الموسوعة البيطرية الشاملة

ونبدأ أولا ب Physical Exam


وشوف الصور دي وركز مع الارقام وان شاء الله هانقول عنوان كل رقم تحت في الشرح





In order to perform a complete physical exam, proper restraint is
required . Observe the cow from a distance first. Prior to restraint,
reluctance to move, arched posture, abducted elbows, stilted gait, and
teeth grinding are positive indications for pain. In general, cattle
are extremely stoic to pain, but occasionally cattle with acute pain
may kick at their abdomen. Examine the head for symmetry, and observe
head position and any cranial nerve deficits. Assess body condition
from the rear and observe the abdomen for contour and distention. It is
equally important to obtain all the details of the case in hand by
either asking questions or allowing the owner, manager, or farm staff
to contribute information. When performing a physical examination a
strict sequence of procedures should be followed beginning on the left
side of the cow. To start your physical exam, click on the numbers in
sequence, beginning with No. 1.





number 1 :Starting Point

1. The first procedure is to obtain a urine sample.
   
2. The second prodedure is to insert the thermometer. The pulse can also be taken at this point.
   
3. Next is the visualization of the vulvar mucous membranes
   

The urine will be used to measure ketone bodies.



Insert a well lubricated thermometer into the
rectum of the cow. A large animal thermometer is required for this
procedure. This will allow for complete insertion through the anal
sphincter and into the rectum. Rectal temperatures vary according to
season. Temperatures range from 101.5° to 102.5°F.
The
pulse can be obtained from the coccygeal vein by placing index finger
on the ventral midline aspect of the tail at the level of the vulva. It
is normally faint and intense concentration is needed to feel this
pulse. The normal pulse is 60 - 80 bpm.



The vulvar mucous membranes
should be moist, shiny, smooth, and pale pink. To assess the mucous
membranes, gentle separation of the vulvar lips using both hands is
preferred.




رقم 2 في الصورة فوق هو number toe in picture is Auscult Heart





The apex of the heart lies caudal to the elbow at the sixth intercostal
space. The base of the heart lies cranial to the elbow. The aortic,
pulmonic and mitral valves are ausculted on the left side
of the heart. Insert your stethoscope deep under the axilla to find the
pulmonic valve area between the shoulder and the elbow at the left
third intercostal space. The aortic valve area is located at the left
fourth intercostal space at the level of the shoulder. The mitral valve
is located between the shoulder and elbow at the fifth intercostal
space. Auscultation should take place in a reasonably quiet
environment. The most successful way of examining the heart is to place
the bell of the stethoscope sufficiently forward between the upper
foreleg and the chest wall. The heart is located in the ventral part of
the thorax between the third and sixth ribs. Careful interpretation of
rate, rhythm, and heart sounds is necessary. Observe the jugular vein
and mammary vein for any signs of distention or pulsation while you are
ausculting the heart. Most dairy cows with cardiac disease have
tachycardia at rest, but many diseases result in high heart rates (such
as infectious diseases). Bradycardia (40-60 bpm) is often associated
with vagal indigestion. Muffled heart sounds occur with pericardial and
pleural effusion. Increased intensity of the heart sounds is associated
with increased cardiac contractility. Cardiac diseases such as
bacterial endocarditis and some cases of lymphosarcoma can be
accompanied by fevers. The most common cause of murmurs is bacterial
endocarditis. The most common valve is the tricuspid on the right side
followed by the mitral valve on the left. Cardiac diseases may occur
secondarily to GI diseases such as "hardware", traumatic
reticulopericarditis. Muffled heart sounds with or without a washing
machine-like murmur, distended jugular veins, jugular pulse and brisket
edema are compatable findings with hardware disease. Atrial
fibrillation causes a irregularly, irregular heart beat, and is
generally associated with a GI problem such as an LDA.


Brisket and ventral edema.


Bottle jaw. Edema
in the neck and brisket area are often associated with cardiac disease,
or low plasma protein as is seen with Johne's disease, enteritis, or
parasitism.




