorts of lines, which are called herpes.

And we normally get herpes on ultrasound images when we've got very, very clear fluids. So much less likely to be a peritonitis, which would have lots of cells, much more likely to be, Caused by perhaps low oncotic pressure with liver disease or with heart failure, and less likely to be, like I said, to be peritonitis or something else that would give us an egg. This was really the only thing that we noticed.

So fluid was sampled and got sent to the, to the lab. And what we found was that the, it didn't smell like, it didn't smell like urine, didn't look like she'd got a, a, urinary tract rupture, and the total solids on. This sample were very low.

But when you look at these mesothelial cells and these cells were looked at straight away, you can see that they vary in size, they've got variable size of their nucleus, sometimes we've got multiple nuclei and multiple nucleoli. And we can see that some of them look to be, look to be dividing. So very suspicious that this animal had got, based on these, on, on these cells had got a mesothelioma.

And when you look closely with the ultrasound at a much higher frequency, you could see the thickening of that peritoneal lining with sort of bubbly bath mat. So we discussed with the owner that actually treatment of this particular neoplasm was very difficult. We placed an IV catheter, we gave the, gave Molly some fluids.

We slowly drained the abdomen because one of the reasons her heart rate and respirate was so high was because her thoracic cavity was being squashed. She looked significantly better after the fluid had been drained. We did give her some, some non-steroids and some some steroids palliatively, but then within 3 days, that fluid had reformed and the decision was made to, euthanasia.

And then this, this is another case that is more difficult to pattern recognise. It was a 6 year old male stud alpaca that was losing weight, was weak, and was breathing very hard. Worm egg counts that had been performed 4 weeks ago were negative, and this was an animal that got imported in the peak of the alpaca trade, and they paid a reasonable amount of money for him, but he looked in pretty poor condition.

Pulse rate was 80, respiratory rate was 45, and no abnormal lung sounds, temperature was largely normal, skin tent was normal. He did have increased, size of his submandibular lymph nodes. Tees were normal on palpation, nothing obvious on a.

Musculoskeletal exam other than muscle wastage, and he just got very little compartment fill, and low small intestinal, motility. So if you were gonna pick a body system for this case, you're pointed immediately towards, towards the respiratory system. Again, we did do haematology, not very exciting, that's not that unusual, and we didn't see any other abnormalities on biochemistry except for a high fibrinogen.

What we did find on the, on a blood smear, however, was that we've got these, quite large, lymphocytes that we've got sitting here, and that those lymphocytes again looked to be varying in appearance. So, although we've got, I'd gone on a route, I'd radiographed this animal's lungs, they weren't particularly exciting, . The the increased size of the submandibular lymph nodes and the findings on that blood smear was sort of suggested that we might be going down a leukaemia lymphoma route.

So the lungs were really very unexciting. And why that rest rate was so high, I'm not really sure I, I ever, ascertained. But what we did find on abdominal ultrasound were there's some sections of, thickened small intestine.

And otherwise, it was largely normal until we got to an area sitting between the sort of kidney and the, and the spleen. And what we've got here is a scan, . Ventrally, we've got the kidney on the left-hand side, and then we've got this sort of irregular mass, that sort of goes all the way from almost from the body wall down to the abdominal aorta.

So it was in a particularly difficult spot to try and biopsy. We did get a fine needle aspirate and the results were non-diagnostic. We just seemed to get quite a lot of blood.

And here's that image again, we've got spleen at the top, kidney, sort of in the further field, and then we've got the mass over to that left-hand side between 4 and 8 centimetres. So the animal got taken to surgery and only a partial resection was possible of the mass because it was adhered to the ventral portion of the of the vertebrae and this did come back and was confirmed, although it looks very odd, was confirmed as as lymphoma. And the owners wanted to opt for treatment in this case, and we did try, a cop protocol, and he lived for another 6 months after cessation of his treatment.

The next case is a 10 year old female alpaca, that the owner notices is completely off her feed, normally quite dominant but coming into feed, much later. So, This again, in terms of driving to a case doesn't really help you with the, with the history. Does this animal have, dental disease?

