Instructions for Cases 1. Do NOT print this out—it will waste a lot of paper. 2. Clicking on the blue underlined questions will take you to the answer. On the answer slide, click return to case. 3. On the diagnostics page, every test is not necessary. Choose only those that you feel will appropriately narrow your differential list or affect your treatment plan. Click on the test to obtain the results and my justification for performing (or not performing) each test. 4. Similarly, not all the offered treatments and preventions are appropriate or necessary. Pick those that you feel are best. Brown Swiss #3048 Background Signalment: 3 year old Brown Swiss cow. 12 days postpartum History: Found down in the pasture this afternoon. Could stand and walk slowly when encouraged. Severely depressed. Herd is vaccinated annually with a killed respiratory disease/lepto vaccine and clostridial vaccine. Physical Exam: T-97.8F, P-115, R-80. No rumen contractions. Ping noted on right flank— approximately 10 inches in diameter and centered over 13th rib. What is the most likely cause of a ping in this location and what should we do about it? Physical exam, cont.: Eyes are approximately 6mm recessed. Right prefemoral and right supramammary lymph nodes are enlarged. Right rear quarter is swollen, red, and painful. Milk from that quarter is watery with some clumps. Rectal exam: Uterus is appropriately involuted for 12 days in milk. Remainder of physical exam is unremarkable. What is the significance of eyeball recession? What is this cow’s problem list? Based on this problem list, what are your differentials? Diagnostic Work Up Complete blood count Chemistry panel Sterile milk culture from affected quarter Abdominal ultrasound Gram stain of milk from affected quarter California mastitis test Abdominal exploratory Serial Salmonella fecal cultures Based on your findings, what is your diagnosis? Diagnosis Acute Toxic Gram Negative Mastitis If you arrived at this diagnosis without any of the diagnostic tests, that is fine. The signs are pretty classic for this disease, though a culture of the milk is a good idea for any cow with clinical mastitis. Now that we have a diagnosis, what should we do about it? Treatment Intramammary Spectramast (ceftiofur) Intramammary ToDAY (cephaparin) Intramammary Gentocin (gentamicin) Subcutaneous Naxcel (ceftiofur) Subcutaneous Baytril (enrofloxacin) IV hypertonic saline IV lactated ringers solution Oral electrolyte solution Frequent stripping of milk from the infected quarter Case Outcome Case Outcome Due to your prompt administration of IV and oral fluids, and IMM and SQ ceftiofur, the cow is improving. The farmer is sufficiently impressed to consider listening to any preventative recommendations that you have. So… What about the rest of the herd? What recommendations do you make? Preventative Measures Gram negative core antigen vaccine Switch to sand bedding Wash any manure off udder prior to milking Switch to Albadry (penicillin/novobiocin) at dry off This is the end of case #1. Please contact me at email@example.com if you have any questions or comments concerning this case. I appreciate any suggestions that you may have.
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