Vagus indigestion

Hoflound Syndrome

by
Dr. Ali H. Sadiek
Prof. of Internal Veterinary Medicine
and Clinical Laboratory Diagnosis
Faculty of Veterinary Medicine Assiut University
E-mail: Sadiek59@yahoo.com
 Vagus indigestion

• The vagus nerve runs along both sides of

the esophagus and terminates in branches
that innervate the forestomachs and
abomasum.
• Inflammation or traumatic damage to the
nerve can result from pharyngeal trauma
or abscesses,
Vagus Indigestion
Vagus nerve
dorsal branch

Vagus nerve
Ventral branch
 Vagus indigestion
It is a subacute to chronic disease as a result of
Lesions affecting the vagus nerve In cattle Ch. by:
1. Gradual rumenoreticular and abdominal distention and
2. Improper forestomach emptying “functional outflow
problem”.
Causes:
1. Traumatic reticuloperitonitis is the common cause of
vagal nerve damage.
2. Mechanical inhibition of motility from adhesions or
abscesses can also decrease forestomach emptying.
 Vagus indigestion
3. Mechanical obstruction of the cardia or
reticulo-omasal orifice (eg, papillomas or
ingested placenta)
4. Perforating abomasal ulcers with a diffuse
peritonitis can also cause outflow
obstructions with no evidence of vagal
nerve damage.
5. Mediastinitis, thoracic inflammation,

There are four types of vagus indigestion:

 Type I vagus indigestion
“Failure of eructation”
• It may results in free gas bloat and ruminal
distention.
• Inflammatory lesions, chronic pneumonia or a
localized peritonitis following hardware disease
of the vagus nerve cranial to the cardia have
been implicated.
• Mechanical factors not related to vagus nerve
damage that cause esophageal obstruction may
also cause failure of eructation.
 Type II vagus indigestion
“Failure of omasal transport”
It is caused by conditions that prevents
ingesta from passing through omasal
canal into abomasum as:
1. Adhesions, reticular and single liver
abscesses (TRP) usually on the right
or medial wall of the reticulum near
the route of the vagus nerve.
2. Mechanical obstruction of the omasal
canal by:
►Ingested material (eg, placenta)
►Masses (eg, lymphosarcoma,
squamous cell carcinoma,
granulomas, or papillomas)
 Type III vagal indigestion
“ Abomasal impaction”
• Feeding of dry, course roughage, such as
straw, in a chopped or ground form with
restricted access to water and usually during
extremely cold temperatures
• Secondary impactions:
 Assoc. TRP
 A sequela of right abomasal displacement or
abomasal volvulus
 Obstruction of the pylorus (eg, by placenta or
trichobezoars).
 Type IV vagal indigestion
“Partial forestomach obstruction”,
• It typically develops in cattle during
gestation.
• It may be related to the enlarging uterus
shifting the abomasum to a more cranial
position, which inhibits normal motility..
 Clinical signsof vagus indigestion

Vary with the location of the obstruction.

1. In all cases, there is a gradual
development of ruminoreticular and
abdominal distention.
2. Distention of the dorsal and ventral sacs
of the rumen result in an “L-shaped”
rumen on rectal examination.
3. Left dorsal and left and right ventral
distention of the abdomen causes a
“papple” (pear plus apple) shape.
 Clinical signsof vagus indigestion

4. Diminished appetite, improves if distention

is relieved.
5. Milk production gradually decreases,
6. Very scant and sticky feces, often contains
long hay particles,
7. Rumen develops a “splashy” fluid
consistency.
8. Increased rate of rum. Cont. (3-4
contractions/min) with decreased strength,
not audible due to the frothy contents
failure of the rumen to empty
 Clinical signsof vagus indigestion

9. Temperature and respiratory rate are

usually normal;
10. Bradycardia is present in 25-40% of cases.
11. Tachycardia develops as the disease
progresses.
12. Over time, the animal develops a rough hair
coat, loses condition, and becomes weak
(in some cases to the point of recumbency)
and dehydrated.
Clinical signsof vagus indigestion
 Clinical signsof vagus indigestion

Left dorsal and

left and right
ventral
distention of
the abdomen
causes a
“papple” (pear
plus apple)
shape.
Clinical signsof vagus indigestion
Clinical signsof vagus indigestion
 Clinical signsof vagus indigestion

