General Subjects Flashcards
Objective and methods of Clinical Diagnostics.
Objective and methods of Clinical Diagnostics.
Objective: Using diagnostics to come to a diagnosis, prognosis then treatment. Differentiate
sick from healthy. Diagnosis so can give treatment, prognosis and prevention of new cases.
Methods – history, physical exam, further methods. Need fundamental knowledge
supplemented by additional knowledge. Physical exam:
● Inspection – skin, posture, behaviour, gait. Good illumination needed. Unaided and
instruments – e.g. penlight, US, x-ray. Take time and care.
● Palpation – direct, indirect, inside, outside, superficial, deep. Alteration in location,
shape, size, borders, structure, pain, movability, surroundings, consistency (doughy,
firm, hard, fluctuating, emphysematous), covered skin, temp. Also undulation,
ballotation (palpation of mass that can be bounced back and forth)
● Auscultation. Direct and indirect. Order. Animal should be still and surroundings
quiet.
● Percussion. Acoustic and to localise pain. Thorax, abdomen, nasal cavity re acoustics.
Determine lung borders. Ok to tissue density of 7cm. Can detect lesions 5cm
diameter. Components of percussion – crackling of hammer and plessimeter, sound of
thoracic/organ wall, resonant sound of gas filled tissue. Loudness, frequency,
resonance, duration. Main sounds – resonant (air – lung), dull (muscle – e.g. heart),
tympanic – stronger, longer, higher than resonant (hollow organ with gas under
pressure). Special – steel like, cracked, drum like.
● Smell – expired air, oral cavity, skin
● Measuring – thermometer, tape, calliper
● Additional methods
o non instrumental such as biopsy, aspiration etc.,
o instrumental such as ECG and ultrasound
o lab exams – blood, faeces, urine, rumen content, liquor, milk
The diagnosis. Diagnosis types. The causes of misdiagnoses.
Signs and symptoms (group of signs) are used to come to diagnosis. Use the history,
physical exam and additional techniques. You require a fundamental knowledge
backed up by additional knowledge such as books.
● Symptom – change seen by owner.
● Sign is abnormal finding by vet during physical exam. Can be pathognomic
(specific)/nonspecific, temporary/permanent, main/accessory.
● Syndromes is a special group of symptoms, which together are highly specific for the
disease [e.g. Hoflund syndrome in cattle – reticular peritonitis – posture,
gluteraldehyde test of rumen content etc.]
● Diagnosis is the name of the disease e.g. alopecia, tetanus. Adequate clinical
diagnosis is central! Purpose of clinical exam is to detect significant abnormalities
and to identify the body system involved.
● Purpose of diagnosis – recommend specific treatment, come to accurate prognosis, to
be able to recommend cost effective control and prevent new cases (herd health)
● How to develop a diagnosis: deductive:
o pathognomic symptoms e.g. tetanus. [Clostridium tetani, horse, wound,
anaerobic bacteria – symptoms include rigid muscles with spasm, cannot eat
or drink (lock jaw). Tail often held away from body. Look for entry wound –
particularly legs and feet.]
o excluding/differential diagnosis. So gradually in a process of elimination
reduce the options.
o from therapeutic result – ex juvantibus (e.g. babesiosis). [Acholergic faeces,
haemolytic anaemia, fever, pale mucus membranes, vomiting]
● Types. Causal – e.g. parvo enteritis, topographical, symptomatic (e.g. fever),
functional (e.g. lameness), tentative (sarcopes), main & additional (enteritis and flea
bite allergy). Can be exact, objective, presumptive, undetermined, false.
● False diagnosis – no exam, exam not accurate, misunderstanding symptoms, prestige,
neglecting repeated exams, not correct eqpt, not interp lab data well.
Describing an animal, the importance and parts of the identification.
Permanent data of the animal – colour, markings, species, sex, breed, colour pattern,
nose/muzzle impression, blood group, whorls, scars, date of birth
● Transient data of the animal – age, microchip, tattoos, weight, ear tag, type of coat
e.g. wavy or straight$$, short or long, ears – cropped or dropped, tail – long or
docked.
● Importance. Transit – pet passports, animal/environmental health issues – if diseased
need accurate ID, sale – horse. Legal disputes over identification at sale etc. Horse has
a passport – silluette with markings and description and may be photographs e.g.
KWPN
History-taking, the parts of the history.
Enquiries on animal
● Health state – how long ill, abnormalities, changes since onset of disease, were same
or other symptoms previously observed?
● Previous vet and other interventions – vaccines, ops, clinical tests and exams.
Intervention by other people e.g. at calving.
● Repro state. Female (oestrus, bred, parturition, contraceptives etc), male (mating),
neutered
● Transport
● Productivity
Enquiries on environment
● Health of population. How many and what kind of animals kept together with sick
ones.