The jugular and abdominal veins should be palpated to assess the venous system. Distention of these veins are indicative of increased venous pressure and right sided heart failure. Assessment
of the jugular pulses is best done with the head elevated and it is
normal to see pulses at the level of the heart. With the head being
elevated, make sure nothing is occluding the jugular veins to give a
false positive such as a neck chain. The vein will fail to empty with
the occlusion of the vein with your hand and then the release of the
occlusion when cardiac disease is present. Pinch the skin of the neck
to evaluate hydration status. Examine the prescapular lymph nodes
cranial to the point of the shoulder and the prefemoral lymph nodes
cranial to the stifle.

The assessment of abnormal lungs can be extremely difficult in the
cow. The reason for this is that they have a smaller area to auscult
due to the reduced number of ribs and a steeper angle of the diaphragm.
The caudal border is the 11th rib. Note the area of auscultation that
is outlined with tape in the picture to the left. Caution:
Significant pathological lesions may be present without any abnormal
lung sounds. Observation of rate and effort is important during
auscultation. Cattle normally have a costoabdominal effort. Normal lung
sounds are louder on inspiration than on expiration and are loudest in
the ventral lung fields. Consolidation in the lungs caused by pneumonia
often results in large airways sounds in the ventral lung field.
Crackles and wheezes are abnormal lung sounds. Deeper breaths can be
induced by holding off the nostrils. Palpate the tracheal to try and
induce a cough. The normal rate is 12 -36 bpm.

ورقم 5في الصورة هو Ping on Left


Ping the left side of the cow by simultaneously percussing and
ausculting the whole left side of the cow by firmly flicking your
finger against the body wall of the cow. A "ping" represents a
fluid-gas interface. On the left side of the cow, gas may be present in
the abomasum (LDA), rumen, or peritoneal cavity. LDA pings are variable
in tone, and often tinkling sounds are heard over the area of the LDA.
Rumen pings are located over the rumen area and tend to be monotone.
LDA and rumen pings often occur together and are usually distinguished
by two distinct pings of different tones. The most confusing ping for
us on the left side of the cow, is a monotone ping that extends over
the rumen and LDA area. Often, this ping is accompanied by a small
gas-filled rumen on rectal palpation and is referred to as a
"rumen-void" ping. These cows do not have surgical problems.


ورقم 5 في الصورة هو Auscult Rumen



Listen to the rumen contractions by placing your stethoscope in the
left paralumbar fossa. Normal rumen contractions (1-3/minute) are
strong, and can be felt and seen. Palpate, auscult, and ballot the
rumen to assess consistency. A gradation in consistency exists from the
dorsal to the ventral sac of the rumen. The dorsal sac of the rumen
generally has a gas cap and becomes more doughy in consistency (feed
layer) towards the ventral fluid-filled sac of the rumen. A rumen ping
is differentiated from an LDA ping by its location over the left
paralumbar fossa. It is possible to have a rumen ping and an abomasal
ping at the same time, but they generally have different tones. If a
ping with the same tone extends over both the rumen and the abomasal
area, and rectal examination reveals a very small rumen with a
distended gas-filled dorsal sac, the ping is most likely a rumen void
ping

.



Withers Pinch Test

Many gastrointestinal diseases cause abdominal pain in the cow. Cows with GI pain often
stand hunched up with their elbows abducted. The withers can be pinched
as shown in the above picture (sometimes it requires two hands). A
normal cow will flex her back ventrally when her withersare pinched as
seen above. A cow who is painful will not flex ventrally. False
negatives are common. Common reasonsfor abdominal pain are hardware,
abomasal ulcers, or distention of the small intestine with gas.

Either by using your fists pushed up with your knee or by using a board with one person on each side lifting the board up, apply
pressure to the xiphoid region. If the cow grunts, kicks, or acts
uncomfortable, you can assume she is painful. Often, you have to listen
over the trachea during the peak of inspiration while simultaneously
applying pressure to the xiphoid area to hear a grunt.




