酮病和真胃变位

CalvingDiseaseComplex

产后疾病

ketosis&LDA

酮病&真胃变位TalSchcolnikAfimilk,S.A.E.Afikim,Israel以色列阿菲金公司Metabolicdiseases代谢疾病Metabolism新陈代谢

Thewholerangeofbiochemicalprocessesthatoccurwithinalivingorganism.Metabolismconsistsbothofanabolismandcatabolism-buildupandbreakdownofsubstancesinthebody.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。Superproductivecowsproduces15,000kgmilkin305lactationdays-requiredsupermetabolism.305天生产15,000kg的高产牛需要特别的新陈代谢Milkproductionandreproductionforcedairycowstoconsumeenergyatleast3timesabovetheirenergyneedsformaintenance.

奶牛生产和繁殖消耗的能量至少是维持能量需要的3倍。Ontheedge…极限Feb12postparturiantdiseasecomplex4Calving产犊Conception怀孕Drying-off干奶Puerperium产后配种Dairycowlifecycle奶牛周期循环DairycowLactation奶牛胎次循环periparturiantdiseasecomplex,TamirGoshen产犊产后疾病怀孕繁殖管理305天时干奶365天时产犊干奶牛管理围产牛CalvingInterval产犊间隔Calving产犊Calving产犊1stIns.首次输精RestPeriod始配期SuccessfulIns.有效输精WastePeriod浪费天数OpenPeriod空怀天数Dry-Off干奶DryPeriodTransition

Period围产期Pregnancy怀孕Lactation泌乳期CalvingInterval产犊间隔DairyCow’sLactation奶牛泌乳期Lactationphases胎次阶段Terminology专业术语Numberofdaysfromcalvingtopregnancy产犊至怀孕的天数OpenDays空怀天数Daysuptofirstservice产后至首次输精天数RestDays始配天数Daysbetweenfirstandeffectiveinsemination首次输精和有效输精间隔天数WasteDays浪费天数Periodbetweentwosuccessivecalvingtimes两次产犊间隔CalvingInterval产犊间隔Term术语Explanation解释Lactationscomparison胎次对比DairyCowLactations泌乳期LactationTransitionperiod

围产期Managementofthedrycowplaysanimportantroleinthecontrolofmetabolicdisordersnearoratcalvingtime

干奶牛管理在产犊前后牛只新陈代谢起很重要的角色Calvingandatleast6weekslaterarecriticaltimesforthedairycow

产犊及产后6周是奶牛决定整个胎次的关键期BCSatcalving产犊时体况评分Foodconsumption饲料消耗Bodyfatmobilization体脂代谢Thechallengesofthetransitioncow围产期管理的挑战Productiondisturbance生产紊乱Immunity免疫ReproductionPerformance繁殖性能Milkproduction奶产量5-12DIMPhysicalExam产后5-12检查Diagnosis诊断Prognosis预测Treat治疗Observe观察Cull淘汰Clinicalexamination临床检查

Routineexamination5-12Daysinmilk

(DIM)产后5-12天检查流程（泌乳天数<DIM>）

Anamnesis:记忆LactationNo.?胎次数No.ofcalvesatlastcalving?最后一次产犊胎儿数Calvesfate?犊牛现状DaysInMilk?泌乳天数（DIM）Milkyield?产量Anyproblemsincecalving?是否有产后疾病？periparturiantdiseasecomplex,TamirGoshenDr.TamirGoshen,

Hachaklait,

KoretschoolofVeterinarymedicine,

TheHebrewUniversity,

Jerusalem,Israel.13DifferentialDiagnosis(DD’s):鉴别诊断Ketosis酮病FattyLiver-Fatcowsyndrome脂肪肝-肥胖综合征DisplacedAbomasum真胃变位Metritis子宫炎RetainedPlacenta胎衣不下Mastitis乳房炎Laminitis蹄病Traumaticreticulo-pericarditis外伤-心包炎Pyelonephritis肾炎Vagusindigestion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Fielddiagnosis/Lab.Sample

现场诊断/实验室分析CostofRx治疗成本Cull淘汰Postpartumexamination产后检查

Routine5-12DIM产后5-12天规程14InterrelationsbetweenCalvingDiseases产后疾病间的相互关系STILL死胎

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3.46.82.06.82.450.45.812.0MultifactorialApproach(OdedNir)多因子分析方法15Multivariatelogisticregression多元回归方程Dr.TamirGoshen,

