basics Flashcards
Diagnosis
An adequate clinical examination is central for the diagnostic process.
The purpose of the clinical examination is to detect the clinically significant abnormalities of function and to determine the body system involved.
Purpose of a diagnosis
- Being able to recommend a specific treatment
- To provide an accurate prognosis
- To make recommendations for cost effective control
- Prevention of new cases when group animals are at risk
Physical examination:
- Inspection
- Palpation
- Auscultation
- Percussion
- Smelling
- Measuring
Additional clinical examination:
Non-instrumental: biopsy, aspiration, diagnostic laparotomy, puncture Instrumental: X-ray, ECG, US, CT, MR
Clinical laboratory examination
Blood, urine, rumen-content, faeces, liquor, milk
Symptom:
Changes, which are observed by the owner → special group of symptoms together are highly specific for a disease
signs
Abnormal findings of the vet during the physical examination
- Specific (pathognomic) – non-specific
- Permanent - temporary
- Main – accessory
Diagnosis:
name of the disease
Inspection
- General body regions (skin, posture, behaviour, gait, condition)
- With the unaided eye
- With the aid of instruments (ophthalmoscope, otoscope, vaginoscope, penlight,
radiography, ultrasonography, endoscope) → Time and attention given
→ Good illumination
Palpation
- Direct – indirect
- Outside – inside
- Superficial – deep
- Alteration in: Location, shape, size, borders, surface, consistency, structure,
painfulness, movability, surroundings, covered skin, temperature - Ballotation (ballotation and auscultation)
- Undulation (tactile percussion)
Terms of consistency
Utrecht:
water in think plastic bag, putty, soft rubber, hard rubber, stone
Terms of consistency
Budapest:
fluctuating, doughy, firm (muscle-like or wood-like), hard (cartilage-like or bone- like), glandular, emphysematous (crackling)
Doughy:
pressure causes pitting which persist for a variable time as in oedema
Firm:
resistance to pressure is similar to that of normal liver
Hard:
the structure has a bone-like consistency
Fluctuating:
wave-like movement is produced in a structure by the alternating application of pressure
Emphysematous
the structure is enlarged and puffy and yields on pressure, it produces a crepitating or crackling sound due to the presence of air or gas in the tissue
Auscultation
Auscultation of spontaneous or artificially induced sounds Indirect (mediate) or direct (immediate)
Auscultation general rules
- The animal should stand still
- A certain examination order should be followed
- Silent circumstances
sound
Combination of vibrations with different frequencies
noise
no special underlying relation among frequencies, no periodic character
Acoustic percussion: used to
To obtain information about the condition of the surrounding tissues (create sound waves, resonance) thorax, paranasal sinuses, abdominal cavity, sc emphysema
Border estimation (lung border)
Assessment of a tissue density to a depth of 7cm,
detection of a lesion at least 5cm in diameter.
Percussion to localize pain (Pain Percussion)
Percussion blow: weak, superficial (define the borderline)/strong, deep Methods:
- Direct (finger to finger)
- Indirect (Plessimeter and percussion hammer)
Components of percussion sound (Marek)
- Crackling sound on tapping the hammer and the plessimeter
- Sound of the thoracic wall or the wall of any organ
- Resonant sound of gas-containing tissue (lung) or other filled organ
Main characteristics of percussion sound
- Volume/loudness,
vibrations amplitude: strong/sharp, weak/dull - Pitch/frequency,
number of vibration/min: high/low - Tone/resonance: homogenous/non-homogenous, sonorous/resonant, damped
- Duration: short, long
- Special sounds: steel-like, cracked, drum-like
Smelling
- Expired air
- Oral cavity (foetor ex ore)
- Skin
- Excreta (urine, faeces, other)
Measuring
Instruments:
thermometer, measuring tape, vernier calliper, string of calibrated ovoids
How to develop a correct diagnosis:
- Deductive diagnosis (dg. per deductionem)
- Pathognomic symptoms
- Excluding diagnosis (dg. per exclusionem or dg. differencialis)
- Diagnosis obtaining from the therapeutic results (dg. ex juvantibus)
Types of diagnosis
- Causal, etiological diagnosis (e.g. parvovirus enteritis)
- Topographical diagnosis (concerning and organ, e.g. hepatitis)
- Symptomatic diagnosis (e.g. jaundice, fever)
- Deductive diagnosis (e.g. tetanus)
- Functional diagnosis (e.g. lameness of the urinary bladder)
- Tentative diagnosis (e.g. sarcoptes)
- Main and additional diagnosis (e.g. enteritis and flea allergy)
Comparing the diagnosis with the reality:
- Exact → diagnosis vera, certus
- Objective → diagnosis objective
- Presumptive → diagnosis verosimilis
- Undetermined → diagnosis incerta
- False → diagnosis falsa
Possible causes of a false diagnosis:
- Diagnosis without examination
- Examination isn’t accurate enough
- Misunderstanding one or more symptoms
- Prestige-based diagnosis
- Neglecting of repeated examinations
- Insufficient diagnostic equipment
- Inappropriate interpretation of the laboratory data
Order of the documentation of the examination results
NATIONALE/
• ANAMNESIS (history)
• STATUS PRAESENS (current state)
Nationale
(Patient identification date)
- Name and address of owner, phone, email
- Permanent data of the animal
o Species, breed, sex, colour, colour pattern, nose or muzzle impression, blood group, marks (chestnut, whorl, permanent blemishes or defects) - Transient data of the animal
o Age, body weight, brand marks, tattoos, ear tags, microchip
HISTORY
Inquiries concerning the animal:
Health state:
