奶牛酮病和真胃变位课件

Calving Disease ComplexCalving Disease Complex 产后疾病产后疾病 ketosis & LDAketosis & LDA 酮病酮病& &真胃变位真胃变位 Tal SchcolnikTal Schcolnik AfimilkAfimilk, , S.A.E.S.A.E. AfikimAfikim, Israel, Israel 以色列阿菲金公司以色列阿菲金公司 Metabolic diseasesMetabolic diseases 代代谢谢谢谢疾病疾病 MetabolismMetabolism新陈代谢新陈代谢 The whole range of biochemical processes that occur within a living organism. Metabolism consists both of anabolism and catabolism - buildup and breakdown of substances in the body. 发生在机体内生化过程。分合成代谢和分解代谢即聚集和分解。 Super productive cows produces 15,000 kg milk in 305 lactation days - required super metabolism. 305天生产15,000kg的高产牛需要特别的新陈代谢 Milk Milk production and production and reproduction force dairy cows to reproduction force dairy cows to consume consume energy at least 3 times above energy at least 3 times above their energy their energy needs for maintenance.needs for maintenance. 奶牛生产和繁殖消耗的能量至少是维持能量需要的奶牛生产和繁殖消耗的能量至少是维持能量需要的3 3 倍。倍。 On the edgeOn the edge极限极限 Feb 12postparturiant disease complex 4 产犊Calving 怀孕Conception Drying-off 干奶 产后配种Puerperium 奶牛周期循环奶牛周期循环cyclecyclelife life Dairy cow Dairy cow 奶牛胎次循环奶牛胎次循环Dairy cow LactationDairy cow Lactation periparturiant disease complex, Tamir Goshen 产犊 产后 疾病 怀孕 繁殖 管理 天时305 干奶 天时365 产犊 干奶牛管理 围产牛 Calving Calving IntervalInterval产犊间隔产犊间隔 Calving 产犊产犊 Calving 产犊产犊 . Ins st 1 首次 输输精 PeriodRest 始配期 .Successful Ins 有效输输精 PeriodWaste 浪费费天数 PeriodOpen 空怀怀天数 Dry-Off 干奶 Dry Period Period Transition 围产围产 期 怀怀孕Pregnancy 泌乳期Lactation IntervalCalving 产犊间产犊间 隔 Dairy Cows Lactation奶牛泌乳期 Lactation phasesLactation phases胎次阶段胎次阶段 Terminology专业术语 产犊至怀孕的天数pregnancyNumber of days from calving to Open Days空怀天数 产后至首次输精天数serviceDays up to first Rest Days始配天数 首次输精和有效输精间隔天数 first and effective inseminationDays between Waste Days浪费天数 Period between two successive calving times两次产犊间隔 Calving Interval 产犊间隔 Term术语Explanation解释 Lactations Lactations comparisoncomparison胎次对比胎次对比 Dairy Cow Lactations泌乳期 Lactation Transition periodLactation Transition period 围产期围产期 Management of the dry cow plays an important role in the control of metabolic disorders near or at calving time 干奶牛管理在产犊前后牛只新陈代谢起很重要 的角色 Calving and at least 6 weeks later are critical times for the dairy cow 产犊及产后6周是奶牛决定整个胎次的关键期 BCS at calving 产犊时体况 评分 Food consumption饲料消耗 Body fat mobilization 体脂代谢 The challenges of the transition cow The challenges of the transition cow 围产期管理的挑战围产期管理的挑战 Production disturbance 生产紊乱 Immunity免疫 Reproduction Performance 繁殖性能 Milk production奶产量 5-12 DIM 5-12 DIM PhysicalPhysical ExamExam 产后产后5-125-12检查检查 DiagnosisDiagnosis 诊断诊断 PrognosisPrognosis 预测预测 TreatTreat 治疗治疗 ObserveObserve 观察观察 CullCull 淘汰淘汰 Clinical examinationClinical examination临床检查临床检查 Routine examination 5 -12 Days in milk (DIM) 产后产后5-125-12天检查流程（泌乳天数天检查流程（泌乳天数） AnamnesisAnamnesis :记忆 Lactation No.?