● How many ill. Similar or previous diseases, Any deaths, and amount.
● Lab exams
● Vaccinations, worming etc
● Husbandry. Housing, hygiene, toxins, change in staff
● Nutrition. Quality and quantity and feeding technology
● Change in ownership
Parts of the current clinical state (status praesens). The order of the examination of
organs and organ-systems.
General Impression, Basic Clinical Values (temp, pulse, respiration, rumen contraction rate
per 5 min), Skin, lymph nodes, mucus membranes, respiratory system, circulatory system, GI
system, urinary system, genital system, hormonal system, nervous system, locomotion
General state (General clinical impression).
General impression – species, age, sex, breed are factors.
● Body size, shape and maturation
● Nutritional conditioning is good with good musculature. Skeleton ok. BCS 1-5
emaciated, thin, good, stout, obese.
● Well groomed – hair is shiny and clean. Hair, footpads, claws
● Behaviour – conscious and alert. A little excitement and panting is ok, Bright/alert,
dull/apathetic, spoor (sleepy), stupor (not v responsive) coma. Other way –
nervous/tense/excited/anxious, restlessness, mania. Pathological – mutilation, pacing,
aggression
● Posture, gait and movement – head high, tail out and weight on all 4 legs, Step equal
length.
Taking the temperature and the normal temperature of different animal species, the
subnormal temperature.
Use rectum. Lift tail, lubricate (and disinfect) thermometer. Species, breed, age, sex,
condition will affect the result.
Normal temp. Dog: 38.2 – 39. Cat 38.5-39.2. Horse - 37.5 – 38. New-born 37.5-38.5, Cow -
38-39. New-born 39-39.5, Sheep, goat, pig- 38.5-39.5,
Abnormal temp:
Increased temp: sun, work, excitement, feeding – physiological. Pathological – fever,
inflammation, irritation of the heat centre, heat stroke.
Decreased temp – in cool surroundings, 1-1.5 days before calving, cachexia, exhaustion,
open anus, hypovolemic shock, barbiturate toxicosis.
Pulse rate. Determination of the respiratory rate and the normal respiratory rate in
different animal species.
Normal respiratory rates:
Horse – 10-15, Cattle – 10-30, Dog, sheep, goat – 15-30, Cat – 20-30, Pig – 12-20.
Tachypnoe – breathing rate increases due to:
● Fever
● Narrowing/obstruction of airway – inflam, foreign body, oedema, tracheal collapse or
hypoplasia, larynx paralysis, macro/micro bronchitis
● Reduced surface area of breathing – oedema, neoplasm, pneumonia, abscess,
pneumothorax, hydrothorax, pleuritis
● Obstacle to moving diaphragm – tetanus, ascites, gastric torsion, metorism
● Systemic painful disease
● CNS – epilepsy, encephalitis
● Reduced oxygen level in blood – anaemia, CO toxicosis, methaemaglobinaemia
Bradypnoe – decreased breathing rate:
● Brain oedema, toxicosos, encephalitis (between periods of excitement)
Pulse rate :
● Dog- femoral artery. 70-100 beats per min large breed (150-200 new-born)
● Cat - Pulse – 120-160 beats per min adult (new-born 200-250) femoral artery
● Horse - Pulse: 30-40 bpm. Facial, transverse facial, brachial, digital pulse
● Cow, sheep, goat, Pig - Pulse: 60-80 bpm. Facial, transverse facial, coccygeal,
saphenous. Pig same pulse but just 2 arteries - Coccygeal, auricularis magna
Significance, methods and order of the skin examination.
[Importance. The skin is the largest organ in the body so its importance cannot be
underestimated. The condition of the skin is also important in terms of helping to come to a
diagnosis of other problems: 3 examples:
● elasticity of the skin and its turgor is an important test used very frequently in
determining the hydration status of the animal.
● less elastic skin, poor sparse haircoat and comedo found on an old dog could indicate
Cushing’s disease.
● plaques may indicate eosinophil granuloma complex in cats]
Methods of examination.
Inspection – look at examination No 11 below
Palpation - look at examination No 11 below
Smelling – greasy skin can smell!
Additional exams – vitally important:
● Take a skin scraping. With a scalpel collect the hair shaft and surface into a sterile
20ml syringe usually. Superficial just the skin. Deep scrape to 1st capillary bleeding.
Take from a few different areas. Very important to include is from the border of a
lesion (as healthy part is in the centre). Not always conclusive e.g. sarcoptic mange
may find nothing. Pull out hair and put into same syringe. If you can, push out the
content of the follicle (e.g. pus)
● Lab exams – microbiology – culture for bacteria and fungi. Information on antibiotic
resistance is very important. Also look under microscope for parasites and finally
cytology after painting the sample
● Otoscopic exam of external ear canal – make sure go into horizontal part of the canal.