ورقم 7 في الصورة هو Examine Udder



The ideal udder has symmetrical
quarters and teats that subjectively look ideal for milking. Pendulous
and irregular quarters are generally the result of stretching due to
repeated episodes of edema after calving or inflammation. These udders
can be more difficult to milk, but are probably not making the cow
sick. Palpation of the udder gland is an art. The best starting place
for inexperienced students is to compare the quarters to each other. It
is rare that all 4 quarters have mastitis, but common that all 4
quarters have edema. Generally an abnormal quarter will be obvious
compared to the other 3 normal quarters. Abnormalities in consistency
of the glandular tissue of the udder include edema, hardening, and
acute swelling. The palpation findings should be integrated with the
examination of the mammary secretions and the physical exam findings.
First, milk should be stripped from each quarter onto a strip plate.
Any deviation from normal milk in color and consistency is abnormal.
Then strip each quarter's secretion on top of each other and repeat in
the reverse order. Any subtle abnormalities in secretion from quarter
to quarter will be picked up in this method. This technique of
stripping a quarter's milk onto a pooled milk sample is an excellent
way to pick up watery milk.

It is critical to evaluate the
mammary gland and integrate your findings with the rest of the physical
exam to arrive at an accurate diagnosis and treatment plan. For
example, a cow with clots in the milk or a watery secretion accompanied
by a normal physical exam is handled differently than a cow with a
watery secretion, elevated heart rate and temperature, rumen stasis and
diarrhea.

In general, contagious
organisms, such as, Staphylococcus aureus, Streptococcus agalactia, and
Mycoplasma bovis tend to cause sub-clinical mastitis. The udder
palpates normally, the milk grossly looks normal, and the cow's
physical exam is normal. Special tests, such as, the cow-side
California Mastitis Test or DHIA somatic cell counts would be needed to
quantitate any inflammation in the udder, and bacterial culture would
be necessary to make a diagnosis of the organism causing the
sub-clinical mastitis. In general, the environmental organisms cause
clinical mastitis (abnormal milk /- swelling in the udder). The Strep.
nonag. group of organisms cause clinical mastitis 50% of the time, and
the coliform organisms (Eschericia coli, Klebsiella, Enterobacter sp.,
etc.) cause clinical mastitis 90% of the time. Probable diagnosis of
the organism causing the mastitis can be made in certain cases.
Secretions that smell foul and have a necrotic odor are usually caused
by Arcanobacterium pyogenes or some anaerobe. Secretions that are very
watery accompanied by a swollen udder are generally caused by coliform
organisms. Secretions that are watery, but red accompanied by a sick
cow are generally caused by Staph. aureus and carry a poor prognosis
for recovery. All other gradation of secretions between the normal milk
and the extreme watery secretion are indistinguishable from each other,
and bacterial culture would be necessary to identify the organism
causing the mastitis.

ورقم 5في الصورة هو Ping on Left


Ping the left side of the cow by simultaneously percussing and
ausculting the whole left side of the cow by firmly flicking your
finger against the body wall of the cow. A "ping" represents a
fluid-gas interface. On the left side of the cow, gas may be present in
the abomasum (LDA), rumen, or peritoneal cavity. LDA pings are variable
in tone, and often tinkling sounds are heard over the area of the LDA.
Rumen pings are located over the rumen area and tend to be monotone.
LDA and rumen pings often occur together and are usually distinguished
by two distinct pings of different tones. The most confusing ping for
us on the left side of the cow, is a monotone ping that extends over
the rumen and LDA area. Often, this ping is accompanied by a small
gas-filled rumen on rectal palpation and is referred to as a
"rumen-void" ping. These cows do not have surgical problems.


ورقم 5 في الصورة هو Auscult Rumen



Listen to the rumen contractions by placing your stethoscope in the
left paralumbar fossa. Normal rumen contractions (1-3/minute) are
strong, and can be felt and seen. Palpate, auscult, and ballot the
rumen to assess consistency. A gradation in consistency exists from the
dorsal to the ventral sac of the rumen. The dorsal sac of the rumen
generally has a gas cap and becomes more doughy in consistency (feed
layer) towards the ventral fluid-filled sac of the rumen. A rumen ping
is differentiated from an LDA ping by its location over the left
paralumbar fossa. It is possible to have a rumen ping and an abomasal
ping at the same time, but they generally have different tones. If a
ping with the same tone extends over both the rumen and the abomasal
area, and rectal examination reveals a very small rumen with a
distended gas-filled dorsal sac, the ping is most likely a rumen void
ping

.