1. How long has the animal been ill?
2. What kind of abnormalities has the owner observed?
3. Were there any changes in the state of the animal since the observation of the
disease?
4. Were the same or any other symptoms previously observed? If yes, at what time?
Previous veterinary and other interventions:
- Veterinary interventions (previous treatments, immunizations, operations, diagnostic processes → rectal examination, abdominocentesis)
- Interventions by other people (enema per rectum, per os treatment, sounding, assistance during calving, etc.)
Reproductive state:
- Female animal: oestrus, parturition, pseudo-gravity, contraceptives
- Male animal: mating
- Neutering
Productivity
Transport
Inquiries concerning the environment
Health state of the animal population
1. How many and what kind of animals are kept together with the sick animal?
2. How many of them are ill? Were there any similar or different disease previously
observed among them? Is there any loss from the population? If yes, its degree?
3. Were any laboratory examinations performed?
4. General epidemiological, parasitic state of the group/herd?
Husbandry
- Housing
- Hygienic conditions
- Possibility of the ingestion of toxic materials
- Change of the person who works with the animal
Nutrition
1. Quality and quantity of the ration
2. Feeding technology
Change of the owner (sale and purchase)
STATUS PRAESENS
- General impression
- Basic clinical values
- Skin
- Lymph nodes
- Mucous membranes
- Respiratory system
- Cardiovascular system
- Gastrointestinal system
- Urinary system
- Genital system
- Spleen and haemopoetic system
- Hormonal glands
- Locomotion system
- Nervous system
General impression:
- Body size (height, BW)
- Body shape and developmental state, maturity
(skeleton, muscles) - Nutritional condition
o Muscle, fatness of sc tissue
o Body condition score BCS 5 (obese, overweight, normal, underweight, very
thin, emaciated, cachexia - General condition, grooming (Hair, fleece, footpads, claw, hoof)
- Consciousness and behaviour (general demeanour): restless, excited, raging, maniac
behaviour, bright/alert, dullness/apathetic, spoor (“deep sleep”), dummy/stupor,
coma - Posture
- Locomotion (gait)
- Obvious abnormalities
General impression: Normal result
The physique concerning the body size, shape and maturity is according to age and breed specificity.
Nutritional condition is good (upper range of breed specific weight) and general condition is good with good muscling.
The groomed state of the animal is very good; the hair coat is shiny and clean.
The behaviour of the dog is conscious and alert and a little excited showing panting and restlessness.
Posture, gait and movements are physiological with head held high, tail straight-out and putting weight on all four limbs.
Steps are equal length and powerful walk showing no signs of limping, circling or other lesions concerning locomotion.
BASIC CLINICAL VALUES
- Temperature
- Pulse/minute
o Depending on species, breed, age, sex, training, body size - Breathing rate/minute
- Rumen contraction/5 min
Temperature
- High:
sun, work, excitement, feeding, heating, fever, inflammation, irritation of heat centre, heat stroke, muscle contraction (unregulated hyperthermia)
Temperature Low:
cold, 1-1.5 days before calving, exhaustion, cachexia, opened anus, hypovolemic shock, barbiturate toxicosis
Where are the pulses taken?
Horse:
a. facialis,
a. transversa faciei,
a. digitalis lateralis et medialis
Where are the pulses taken? Cow
a. facialis,
a. transversa faciei,
a. coccygea,
Where are the pulses taken? Pig
a. auricularis caudalis
a. coccygea
Where are the pulses taken?
Small ruminants, dog, cat:
a.femoralis
tachypnoe reasons
fever
• narrow or obstruction of the airways
(nose:inflammation, foreign body, larynx paralysis, oedema, trachea hypoplasia, collapse, inflammation, oedema, neoplasma, macro or microbronchitis)
• decreased breathing surface
(pneumonia, lung oedema, neoplasma, abscess, pneomothorax, hydrothorax, haemothorax, pleuritis)
- obstacle of the movement of the diaphragma (tetanus, ascites, gastric torsion, meteorism)
- systemic painful disease
• central nervous irritation
(encephalitis, epilepsy)
• decreased oxygen level of the blood (anaemia, methaemoglobinaemia, CO toxicosis)
bradypnoe
encephalitis between the excited periods,
brain oedema,
toxicosis
