Clinical examination of digestive system Principal manifestation of alimentary tract dysfunctions:-

1-Abnormalities of perhension, mastication and swallowing 2- Excessive salivation 3- Diarrhea and constipation4- Vomition 5- Hemorrhage of alimentary tract6- Abdominal pain 7- Shock & dehydration 8- Abdominal distention9- Tenesmus

*Routine examination of the Dig. system :-(1)Appetite

*Abnormalities a- Poor appetite (diminished appetite) (inappetance)

- Poor quality food (apparent inappetance)- Systemic diseases (symptomatic inappetance)- Diseases of the dig. system that affect feed intake

b- Complete loss of appetite (anorexia)- In case of acute and severe diseases, e.g.:- acute impaction

c- Depraved appetite (pica or allotrio phagia)a. It means deviation of animal form normal feed b. It is observed in case of nutritional deficiencies & rabies

e.g.:- Coprophgia eating of feces B12 deficiency - Ostesphagia eating of bone Ca+ & Ph-def normal in dog

(2)Prehension -It means the manner by which the animal can select the food

* Normally:- Cattle solid feed by the tongue

Liquid by suction Horse solid feed by the lipis

Liquid by suction Sheep &goat solid feed by incisors with their lips

Liquid by suction Dog & cat solid feed by canine

Liquid by tongue Abnormal manner of prehension indicate lesion in organ of prehension as :

Painful conditions of the lips, tongue & teeth

Paralysis of tongue ( tetanus )

Inflammation of tongue

Broken teeth

(4) Mastication * Abnormal mastication:-a- Painfull mastication in case of inflammatory condition of cheek , gum & tongueb-impaired mastication in case of defective teeth ch’ by slow jow movementsc-incomplete mastication ch’by . Dropping of food from the mouth . Passage of undigerted food particles in fecesd- Vountary interrupted mastication in case of presence of sharp object in food as needles & nailse- Empty mastication in case of rabies & cerebral affection

(5)Deglutition (swallowing)* Abnormalilities :-1- Painful swallowing painful condition of pharynx & esphagus 2- Difficult swalling (dysphagia) ch< by 1- Inability to swallow food ● Paralysis of esophagus food material ● Stenosis of esophagus 2- Regurgitation of food through ● Tetanus nostril or mouth. ● Enlargement of regional L.N 3- By PH differentiate between the regurgitated material &(vomitus is acidic)

(6) Rumination * Abnormalities of rumination :-(1)Ceasation of rumination In case of:-

1- systemic disease & febrile condition .2- Absence of coarse fiber ( roughage ) in the rumen .3- Diseases of dig . system such as

- Acuto R.impaction - Ruminal bloat- Vagus indilgestion - Tr. Reticulitis- Abomasal torsion & displacement

(2)Slowly of Rumination reduced no. of jaw movements ● In painful disease affecting mouth structure(7) Vomition ( Emesis )

* Types ( forms) (1) Projectile ( false ) vomition (2) true vomition

* Cause :- Stimulation of reverse peristaltic - mainly stomach irritation movements* Species :- cattle & horse - dog & cat * Ch :- the vomitus in large in volume , - the vomitus is small , party liquid & come without any efforts & has retehing movement & Not accompanied by retching movement contract of abdominal muscle & diaphrogn sextension of head this movement is prolonged & repeated * e.g :- *Ruminal over distension , poisonus - commenly in case of plants in cattle gastritis & peptic ulcer *in horse terminal stage of acute gastric diflat ( fattly )

(8) Defecation * Items of examination :-A)Act of defecation ●Normal act of defecation is raising of the tail & widing of both hind limb ● If arching of back , tenesmus & protrosion of rectal mucosa abnormal ● difficult defecation in case of :.- constipation - paralysis of rectum -intestinal obstruction● Easily defecation in case of :. Diarrhoea ● Painful defecation in case of :. Inflammation of rectum & abd . cavity B )Frequancy of defecation * Abnormalities of frequancy :- 1- Increased diarrhoea 2- Decreased constipation, intestinal obstruction & impaction(c) Volume of faces :- * Abnormalities:- 1- Increased diarrhoea 2- Decreased (scanty) constipation , vagas indigestion (pasty)3- Absence ● Itestinal obstruction ● Paralylic ileusD) Gross examination of feces:-1- Color of feces2- Consistency and form of feces3- Odor of feces

4) Other substances in the feces a) Mucus & fibrin

b) Blood c) Parasites d) Indigerted food particles F) Microscopical examination of feces.