Withers Pinch Test

Many gastrointestinal diseases cause abdominal pain in the cow. Cows with GI pain often
stand hunched up with their elbows abducted. The withers can be pinched
as shown in the above picture (sometimes it requires two hands). A
normal cow will flex her back ventrally when her withersare pinched as
seen above. A cow who is painful will not flex ventrally. False
negatives are common. Common reasonsfor abdominal pain are hardware,
abomasal ulcers, or distention of the small intestine with gas.

Either by using your fists pushed up with your knee or by using a board with one person on each side lifting the board up, apply
pressure to the xiphoid region. If the cow grunts, kicks, or acts
uncomfortable, you can assume she is painful. Often, you have to listen
over the trachea during the peak of inspiration while simultaneously
applying pressure to the xiphoid area to hear a grunt.




ورقم 7 في الصورة هو Examine Udder



The ideal udder has symmetrical
quarters and teats that subjectively look ideal for milking. Pendulous
and irregular quarters are generally the result of stretching due to
repeated episodes of edema after calving or inflammation. These udders
can be more difficult to milk, but are probably not making the cow
sick. Palpation of the udder gland is an art. The best starting place
for inexperienced students is to compare the quarters to each other. It
is rare that all 4 quarters have mastitis, but common that all 4
quarters have edema. Generally an abnormal quarter will be obvious
compared to the other 3 normal quarters. Abnormalities in consistency
of the glandular tissue of the udder include edema, hardening, and
acute swelling. The palpation findings should be integrated with the
examination of the mammary secretions and the physical exam findings.
First, milk should be stripped from each quarter onto a strip plate.
Any deviation from normal milk in color and consistency is abnormal.
Then strip each quarter's secretion on top of each other and repeat in
the reverse order. Any subtle abnormalities in secretion from quarter
to quarter will be picked up in this method. This technique of
stripping a quarter's milk onto a pooled milk sample is an excellent
way to pick up watery milk.

It is critical to evaluate the
mammary gland and integrate your findings with the rest of the physical
exam to arrive at an accurate diagnosis and treatment plan. For
example, a cow with clots in the milk or a watery secretion accompanied
by a normal physical exam is handled differently than a cow with a
watery secretion, elevated heart rate and temperature, rumen stasis and
diarrhea.

In general, contagious
organisms, such as, Staphylococcus aureus, Streptococcus agalactia, and
Mycoplasma bovis tend to cause sub-clinical mastitis. The udder
palpates normally, the milk grossly looks normal, and the cow's
physical exam is normal. Special tests, such as, the cow-side
California Mastitis Test or DHIA somatic cell counts would be needed to
quantitate any inflammation in the udder, and bacterial culture would
be necessary to make a diagnosis of the organism causing the
sub-clinical mastitis. In general, the environmental organisms cause
clinical mastitis (abnormal milk /- swelling in the udder). The Strep.
nonag. group of organisms cause clinical mastitis 50% of the time, and
the coliform organisms (Eschericia coli, Klebsiella, Enterobacter sp.,
etc.) cause clinical mastitis 90% of the time. Probable diagnosis of
the organism causing the mastitis can be made in certain cases.
Secretions that smell foul and have a necrotic odor are usually caused
by Arcanobacterium pyogenes or some anaerobe. Secretions that are very
watery accompanied by a swollen udder are generally caused by coliform
organisms. Secretions that are watery, but red accompanied by a sick
cow are generally caused by Staph. aureus and carry a poor prognosis
for recovery. All other gradation of secretions between the normal milk
and the extreme watery secretion are indistinguishable from each other,
and bacterial culture would be necessary to identify the organism
causing the mastitis.