胎次数 No. of calves at last calving?最后一次产犊胎儿数 Calves fate?犊牛现状 Days In Milk?泌乳天数（DIM） Milk yield?产量 Any problem since calving?是否有产后疾病？ periparturiant disease complex, Tamir Goshen Dr. Tamir Goshen, Hachaklait, Koret school of Veterinary medicine, The Hebrew University, Jerusalem, Israel. 13 Differential Diagnosis (DDs):鉴别诊断 Ketosis酮病 Fatty Liver - Fat cow syndrome脂肪肝-肥胖综合征 Displaced Abomasum真胃变位 Metritis子宫炎 Retained Placenta胎衣不下 Mastitis乳房炎 Laminitis蹄病 Traumatic reticulo-pericarditis外伤-心包炎 Pyelonephritis肾炎 Vagus indigestion消化不良 Considerations:注意事项 Herd/ Individual牛群/个体 Acute/ Chronic急性/慢性 Interrelations相互关系 Field diagnosis/ Lab. Sample 现场诊断/实验室分析 Cost of Rx治疗成本 Cull淘汰 Postpartum examinationPostpartum examination产后检查产后检查 Routine 5-12 DIM产后5-12天规程 14 Interrelations between Calving Interrelations between Calving DiseasesDiseases 产后疾病间的相互关系产后疾病间的相互关系 死胎STILL TWIN 双胎PROMF 产褥热 KET酮病 MET子宫炎 RP胎衣不下 ACID 酸中毒 LDA 真胃变位 3.46.8 11.5 2.3 1.8 2.0 6.8 2.4 50.4 5.8 12.0 2.3 1.4 1.8 2.9 4.3 1.7 3.4 2.5 4.7 Multifactorial Approach (Oded Nir)多因子分析方法 15 多元回归方程多元回归方程regressionregressionMultivariate logistic Multivariate logistic Dr. Tamir Goshen, Hachaklait, Koret school of Veterinary medicine, The Hebrew University, Jerusalem, Israel. 发病原因 牧场 年份 季节 胎衣不下 子宫炎 真胃变位 产褥热 双胎 Risk factorOR p 95%CI ConstantNA 4.0 1.20.3Ketones (mmol/L)酮酮体 3.10.3 NEFA (mmol/L) 游离脂肪酸 Nadav Galon 24 Diagnosis of Subclinical & Clinical Ketosis 隐性酮病和临床酮病的诊断 )个牛群7年的-1982-1984(7 herds 1982-84 O.Nir Epidemiology - Incidence & PrevalenceEpidemiology - Incidence & Prevalence 流行性病学流行性病学- -发病率发病率& &流行性流行性 Incidence: 发病牛群 4 days to 6 weeks after calving in high producing cows 产后4天-6周高产牛 Prevalence: 发病率 Rates of ketosis in the Israeli herd 20% 以色列牛群酮病发病率约20% periparturiant disease complex, Tamir Goshen 26 Year年份 Season季节 Herd - Some herds high incidence in heifers 牛群-部分牛群后备牛发病率较高 Total Mixed Rations 全混合日粮（TMR） Epidemiology Epidemiology - general - general 流行病学流行病学- -常见常见 Risk Factors发病原因 periparturiant disease complex, Tamir Goshen 27 Lactation Incidence Rate Lactation Incidence Rate (LIR) by by Year Year 泌乳期发病率（泌乳期发病率（LIRLIR）- -全年全年 Shpigel et al 1996 periparturiant disease complex, Tamir Goshen 28 SeasonSeasonLIR by LIR by 按季节按季节 - - 泌乳期发病率泌乳期发病率 Shpigel et