Hachaklait,

KoretschoolofVeterinarymedicine,

TheHebrewUniversity,

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RiskfactorORp95%CIConstantNA<0.001NAFarm1.02<0.0011.01-1.03Year0.69<0.0010.64-0.75Season0.880.0090.80-0.97Parity1.17<0.0011.08-1.25Retainedplacenta2.60<0.0011.96-3.44Metritis2.91<0.0012.21-3.82LDA51.47<0.00121.5-123.2Milkfever1.510.2070.80-2.88Twinbirth1.470.031.04-2.08LowEnergyIntake能量采食量低FatMobilization脂肪代谢PoorImmuneFunction免疫力低EmptyRumen瘤胃空FattyLiver/Ketosis脂肪肝/酮病Mastitis/Metritis乳房炎/子宫炎DisplacedAbomasum真胃变位ImpairedLiverFunction肝功能损坏Death死亡Neuralketosis酮病Metabolicdisordersofthefreshcow

新产牛代谢紊乱Ketosis酮病Fatcowsyndrome肥胖综合症Displacedabomasum真胃变位Retainedplacenta胎衣不下Rumenacidosis瘤胃酸中毒Laminitis蹄病Milkfever产褥热GrassTetany(tetanushypomagniesemic)低血镁症Hypophosphatemia低磷血症Udderedema水肿Ketosis酮病Ametabolicdisorder,thatresultsfrominadequatedrymatterintakebythedairycowinearlylactation.

代谢紊乱是因为泌乳早期牛只干物质采食量不足。Whenbloodglucoselevelistoolow,thecowmobilizesbodyreserves,especiallyfat.

当体内血糖水平过低，奶牛动用身体储藏尤其是脂肪。Substantialpartofexcessivemobilizedbodyfatconvertedintoketonebodiesintheliverdamaginggluconeogenesis,whichresultsinelevatedketonelevelsintheblood.

大量动用体内脂肪，转化为酮体，从而影响肝脏对血糖的代谢，从而造成体内酮体累积EtiologyofKetosis酮病病因Toincreasetheirmilkproductionaftercalving,cowshavehighenergyrequirements,whichusuallycannotbemetbyfeedconsumption.Theyare,therefore,athighriskofNEBandtheconsequencebeingketosis.要提高产后牛只产量，产后牛可通过日粮获取体内高能需要。因此能量负平衡高风险的结果是酮病的发生NadavGalon20EnergyCurve能量图泌乳性能和维持需要能量Mcal/天饲料功能配种时期体内能量酮体-Anorexia厌食-Rumeninactivity瘤胃迟缓-Weightloss体重下降-Lowermilkyield产量下降-Diarrhea腹泻Centralnervoussystemsymptoms(rare)中枢神经系统紊乱

Ketosisclinicalsymptoms酮病临床综合症Pathophysiology病理生理学negativeenergybalance能量负平衡Increasedlipolysis增加脂类分解hepaticlipidaccumulation肝脏内脂类堆积Impairedgluconeogenesis糖异生受阻Impairedhepaticfattyacidsoxidation,esterificationandlipoproteinsynthesis脂肪酸氧化、酯化及脂蛋白合成受阻，Hypoglycemia,hypoinsulenemia,excessiveketogenesis低血糖症、酮体合成过多periparturiantdiseasecomplex,TamirGoshenKetosisintheblood

ofcow

酮病牛只血检指标Ketotic临床酮病Sub-clinicalketosis隐性酮病Normal正常2852Glucose(mg/dl)葡萄糖>

4.0>1.20.3Ketones(mmol/L)酮体>3.10.3NEFA(mmol/L)游离脂肪酸NadavGalon24DiagnosisofSubclinical&ClinicalKetosis

隐性酮病和临床酮病的诊断

(7herds1982-84O.Nir-1982-1984年的7个牛群)

Epidemiology-Incidence&Prevalence

流行性病学-发病率&流行性Incidence:

发病牛群4daysto6weeksaftercalvinginhighproducingcows产后4天-6周高产牛Prevalence:

发病率RatesofketosisintheIsraeliherd~20%以色列牛群酮病发病率约20%periparturiantdiseasecomplex,TamirGoshen26Year年份Season季节Herd-Someherdshighincidenceinheifers

