Clinical Examination of the Mammary Gland Prof.

Khaled Qudah

Clinical examination of mammary glands

● Clinical anatomy of mammary glands:
In cattle, sheep and goats the teat has a single opening, the teat sphincter that
communicates with the teat cistern. The teat cistern opens into the gland cistern.
Lactiferous ducts, which arborize into smaller and smaller ducts, drain milk from
alveolar glands, which are arranged in lobules within the mammary gland
parenchyma and empty into the gland cistern. In the mare each teat has two
separate orifices. Each serves as an anatomically distinct duct and gland system
located within the single mammary gland. Each gland has 2-3 ducts/gland
systems.
Normal anatomical structures of the mammary gland, which should be examined
in the course of clinical examination include the: teats, streak canal, teat cistern,
glad cistern, and udder parenchyma.
● Clinical examination of mammary glands of farm animals:
The mammary gland should be inspected both visually and manually for
symmetry and consistency.
An asymmetrical udder may be caused by either unilateral increases or unilateral
decreases in the size of a mammary gland. Active inflammation, edema, and
abscessation will often cause enlargement of the udder. However, edema will
typically be symmetrical (equal in both sides), involving the lower third of the
entire udder and extending forward sometimes to the belly wall. In deep
palpation edematous udders will “pit”, leaving hand or fingerprints in the
palpated tissues. End stage fibrosis caused by chronic infection may cause atrophy
of single or multiple glands. Affected glands are usually firm and fibrotic. Of the
common intramammary pathogens of cattle, diffuse glandular atrophy and
fibrosis is most consistent with staphylococcus aureus mastitis. In herd with
endemic staph. aureus mastitis “blind-quartered” or “three teated” cows are
often presumptively diagnosed and classified as staph. aureus infected.
Changes of temperature in the mammary gland should be noted during physical
examination, particularly if they are restricted to a single gland or half of the
udder: inflamed glands are often warm, while glands undergoing gangrenous
Clinical Examination of the Mammary Gland Prof. Khaled Qudah

mastitis are cool or cold. Gangrenous mastitis is most commonly caused by

peracute staph. aureus or alternatively clostridial infection.
Clostridial infections tend to produce a dry gangrene because the toxins released
by bacteria comprise the arterial blood supply to the mammary gland. In direct
contrast, gangrenous mastitis caused by staph. aureus is a wet gangrene, which
results from the destruction and occlusion of the venous drainage of the affected
glands. Clostridial infections of udder results in production of a mammary gland
secretion, which has strong fetid odor.
Table 1. Comparison between dry and wet gangrene
Dry gangrene (clostridia perfringenes) Wet (moist) gangrene (staph. Aureus)
Tissue diminish in volume Tissue swollen and engorged with
blood
A clear line of demarcation between No line of demarcation and it could be
healthy and necrotic tissue extended to adjacent tissues
Loss of sensation Severe pain

Areas of localized fibrosis and abscessation are readily identified by deep

palpation of the mammary gland, ranging in size from microscopic to several
centimeters in diameter. Abscesses are usually roughly spherical and surrounded
by a firm capsule. Superficial abscess may be visible beneath the skin of the gland.
Lesions of this type are usually associated with chronic pyogenic infection, the
most common being stap. aureus mastitis, although mycoplasma spp., and
actionmyces pyogenes have been associated with intramammary abscesses.
Fibrotic areas are readily recognized because adjacent normal parenchyma tissue
provides a direct and distinct contrast. Diffuse increase in firmness are often seen
in sheep and goats following:
● Caprine arthritis- encephalitis virus
● Ovine progressive pneumonia

The skin of the udder also should be examined closely. Several viral diseases have
been associated with lesions in the udder such a bovine mammilitis virus, pox,
Pseudocowpox, FMD, Papillomavirus (teat wart).
Recognition of such lesions warrants closer examination and diagnostic testing.
The skin of the clefts formed between the right and left halves of the udder and
Clinical Examination of the Mammary Gland Prof. Khaled Qudah

between the lateral surface of the udder and the medial surface of the pelvic
limbs is moist, warm and anaerobic. Superficial pyoderma is common in these
areas particularly in recently fresh cows with large udders or marked udder
edema.

The bulk of lymphatic drainage in the ruminant mammary gland is through the
supramammary lymph nodes. These are paired structures located within the
parenchyma of the proximal mammary glands lateral to the median suspensory
ligament. They are readily palpated by placing the thumbs in the furrow formed
by the median suspensory ligament and the remaining four fingers of either hand
on the lateral aspect of the mammary gland. Deep palpation reveals a flat bean-
shaped structure approximately 7 x 5 x2 cm. the supramammary lymph nodes are
often enlarged in ruminant with either chronic mastitis or multicentric
lymphosarcoma. They are also enlarged with caseous lymphadenitis in sheep and
goats.