al 1996 periparturiant disease complex, Tamir Goshen 11.6 17 12.7 6.1 0 2 4 6 8 10 12 14 16 18 Jan-Mar 1-3月 Apr-Jun 4-6月 July-Sept 7-9月 Oct-Dec 10-12月 Season季节 LIR (%)泌乳期发病率 29 LIR byLIR by HerdHerd泌乳期发病率泌乳期发病率- -按牛群按牛群 Shpigel et al 1996 periparturiant disease complex, Tamir Goshen 26.9 25 16.4 11.8 6.1 3.83.7 2.9 0 5 10 15 20 25 30 3566881055156356 Herd牛群 LIR (%) 30 Parity Lactation Incidence Rate (LIR) increases with Lactation no. (parity) 胎次-随着胎次的增加发病率也提高 High-yielding 高产牛 Long dry period干奶期过长 Excessive BCS at dry off or at calving干奶/产犊时体况变化大 Uterine disorders Twins, RP, Metritis, ect. 子宫扭转-双胎，胎衣不下，子宫炎等 Displaced Abomasum真胃变位 Epidemiology Epidemiology Individual cowIndividual cow Risk Factors periparturiant disease complex, Tamir Goshen Feb 12 31 按胎次按胎次ParityParityLIR by LIR by Shpigel et al 1996 periparturiant disease complex, Tamir Goshen Ketosis and FertilityKetosis and Fertility酮病和繁殖率酮病和繁殖率 Herds with Effects of Yield on Fertility* % adversely affected by NEB & other factors 牛群产量对繁殖的印象 牛群存在能量负平衡或其他原因 (148 Herds, 2007)* Oded Nir, 2010 Ketosis and ProductionKetosis and Production 酮病和产奶量酮病和产奶量 Peak, Peak, Persistency and Negative Energy Persistency and Negative Energy Balance (NEB) 1st Lactations Balance (NEB) 1st Lactations Cows* Cows* (8882 (8882 cows in 86 cows in 86 herds)herds) 头胎牛泌乳峰值，持续力及能量负平衡（头胎牛泌乳峰值，持续力及能量负平衡（NEBNEB）-86-86个牛群的个牛群的88828882头牛头牛 1 % persistency = 304.0 lbs in 305 days 1%持续力=305天产量为304L * Oded Nir, 2010 34 Diagnosis Diagnosis of of ketosisketosis酮病的诊断酮病的诊断 Tamir Goshen Testing for Testing for ketonuriaketonuria酮体的检测酮体的检测 Urine and Milk TestsUrine and Milk Tests 尿检和牛奶检测尿检和牛奶检测 periparturiant disease complex, Tamir Goshen 35 Low milk production Poor appetite 低奶量和采食量下降 Routine postpartum examination 5-12 days 产后5-12天检查 Primary ketosis 酮病（仅） Vaginal and Rectal Examination 阴道和直肠检查肠检查 Retained placenta Metritis, LDA, MF 胎衣不下、子宫炎、 真胃变位和产褥热 Normal 正常Ketonuria 酮酮体 = 1.5 mmol/L Complicated ketosis 酮病综合征 检查规程检查规程protocolprotocolExamination Examination periparturiant disease complex, Tamir Goshen 36 Rabies狂犬病 Listeriosis李氏杆菌病 CCN BSE - Mad Cow Disease.疯牛病 Lead poisoning铅中毒 Grass tetany低血镁症 Claviceps paspali poisoning雀稗麦角菌 Differential Differential Diagnosis of ketosis Nervous formDiagnosis of ketosis Nervous form 酮病的鉴别诊断酮病的鉴别诊断 37 Clinical Clinical PathologyPathology 临床病理学临床病理学 BloodBlood: :血检血检 Glucose血糖 BHBA羟丁酸 Acetoacetate乙酰乙酸 NEFA (FFA)游离脂肪酸 Liver enzymes肝脏酶 UrineUrine: :尿检尿检 Acetoacetate乙酰乙酸 BHBA羟丁酸 MilkMilk: :牛奶检测牛奶检测 Acetoacetate乙酰乙酸 BHBA羟丁酸 38 Problematic herds - all postparturient cows 亚健康牛群-所有产后牛 Other herds:其他牛群 - Sick cows病牛 - Dry for 70 days干奶天数70天 - Dry off BCS = 3.75干奶时体况评分3.75 - BSC Loss in the dry period=0.5 干奶期体况下降超过0.5分的牛只 - Milk production 25/30 L 25L产量30L Which cow should be tested Which cow should be tested ? ? 