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Rectal Examination Minimize
rectal2.jpg (47132 bytes) The rectal exam should be performed last to avoid creating pneumorectum and confusing the interpretation of abdominal auscultation and percussion. The rectal examination is an extremely important part of the physical exam and even if a sure diagnosis is made prior to this procedure, it should never be skipped. A routine sequence of examination should be established and the examiner should use a lot of lubrication.

Manure and Uterine Discharge

Examine the perineal and tail area for evidence of blood, mucus, discharge or feces. Fresh blood on the tail suggests the cow has just gone through estrus. A moderate stream of clear, highly viscous (stringy) mucus suggests a cow may be close to or in estrus. Sometimes a thin clear mucus may be seen with urine poolers(vaginitis) or cows with cystic ovarian disease. A variety of vaginal/uterine discharges may be evident depending on the stage of lactation. Fresh cows (cows that have calved recently) can have normal lochia (3-12 days postpartum) or depending on the severity of metritis may have thin, watery brown-red to tan discharge that is malodorous. The more mucoid the discharge, the less severe the metritis is for the cow. Normally cows should have a clean tail and perineal area. If there is a lot of manure on the tail, the cow may have diarrhea or perhaps tail paralysis. Inspect the manure for volume, color, fiber length, consistency, mucus-covering and odor. Absence of production of feces during the physical examination suggests reduced fecal output. Off-feed cows may produce scant, pasty feces and cows with intestinal stasis may have no feces or scant blood-tinged , thick mucous-covered feces. The color of the feces varies with feed and bile secretions. Feces covered with orange mucus is typical of bile secretions seen in cows with fatty liver. Excessive amounts of mucus may be seen with constipation or inflammatory bowel disease. Digested blood appears black (melena) and is caused by blood in the abomasum or proximal small intestine, and would typically be found in a cow with a bleeding abomasal ulcer. Fresh blood indicates bleeding from the distal intestine, and may occur with colitis caused by coccidiosis or clostridium enteritis. Fibrin occurs in severe inflammation such as that caused by salmonellosis and may appear as casts. Diarrhea can be associated with forestomach diseases such as displaced or ulcerated abomasum, or small intestinal problems. In general, large quantities of liquid feces suggest a small intestinal problem such as Johnes disease, winter dysentery, salmonellosis, or enteritis of unknown origin (bad feed?). Large quantities of well digested soft feces may suggest a large intestine problem.

Pelvic Inlet

Easily recognizable landmarks are the pelvic inlet, the pelvic/pubic brim, and the iliac shafts. The pelvic brim is useful because of its central location. It is necessary to do a thorough exam of the pelvic canal for gross changes that could be caused by severe vaginitis from birth trauma, abscesses or tumors. The reproductive tract including the cervix, and uterus should be located. The cervix is located in the middle of the floor of the pelvic cavity and should be freely movable. The uterine horns may be located in the pelvis or abdomen. Physiological and pathological conditions that affect the position and freedom of movement of the cervix are listed below:

Cervix predominantly pelvic and freely movable

  • Normal nonpregnant uterus
  • Pregnancies up to 60 to 70 days
  • Postparturient involution more than 14 days after parturition
  • Pyometra and hydrometra with exudates or secretion <2 liters
  • Chronic metritis without appreciable accumulation of exudates

Cervix abdominal and fixed

  • Pregnancies after 70 days
  • Uninvoluted postpartum tract
  • Pyometra and hydrometra with exudates >2 liters
  • Extensive adhesions
  • Tumors (Lymphosarcoma)

See Reproductive Exam for more details... The bladder is palpable ventral to the reproductive tract if it is distended, but will not be palpable if it is empty. The deep inguinal lymph nodes can be palpated just cranial and lateral to the brim of the pelvis along each shaft of the ilium. Enlargement of these lymph nodes suggest pelvic inflammation, mastitis or lymphosarcoma. The iliac lymph nodes are palpated along the termination of the aorta.

Rumen

Next the rumen is palpated for size and consistency which varies with disease states. The rumen is palpated from the left of midline and cranial. The dorsal contents of the rumen may have some gas and are generally doughy, while the ventral contents are more fluid-like. Absence of a readily palpable rumen in an off-feed cow sometimes results in a "rumen void" ping which can be heard during simultaneous auscultation and percussion of the left side of the abdomen. This "rumen void" ping can be confused with a diagnosis of LDA.

Kidney

To the right of the rumen in the midline area is the left kidney. The arm is normally inserted beyond the elbow to find the left kidney unless it is enlarged. The most common reason for enlargement of the kidney is pyelonephritis. Often a kidney with pyelonephritis is painful on palpation.

Right Quadrant

Small bowel and cecum are palpated ventral and to the right of the left kidney. The right side of the abdomen will feel empty if everything is normal. Potential pathological conditions such as a distended cecum or small intestine are readily palpable in this region.


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