Examination methods Flashcards
PURPOSES of a diagnosis
The purpose a clinical examination is to detect the clinically significant abnormalities of function and determine the body system involved
• being able to recommend specific treatment
• to provide an accurate prognosis
• to make recommendations for cost effective control
• prevention of new cases when groups of animals are at risk
METHODS OF EXAMINATION
PHYSICAL EXAMINATION • Inspection (inspectio) • Palpation (palpatio) • Auscultation (auscultatio) • Percussion (percussio) • Smelling (olfactus) • Measuring (mensuratio) ADDITIONAL CLINICAL EXAMINATION • non instrumental (aspiration, biopsy, centesis, excision, extirpation, tubing, catheter, diagn. lapar) • instrumental (X-ray, ECG, US, endoscopy, CT, MR) CLINICAL LABORATORY EXAMINATION • blood, urine, rumen-content, faeces, liquor, milk
SIGN and SYMPTOM
• Symptom: changes which are observed by the owner
• Sign: the abnormal findings of the vet during physical examination
-specific (pathognomic) v nonspecific
-permanent v temporary
-main v accessory
• Syndrome: special group of symptoms, together are highly specific for disease
DIAGNOSIS (the name of a disease)
INSPECTION - parameters
• general (skin, posture, behaviour, gait, condition) body regions
• with the unaided eye with the aid of instruments ophthalmoscope, otoscope, vaginoscope, penlight, radiography, ultrasonography, endoscope
-give time and attention!
-good illumination
PALPATION- parameters
- direct vs indirect
- outside vs inside
- superficial vs deep
- alteration in: location, shape, size, borders, surface, consistency, structure, painfulness, movability, surroundings, covered skin, temperature
- Ballotation (ballotation+auscultation)-LA
- Undulation (tactile percussion)-SA
TERMS of consistency
DOUGHY: pressure causes pitting which persist for a variable time as in edema
FIRM: resistance to pressure is similar to that of normal liver/ muscle-like
HARD: the structure has a bone/cartilage-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
GLANDULAR
AUSCULTATION
auscultation of spontaneous or artificially induced sounds
• indirect (mediate) vs direct (immediate)
• general rules:
–the animal should stand still
–a certain examination order should be followed (min 2 full breathing cycles in min 5-6 sites on each side)
–silent circumstances
• sound: combination of vibrations with different frequencies
• noise: no special underlying relation among frequencies, no periodic character
PERCUSSION
short weak=>dull resonant=>resonant=>tympanic (based on air quantity)
-Acoustic percussion: obtain information about the condition of the surrounding tissues (create sound waves, resonancy) thorax, paranasal sinuses, abdominal cavity, sc emphysema
• border estimation (lung border)
• assessment of a tissue density to a depth of 7 cm
• detect a lesions at least 5 cm in diameter
-percussion to localize pain (pain percussion) percussion blow: 5 reticular pain tests
-weak, superficial (define the borderline)
-strong, deep
• methods:
–direct (finger to finger)
–indirect (pleximeter and percussion hammer)
Components of percussion sound (Marek)
- Crackling sound of tapping the hammer and the pleximeter/finger-finger
- Sound of the thoracic wall or the wall of any organ
- Resonant sound of gas-containing tissue (lung) or other organ filled
• Main characteristics of percussion sound
-volume/loudness vibrations amplitude (air dependent):
strong/sharp <=> weak/dull
-pitch/frequency number of vibration/min (size dependent):
high<=>low
-tone/resonance homogenous/non-homogenous sonorous/resonant(normal lung)<=>damped/dull/non-resonant
-duration
short <=>long
Main percussion sounds
• sonorous/resonant: fairly low, strongly resonant (air containing organ, i.e. normal lung)
• damped/dull: short sound of low intensity (any part does not contain gas, liver, heart, muscle)
• tympanic (stronger, longer, higher than sonorous, w/ higher pitch) i.e. striking a hallow organ containing gas under pressure, gastric volvulus
• Special sounds:
-steel-like (pathognomic for torsion)/ -cracked /-drum-like
SMELLING
-expired air
-oral cavity (foetor ex ore)
=>bad smell can be putrid/ acetone/ NH3(= kidney failure)/ faeces smell
-skin
-excreta (urine, faces, other)
MEASURING
Instruments:
-thermometer, measuring tape, vernier caliper, string of calibrated ovoids
Developing diagnosis
Developing a correct diagnosis:
- Deductive diagnosis (dg. per deductionem) w/ pathognomic symptoms
- Excluding diagnosis (dg. per exclusionem or dg. differencialis)
- Diagnosis obtaining from the therapeutic results (dg. ex juvantibus)
TYPES
• causal, ethiological diagnosis (e.g. parvovirus enteritis)
• topographical diagnosis (concerning an organ e.g. hepatitis)
• symptomatic diagnosis (e.g. jaundice, fever)
• functional diagnosis (e.g. lameness of the urinary bladder)
• tentative diagnosis (e.g. sarcoptes)
• main and additional dg (e.g. enteritis and flea allergy)
Types of diagnosis
Comparing with the reality: • exact- diagnosis vera, certus • objective- diagnosis objective • presumtive- diagnosis verosimilis • undetermined- diagnosis incerta • false- diagnosis falsa Possible causes of a false diagnosis - diagnosing without examination - examination is not accurate - misunderstanding one or more symptoms - prestige-based diagnosis - neglecting of repeated examinations - insufficient diagnostic equipment - inappropriate interpretation of the laboratory data
