Management of calves with umbilical disease and arthritis (Proceedings)

Omphalophlebitis and arthritis are common diseases in calves from 0 to 90 days of age, being the 4th and 5th most common diagnoses in calves; omphalophlebitis, 0.06 cases per calf year of risk; arthritis, 0.024 cases per calf year of risk. The three most common calf hood diseases are diarrhea, respiratory disease, and ringworm.

When performing umbilical surgery, there are 2 major conditions are encountered: 1) simple umbilical hernia; 2) infected umbilical structures: umbilicus, urachus, umbilical arteries, umbilical vein (may also have a hernia). It is important to differentiate the 2 conditions because of the possibility of an inherited condition for simple umbilical hernia (not proven in cattle). Moreover, the time needed for surgery and therefore anesthetic protocol varies with the abnormality. For instance, simple hernias can be repaired using injectable anesthesia (xylazine 0.20 mg/kg IM) followed by ketamine (4 mg/kg IV) when needed; xylazine and ketamine can be repeated every 20-30 minutes as needed. Alternatively, simple hernias can be repaired using xylazine sedation (0.10 mg/kg IM) and lumbosacral epidural (2% lidocaine, 1 ml/10 lbs bodyweight). If infected umbilical structures are present, then repair is best perfomed using isoflurane inhalation anesthesia (halothane is no longer available). A much higher level of surgical skill is required in bull calves and large body weight calves.

Umbilical abnormalities are usually diagnosed based on the history and physical examination. Pollakiuria indicates urachal infection/inflammation. Fever, diarrhea, septic joints, meningitis may indicate septicemia. Patent urachus is extremely uncommon compared to foals. Attempt to reduce the contents into the abdomen, gently feel around the hernia edge. Hernia contents are usually omentum, sometimes abomasum, rarely intestine. Abdominal palpation (with the calf standing or dorsal recumbency, possible using xylazine sedation) is extremely valuable, may be just as good as ultrasound. Be gentle, as vigorous palpation can rupture an internal abscess and result in diffuse peritonitis and death. Ultrasound is useful to document anatomical structures involved and predict surgical duration and therefore anesthetic protocol required. Ultrasound is extremely valuable if the body wall is intact and the abscess is ventral. In this case the abscess can be lanced and drained.

Treatment of abnormal umbilical structures is medical or surgical. Medical management should be used if <2 finger simple hernia. Restrain the calf in a standing position, return hernial contents into abdomen. Glue an old ear tag or flat flexible piece of plastic to skin using glue (such as Household Goop). Tape the abdomen with Elastikon or other tape. Repeat as needed (when tape moves). If an umbilicus abscess is present and the abscess is outside the body wall and the body wall is intact, then lance, drain, flush, and pack the abscess with betadine soaked gauze roll, which should be removed after 24-48 hours.

Surgical management should be undertaken for umbilical hernias of 3 or more fingers, or infected umbilical structures. For large hernias/resection in calves >8 weeks, hold the calf off feed for 48 hours and administer perioperative antibiotics (procaine penicillin G 10,000 U/lb IM, or ceftiofur, 1 mg/lb, IM, 1 hour before surgery). Place calf in dorsal recumbency, make an elliptical incision around the umbilicus and remove excess skin. Cut through the external rectus sheath, then internal rectus sheath, then peritoneum. Spend considerable time ensuring hemostasis, using electrocautery if available. Enter the abdomen laterally at 3 or 9 o'clock to avoid the umbilical vein (cranial) and umbilical arteries and urachus (caudal). We usually do not routinely explore the abdomen, but gently dissect away any adhered structures. Infected umbilical structures are resected above the infected areas, which are detected by palpation. If the urachus is infected, the apex of the bladder should be resected. Close the bladder with 2/0 Vicryl in a 2 layer inverting pattern. If the umbilical vein is infected all the way to the liver, some surgeons marsupialize the vein cranial and lateral to incision, purportedly to permit flushing and drainage of vein from liver abscess. The abdomen is closed in the following manner: peritoneum and internal rectus sheath, simple continuous (0 or 2/0 PDS or Maxon); external rectus sheath (the strength closure), simple interrupted 0 PDS or Maxon.