Look for any materials – e.g. brownish dirty, gritty something – mites possibly. Also
look for inflammation and greasiness.
● Cytology – aspiration, swab, smear, impression, scraping. Usually aspiration if lesion
has any volume – 22G needle and 5ml syringe. Also for lymph nodes. Impression –
for greasy skin. Helps determine if you are dealing with inflammation or neoplasms.
If aspiration is not conclusive then follow up with a biopsy. Always do a biopsy if
you do not know what it is. Biopsy generally required for a final diagnosis for
hereditary skin problems, auto-immune diseases and neoplasms. Biopsy not needed
for parasite diagnosis.
● Blood tests – hormone, function tests. Parasites, allergy eosinophilia not specific
enough really. Cushing’s disease is - will be increase in alkaline phosphatase, though
it could also be steroid induced. Helpful but not specific. However total T4 test for
thyroid problems is vitally important. Sex hormones can be misleading. again testing
for one single hormone not very helpful.
● Histo-pathology – immunofluorescence, immunohistochemistry. Not used commonly
in animals – more common in human medicine
● Special tests – ANA test for auto-immune disease (anti nuclear antibody test). Do is
suspect systemic lupus but can get false positive. Also immunocomplex test from
serum but also high ;levels if chronic allergy so can be misleading. Coombs test used
if suspect systemic immune haemolytic anaemia. Flow cytometry to see if lymphocyte
carries CD4 or CD8 and is a very complex immunological exam.
Order of examination ● hair coat ● condition of the skin ● physical examination of skin lesions ● swellings ● cutaneous appendages – e.g. hooves, claws etc. ● External ear
Examination of the hair, accessory parts of the skin and ear.
Density. Guard and undercoat hairs. Alopecia – lack of hair (hypotrichosis). Must
differentiate between:
o primary alopecia – endocrine or congenital. Can easily pull out hair.
Endocrine problems e.g. hypothyroid or Cushing’s –symmetrical hair loss
o secondary alopecia – trauma, inflammation. Hair will not pull out easily.
Often see stubble where hair trying to grow. Hair loss not symmetrical.
o Also hyperkeratosis – increased hair. Irish setter can have estrogen responsive
hypertrichosis and in the husky it can be physiological in winter. Alopecia can
be localised/generalised, single/multiple, continuous/circumscribed,
patchy/diffuse, multifocal/focal.
● Colour – species and breed differences
● Gloss – if little gloss indicates problem with grooming, nutrition etc.
● Closure – how skin sits next to the coat e.g. staring coat
● How loose is hair. Easily pull-able indicates a follicular problem if you can pull out an
allopecic patch. If can’t pull a patch then may be increased shedding in cycle of hair
growth (e.g. horse loses winter coat in spring)
● Stiffness – can differ between breeds e.g. wire haired terrier and Yorkshire terrier
● Localisation of abnormalities
● Parasites. Important!!! Puritis – fleas? Look for fleas or their faeces – test with damp
white paper – if get red/brown ring is blood in flea faeces. Also lice and their eggs on
the hair shaft. Also mites – Cheyletiella (walking dandruff) is common and
trichodectes.
Accessory parts of the skin include:
● Footpads
● Nasal plane
● Cutaneous appendages – claws, paws, nails, hooves, horns
● Perianal and circumanal – lots of very small glands round the anus
● Paraproctal – i.e. the 2 big glands round the anus
External ear – look for signs of swellings, lesions, discharge, or dirty, gritty substance – mites
possibly. Also can use an otoscope to check the ear canal – both the vertical and horizontal
parts
Examination of the condition of the skin.
Condition of the epidermis. If ok it is intact.
● Colour & presence of hemorrhages: pigmentation, albinism. Appropriate to breed.
● Odour»_space;sex pheromones. Sebaceous gland and apocrine sweat gland produce smells.
Uremia – ammonia smell. Diabetes mellitus smells like acetone and also ketone
bodies. Male goat has a very distinctive smell!
● Temperature of the extremities and the body. Footpads according to the environment,
body less affected. Due to hair coat do not take skin temp as with humans.
● Moistness: Palpate or can see. Sweating, sudation (sweat gland secretion), hydrosis,
hyperhidrosis – increased production of moisture – can be atopic dermatitis.
Apocrine sweat glands are on body – horse has them everywhere for
thermoregulation, cattle on the lateral neck, behind ear, near the groin and at the
udder, sheep and goats on the inside of the thighs and rabbits and rats have one at all.
Eccrine sweat glands are on the footpads, nasal plane and also the lower eyelids of
dogs and cats.
● Greasiness: sebaceous glands. Palpate and smell. If increased production it is called
seborrhea oleosa (smells like rancid fat) and if less production it is called seborrhea
sicca.