Palpation of the inflamed mammary gland will often elicit pain. Cattle will often
attempt to kick, and sheep and goats will stamp their hind feet. Inflammation of
the mammary gland will also often cause ruminants to have dramatic change in
their gait. The hind limb ipsilateral to the affected gland is often abducted.

The examination of the mammary gland secretions is a component of the clinical

examination of all lactating animals. Milk should be stripped on the flooring
surface or into a container. So. The consistency and the color of the milk can be
easily examined. Watery or thin milk and clots are presumptive evidence of acute
intramammary inflammation, usually infective in origin. Inflamed glands will often
produce a secretion, which is either red or yellow tinged. Red discoloration may
also be caused by udder trauma or postpartum hemorrhage in the udder.
Postpartum hemorrhage causing bloodstained milk occurs frequently in cows and
usually resolves without specific treatment.

The teat sphincter should be assessed for competency. Manipulation of the udder
will often trigger an endogenous release of oxytocin and cause some cows to drip
milk. This is a normal response. The spontaneous dripping of milk without
external stimulation that occurs in some cows is abnormal and may be caused by
Clinical Examination of the Mammary Gland Prof. Khaled Qudah

an incontinent teat sphincter. In these cases chronically open sphincter may

permit environmental bacteria to invade the mammary gland and cause sever
clinical mastitis. Cattle affected with acute clinical coliform mastitis are purported
to undergo endogenous oxytocin release. consequently, inappropriate dripping of
milk should be considered an indication for closer clinical examination.

The streak canal should be also palpated. It is readily palpated by rolling the distal
1 cm of the teat between the thumb and forefinger.
Although the canal is readily palpable in this manner, scarring and fibrosis of the
teat is readily diagnosed when the veterinarian detects an increased firmness of
this structure.

● California mastitis test

There are many methods to detect abnormal milk. These methods include CMT
(California Mastitis Test), WMT (Wisconsin Mastitis Test), and MWT (Modified
Whiteside Test). Of these, the CMT is easiest to do at the side of the cow. I this
test the mammary gland secretion is mixed with an equal volume of detergent
solution, releasing the chromosomal DNA contained in milk leukocytes. This DNA
increases the viscosity of the milk- detergent solution. Inflamed gland will
typically have increased consequently, the thickness of the gel observed in the
essay is roughly related to the severity of the intramammary inflammation.
Observed reactions are graded on a negative (SCC is 0-200,000/ml), trace (SCC is
200,000-500,000/ml), +1 (SCC is 500,000-1.5 million/ml), +2 (SCC is 105 million-5
million/ml) and +3 (SCC is above 5million/ml) scale. (table 2)

The CMT is usually performed on foremilk, the milk contained in the teat cistern.
The cell count of foremilk is higher than that of composite or stripping, enhancing
the sensitivity of the test procedure. The recently fresh cow and those drying off
will give high-test results in the absence of infection. Thus, these cows will give
false positive resulting using CMT test. (be careful please)
Clinical Examination of the Mammary Gland Prof. Khaled Qudah

*** Table 2 CMT analysis chart

Test result Reaction observed judgment
Negative The mixture remains No mastitis
fluid without thickening
or gel formation
Trace A slight slime formation Trace of mastitis
is observed. It is most
noticeable when the
paddle is rocked from
one side to side
+1/+2 Mixture distinctly forms mastitis
a gel
+2/+3 Mixture thickens mastitis
immediately. Tends to
form jelly. swirling the
cup moves mixture in
towards the center,
exposing the outer edge
of the cup

The CMT is also useful in small ruminants. However, normal goat milk has a higher
cell count than normal milk from cows. Thus, current grade A standards require
that goats milk contain no more than 1,000,000 cells/ml. however, the SCC limit is
lowered to 500,000/ml for cow milk.in goats, milk from noninfected glands will
yield a negative (0), trace, or 1≥ reaction. Score of 2≥ or 3≥ are indicative of
mastitis.
Somatic cell counts in excess of 1,500,000/ml are suggestive of intramammary
infection. (Table 3)
Clinical Examination of the Mammary Gland Prof. Khaled Qudah

Table 3. interpretation of California Mastitis Test scores on goat milk

CMT Score Reaction Mean no. Neutrophils
per ml
0 No reaction 68,000
Trace Slight slime, tend to 268,000
disappear with
continued swirling
1 Distinct slime but 800,000
without gel
2 Immediate gel 2,560,000
formation; moves as a
mass during swirling
3 Gel develops a convex ≥ 10,000,000
surface and adheres to
the bottom of the cup