Septic arthritis occurs via hematogenous or periarticular infection, or via direct trauma. Calves usually have one joint affected, rarely multiple joints in one calf, and rarely multiple calves (if so, consider herd epidemic of Mycoplasma bovis or Histophilus somni. Neonatal calves may have omphalophlebitis and inadequate colostral IgG transfer (Total protein concentration < 5.2 or 5.5 g/dl. Older calves may have traumatic (carpus) rough flooring, flexural deformities, or penetrating wounds.

Calves with septic arthritis are lame, acute, severe (fracture lame). Pain is due primarily due to joint distention, lesser due to inflammation. Palpate umbilicus (may consider using ultrasound) and all other joints. Radiographs may not be helpful in acute cases because boney changes are not visible for 5-7 days; however, radiographs are helpful in chronic cases, as they indicate the extent of osteomyelitis & assist debridement.

Arthrocentesis using a 16 g needle can be helpful in equivocal cases, but is usually not needed to make a diagnosis. Arthrocentesis is rarely indicated because acute joint effusion and lameness equals septic arthritis almost 100% of the time, and because visible changes in synovial fluid are usually present (decreased viscosity, increased turbidity, presence of fibrin). Cytology could be run, and is characterized by leukocyte counts greater than 25,000 cells/μl, a neutrophil percentage >80%, and a total protein concentration >4.5 g/dl. Bacteriologic culture is rarely performed or indicated. Only 60% of septic arthritis cases are culture positive in cattle; however, the larger the fluid volume cultured the better the success rate in isolation. The most common isolates are Escherichia coli in neonates and acute cases, Arcanobacterium pyogenes in older calves and chronic cases, and Mycobacterium bovis in multiple calves

The goals of treatment of septic arthritis are eliminate infection, remove abnormal joint fluid, control inflammation, and restore joint function. This can be accomplished by joint lavage or arthrotomy. Resection of omphalophlebitis will be helpful in calves with abnormal umbilical structures. Antimicrobial agents should be administered to 2-3 weeks, IV if possible. Ceftiofur 1 mg/kg IV, q 12 h; Procaine Penicillin G 22,000 U/kg IM, q 12 h; Ampicillin/amoxicillin 10 mg/kg IM, q 12 h; Potentiated sulfonamides 25 mg/kg IV, q 24 h. Anti-inflammatory/analgesic agents may be helpful in increasing feed intake and decreasing swelling. Flunixin meglumine 1 mg/kg IV, q 24 h is the most useful, while aspirin does not appear to be very effective in mitigating pain due to arthritis in cattle. Physical therapy may also be helpful, although clinical studies are lacking. Joint lavage should be done in acute cases where fibrin is not present in the synovial fluid. Through & through needle lavage is performed, with the ingress needle being 18 g, and the egress needle being 16 g 1 L of sterile Ringers/0.9% NaCl is used for infusion. Periodic distention of joint is helpful in facilitating lavage.

At the end of lavage, the joint is emptied and antimicrobial agents are injected directly into the joint. These should be water soluble and non cytotoxic, such as ceftiofur sodium or potassium penicillin. This route of administration is used because the goal is to attain and maintain an effective concentration at the site of infection (joint). Periodic intraarticular injection (≥ 3 days) is safe & effective; and is cheaper, faster, and simpler than other routes of administration. Do not place a catheter in the joint because a catheter is a 2 way street for bacterial migration. Other treatment modalities (antibiotic impregnated collagen strips, polymethylmethacrylate beads, local intravenous administration using a tourniquet) appear more complicated, more expensive, and do not offer a higher rate of clinical improvement. Lavage should be repeated only once; one study reported that one lavage was effective in 80% (16/20) of cases. An alternative is to perform an arthrotomy and monitor the use of the limb (pain = joint distention, inflammation).

References

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Lewis CA, Constable PD, Huhn JC, Morin DE. Sedation with xylazine and lumbosacral epidural administration of lidocaine and xylazine for umbilical surgery in calves. J Am Vet Med Assoc. 1999;214:89-95.

Staller GS, Tulleners EP, Reef VB et al. Concordance of ultrasonographic and physical findings in cattle with an umbilical mass or suspected to have infection of the umbilical cord remnants: 32 cases (1987-1989). J Am Vet Med Assoc 1995;206:77-82.

Kotschwar JL, Coetzee JF, Anderson DE et al. Analgesic efficacy of sodium salicylate in an amphotericin B-induced bovine synovitis-arthritis model. J Dairy Sci 2009;92:3731-3743.