● Thickness:
o Dog average: 0.5-5mm
o Cat average: 0.4-2mm
o The skin is thickest on the back, rump, base of tail, dorsal neck/thorax.
o Thinnest on pinnae, inguinal and perianal areas
● Elasticity: turgor, dehydration, collagen and elastic fiber content too. An old dog or
cat can have less elasticity due to Cushing’s
● Sensitivity: pruritus from skin problems e.g. parasite, hyperaesthesia,/hypoaesthesia
(sensitivity) are from nerve problems
● Ectoparasites: fleas, lice, walking dandruff etc. Check fleas re faeces and dandruff on
dark background – may move!
● Skin lesions: exanthema, efflorestentia
● Skin swellings
Condition of the epidermis. The colour, smell and temperature of the skin.
Colour & presence of hemorrhages: pigmentation, albinism. Appropriate to breed.
● Odour»_space;sex pheromones. Sebaceous gland and apocrine sweat gland produce smells.
Uremia – ammonia smell. Diabetes mellitus smells like acetone and also ketone
bodies. Male goat has a very distinctive smell! [Ferrets smell bad when stressed]
● Temperature of the extremities and the body. Footpads and extremities according to
the environment so will be cool, body is less affected and will be warmer. Due to hair
coat do not take skin temp as with humans. [Cold, clammy ears are a bad sign in a
horse]
Note: very little said on this topic in lecture and also very little in lecture slides.
The thickness, elasticity, greasiness and humidity of the skin.
Elasticity: turgor, dehydration, collagen and elastic fiber content too. An old dog or
cat can have less elasticity due to Cushing’s
● Moistness: Palpate or can see. Sweating, sudation (sweat gland secretion), hydrosis,
hyperhidrosis – increased production of moisture – can be atopic dermatitis.
Apocrine sweat glands are on body – horse has them everywhere for
thermoregulation, cattle on the lateral neck, behind ear, near the groin and at the
udder, sheep and goats on the inside of the thighs and rabbits and rats have one at all.
Eccrine sweat glands are on the footpads, nasal plane and also the lower eyelids of
dogs and cats.
● Greasiness: sebaceous glands. Palpate and smell. If increased production it is called
seborrhea oleosa (smells like rancid fat) and if less production it is called seborrhea
sicca.
● Thickness:
o Dog average: 0.5-5mm
o Cat average: 0.4-2mm
o The skin is thickest on the back, rump, base of tail, dorsal neck/thorax.
o Thinnest on pinnae, inguinal and perianal areas
Note: very little said on this topic in lecture and also very little in lecture slides
Alterations of the sensitivity of the skin.
Sensitivity:
● pruritus from skin problems [e.g. milliary dermatitis in cat or hot spot in dogs due to
fleas, but could be mange, demodex etc.]
● hyperaesthesia,/hypoaesthesia (sensitivity) are from nerve problems!
[This is all that was said in lecture and noting specific in lecture notes!!!!!!!!!!!!!!]
[For details on nerve problems see topics below. Also
● Zone test in cattle – problems with reticulum
● Spinal reflexes - Panniculus reflex to detect sensitivity and also superficial pain
sensation test squeezing footpads
● Deep pain sensitivity test if no reaction to superficial test
● Hyperaesthesia
o Feline hyperaesthesia and feline psychogenic alopecia are linked. Cats are
sensitive down the back and base of the tail. Can see tail twitching and muscle
spasms. Cat may become aggressive and self-mutilate. The cause is unknown
but may be due to stress. Particularly affects Siamese, Burmese and
Abyssinian cats
o Dogs with distemper may also suffer from hyperaesthesia.
● Hypoaesthesia – reduced touch and pain sensation. See below and also:
o Daxi – intervertebral disc disease can cause paralysis and lack of deep pain
and skin sensation if severe. ]
Primary skin lesions.
Primary lesions develop due to a direct cause or disease. Primary lesions can then go on to
develop into secondary lesions.
● Macule and Patch. Not elevated or palpable - just a difference in colour of the skin.
o Macule is smaller than 1cm. Pigments such as melanin can cause this change.
Melanin – vitilago or post inflammation hyper/hypo pigmentation.
Haemoglobin – haemorrhage – petechiae (pinpoint), purpura (bleeding into
skin), vibex (line form), ecchymosis and suffusion where greater than 1cm.
o Patch is larger than 1cm – erythema (redness). Functional – active or passive
hyperaemia. Anatomical – hyperplastic or aplastic.
● Papule is a small, solid elevation with a volume (so can be palpated) which is less
than 1cm. May be crusted. Can be pink or red due to tissue infiltration or
inflammatory cells. May or may not involve hair follicle. Examples – FAD, scabies,
superficial bacterial folliculitis.
● Plaque. Continuous developing group of papules. Are larger and flat topped –
eosinophil granuloma complex in cats.
