Clinical Examination of the Cow

Clinical Examination Routine

University of Glasgow crest

The Left Hand Side

There are several things to check from the left hand side of the animal. You should try and get into a routine of checking everything in a set order; that way there is less chance of you forgetting something when you're being distracted by talking to the farmer.

General appearance

It is important to step back and look at the whole animal before you start. What is the coat condition like? Are there any suspicious lumps and bumps? How is the animal standing - does the posture suggest pain in the limbs, or is the animal tucking the hindlimbs under the body because of abdominal pain?

General appearance of the animal General appearance of the animal

Lymph nodes

There are two lymph nodes that should be palpable on the left hand side of the animal:

Heart

Auscultation of the heart can be used to obtain a heart rate for the animal, as well as to listen for any abnomalities in rhythm or heart murmors. A murmor may indicate a congenital defect such as a ventricular septal defect (VSD), or an endocarditis, but is also common and likely to resolve in very young calves. It is important to auscultate at several different rib spaces - some murmors can be quite localised and might otherwise be easily missed, and because the intensity of the murmor does not correlate well with degree of circulatory compromise, a localised murmor may be clinically significant. Note that auscultating the most cranial part of the heart requires forcing the stethoscope quite a long way behind the elbow.[listen to some heart sounds]

Auscultating the heart Auscultating the cranial part of the heart requires the head of the strethoscope to be some way underneath the elbow!

Lungs

Relative to horses, cows have a very limited lung volume and are quite limited in their capacity to cope with pneumonia. A thorough auscultation of the lung fields is a critical part of the clinical exam; mild respiratory disease or consolidated lung fields from a past pneuomina is a frequent finding. The lung field may be broken down into four areas - two dorsally, one in the middle and one ventrally - although heart sounds may interfere with auscultation of the most ventral field. Note any harshness, crackling or wheezing - very quiet or absent lung sounds are quite normal but may also be present in consolidated lung fields.[listen to some lung sounds]

The lung field extent (auscultation locations shown in yellow circles)
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Lung fields

Remember that increased respiratory rate (either due to stress, exercise or acidosis) will lead to increased or harsh lung sounds - if an animal is breathing quickly then it can be hard to differentiate normal sounds from abnormal. Percussion of the thorax may be helpful in identifying areas of consolidated lung field.[watch video]

Digestive system

The left hand side of an adult ruminant's abdomen is dominated by the rumen. Inside the rumen there should be three distinct layers - a gassy layer on top, a doughy fibrous matt in the middle and a fluid layer on the bottom - ballot the rumen using your fist to assess the consistency of each layer.[watch video]

You should also either feel for rumenal contractions by either placing your fist in the paralumbar fossa, or holding your stethoscope in the same place. You should hear/feel the rumen turnover as a strong contraction wave accompanied by a noise like a washing machine spinning [listen to a rumenal contraction]. Rumenal contractions should occur every 90 seconds to 3 minutes - more frequently than 1 contraction per minute is considered hyper-motile, and less frequently than 1 contraction every 3 minutes is hypo-motile.

Auscultating the rumen Feeling for a rumenal contraction with a fist (left) and auscultating a rumen contraction (right) Feeling for rumenal contractions

If the animal has any history of inappetence or dietry/management transition (including recent calving), you should make sure that there is no displacement of the abomasum. A left displaced abomasum (LDA) can be diagnosed as a 'ping' caused by the sound wave from flicking the animal's side bouncing off a gas/fluid boundary in the abomasum. It is important to be thorough when performing this procedure - some pings can be highly localised.watch video

Limbs

Even if the animal has not presented with a history of lameness, a visual examination of the limbs and feet is a necessary part of the clinical examination. Look for evidence of swellings in the joints, and assess the length of the toes - trimming feet is much better to be done before the animal becomes lame than afterwards. Inspect the coronary bands for any signs of lesions - important differentials such as mucosal disease and several notifiable diseases can present in this way.


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