应检测哪头牛？应检测哪头牛？ periparturiant disease complex, Tamir Goshen Negative Energy Balance at Calving (1) Negative Energy Balance at Calving (1) 产后能量负平衡（产后能量负平衡（1 1） the Familiar Pattern, Herd #1the Familiar Pattern, Herd #1相近的牛只相近的牛只- -牛群牛群1 1 Calving traits产产后指标标First lactation头头胎牛Second lactation2胎 a. Total calved总产犊总产犊259555 i. % with ketosis酮酮病比例40.2(8.3)21.1(14.0) The routine test is partially efficient, 90/176 (51.1%) of cows with NEB were missed 检测程序明显有效，51.1%（176头中的90头）的能量负平衡牛只未再出现 39 Oded Nir, 2011 Calving traits产产后指标标First lactation头头胎Second lactation2胎 a. Total calved总产犊总产犊224712 i. % with ketosis酮酮病比例1.4(8.3)4.6(14.0) The routine test is of no value 121/130 (98.8%) of cows with NEB were missed 检测程序没有价值：98.8%（130头中的121）没有再出现 NEB at Calving - “the Smeller” Herd #2NEB at Calving - “the Smeller” Herd #2 产后能量负平衡产后能量负平衡- -牛群牛群2 2（牛群较小）（牛群较小） 40Oded Nir, 2011 头胎二胎胎3 胎3二胎头胎 NEB at Calving - the Late Pattern (PH)NEB at Calving - the Late Pattern (PH) Calving traits产产后指标标First lactation投胎Second lactation2胎 a. Total calved总产犊总产犊8261 i. % with ketosis酮酮病比例0.0(8.3)1.7(14.0) No routine test. 26/27 (96.3%) of cows with NEB were missed 没有检测程序：96.3%（27头中的26）没有再出现 41Oded Nir, 2011 酮病诊断酮病诊断Diagnosing Ketosis Diagnosing Ketosis Conventional methods of diagnosing ketosis are not satisfactory - afflicted animals may be missed and healthy cows may needlessly receive treatments. 酮病诊断方法不尽人意-牛只痛苦并健康牛只无需接受治疗 Oded Nir, 2010 Ketosis in Ketosis in afifarmafifarm by by afilabafilab阿菲牧魔盒对酮病的检测阿菲牧魔盒对酮病的检测 Diagnosis of ketosis by Fat/Protein Ratio in Milk 酮病诊断-牛奶中的脂蛋比 Ketosis events 酮酮病事件 Oded Nir, 2010 Ketosis TreatmentKetosis Treatment 治疗治疗 - - 酮病酮病 -Dextrose infusion (IV): The most rapid and direct way of supplying blood glucose. - 静脉注射-最直接最见效的补糖方法 - Hormonal treatment (IM): Glucocorticoids (Dexamethasone) - 激素治疗-糖皮质激素-地塞米松 -Oral sugar precursors: Sodium propionate and propylene glycol are two oral sugar precursors. They can be fed or drenched at a rate of 250-450 gr per day usually following glucose or hormonal treatment. - 口服糖：丙酸钠和丙二醇。