* Clinical examination of Alimentary tract(I) Examination of the buccal cavity * Items of examinations

a) Closure of the mouth ● Incomplete closure due to unilateral or bilatral nerve paralysis ( facial .n)● Permenant opening of the mouth due to trigeminal nerve paralysis , Actinobacillosis ( swelling of tongue )

b) Temperature of the mouth c) Color of the buccal mucosa

d)Odour of the buccal cavity ● Normal odour sweat odour ● Abnormal odour

- Acetone odour ( putried apple ) ketosis in cattle & pregnancy toxemia in sheep

- Sweetish odour due to decomposition of food in mouth as in stomatitis .

- Urineferous odour in case of uremia . - Offensive odour in case of dental caris, gingivitis & Ganagrenous

pneumonia .d) Salivation

* Normally the muzzle of the animal is wet &moist* Abnormalities 1- Reduced ,scanty salivary secretion recorded in case of fever, dehydration 2- Increased salivary secretion (excessive secretion)(ptyalism) in case of :- dental disease, stomatitis, dis of salivary gland,presence of foreign body in buccal cavity & pharynx,chock, rabies, meningoencephalitis and organoosphrous compound toxicity.Also some infections diseases as F.M.DN.B.: We should differentiat between salivation due to lesion or due to mastication From lesion without martication movement, from mouth Commisure, roapy copisus SalivationF) condition of the teethg) Presence of macrospic pathological lesions. reddening and swelling of buccal mucosa local inflammation. vesciles F.M.D. errosive lesion (red ulcer) cattle plage. dyphthertic membrane calf dyphteriah) Tongue

*Smooth tongue congenital*Wooden tongue actinobacillosis*Blue colour blue tongue disease

*Presence of (vesicle ulcer ) on anterior 1/3 dorsal aspect of tongue F.M.D. while presence of ulceration in lower ventral surface of tongue rinder pert .

*Paralysis of tongue .

2-Examination of the throat and esophagusa)Inspection

For detection presence of the abnormalities such as -Circumscribed localized swelling abscess or tumor .-Stenssis of esophogus by forigen bodies ( chock ) .b)External palpation (To detect ) Painful inflammation condition . Esophageal obstruction . Esophageal diverticulum . S/C phlegmon .c)Special examination By passage of st. tube to detect if the stenosis from external or from internal Radiological examination . Endoscopy .

3-Examination of the Abdomen Clinical examination of the Abdomen

1) External examination A)Inspection ( from behind the animal )

To assess the relative size of the abdomen : the abdomen may be Normal size Reduced capacity Distended

Distension of abdomen

* Physiologycal * Pathological

Pregnancy

In advanced stage distension of the ventral part of the abdomen.

Pathological distension

1. Distension of rumen

Acute ruminal tympany * marked distention of left flank region Ruminal impaction * hyper resilient on palpation * Moderate distension of left flank Region * Doughy R. contents on palpation Vagus indigesion (ant . type) *Papple shape

(enlarged left flank & enlarged of both sides of abdomen from distal ) * L-shape rumen on rectal palpation (2) distension of abomasum Left abomosal displacement *distension of left abdomen * Ping sound over the distended part (left side) Righ abomosal displacement *Rectal palpation

*Distension of right abdomen *Ping sound over the right side *Rectal palpation Abomasal impaction

* distension of right lower abdomen *doughy viscus in right lower abdomen *by rectal palpation

(3) distension of intestion intestinal obstruction

*slight distension of right abdomen *Rectal examination (obstruction) *Fluid tinking sound on auscultation & ballottement

Cecal dilatation & torsion Slight distended in of right abdomen Ping sound in right side . Rectal examination ( cecum )

(4) enlargement of uterus *hydropsy of fetal membrane *hydro metra & pyometra

(gradual distenrion of lower of abdomen in late gestation)(5) fluid a ccumulation in peritoneal cavity

Ascitis * bilateral distension of lower a bdomen Ruptured U.B * ve fluid ( paraconteris )

* signs * Decreased circumference of the abdomen

( Tucked – up abdomen )a- prolonged mal mitrition b- prolonged sever dehydration c- chronic deblitating diseases d- ketosis

Examination of Rumen Regional anatomy of rumen:-

- It occupies almost the whole left half of the abdominal cavity- It extend from the 7th intercostal space to the pelvic inlet after the bounderies of

lung- In the practical it is examined in the left flank region

Examinations:-1. Inspection Discused previousily2. Palpation*Normaly:- The upper part of the rumen reveals resilient palpation while the lower part reveals some what firm consistancy*Abnormalities:-

a) Hyperresilient tympanyb) Doughy or hard impaction

(presence of impresion of fist of hand on the flank region)3. Percussion

* Normal percussion sound:-Tympanic sound upper third GasIncomplete dull sound middle third liquidComplete dull sound lower third solid * Abnormal percussion sound:-a) Complete dull sound over the whole area of rumen R.impactionb) Tympanic sound over the whole area of rumen free gas tympanyc) Resonant sound frothy tympany d) Tinkling sound in case of over loding of rumen with fluid or liquid

ingesta.4-Auscultation * Rate of R.movements:-

Cattle 2-5 movements / 2 minutesSheep 3-6 movements / 2 minutesGoat’s 2-4 movements / 2 minutes

