Vagus Indigestionعسر الهضم المسبب باصابة العصب الحائر

Vagus indigestionHoflound Syndrome

byDr. Ali H. Sadiek

Prof. of Internal Veterinary Medicine and Clinical Laboratory Diagnosis

Faculty of Veterinary Medicine Assiut UniversityE-mail: [email protected]

Vagus indigestion

• The vagus nerve runs along both sides of the esophagus and terminates in branches that innervate the forestomachs and abomasum.

• Inflammation or traumatic damage to the nerve can result from pharyngeal trauma or abscesses,

Vagus Indigestion

Vagus nerveVentral branch

Vagus nervedorsal branch

Vagus indigestionIt is a subacute to chronic disease as a result of

Lesions affecting the vagus nerve In cattle Ch. by:1. Gradual rumenoreticular and abdominal distention and 2. Improper forestomach emptying “functional outflow

problem”.Causes: 1. Traumatic reticuloperitonitis is the common cause of

vagal nerve damage.2. Mechanical inhibition of motility from adhesions or

abscesses can also decrease forestomach emptying.

Vagus indigestion3. Mechanical obstruction of the cardia or

reticulo-omasal orifice (eg, papillomas or ingested placenta)

4. Perforating abomasal ulcers with a diffuse peritonitis can also cause outflow obstructions with no evidence of vagalnerve damage.

5. Mediastinitis, thoracic inflammation,

There are four types of vagus indigestion:

indigestion vagusType I “Failure of eructation”

• It may results in free gas bloat and ruminal distention.

• Inflammatory lesions, chronic pneumonia or a localized peritonitis following hardware disease of the vagus nerve cranial to the cardia have been implicated.

• Mechanical factors not related to vagus nerve damage that cause esophageal obstruction may also cause failure of eructation.

Type II vagus indigestion “Failure of omasal transport”

It is caused by conditions that prevents ingesta from passing through omasalcanal into abomasum as:

1. Adhesions, reticular and single liver abscesses (TRP) usually on the right or medial wall of the reticulum near the route of the vagus nerve.

2. Mechanical obstruction of the omasalcanal by:

►Ingested material (eg, placenta) ►Masses (eg, lymphosarcoma,

squamous cell carcinoma, granulomas, or papillomas)

Type III vagal indigestion “ Abomasal impaction”

• Feeding of dry, course roughage, such as straw, in a chopped or ground form with restricted access to water and usually during extremely cold temperatures

• Secondary impactions: Assoc. TRPA sequela of right abomasal displacement or

abomasal volvulusObstruction of the pylorus (eg, by placenta or

trichobezoars).

Type IV vagal indigestion“Partial forestomach obstruction”,

• It typically develops in cattle during gestation.

• It may be related to the enlarging uterus shifting the abomasum to a more cranial position, which inhibits normal motility..

Clinical signsof vagus indigestion

Vary with the location of the obstruction. 1. In all cases, there is a gradual

development of ruminoreticular and abdominal distention.

2. Distention of the dorsal and ventral sacs of the rumen result in an “L-shaped”rumen on rectal examination.

3. Left dorsal and left and right ventral distention of the abdomen causes a “papple” (pear plus apple) shape.


4. Diminished appetite, improves if distention is relieved.

5. Milk production gradually decreases, 6. Very scant and sticky feces, often contains

long hay particles, 7. Rumen develops a “splashy” fluid

consistency. 8. Increased rate of rum. Cont. (3-4

contractions/min) with decreased strength, not audible due to the frothy contents failure of the rumen to empty


9. Temperature and respiratory rate are usually normal;

10. Bradycardia is present in 25-40% of cases. 11. Tachycardia develops as the disease

progresses. 12. Over time, the animal develops a rough hair

coat, loses condition, and becomes weak (in some cases to the point of recumbency) and dehydrated.



Left dorsal and left and right ventral distention of the abdomen causes a “papple” (pear plus apple) shape.




13.On rectal palpation, The rumen is distended with gas or froth

pushing the left kidney to the right of the midline.