每天灌服250-450gr，通常也进 行静脉注射葡萄糖或激素辅助治疗 periparturiant disease complex, Tamir Goshen 13 1545 治疗治疗Treatment Treatment periparturiant disease complex, Tamir Goshen Cost Benefit Ratio of Ketosis RxCost Benefit Ratio of Ketosis Rx 酮病治疗成本与价值比例酮病治疗成本与价值比例 10 2 Loss损失 Treat治疗 Ins 牧场Farm牧场Farm Nadav Galon Ketosis PreventionKetosis Prevention 酮病酮病- -预防预防 -Avoid over-conditioned cows in late lactation and dry period. Body condition score should be 3-3.5 at calving. -泌乳末期和干奶期避免体况过肥。产犊时体况在3-3.5分 -Feed 2-4 kg of grain per cow during the close-up period (3 weeks before calving). -围产期（围产期）饲喂2-4kg谷物 -Encourage maximum energy intake after calving by feeding high quality forages. -产后饲喂优质粗饲料以增加牛只能量采食量 -Feed total mixed rations if possible. If not, limit grain intake to 2-4 kg per feeding. -如果可能饲喂TMR。没有TMR，限制2-4kg谷物采食量 Oded Nir 2012 Kronfeld, 1970 Sodium propionate丙酸钠 Glycerol甘油 Propylene Glycol丙二醇 Radostits, 1989 Sodium propionate丙酸钠 Propylene Glycol丙二醇 Monensin莫能菌素 11ICPD, 2001 Niacin烟酸 Glycerol甘油 Propylene glycol丙二醇 Merck Vet Manual, 2010 2010年Merk兽医手册 Niacin烟酸 Methionine蛋氨酸 Sodium (calcium) propionate丙酸钠/钙 Rumen protected choline过瘤胃胆碱 Propylene Glycol丙二醇 Ketosis PreventionKetosis Prevention酮病预防酮病预防 49 Ketosis interrelations with fatty liverKetosis interrelations with fatty liver 酮病与脂肪肝相关性酮病与脂肪肝相关性 Ketosis in ruminants is a disease of the periparturient period caused by impaired metabolism of carbohydrates and fats and is interrelated with fatty liver. 反刍动物酮病与围产前期碳水化合物和脂肪代谢紊乱及 脂肪肝相关联。 Biochemically - the disease characterized by: 生化理性-该疾病特点 Ketonemia.酮血症 Ketonuria.酮尿 Hypoglycemia. 低血糖 periparturiant disease complex, Tamir Goshen 50 Fatty Liver Syndrome Fatty Liver Syndrome 脂肪肝综合症脂肪肝综合症 Lipomobilization syndrome Fatty infiltration of the liver in cattle牛只肝 脏脂肪外渗 Fat cow syndrome牛只肥胖综合症 “Goose Liver”肝肿大 periparturiant disease complex, Tamir Goshen 51 q Low milk production产量下降 q Anorexia, Depression, Weakness 厌食、消沉、体弱 q Rumen atony, GIT ileus - scant mucoid, 便黄且稀 前胃迟缓、肠梗阻-粘液分泌不足、 q Mild icterus (rarely visible clinically)轻微黄疸-临床不常见 q Nervous signs: staring gaze, holding head high, muscle tremors, coma q 神经紧张：发呆、仰头、肌肉痉挛、昏迷 q Recumbency, death卧地、死亡 Fatty Liver Fatty Liver SyndromeSyndrome脂肪肝综合征脂肪肝综合征 Clinical Signs 临床表现 periparturiant disease complex, Tamir Goshen 52 Hypoglycemia低血糖 Ketonemia & Ketonuria酮血、酮尿 Elevated blood NEFA, Bilirubin, Liver enzymes 血液中游离脂肪酸、胆红素、肝脏酶浓度上 Decreased blood cholesterol, albumin, TG 血液中胆固醇、白蛋白及甘油三酯浓度降低 Prolonged BSP clearance test 延长BSP清除测试 Fatty Liver Fatty Liver SyndromeSyndrome脂肪肝综合征脂肪肝综合征 Clinical PathologyClinical Pathology临床病理学临床病理学 periparturiant disease complex, Tamir Goshen 53 脂肪肝综合征脂肪肝综合征SyndromeSyndromeLiver Liver Fatty Fatty 诊断诊断DiagnosisDiagnosis o History发病历史 o Clinical signs临床表现 o Clinical pathology临床病理学 o Liver biopsy - the only reliable method accurately estimating the degree of fatty liver o 肝脏活体组织-唯一用来准确评估脂肪肝患病程度 的方法 periparturiant disease complex, Tamir Goshen 54 Treat accompanying conditions治疗并发情况 Some cows response to treatment:一些牛只治疗效果 Parenteral glucose infusion补糖 Glucocorticoids ?