* The normal contractions of the rumen revelas gurgling sound as the result of movement of fluid & solid material

* Abnrmalities of R.movements:-

a) Reduced R.movements ( R. atony ) ( R. hypomatile ) * simple indigestion .

* R. impaction(1st stage) b) Absence of R. movements ( R. stasis )

* lat stage of R. impaction * Toxic conditions *Tr. Reticulitis .

c) increased R. movements ( R. hypermotile ) *early stages of digestive troubles ( Tympany ) * Vagus indigestion w’ hypermotility .

* Quality & strength of R. motility :-- may be complet or incomplet

high pitched sound then high pitched sound then sudden disapper gradually disapper .- Strength

moderat strong in healthy animals ( normal ) weak in R. atony very strong in early stage of vagus in digestion & in digestive

disorders ( tympany )* Simultaneaus percussion & auscultation tech :-

it is performed on the left paralumber fossa over an area extend from the mid point of the 9th rib to 13th rib .Also include whole Right side of abdomen * ( in case of viscus organ has gas & fluid )*Aims :-

it is performed to determine presence of gases &fluid or not which detected as .ping or high pitched metalic tympanic sound .* Left sided pings :- “ in case of

a- Left a bomasal dis placement b- Atonic rumenc- pneumopertonium

But the tympanic sound of rumen is of lower pitched & may be called “ pung “ Ahso to differentiat between ping sound from Rumen & abomasum .

- Passage of st. tube : relived of free gas .- Rectal examinatim : gaseous distension of rumrn or displaced abomasun to leftside

* Area of hearing of ping sound .* LDA : 9th – 13th rib ( middle to uppor 1/3 ) * Rumen : 9th – tuber coxae

* Right – sided pings :- in case of - Right abomasal displacement: 9th – 13th - & extend to right flank & torsion - Cecal dilatation & torsion : 13th rib to tuber coxac .- Torsion of the coild colon .- Intestinal tympany .

- Intussuception .- Pneumo peritonium bilaterally over the dorsal 1/3 of abdomen .

* Fluid – Tinkling ( splashing ) soundsPresence of the tinkling sounds over the left paralumber fossa associated w’ R. atomy suggests presence of excessive Quantity of liquid content in the rumen & the coarse

ingesta is not floating on fluid layer grain over load ( late&advanced stage )

Also This sound cound can be elicited by simultaneaus auscultation & ballottement .- The causes of fluid – splashing sounds on right side in chude .

* Fluid – filled intestines acute intestinal obstruction.* Fluid – filled abomasum abomasal displacement

* Examination of the reticulum* Regional anatomy of reticulum :-

The reticulum is located on The left side at the ventral end of 6th – 7th rib ( at xiphsid cartilage )

* Examination :-a) Palpation is useful tech . in case of traumatic reticuliltis and / or

reticuloperitonitis where deep palpalion the animal exhibit pain reactions ch’ by grunting .

b) Percussion Reduced frequancy of reticular contractions in case of

Tr . r . p Vagus indigestion . Febrile & toxaemic condition

* Examination of Abomasum* Regional anatomy of abomasum :--It is an elongated sac lying on the abdominal floor On the right side in the area of 7th – 10th intercostal space .* Examination :-

Neither percussion nor auscultation con be done in the investigation of the abomasum . It is only valuable & diagnostic in case of L.A.D & R.D.A“ Ping sound “

* Clinical examination of intestine*Regional anatomy:- Local at the lower part of the abdomen in the right Side.*examination:- by auscultation *the normal intestinal movement is peristaltic sound *abnormalities:- a)- peristaltic movements incase of *Spasmodic colic *Acute enteritie b)- peristaltic movements (sluggish)

*intestinal paralysis *flatulent colic *intestinal impaction *intestinal obstruction c)-tinkling sound

in case of gaseous distension of the intestine in association w’liquid ingesta

*Rectal examination 1-Anal region(sphincter)