● Nodule is similar to a papule but is greater than 1cm and usually extends deeper into
the layers of skin. Usually results from a massive infiltration of neoplastic cells into
the dermis or subcutis. Deposition of fibrin or crystalline material also produces
nodules.
o Tuber – inflammatory elevation of papillary zone of skin or mucus membrane
with a different shape or size.
o Tumour – large mass that may any structure of the skin or subcutaneous tissue.
Most are neoplastic or granulonastic in origin. Lipoma, fibroma, melanoma.
● Wheals are sharply circumscribed, elevations which have a flat surface. Usually
caused by oedema and can appear and disappear in hours or minutes. Usually no
change in overlying skin and haircoat. They blanch on diascopy – when a glass slide
is pressed to them it causes colour to fade (if not haemorrhage) – though hard to see
with haircoat. For example, urticaria and fly bites can be seen in horses and also
allergy testing. If located on face (lips or eyelids) or paw it is called angio-odema.
Seen in type one hypersensitivity reaction, particularly round eyes if intradermal skin
test.
● Vesicles and Bulla. Vesicles are sharply circumscribed elevation of the epidermis
filled with fluid less than 1cm.If greater than 1cm are called bulla. Can be intra or
sub-epidermal. Rarely seen in dogs and cats as they are fragile and transient so burst.
Viral and auto-immune disease can cause vesicles and can also be seen in shar pei as
they have increased mucin in the dermis and epidermis. Large – bullus pemphigoid.
● Cysts – an epithelium lined cavity. It can contain fluid, sebaceous material or dried
mass.
● Pustules – a small, circumscribed elevation of the epidermis filled with pus. Colour
usually yellow but can be green or red. Usually contain neutrophils and are
infections, but can contain esinophils and can be sterile – particularly in parasitic or
allergic disorders. Green cysts indicate gram negative bacterial infection or marked
toxic changes e.g. acne or folliculitis. If it is larger and deeper than a pustule it is
called an abscess – usually dermal or subcutaneous collection of pus. Is fluctuant and
the pus cannot be seen on the surface of the skin. [Un-neutered male tom-cats that
have a territory to defend and who get into fights are prone to abscesses.]
Some conditions can be primary or secondary:
● Alopecia (debateable but lecturer thinks it is). Primary hypothyroid, secondary
allergic dermatitis or chronic inflammation
● Scales – squamous loose scales of keratin. Differ in consistency and colour. Every 21
days the whole epidermis is renewed in dog and cat so a small amount of scaling is
physiological. Primary – follicular dysplasic [and shar pei –primary idiopathic
sebhhorroa]. Secondary – chronic inflammation or when a stressed cat is examined it
may shed scales onto the table
● Crusts – dried exudate, serum, pus, blood, medications etc. adhere to the surface of
the skin. Primary - primary idiopathic sebhorroa, secondary – pyoderma, fly strike,
puritis. Scabies – get papulacrust. Crusts adhere more tightly to glabrous (hairless)
skin and the colours are as follows:
o Brown/dark red – haemorrhagic crust in pyoderma – can also be yellowish
green
o tan lightly adhering crusts in impetigo
o honey coloured crusts are often infections
o thick dry yellow crusts scabies and zinc responsive dermatitis
o tightly adherent crust seen in zinc responsive dermatitis
● Comedones (comedo) –plugs or keratin and sebum in a dilated hair follicle. Top
usually black due to dirt. Primary is Cushing’s or initial lesion in feline acne –
predisposes to secondary bacterial infections, demodex etc. schnauzers also prone to
comedo. Secondary the administration of corticosteroids or greasy topical
medications.
● Follicular cast – an accumulation of keratin and follicular material. Like a comedo
but the hair shaft is still there. Get a greasy mass usually a group of hairshafts
together. [Pathognomic]/primary in shar pei for primary idiopathic sebhorrea.
Secondary – dermatophytosis caused by fungi e.g. microspore canis and also mange
(demodex).
● Pigmentation changes – caused by melanin changes, Lots of colours.
o Hypo-pigmentation – primary vitiligo (leuko-derma is white skin but vitiligo
is a specific disease), secondary – after inflammation
o Hyper-pigmentation – increased melanin. Primary is endocrine and is diffuse,
secondary is post inflammation or trauma.
Secondary skin lesions
Secondary skin lesions come from a primary skin lesion or from a secondary cause e.g. self-
trauma.
● Epidermal collarette. Very common – at one point it was a vesicle/bulla/pustule etc.
that ruptured. Get spreading at border outwards and healing in the centre, so is
crusting of keratin flakes at the border and may be a hyper-pigmented ‘bulls-eye’ in
the centre.
● Excoriation:
● Erosion or ulcer caused by scratching, biting or rubbing
● Result of pruritus»_space; secondary bacterial infection
● Identified by their linear pattern
● Erosion. Usually get after vesicle rupture.