糖皮质激素 B vitamins VB Oral fluids and electrolytes 口服液体或电解质 Trans-faunation, Rumen stimulants瘤胃刺激 Oral propylene glycol or sodium propionate口服丙二醇或丙酸 钠 Glucagon胰高血糖素 Fatty Liver Fatty Liver SyndromeSyndrome脂肪肝综合征脂肪肝综合征 TreatmentTreatment治疗治疗 periparturiant disease complex, Tamir Goshen 55 q Guarded 监测 q Severe cases - poor prognosis极端病例-治疗无效 q Salvage slaughter屠宰 Fatty Liver Fatty Liver SyndromeSyndrome脂肪肝综合征脂肪肝综合征 PrognosisPrognosis 预测预测 periparturiant disease complex, Tamir Goshen 56 Fatty Liver Fatty Liver SyndromeSyndrome脂肪肝综合征脂肪肝综合征 Glucagon treatment in fatty Glucagon treatment in fatty liverliver胰高血糖素治疗脂肪肝胰高血糖素治疗脂肪肝 10 mg/day for 2 10 mg/day for 2 days2days2连续两天：连续两天：1010mg/mg/天天 periparturiant disease complex, Tamir Goshen 0 5 10 15 20 25 30 35 40 45 0214 Days after treatment治疗后天数 % Liver triglycerides肝脏甘油三酯浓度 Contro l对照组 Glucagon 注射胰高血糖素 57 Left Displaced Left Displaced AbomasumAbomasum真胃变位真胃变位 DefinitionDefinition定义定义 LDA is an entrapment of the abomasum LDA is an entrapment of the abomasum between the rumen and the left abdominal between the rumen and the left abdominal wallwall 真胃变位（真胃变位（LDALDA）是真胃（皱胃）被瘤胃和腹）是真胃（皱胃）被瘤胃和腹 壁包裹壁包裹 periparturiant disease complex, Tamir Goshen 58 Etiology - LDAEtiology - LDA 真胃变位病原学 Not fully understood发病原因不全被研究出 Multifactorial多种原因 A prerequisite for development of LDA is hypomotility and gaseous distention of the abomasum LDA的一个发病原因是肠胃蠕动缓慢及皱胃鼓气 There might be an association of LDA with: 与LAD可能相关联： Malfunctions at the level of the intrinsic nervous system 神经系统机能紊乱 Impaired cholinergic muscle response 胆碱能肌肉反射受损 periparturiant disease complex, Tamir Goshen 59 Risk Risk Factors LDAFactors LDA致病原因致病原因 TMR or grain feeding TMR/精料 Ketosis酮病 Retained placenta胎衣不下 Primary metritis早期子宫炎 Twins双胎 Stillbirth死胎 Low milk yield previous lactation 泌乳早期产量过低 Low feed intake before and after calving 产前和产后采食量过少 periparturiant disease complex, Tamir Goshen 60 Tamir Goshen periparturiant disease complex, Tamir Goshen -1 1 2 DA 变位牛 NORMAL 正常牛 - 2.00 4.00 6.00 8.00 10.00 12.00 14.00 16.00 18.00 DMI (Kg/day) 干物质采食量（DMI）kg.天 Time from calving (weeks) 产后时间.