Clinical Examination of the cow
 

268-275

History

• In getting a history, is it available? Some producers have few, if any, written records and may rely too much on memory. You can use your previous experience with the producer to determine if the history is accurate. A written record is always preferred, as "A dull pencil is better than a sharp mind".

• The expected status of the animal can aid in your examination, but should not prejudice you in your findings.
• Is the cow post partum (just calved), if so what is the calving date?
• Is this a pregnancy exam, if so what is the breeding date? You must be a skilled in determining pregnancy status as sometimes the cow is pregnant to a different breeding date than you are given.....if you are given one at all.
• Is the cow a 'repeat breeder' What is her history of repeat breeding.... when, how often?
• Is the cow being examined for anestrus? What is the heat detection history? Is there any history of breeding or bull exposure? Was it born a twin?
• Is this a purchase exam?
• What is the cow's temperament? Is she a kicker?? This would certainly be nice to know before you are lying on the ground in pain with the farmer looking on (usually they think it is funny when the vet gets kicked!!) with a sheepish look.

• What is the age of the cow? A cow may be examined for different reasons than a heifer.

• Many times you will be too preoccupied and not do a visual exam. This can be most embarrassing not to do. You can often estimate the age and determine whether it is a cow, heifer.....and make sure it is not a bull that you are pregnancy checking!

• Look at the conformation. Is it normal, or does it look more steer-like? Is there a sloped tail head, small vulva, enlarged clitoris, or long vulvar hair? These are all suspicious signs of a freemartin.
• Look at the udder. Is it large, indicating a post partum cow or is it small suggesting a heifer or dry cow?
• Look for vulvar discharge. Is there any? If there is some, is it clear mucus, cloudy mucus, blood, normal lochia, or pus? Take a whiff.....it can tell you a lot about the meaning of the discharge.

Mucus on tail. Metestrus blood in mucus.


Pus discharge. Slight pus discharge.

• Why do we emphasize rectal palpation so much (actually it is palpation of the uterus per rectum.....rectal palpation means palpating the rectum.......I will stop now) ?
• Rectal palpation is currently the fastest, cheapest, most accurate, and easiest technique to accurately assess the condition of the uterus.
• It is best to use the opposite hand with which you write, because you are usually more dexterous with the hand with which you write and you can do things better with that hand. Since you cannot palpate yet, you may as well train your 'other' hand to be more useful.
• The landmarks for palpation are the pelvic floor and the iliac shafts. The cervix is 8-12 cm x 4-6 cm on pelvic floor and consists of cartilage which gives it the firm feel of a "turkey neck". It is always firm and on the pelvic floor.
• The broad ligament is a sheet of tissue extending from uterus and ovaries to the body wall. It may be at 45⁰ or almost ventral. You need to identify it !!! The middle uterine artery runs in it.
• Other normal structures include the external iliac artery, pelvic lymph nodes, the rumen, the ceacum, the bladder, and the kidney.

Procedure for Indirect Uterine Retraction of the Bovine Uterus
                      
Click here, then right click on the frame to see a video on retraction.

• Put on a sleeve .....please! At some places you will be asked to use a new sleeve on each cow. Why? 
• Lube your hand well. You usually need to lube on the first cow only. Usually one sleeve is used as long as possible. There is some evidence however, that there may be some diseases spread by rectal palpation, so this may change during your careers.
• Point your fingers and insert one finger, then your hand into the rectum.
• Now make a fist and ram your stiffened arm into the cow. This will help conserve energy. Try to go under feces if possible, as this will also conserve time and energy.
• Remove excess feces without removing your hand.
• Grasp the cervix and pull it backward.
• Place your thumb under the cervix.
• Fan your hand out laterally about 45⁰ or almost ventrally to engage the broad ligament.
• Pull back on the broad ligament.
• The uterine horn and the ovary are now within your grasp, but disregard the ovary and move your hand medial to the ventral intercornual ligament.
• Drive your hand down between the uterine horns to the ventral intercornual ligament.
• Pull caudally on the ligament to pull uterus back. Flip the uterus over so that tips of horns and cervix are pointing caudally.
• Now you can systematically palpate the horns, ovaries, oviducts, and bursa.

• Direct retraction may work on smaller, non pregnant tracts, but it is not the method to learn first.
• Pull back on cervix and reach directly for the ventral intercornual ligament.
• Pull the uterus back and flip over as before.

Click to enlarge

Corpus hemorragicum (CH), intact and cut surface.

Corpus luteum (CL3) on right ovary, palpation, cut surface.

• Sensitivity and Specificity of Rectal Palpation to Determine the Presence of a
  Mature Corpus Luteum in Cycling Cows
  • If we look at the sensitivity and specificity of either of these tests, we find that they are probably not cost beneficial. The cost of the mistakes outweighs the cost of palpation.
  • For example, looking at the figure and using a sensitivity of 83% and a specificity of 53% for rectal palpation identification of a corpus luteum (both figures are what good palpators can achieve) we see that in a random cycling herd of 21 cows, 10 would have corpora lutea and 11 would not.
  • Palpation would say that 13 have a corpus luteum and 8 do not.
  • That means that we correctly identify 8/10 CLs, but miss 6/11 when we say they do not have a CL.

• Sensitivity of 83%
• Specificity of 53%
• Positive predictive value of 61%
• Negative predictive value of 75 %

Ultrasound examination

• Becoming more popular for pregnancy diagnosis and ovarian structure identification.
• Dairy primarily.
• Pixel values of ultrasound images of corpora lutea were correlated with luteal (r = -0.72, P < 0.05) and plasma (r = -0.71, P < 0.03) progesterone concentration, and to the volume densities of luteal cells (r = -0.75, P < 0.02) and connective tissue (r = 0.69, P < 0.03) (Ultrasound image attributes of the bovine corpus luteum: structural and functional correlates.J Singh, RA Pierson, and GP Adams . Journal of Reproduction and Fertility (1997) 109 35-441997.)
   

Bovine corpus luteum

Bovine corpus luteum with central lacuna

Vaginal examination

• Usually use a vaginal speculum. It can be made of glass, PVC or cardboard. 
• Insert the speculum over pelvis and into the vagina. The vagina is a potential space, inserting the speculum will cause a rush of air to 'inflate' the vagina.
• Use an external light source to look into the vagina.
• You can look for discharge from cervix and vagina, urine pooling, cervical ring eversion, adhesions, tears, and abscesses.
• Manual vaginal exam. You can insert a clean hand into vagina and instead of looking you can feel for tears, adhesions, abscesses, cervical dilation, and debris (such as mummy, fetus).

• GnRH, LH, FSH, PGF, are all experimental now. Their release may be episodic so you need more than one sample to accurately determine the true concentration and activity.
• Estrogen is difficult as the assay is hard to do and there are many cross reactions. There are no 'in house' kits , so you need to send the sample to a lab for assay. This will take some time to get back results.
• Progesterone is generally accurate. There used to be qualitative on farm kits available at about $3/test. They generally gave good results, but are not marketed now. You needed to have someone run the test that used good laboratory techniques to give accurate results.