● Shallow epidermal defect that doesn’t penetrate the basal lamina
● Heals without scarring
● Caused by epidermal disease or self-inflicted trauma
● Ulcer
● This is deeper than an erosion and causes a break in epidermis, leaving the
underlying dermis exposed. Look at edge – is it thickened or necrotic? Look
at firmness and type of exudate in the crater.
● Scars occur with healing
● Feline indolent ulcer, severe deep pyoderma, vasculitis. Auto-immune disease
can get erosion and ulceration
● Scar (Cicatrix) – often after severe burning, deep pyoderma or ulceration.
● Area of fibrous tissue has replaced the damaged dermis or SC tissue
● Remnant of trauma or dermatological lesion
● Alopecia (no follicles), atrophic and depigmented
● Darked skinned dogs: scars can be alopecic and hyperpigmented
● Fissura:
● Single or multiple tiny cracks, clefts – through epidermis into dermis. Have
sharply defined margins.
● Can be dry/moist, straight/curved/branching
● Occur when skin is thick and inelastic and then subjected to sudden swelling
from inflammation/trauma
● Founds at ear margins, ocular, nasal, oral and mucocutaneous borders
● Lichenification
● Thicking and hardening of epidermis – see exaggeration of superficial skin
markings
● Often result of friction
● Normal coloured but more usually are hyperpigmented
● Crusted litchified plagues are usually infected with bacteria and occasionally
Malassezia
● E.g. chronic atopic dermatitis…
● Callus
● Thick, rough, hyperkeratotic, alopecic and lichenified plague found on skin
● Occur over bony prominences due to pressure and chronic friction e.g. at
elbow
● Necrosis due to disease, infection e.g. gangraenosa, humida, sicca
The swellings of the skin.
Oedema – caused by excess fluid under the skin. It can be:
o Oedema inflammation
o Oedema stagnationis
o Oedema hydraemica
● Emphysema – subcutaneous emphysema when gas or air is trapped in the subcutis of
the skin. Can be caused by trauma e.g. bite wound. If X ray may see the radiolucent
air under the skin. Can crepitate when touched. Can also be caused by damage to the
trachea e.g. during intubation.
● Haematoma – haematoma cutis. A collection of blood within the tissues. Is larger
than an ecchymosis which is a bruise. Petechiae, suffaction, ecchymosis, haematoma
etc.
o Cats are prone to haematomas on the ears – can be a result of fighting or
scratching from ear mites. Dogs are also prone to aural haematomas.
● Tumour – tumour cutis. An abnormal growth of cells. Common in cats and dogs –
but possibly because they are easily recognised by owners
● Cats prone to:
o Basal cell tumour – Siamese and Persian are predisposed. Solitary, round,
well defined hairless masses. May ulcerate.
o Squamous Cell Carcinoma - arises from the hair follicles. Old white cats that
have been exposed to a lot of sunlight are prone to these – see on tips of ears,
eyelids, nose and lips. Usually small and crusty and prone to bleed.
o Mast cell tumours. Siamese over 4 years predisposed. Solitary nodule under
skin – may be hairless and ulcerated. In cats considered benign, but not so in
dogs.
o Fibro sarcoma – malignant soft tissue tumour. Vary in appearance but
generally fleshy and firm. Young cats (under 4) are caused by feline sarcoma
virus. However at any age is a vaccine induced form.
● Dogs prone to:
o Papilomas. Cocker spaniel and pugs are prone. Young dogs or
immunocompromised adults.
o Lipoma – mature fats cells in subcutaneous tissue. Older dogs prone – labs and
dobe.
o Mast cell tumours
● Horses prone to:
o Sarcoid. Possibly bovine papilloma virus.
o Squamous cell carcinoma
o Melanomas – very common in grey horses. Often on dock.
[In the lecture we did not discuss and slides only had one word bullet points so this may not
be what is required]
The importance and methods of the examination of lymph nodes and lymph vessels.
Lymphatic system – moves lymph fluid, waste and nutrients. Lymph nodes act as a filter for
pathogens such as bacteria, viruses. B lymphocytes, T and other immune cells are found in
the lymph nodes. Importance – whenever there is an infection or pathogen (or more rarely a
lymphoma), lots of lymphocytes are required to deal with it in addition to increased quantities
of lymph from the affected area being filtered via the lymph nodes. Therefore enlargement of
the lymph nodes is usually a sign of infection.
Inspection and palpation. Additional – biopsy, aspiration, excision, extirpation, x-ray,
ultrasound etc. Compare both on opposite sides as follows:
● Size – more than one and a half times normal size is suspicious. Different species
different sizes.
● Shape – ellipsoidal, round, special
● Consistency – soft, rubber, firm
● Structure – homogenous or non-homogenous
● Painfulness – should be none
● Movability – should be moveable
● Surface – smooth and regular
● Skin above – temp, elasticity, damage
Examination of the lymph nodes of the horse, ruminants, carnivores and swine.