The ventral sac of the rumen is enlarged and palpable to the right of the midline (“L-shaped”).

Palpation of the lower half of the right side of the abdomen below the costochondraljunction may detect an impacted abomasum that feels doughy


13.On rectal palpation,

Lab. Findings in vagus indigestion

• The PCV : Increased because of dehydration or decreased because of bone marrow depression (anemia of chronic disease).

• The WBC may be normal, increased, or decreased. • Neutrophil to lymphocyte ratio is typically reversed,

and a neutrophilia may be present, if an inflammatory condition such as peritonitis is present,.

• Lymphocytosis can be seen with vagal indigestion due to lymphosarcoma.

• Leukopenia may be present with diffuse peritonitis.• Increased serum globulin and total protein can be

seen with abscesses.


• Metabolic status is normal, or metabolic alkalosis may be present if Serum Cl is decreased.

• Serum Cl is usually normal if the lesion is cranial to the abomasum.

• Low Cl indicates reflux of Cl from the abomasum into the rumen and obstruction at the level of the abomasum.

• Cl levels of the rumen fluid may be increased. • K is usually low due to decreased K intake in the feed. • Ca is often moderately decreased because of ongoing milk

production; however, it can be low enough to cause recumbency.

• BUN and creatinine increase with dehydration due to prerenal azotemia.

Diagnosis of vagus indigestion

Identifying the cause is difficult but is important because of differences in treatment and prognosis:

1. Physical examination, 2. Rectal examination, 3. Lab. Findings: CBC, blood acid-base determination,

and serum chemistry values are often useful. 4. Peritoneal fluid analysis: Total protein or nucleated

cells are increased in peritonitis.5. Radiographs of the reticulum should be taken to

identify a radiopaque linear foreign body (eg, wire) or reticular abscess.

6. Exploratory surgery often required for a definitive diagnosis (left paralumbar fossa laparotomy and rumenotomy).

Diagnosis of vagus indigestion

Differential diagnosis (Rule out all conditions of Abd. Distension)

1. Ascites and uterine enlargement: ruled out by rectal palpation due to the absence of ruminoreticular distention.

2. Occasional cases of long standing obstruction of the cecum or small intestine; cecal or small-intestinal distention is also palpable rectally.

3. Cecocolic volvulus: the rumen is distended but not L-shaped, and a characteristic ping is present .

Treatment of vagus indigestion

• Surgical exploration of the abdomen can help determine the primary cause of vagalnerve damage, the animal's prognosis and may aid in therapy.

• Treatment of Type I vagusindigestion focuses on relieving free gas accumulation via a rumen fistula or stomach tube.

• An open-ended plastic syringe sutured into the rumen allows gas to escape.


Therapy for early cases of Type II vagusindigestion is mostly supportive.

Fluids, electrolytes, rumen cathartics, access to water and exercise.

Subcutaneous administration of Ca borogluconate Advanced cases usually require surgery. A left

paralumbar fossa celiotomy and rumenotomy allows the clinician to palpate the reticulo-omasal orifice for foreign bodies, placenta, papillomas or impactions. Biopies can be obtained and abscesses can be drained using this approach.


Treatment of Type III vagus indigestion• Stimulate rumination: Neostigmine (6-10 mg QID SC),

Metoclopromide (0.1mg/kg QID SC)• I.V. fluid adminis. to correct hypokalemia,

hypochloremia and metabolic alkalosis. • Rumenotomy allows the clinician to administer

mineral oil directly into the abomasum via the omasal-abomasal orifice, or removal of impacted abomasalingesta.

• Severe cases of abomasal impaction may require an abomasotomy via a right paracostal approach, but affected animals have a poor prognosis.


Treatment of Type IV vagus indigestionFluids, electrolytes, calcium.Therapeutic abortion may be required. A rumenotomy using a left paralumbar

fossa approach can be utilized to detect and treat underlying disease processes.

A left paralumbar fossa rumenotomy

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Vagus Indigestionعسر الهضم المسبب باصابة العصب الحائر