牛群-部分牛群后备牛发病率较高TotalMixedRations

全混合日粮（TMR）Epidemiology-general

流行病学-常见

RiskFactors发病原因periparturiantdiseasecomplex,TamirGoshen27LactationIncidenceRate(LIR)byYear

泌乳期发病率（LIR）-全年Shpigeletal1996periparturiantdiseasecomplex,TamirGoshen28LIRbySeason

泌乳期发病率-按季节Shpigeletal1996periparturiantdiseasecomplex,TamirGoshen11.61712.76.1024681012141618Jan-Mar1-3月Apr-Jun4-6月July-Sept7-9月Oct-Dec10-12月Season季节LIR(%)泌乳期发病率29LIRby

Herd泌乳期发病率-按牛群Shpigeletal1996periparturiantdiseasecomplex,TamirGoshen26.92516.43.72.90510152025303566881055156356Herd牛群LIR(%)30Parity–LactationIncidenceRate(LIR)increaseswithLactationno.(parity)胎次-随着胎次的增加发病率也提高High-yielding高产牛Longdryperiod干奶期过长ExcessiveBCSatdryofforatcalving干奶/产犊时体况变化大Uterinedisorders–Twins,RP,Metritis,ect.

子宫扭转-双胎，胎衣不下，子宫炎等DisplacedAbomasum真胃变位Epidemiology–Individualcow

RiskFactorsperiparturiantdiseasecomplex,TamirGoshenFeb1231LIRbyParity按胎次Shpigeletal1996periparturiantdiseasecomplex,TamirGoshenKetosisandFertility酮病和繁殖率HerdswithEffectsofYieldonFertility*%adverselyaffectedbyNEB

&otherfactors牛群产量对繁殖的印象牛群存在能量负平衡或其他原因(148Herds,2007)*OdedNir,2010KetosisandProduction

酮病和产奶量Peak,PersistencyandNegativeEnergyBalance(NEB)1stLactationsCows*(8882cowsin86herds)头胎牛泌乳峰值，持续力及能量负平衡（NEB）-86个牛群的8882头牛1%persistency=304.0lbsin305days1%持续力=305天产量为304L*OdedNir,201034Diagnosisofketosis酮病的诊断TamirGoshenTestingforketonuria酮体的检测UrineandMilkTests尿检和牛奶检测periparturiantdiseasecomplex,TamirGoshen35LowmilkproductionPoorappetite低奶量和采食量下降Routinepostpartumexamination5-12days产后5-12天检查Primaryketosis酮病（仅）VaginalandRectalExamination阴道和直肠检查RetainedplacentaMetritis,LDA,MF胎衣不下、子宫炎、真胃变位和产褥热Normal正常Ketonuria酮体>=1.5mmol/LComplicatedketosis酮病综合征Examinationprotocol检查规程periparturiantdiseasecomplex,TamirGoshen36Rabies狂犬病Listeriosis李氏杆菌病CCNBSE-MadCowDisease.疯牛病Leadpoisoning铅中毒Grasstetany低血镁症Clavicepspaspalipoisoning雀稗麦角菌DifferentialDiagnosisofketosisNervousform

酮病的鉴别诊断

37ClinicalPathology

临床病理学Blood:血检Glucose血糖BHBA羟丁酸Acetoacetate乙酰乙酸NEFA(FFA)游离脂肪酸Liverenzymes肝脏酶Urine:尿检Acetoacetate乙酰乙酸BHBA羟丁酸Milk:牛奶检测Acetoacetate乙酰乙酸BHBA羟丁酸38Problematicherds-allpostparturientcows亚健康牛群-所有产后牛Otherherds:其他牛群 -Sickcows病牛 -Dryfor>70days干奶天数>70天 -DryoffBCS>=3.75干奶时体况评分≥3.75BSCLossinthedryperiod>=0.5

干奶期体况下降超过0.5分的牛只 -Milkproduction<25/30L 25L<产量<30LWhichcowshouldbetested?