13. On rectal palpation,

 The rumen is distended with gas or froth
pushing the left kidney to the right of the
midline.
 The ventral sac of the rumen is enlarged
and palpable to the right of the midline (“L-
shaped”).
 Palpation of the lower half of the right side
of the abdomen below the costochondral
junction may detect an impacted
abomasum that feels doughy
 Clinical signsof vagus indigestion

13.On rectal palpation,

 Lab. Findings in vagus indigestion

• The PCV : Increased because of dehydration or

decreased because of bone marrow depression (anemia
of chronic disease).
• The WBC may be normal, increased, or decreased.
• Neutrophil to lymphocyte ratio is typically reversed,
and a neutrophilia may be present, if an inflammatory
condition such as peritonitis is present,.
• Lymphocytosis can be seen with vagal indigestion due
to lymphosarcoma.
• Leukopenia may be present with diffuse peritonitis.
• Increased serum globulin and total protein can be
seen with abscesses.
 Clinical signsof vagus indigestion

• Metabolic status is normal, or metabolic alkalosis may be

present if Serum Cl is decreased.
• Serum Cl is usually normal if the lesion is cranial to the
abomasum.
• Low Cl indicates reflux of Cl from the abomasum into the
rumen and obstruction at the level of the abomasum.
• Cl levels of the rumen fluid may be increased.
• K is usually low due to decreased K intake in the feed.
• Ca is often moderately decreased because of ongoing milk
production; however, it can be low enough to cause
recumbency.
• BUN and creatinine increase with dehydration due to
prerenal azotemia.
 Diagnosis of vagus indigestion
Identifying the cause is difficult but is important
because of differences in treatment and prognosis:
1. Physical examination,
2. Rectal examination,
3. Lab. Findings: CBC, blood acid-base determination,
and serum chemistry values are often useful.
4. Peritoneal fluid analysis: Total protein or nucleated
cells are increased in peritonitis.
5. Radiographs of the reticulum should be taken to
identify a radiopaque linear foreign body (eg, wire) or
reticular abscess.
6. Exploratory surgery often required for a definitive
diagnosis (left paralumbar fossa laparotomy and
rumenotomy).
 Diagnosis of vagus indigestion

Differential diagnosis (Rule out all conditions of

Abd. Distension)
1. Ascites and uterine enlargement: ruled out
by rectal palpation due to the absence of
ruminoreticular distention.
2. Occasional cases of long standing
obstruction of the cecum or small intestine;
cecal or small-intestinal distention is also
palpable rectally.
3. Cecocolic volvulus: the rumen is distended
but not L-shaped, and a characteristic ping is
present .
 Treatment of vagus indigestion
• Surgical exploration of the
abdomen can help determine
the primary cause of vagal
nerve damage, the animal's
prognosis and may aid in
therapy.
• Treatment of Type I vagus
indigestion focuses on
relieving free gas
accumulation via a rumen
fistula or stomach tube.
• An open-ended plastic syringe
sutured into the rumen allows
gas to escape.
 Treatment of vagus indigestion

Therapy for early cases of Type II vagus

indigestion is mostly supportive.
 Fluids, electrolytes, rumen cathartics, access to water
and exercise.
 Subcutaneous administration of Ca borogluconate
 Advanced cases usually require surgery. A left
paralumbar fossa celiotomy and rumenotomy allows the
clinician to palpate the reticulo-omasal orifice for foreign
bodies, placenta, papillomas or impactions. Biopies can
be obtained and abscesses can be drained using this
approach.
 Treatment of vagus indigestion
Treatment of Type III vagus indigestion
• Stimulate rumination: Neostigmine (6-10 mg QID SC),
Metoclopromide (0.1mg/kg QID SC)
• I.V. fluid adminis. to correct hypokalemia,
hypochloremia and metabolic alkalosis.
• Rumenotomy allows the clinician to administer
mineral oil directly into the abomasum via the omasal-
abomasal orifice, or removal of impacted abomasal
ingesta.
• Severe cases of abomasal impaction may require an
abomasotomy via a right paracostal approach, but
affected animals have a poor prognosis.
 Treatment of vagus indigestion

Treatment of Type IV vagus indigestion

Fluids, electrolytes, calcium.
Therapeutic abortion may be required.
A rumenotomy using a left paralumbar
fossa approach can be utilized to detect
and treat underlying disease processes.
A left paralumbar fossa rumenotomy