Does this animal, animal have some form of, other gastrointestinal disease that's making it feel nauseous, that means it doesn't want to, that doesn't want to eat? And on physical exam, her body condition score was pretty high, although the whole herd was pretty high. The animal wasn't in Korea, and it did have a normal heart rate, but was excessively salivating, had got matted fibre all over its chest and it was really wet, but I'm not entirely certain that that owner had noticed and was still passing normal faeces.

So my thoughts for the salivation were, we probably got a, a gastro, probably got a gastrointestinal, problem. The pathology, it could have been, nauseous, but it's, that's an excessive amount of fluid for any form of nauseous animal to, To produce, was it toxic or was it, had it got a particular taste for something that was very bitter, that was stimulating excessive saliva production, or in fact, did this animal have some form of dental disease or dental pain within its mouth? And actually on palpation.

This animal had got, got a very thickened asymmetric tongue, and in fact appeared we did in fact manage to get a few ultrasound images of this, did in fact appear to have an abscess within its tongue, consistent with a wooden tongue that you would be much more likely to . To recognise or think about in a cow, and I think both wooden tongue and lumpy jaw we see not unusually in alpacas, they aren't always caused by by actinomyces and Ainocillus, but they presumably have the same aetiology. They end up with something sharp penetrating either their gum or their tongue.

So this animal got treated, treated with, injectable trimethoprine sulphur, and, the tongue swelling, reduced, and the clinical signs were gone within about 72 hours, and prognosis is pretty good for both of those is pretty good. And then my last case of this section was a 6 month old rea, and part of a herd of 14 alpacas, no known problems in this herd, previously, and no history of MOvis. The career had always been smaller than the others for her age, but had always eaten well and been very active, but she presented as an emergency with flared nostrils, respiratory rate of 60 breaths per minute, and paradoxical abdominal breathing.

So I think in this case, actually the likely body system is pretty easy. It's likely to be the respiratory tract, but the pathology is more challenging if you try to pattern recognise in this animal because common things are common in farm animals and we're used to, lung disease often being associated with. Pneumonia.

And so this animal did receive a course of antibiotics and anti-inflammatories to treat her for pneumonia, which she did not get better with. And then other thoughts are, does this animal have some form of congenital, probably cardiac disease, that's then causing her to demonstrate respiratory signs because she's in heart failure. But in fact, she'd got a normal, if not slightly low heart rate.

On further evaluation. So the key thing for this case is that paradoxical abdominal breathing, not something we necessarily see lots in farm animal practise, but seeing much more commonly in our. And small animals usually after road traffic accidents with things like diaphragmatic ruptures and pneumothorax, etc.

So when I went to see this animal, that's what I was looking for. We radiographed her chest, she did have a small. Pneumothorax, but, and we could see that on, on ultrasound, but this, paradoxical abdominal breathing was really very, very significant.

There was no evidence on ultrasound she'd got any, any abdominal contents within her chest, and we could see that that was also the case on radiography. And in fact, almost as a diagnosis of exclusion. This animal in fact turned out to likely have a Diaphragmatic paralysis, which has been reported in these careers, and they are known to sometimes spontaneously resolve, but because of the severity of her clinical signs and the fact the owners did not want this animal to die, and the decision was made to to euthanize her.

So in summary for these farm animal emergencies, I don't want to put you off by thinking that pattern recognition isn't a great and successful way to approach a case because I definitely think it is, especially in production animals where we've got diseases that you are aware of. But what it does become absolutely imperative is to realise when you've got an emergency that doesn't fit those patterns that you recognise and then it's important to move on to a problem-based approach so that you can perform appropriate tests to make a swift diagnosis and then start an appropriate treatment plan or alternatively, Choose, choose, euthanasia because prognosis is poor. And I think that that last case really emphasises that point.

So thank you very much for your attention with this webinar and I am more than happy to answer any questions by email after, after the date. Thank you very much indeed.