-周 DMI intake in normal and DA cows 正常牛只和变位牛只干物质采食量对比 61 Tamir Goshen periparturiant disease complex, Tamir Goshen -1 1 2 DA NORMAL 0 0.25 0.5 0.75 1 1.25 1.5 1.75 2 2.25 2.5 DMI (% BW/day) DMI-体重%/天 Time from calving (weeks) 产后时间-周 DMI intake in normal and DA cows 正常牛只和变位牛只干物质采食量对比 62 Large size, high producing adult dairy cattle 高产牛 8 -14 weeks calves and in 21 months and older heifers 产后8-14周至泌乳21月及月龄较大的后备牛（新投产） Rare condition in beef cattle, and very rare in sheeps 体况差的肉牛，养较少见 Approximately 90% of the cases world wide are in the first 6 weeks after calving 全世界90%的病例常见于产后6周 Epidemiology - Incidence & PrevalenceEpidemiology - Incidence & Prevalence 流行病学流行病学- -发病率及流行性发病率及流行性 periparturiant disease complex, Tamir Goshen 63 Incidence - 0.2-1.6% in Denmark 丹麦-发病率：0.2-1.6% In Israel the incidence is 1% in 1st calf heifers and 1.5% in cows (best quartile, 2003) 以色列头胎牛发病率1%，成母牛发病率1.5% In Israel more then 90% of the DAs are to the left 在以色列90%的变位是左侧变位 periparturiant disease complex, Tamir Goshen Epidemiology - Incidence & PrevalenceEpidemiology - Incidence & Prevalence 流行病学流行病学- -发病率及流行性发病率及流行性 64 Clinical Clinical Signs LDASigns LDA临床表现临床表现 Inappetence, almost anorexia 食欲不振，几近厌食 Marked drop in milk production产量下降 Varying degree of ketosis不同程度酮病 Feces - reduced in volume and softer than normal 粪便-量减少且较平时稀松 Decreased ruminal movements - both frequency and intensity 瘤胃迟缓-频率和强度均减弱 periparturiant disease complex, Tamir Goshen 65 Left side “ping” in combined auscultation and percussion. 听诊左侧有金属叩击声 In some cases - paroxysmal atrial fibrillation due to the metabolic alkalosis. 一些病例-因代谢性碱中毒，阵发性心房颤动 On rectal examination - small empty rumen, the displaced abomasum is rarely palpated. 直肠检查-瘤胃小且空，皱胃几乎不可触摸到 Fat cows may develop sever ketosis and fatty liver syndrome. 肥胖牛可能发展成急性酮病及脂肪肝综合征 periparturiant disease complex, Tamir Goshen Clinical Signs LDAClinical Signs LDA临床表现临床表现 66 PercussionPercussion& & Auscultation Auscultation 叩诊叩诊 & & 听诊听诊 periparturiant disease complex, Tamir Goshen 67 locationlocation“Ping” “Ping” 叩击声位置叩击声位置 LDA 真胃 变位 periparturiant disease complex, Tamir Goshen 68 临床病理学临床病理学PathologyPathologyClinical Clinical Hemoconcentration - elevated PCV, Hb & TP 血浓缩-血红蛋白、动脉压力升高， Ketonemia酮血症 Mild metabolic alkalosis轻度代谢性碱中毒 Mild hypochloremia轻度低氯血症 Mild hypokalemia轻度 periparturiant disease complex, Tamir Goshen 69 Paracentesis of the displaced abomasum, in the 10 or 11 intercostal space, in the middle third of the abdominal wall : 皱胃游离在第10和11肋骨间即腹壁中间1/3处 Ph = 2 No protozoa没有微生物 periparturiant disease complex, Tamir Goshen 临床病理学临床病理学PathologyPatho