Palpable in dog and cat:
● Mandibular (mandibularis)
● Praescapular (Cervicales superficialis)
● Popliteal (Popliteus superficialis)
Non Palpable are – retropharyngeal, parotid, auxiliary, superficial inguinal, mesenteric
Palpable in horse:
● Mandibular (mandibularis)
● Superficial Inguinal
Can be palpated when enlarged: retropharyngeal, Prae-scapular
Rectal: Illeosacral, Mesenteric
Palpable in cattle:
● Mandibular (mandibularis)
● Prae-scapular
● Subilliac
● Mammary
Can be palpated when enlarged: retropharyngeal, parotid.
Rectal: Illeosacral, Mesenteric
Palpable in pigs: superficial inguinal only.
Examination methods of the visible mucous membranes, their examination in
different animal species.
Inspection and palpation.
● Colour – normal is light pink
● Moisture – normal is shiny and moist. Look for mucus quality and quantity
● Membrane vessels – normal is they can be slightly recognised, if more - haemorrhage
● Surface – normal is smooth. Conjunctiva can be moderately ruffled. Look for lesions.
● Capillary refill time – under 2 seconds. Normal is one second. Longer if hypovolemia
Abnormal – pale, anaemic, cyanotic, yellow, dull, livid, dirty red, homarrage (petechiae,
suffusions, echymosis), sticky, dry (shock), injected (hyperaemia – press and it disappears or
haemorrhage – press it doesn’t disappear). If lesions – how many, size, shape, borders,
location, colour, consistency etc
Look at conjunctiva, mouth (top lip), nasal, anal, genital – 1st clinical signs of icterus
All species look in mouth. Lift upper lip. Can do CRT against gum. Conjunctiva – horse
press on eye and use third eyelid, others just use fingers to widen the eye. Nasal – easy in
horse – watch out for nasolacrimal gland. Penis of dog/vagina – 1st sign of icterus. Anal. In
birds is cloaca.
The abnormalities of the visible mucous membranes, their diagnostic significance.
Normal. Light pink, smooth (conjunctiva moderately ruffled), shiny, moist, smooth and
intact (no lesions), blood vessels slightly recognised, CRF under 1 second.
Abnormal – pale, anaemic, cyanotic, yellow staining, dull, livid, dirty red, homarrage
(petechiae, suffusions, echymosis), sticky, dry (shock), injected (hyperaemia – press and
it disappears or haemorrhage – press it doesn’t disappear). If lesions – how many, size,
shape, borders, location, colour, consistency etc.
Diagnostic significance.
● Different grades of colour can help diagnose systemic disease – e.g.
yellow/orange icterus, v. pale – anaemia, cherry red – CO poisoning, dirty red –
intoxication. Cyanotic – purple – hypoxia, heart failure.
● Dry or shiny – shock go dry. Any secretions describe amount, colour, smell,
consistency.
● Haemorrhages – coagulation problems. Injected blood vessels – hyperaemia v
haemorrhage. Hyperaemia – if press goes away, stays if haemorrhage. Petechial
bleeding one possibility is DIC.
● CRF down if in pain, shock, hypovolemia – colic in horse.
● lesions – systemic disease – e.g. uraemia, also local e.g. gingivitis. Predelictic
place for several problems in the cat – FIV, FeLV - location, how many, shape,
size, borders, colour, consistency.
Nasal discharge, breath, the examination of the respiratory sounds that can be
heard around the nostrils.
History: what are the signs, what is the exact complaint, ask about duration and progression.
Ask about nasal discharge, sounds, coughing, wheezing, abnormal vocalisation, dyspnoea.
Also check vaccination, worming, environment, medications, other animals. General
impression as usual.
Examine – nose and parnasal sinuses, coughing, larynx and pharynx, trachea, thorax
Nasal discharge – amount, consistency, smell, one or both nostrils – horse & choaena
Breath – smell, symmetrical from both nostrils, strength, temp
Respiratory sounds round the nostrils – Different types of stridor as follows: Nasal: sniffing,
Pharyngeal: snoring, Laryngeal: sawing, Collapsed trachea: tooting on expiration. Paralysis
of larynx will get inspiratory stridor, narrow trachea/bronchitis – mixed stridor. See also
below re nasal stridor.
- Examination of the nose and the paranasal sinuses.
Nose – external and internal exam. Inspection, palpation, percussion and smelling. Further
examinations of nasal fluid – bacteriological, cytology, mycology, parasitic exam. Also x-ray,
endoscopy, biopsy, CT, MRA.
● Look at shape and form of nose. Species and breed are important e.g. Atrophic
rhinitis in pig, brachycephalic dogs. Symmetry, intact skin, consistency, temp,
painfulness, movability etc. Fine needle aspiration for cytology.