*ex. Of the tone of the sphincter which is reduced in case of paralysis of rectum or has spasm

e.g:- milk fever flaccid anus 2-Large intestine *Rectum:- -normally it contain amount of feces -empty rectum (reduced quantity of feces) in case of; *impaction *intestinal obst *vagus indigestion(post.type) -also detect the consistancy of feces may be * soft diarrhoea *hard constipation *Cecum:-

the cecum is palpated on the right side of Abd.cavity in the lumber area of Abd.cavity if it is Distended with solid or gasesus substance

(speciouly in equine) *Cecal torsion Palpated as long distended organ usually movable in abd .

cavity *Colon:-detect its consistancy & any torsion . 3-Small intertion Only in case of intussception if S.I detect the stenotic part. 4- Rumen * normally it occupy the left side of the Abd. But if it occupy both heft & right side

.: over filling of rumen with solid or gases .* Hard consistency of D.R.S impaction * Gaesous distension of D.R.S tympany * L. shape rumen Ant . type of vagus indigestion .* Left – abomasal displacement - * reduction in size of rumen .

* palpation of the distended abomsun between left abd. Wall & rumen

* Right – abomasal displacement *Palpation of the distende abomasun between right abd – wall & rumen

* Abomasal impaction : palpation of firm tens viscus in lower right half of abdomen*Cecal torsion Palpated as long distended organ usually movable in abd . cavity

*Examination of liver *

It located in contact with last 2-3 (right side) 1-Inspection :-

Inspection of visible m.m may indicate the condition of the liver

2-Palpation ** Site of palpation ;at the angle between the right costal arch & the vert. Colum* Normally the liver is not palpated if palpated : abnormal conditioin . Gross enlargment hepatomegaly . Local enlargment neoplesia or abcesees

3-Percussion*area of hepatic percussion .Cattel at 10-12 th right inter costal spaces .Sheep&goat at 8-12 th right inter costal spaces .Equines at 10-17 th right inter costal spaces* Normal percussion sound complete dull sound if incomplete dull sound atrophied liver

4-Liver biopsy Horizental line from the middle of right paralumber fossa cranially to the 11th intercostal space -The needle is inserted cranially & ventrally

Special examination of dig . system(1)introduction of stomach tube Indication :- (a)diagnostic -In case of chock -To differentiate between free gas & frothy tympany -For collection of gastric or ruminal fluid (b)Theraputic - For introduction of any drugs directely into the rumen

*Of bitter taste *Of small volume -For relieve of free gas tympany .Site for application :- Cattel Through buccal cavity Equine Through true nostile (avoid enterance in false nostrile)

(2) Trocarization ( By using trocar & canula) *In cattele for rumem ( in left flank region ) upper part.*In equin for cecum ( in right flank region ) with great precaution

Indication :-As stomach tube

(3) Abdominal paracentesis Indication :-

- It is applied in case of Abd. Distension in which the clinical examination revelas presence of fluid in the peritoneal cavity in order to differentiat between these cases :-

*Ascitis . * Ruputer U.B.*Peritonitis . *Internal bleeding .*Perforation of Al. tract wall .

Site of Abd. Paracentesis :- Horse on the ventral midline, 25cm caudal to the

xiphoid cartilage . Cattle 3 – 4 cm medial & 5 – 7 cm cranial to the

foramen of the left S/C abd. Vein . Dog & cat on the ventral mid line, half a way between

the xiphoid cartilage & umblicus . (4) Meat test (Used in dog & cat ) Indication :-

To differentiate between oes. obstruction & gastritis . Technique :-

- Giving a small pieces of meat to the animal .- Observe the time of vomiting of the foofd .

In case of oes . obst the vomition occur shortly after ingestion of meat .While in case of gastritis the vomition occur 1/2 hr. after ingestion of meat

PH of the vomitus .if acidic gastritis .if alkaline oesh.obstruction(5) Special pain test

These tests are usually applied in ruminants in order to detect the pain reaction as in case of trumatic reticulitis

a) Stick methodLifting of the animal at the xiphoid region by ameans of a stick .- If grunting & pain reaction detected

(+) ve for painb) Strong percussion on the reticulum

If the animal exhibit pain reaction (+) ve for pain

c) Moving the animal down hillIf the animal exhibit pain reaction (+) ve for pain

d) Pinching of the withersSpeciuly in small ruminants

e) Circling testBy circling the animal in a very narrow circle .

f) Mine detectorBy using forigen body detector for detect presence of any metal object . ( sharp or blunt )

*Result: hearing of a musical sound ,indicate (+)ve result False (+)result : means the metal obgect is blunt. False(-)result : means that there is a sharp obgect but not a metal( may be wire or pieace of glasse)*Disadvantage : it can not differentiate between the sharp or the blunt metal object.