应检测哪头牛？periparturiantdiseasecomplex,TamirGoshenNegativeEnergyBalanceatCalving(1)产后能量负平衡（1）theFamiliarPattern,Herd#1相近的牛只-牛群1Calvingtraits产后指标Firstlactation头胎牛≥Secondlactation≥2胎a.Totalcalved总产犊259555i.%withketosis酮病比例40.2(8.3)21.1(14.0)Theroutinetestispartiallyefficient,90/176(51.1%)ofcowswithNEBweremissed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39OdedNir,2011Calvingtraits产后指标Firstlactation头胎≥Secondlactation≥2胎a.Totalcalved总产犊224712i.%withketosis酮病比例1.4(8.3)4.6(14.0)Theroutinetestisofnovalue121/130(98.8%)ofcowswithNEBweremissed检测程序没有价值：98.8%（130头中的121）没有再出现NEBatCalving-“theSmeller”Herd#2产后能量负平衡-牛群2（牛群较小）40OdedNir,2011≥3胎

二胎

头胎头胎

二胎

≥3胎NEBatCalving-theLatePattern(PH)Calvingtraits产后指标Firstlactation投胎≥Secondlactation≥2胎a.Totalcalved总产犊8261i.%withketosis酮病比例0.0(8.3)1.7(14.0)Noroutinetest.26/27(96.3%)ofcowswithNEBweremissed没有检测程序：96.3%（27头中的26）没有再出现41OdedNir,2011DiagnosingKetosis酮病诊断Conventionalmethodsofdiagnosingketosisarenotsatisfactory-afflictedanimalsmaybemissedandhealthycowsmayneedlesslyreceivetreatments.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OdedNir,2010Ketosisinafifarmbyafilab阿菲牧魔盒对酮病的检测

DiagnosisofketosisbyFat/ProteinRatioinMilk

酮病诊断-牛奶中的脂蛋比Ketosisevents酮病事件OdedNir,2010Ketosis–Treatment

酮病-治疗Dextroseinfusion(IV):Themostrapidanddirectwayofsupplyingbloodglucose.静脉注射-最直接最见效的补糖方法Hormonaltreatment(IM):Glucocorticoids(Dexamethasone)激素治疗-糖皮质激素-地塞米松Oralsugarprecursors:Sodiumpropionateandpropyleneglycolaretwooralsugarprecursors.Theycanbefedordrenchedatarateof250-450grperdayusuallyfollowingglucoseorhormonaltreatment.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periparturiantdiseasecomplex,TamirGoshen01/02/202312:5645Treatment治疗periparturiantdiseasecomplex,TamirGoshenCostBenefitRatioofKetosisRx

酮病治疗成本与价值比例102损失Loss治疗TreatInsFarm牧场Farm牧场NadavGalonKetosis–Prevention

酮病-预防Avoidover-conditionedcowsinlatelactationanddryperiod.Bodyconditionscoreshouldbe3-3.5atcalving.泌乳末期和干奶期避免体况过肥。产犊时体况在3-3.5分Feed2-4kgofgrainpercowduringtheclose-upperiod(3weeksbeforecalving).围产期（围产期）饲喂2-4kg谷物Encouragemaximumenergyintakeaftercalvingbyfeedinghighqualityforages.产后饲喂优质粗饲料以增加牛只能量采食量Feedtotalmixedrationsifpossible.Ifnot,limitgrainintaketo2-4kgperfeeding.如果可能饲喂TMR。没有TMR，限制2-4kg谷物采食量Oded

Nir2012Kronfeld,1970Sodiumpropionate丙酸钠Glycerol甘油PropyleneGlycol丙二醇Radostits,1989Sodiumpropionate丙酸钠PropyleneGlycol丙二醇Monensin莫能菌素11ICPD,2001Niacin烟酸Glycerol甘油Propyleneglycol丙二醇MerckVetManual,20102010年Merk兽医手册Niacin烟酸Methionine蛋氨酸Sodium(calcium)propionate丙酸钠/钙Rumenprotectedcholine过瘤胃胆碱PropyleneGlycol丙二醇Ketosis–Prevention酮病预防49Ketosisinterrelationswithfattyliver

酮病与脂肪肝相关性Ketosisinruminantsisadiseaseoftheperiparturientperiodcausedbyimpairedmetabolismofcarbohydratesandfatsandisinterrelatedwithfattyliver.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-thediseasecharacterizedby:生化理性-该疾病特点Ketonemia.酮血症Ketonuria.酮尿Hypoglycemia.低血糖periparturiantdiseasecomplex,TamirGoshen50FattyLiverSyndrome

