Vet AI Scribe for Food Animal

Cow 2417

Thursday, October 8, 2026 at 7:40 AM

Farm call — fresh cow, off feed

Subjective

Chief Complaint

4-year-old Holstein cow in her second lactation, 9 days in milk, off feed for two days with a sharp drop in milk yield.

History

• Calved unassisted on September 29; twin bull calves, placenta passed within 6 hours.
• Milk yield fell from 41 kg/day to 23 kg/day over the last 48 hours (parlour records).
• Eating forage but refusing the TMR since yesterday morning.
• No treatment given by the farm before the visit.
• Third fresh cow this month with a similar presentation; the herd manager reports a ration change in the close-up pen four weeks ago.

Objective

Vital Signs

• Weight: Approximately 590 kg (weight tape)
• Temperature: 101.8°F (38.8°C)
• Heart rate: 84 bpm
• Respiratory rate: 28 breaths/min
• Rumen contractions: 1 per 2 minutes, weak
• Body condition score: 3.0/5 (3.75 at dry-off)
• Hydration: Estimated 5% dehydrated; mild skin tent, eyes not sunken

Physical Exam

• General: Quiet, standing, mildly tucked up; manure scant and pasty.
• Left flank: High-pitched ping on simultaneous auscultation and percussion over ribs 9–13, extending to the mid-flank. Splashing sounds on ballottement.
• Right flank: No ping.
• Udder: All four quarters soft; California Mastitis Test negative in all quarters.
• Uterus (rectal): Involuting appropriately for 9 days; small amount of normal lochia, no fetid discharge.
• Thorax: Clear lung fields bilaterally; no murmurs.

Cow-side Tests

• Blood beta-hydroxybutyrate (BHB): 3.2 mmol/L
• Urine ketones: Large

Assessment

1. Left displaced abomasum (LDA) — left-sided ping over ribs 9–13 with splashing on ballottement.
2. Clinical ketosis — BHB 3.2 mmol/L with inappetence and milk drop; likely both a cause and a consequence of the LDA.
3. Herd-level transition problem suspected — third fresh-cow LDA/ketosis case this month after the close-up ration change; loss of 0.75 BCS over the dry period.

Differentials Considered

• Right displaced abomasum or volvulus (no right-sided ping)
• Metritis (rectal exam and temperature unremarkable)
• Hypocalcaemia (standing, normal mentation; not tested today)

Plan

Surgery

• Right paralumbar fossa omentopexy performed standing in the chute.
• Analgesia: inverted L block with lidocaine 2%, 100 mL total. Extra-label use; FARAD-recommended withdrawal of milk 24 hours and meat 1 day, both covered by the flunixin withdrawal below.
• Abomasum decompressed and returned to its normal position; omentopexy completed. Recovery uneventful.

Medications

• Flunixin meglumine: 1.1 mg/kg IV once (650 mg total). Withdrawal: milk 36 hours, meat 4 days. Milk can return to the tank from the first milking after 7:40 PM on Friday, October 9.
• Dextrose 50%: 500 mL IV slowly once.
• Propylene glycol: 300 mL PO once daily for 3 days, given by the farm. No withdrawal.
• Cow marked with red leg bands and entered on the treatment board as a withheld animal.

Monitoring

• Farm to recheck appetite, manure and rumen fill twice daily; recheck BHB on day 3.
• Call if the cow goes off feed again, the incision swells or discharges, or her temperature rises above 103.0°F (39.4°C).
• Skin sutures out in 14 days.

Herd Follow-Up

• BHB screening of all fresh cows between days 3 and 14 in milk, starting this week; results recorded on the fresh-cow sheet.
• Close-up ration and dry matter intake to be reviewed with the herd nutritionist at next week's herd health visit.
• Body condition scoring of the dry cow and close-up pens at that visit.

Producer Communication:
Explained to Mr. Hendricks that the displaced stomach and the ketosis are linked, and that three similar cases in a month point to a transition-period problem rather than bad luck with individual cows. Went through the milk and meat withdrawal times, and confirmed the date and time her milk can go back in the tank. Agreed to start fresh-cow BHB testing now and to bring the ration question to the herd health visit.

— Dr. Aoife Brennan, DVM