脂肪肝综合症LipomobilizationsyndromeFattyinfiltrationoftheliverincattle牛只肝脏脂肪外渗Fatcowsyndrome牛只肥胖综合症“GooseLiver”肝肿大periparturiantdiseasecomplex,TamirGoshen51Lowmilkproduction产量下降Anorexia,Depression,Weakness厌食、消沉、体弱Rumenatony,GITileus-scantmucoid,

便黄且稀

前胃迟缓、肠梗阻-粘液分泌不足、Mildicterus(rarelyvisibleclinically)轻微黄疸-临床不常见Nervoussigns:staringgaze,holdingheadhigh,muscletremors,coma神经紧张：发呆、仰头、肌肉痉挛、昏迷Recumbency,death卧地、死亡FattyLiverSyndrome脂肪肝综合征

ClinicalSigns临床表现periparturiantdiseasecomplex,TamirGoshen52Hypoglycemia低血糖Ketonemia&Ketonuria酮血、酮尿ElevatedbloodNEFA,Bilirubin,Liverenzymes血液中游离脂肪酸、胆红素、肝脏酶浓度上Decreasedbloodcholesterol,albumin,TG血液中胆固醇、白蛋白及甘油三酯浓度降低ProlongedBSPclearancetest延长BSP清除测试FattyLiverSyndrome脂肪肝综合征

ClinicalPathology临床病理学periparturiantdiseasecomplex,TamirGoshen53FattyLiverSyndrome脂肪肝综合征

Diagnosis诊断History发病历史Clinicalsigns临床表现Clinicalpathology临床病理学Liverbiopsy-theonlyreliablemethodaccuratelyestimatingthedegreeoffattyliver肝脏活体组织-唯一用来准确评估脂肪肝患病程度的方法periparturiantdiseasecomplex,TamirGoshen54Treataccompanyingconditions治疗并发情况Somecowsresponsetotreatment:一些牛只治疗效果Parenteralglucoseinfusion补糖Glucocorticoids???糖皮质激素BvitaminsVBOralfluidsandelectrolytes口服液体或电解质Trans-faunation,Rumenstimulants瘤胃刺激Oralpropyleneglycolorsodiumpropionate口服丙二醇或丙酸钠Glucagon胰高血糖素

FattyLiverSyndrome脂肪肝综合征

Treatment治疗periparturiantdiseasecomplex,TamirGoshen55

Guarded监测Severecases-poorprognosis极端病例-治疗无效Salvageslaughter屠宰FattyLiverSyndrome脂肪肝综合征

Prognosis

预测periparturiantdiseasecomplex,TamirGoshen56FattyLiverSyndrome脂肪肝综合征Glucagontreatmentinfattyliver胰高血糖素治疗脂肪肝

10mg/dayfor2days2连续两天：10mg/天periparturiantdiseasecomplex,TamirGoshen0510152025303540450214Daysaftertreatment治疗后天数%Livertriglycerides肝脏甘油三酯浓度Control对照组Glucagon注射胰高血糖素57LeftDisplacedAbomasum真胃变位

Definition定义LDAisanentrapmentoftheabomasumbetweentherumenandtheleftabdominalwall真胃变位（LDA）是真胃（皱胃）被瘤胃和腹壁包裹periparturiantdiseasecomplex,TamirGoshen58Etiology-LDA

真胃变位病原学Notfullyunderstood发病原因不全被研究出Multifactorial多种原因AprerequisitefordevelopmentofLDAishypomotilityandgaseousdistentionoftheabomasumLDA的一个发病原因是肠胃蠕动缓慢及皱胃鼓气TheremightbeanassociationofLDAwith:与LAD可能相关联：Malfunctionsattheleveloftheintrinsicnervoussystem神经系统机能紊乱Impairedcholinergicmuscleresponse胆碱能肌肉反射受损periparturiantdiseasecomplex,TamirGoshen59RiskFactors–LDA致病原因TMRorgrainfeeding TMR/精料Ketosis酮病Retainedplacenta胎衣不下Primarymetritis早期子宫炎Twins双胎Stillbirth死胎Lowmilkyieldpreviouslactation泌乳早期产量过低Lowfeedintakebeforeandaftercalving产前和产后采食量过少periparturiantdiseasecomplex,TamirGoshen60TamirGoshenperiparturiantdiseasecomplex,TamirGoshen-112DA变位牛NORMAL正常牛-2.004.006.008.0010.0012.0014.0016.0018.00DMI(Kg/day)干物质采食量（DMI）kg.天Timefromcalving(weeks)产后时间.-周DMIintakeinnormalandDAcows正常牛只和变位牛只干物质采食量对比61TamirGoshenperiparturiantdiseasecomplex,TamirGoshen-112DANORMAL05522.252.5DMI(%BW/day)DMI-体重%/天Timefromcalving(weeks)产后时间-周DMIintakeinnormalandDAcows正常牛只和变位牛只干物质采食量对比62Largesize,highproducingadultdairycattle高产牛8-14weekscalvesandin21monthsandolderheifers产后8-14周至泌乳21月及月龄较大的后备牛（新投产）Rareconditioninbeefcattle,andveryrareinsheep's体况差的肉牛，养较少见Approximately90%ofthecasesworldwideareinthefirst6weeksaftercalving全世界90%的病例常见于产后6周Epidemiology-Incidence&Prevalence流行病学-发病率及流行性periparturiantdiseasecomplex,TamirGoshen63Incidence-0.2-1.6%inDenmark丹麦-发病率：0.2-1.6%InIsraeltheincidenceis1%in1stcalfheifersand1.5%incows(bestquartile,2003)以色列头胎牛发病率1%，成母牛发病率1.5%InIsraelmorethen90%oftheDA’saretotheleft在以色列90%的变位是左侧变位periparturiantdiseasecomplex,TamirGoshenEpidemiology-Incidence&Prevalence流行病学-发病率及流行性64ClinicalSigns–LDA临床表现Inappetence,almostanorexia食欲不振，几近厌食Markeddropinmilkproduction产量下降Varyingdegreeofketosis不同程度酮病Feces-reducedinvolumeandsofterthannormal粪便-量减少且较平时稀松Decreasedruminalmovements-bothfrequencyandintensity瘤胃迟缓-频率和强度均减弱periparturiantdiseasecomplex,TamirGoshen65Leftside“ping”incombinedauscultationandpercussion.听诊左侧有金属叩击声Insomecases-paroxysmalatrialfibrillationduetothemetabolicalkalosis.一些病例-因代谢性碱中毒，阵发性心房颤动Onrectalexamination-smallemptyrumen,thedisplacedabomasumisrarelypalpated.直肠检查-瘤胃小且空，皱胃几乎不可触摸到Fatcowsmaydevelopseverketosisandfattyliversyndrome.肥胖牛可能发展成急性酮病及脂肪肝综合征periparturiantdiseasecomplex,TamirGoshenClinicalSigns–LDA临床表现66

Auscultation&Percussion

听诊&叩诊periparturiantdiseasecomplex,TamirGoshen67“Ping”location

叩击声位置LDA真胃变位periparturiantdiseasecomplex,TamirGoshen68ClinicalPathology临床病理学Hemoconcentration-elevatedPCV,Hb&TP血浓缩-血红蛋白、动脉压力升高，Ketonemia酮血症Mildmetabolicalkalosis轻度代谢性碱中毒Mildhypochloremia轻度低氯血症Mildhypokalemia轻度periparturiantdiseasecomplex,TamirGoshen69Paracentesisofthedisplacedabomasum,inthe10or11intercostalspace,inthemiddlethirdoftheabdominalwall:皱胃游离在第10和11肋骨间即腹壁中间1/3处Ph=2Noprotozoa没有微生物periparturiantdiseasecomplex,TamirGoshenClinicalPathology临床病理学70Diagnosis诊断Clinicalsigns-especiallythetympanicsoundintheleftparalumbarfossa临床症状-在腰椎窝处可明显听到鼓气声音Rectalpalpation-whenpossibletofeelthedisplacedabomasum直肠检查-可感觉到变位的皱胃periparturiantdiseasecomplex,TamirGoshen71Treatment治疗Conservative-rollingorrunningthecow保守治疗-翻转牛只Surgical:手术Roll&suture翻转&缝合Pennsylvaniamethod–ventralParamedianapproach宾夕法尼亚法-腹中线方法Hanovermethod–rightsideapproachHanover法-右侧法Utrecht