● Occurrence of nasal stridor (stridor = specific sound if narrowing) – ok if faint regular
noise during expiration (pig and brachycephalic dog is more intensive). Abnormal if
stridor (inha/exhale) – try to determine origin. Sneezing – dog & young horse can be
normal – protects air passages. Cats – rhinotracheitis. Also abnormal – snoring,
reverse sneezing, singultation (hiccup) (puppies). Purring, pain noises – groaning,
sighing, howling, shrieking (pig). Alteration of voice (rabies), noiselessness and
panting (dogs)
● Expired air – strength & deepness of breathing, symmetry (hands or mirror), temp,
smell. Upper airway narrow - expired air is weaker.
● Nasal discharge – colour, quality, quantity, consistency, side, continuity, smell. So
water, mucus, foamy etc. All before choanae is one sided, behind choanae is double
sided discharge (e.g horse guttural pouch). Bleeding from nose is epistasis. Bilateral
– coagulopathy, unilateral – trauma or blood vessel rupture. Blood can be from as far
back as duodenum.
● Nasal plane – surface (intact). Dog after distemper hyperkeratisation of nasal plane,
footpads and brown line on teeth. Colour - pigment, moisture (dry, moist, medium
moist). Dog and cat have nasal plane, horse and sheep don’t. Hypopigmentation of
nasal plane may be photosensitisation (puli) or auto-immune disease (ulceration).
● Nasal openings and nostrils – shape, width, movability of allae (horse), symmetrical
(atrophic rhinitis). Facial paralysis – drooping ear, eyelid or nose. Check mucus
membrane esp horse as easy to see.
● Palate, nasopharynx – with or without tools e.g dental mirror. Horse only by
endoscopy and if sedated. Dog and cat just open mouth to look.
● Paranasal and frontal sinuses – inspection, percussion, palpation.
Maxillary Lacrimal Sphenoid Sphenopalatine
Frontal Palatine Ethmoid
● In horse the guttural pouch. Borders – cranial is caudal mandible, ventral is
lingofacial vein, caudal is tendon of insertion of sternocephalicus – usually is a
sunken in hollow unless inflamed. If pus resonance is dull – should be gas filled.
Paranasal sinuses – inspection, palpation, percussion. Also x-ray, diagnostic puncture and
endoscopy in horse. Maxillaris, frontalis, lacrimalis, palitinus, sphenoidales, ethmoidales,
sphenoplaatine.. Cat often prob with sinus – painful on palpation. Chronic inflame & sinus
filled with pus – bones soften and v. painful
Examination of the cough, cough induction.
Coughing – reflex – respiratory system protects itself against injury and foreign materials.
Reflex from larynx to larger bronchi.
Coughing – origin – spontaneous/stimulated – easier to stimulate if inflam, frequency –
rare/frequent, strength – weak, medium intensity, with or without snap (horse cough has snap
– vocal cord snaps shut), tone – sharp, dull, rattling, roaring, hoarse, occurrence – day, night,
exercise, duration – short, long, held, secretion – dry, medium wet, wet, painful/painless,
depth, localisation of origin, quantity of sputum.
● Larynx – heavy, laboured, gagging/retching – tendency to vomit. Larynx paralysis –
deep, long, harsh
● Trachea – tracheitis – loud, explosive, barking like, Tracheal collapse – goose
honking cough
● Bronchi – acute – sounds like tracheitis – is painful, chronic – mucus, wet and dull
● Lung emphysema/chronic bronchitis – short, weak, dry. COPD – deep, weak, held,
dull
● Pneumonia – soft
● Cardiac disease – hacking cough
Cough induction:
● Horse – press larynx and/or tracheal rings close to larynx. Hard to do. Cough is
intensive, sharp, high, short, dry, painless, with snap, which does not reoccur
● Cow. Close mouth and nose until air hunger (approx. 30 seconds). Medium intensive,
medium deep. More dull. Dry, held, painless, unsnapping
● Dog, cat, small ruminants. Press tracheal rings or press thorax rapidly during
expiration. Sheep & goat – weak, deep, groaning like, dry, medium held, painless,
does not reoccur. Dog and cat – medium held, medium intensive, medium deep,
unsnapping, dry, painless, does not reoccur.
Examination of the larynx and the trachea.
Larynx - External examination
● Inspection – skin, deformity, swelling.
● Palpation – form, outline, muscles, surface of larynx, abnormal masses.
Compressibility and pressure sensitivity of arytenoids, Fremitis = surfaces rubbing
against each other.
● Auscultation. Normally weak stridor under inspiration and expiration
● Larynx is from base of tongue & soft palate and caudally is trachea. Lies ventral to
atlas.
Internal examination: Can open mouth of dog, cat(!!!), cow but not horse – need endoscopy
(treadmill or under exercise preferred). Laryngoscopy.
● Epiglottis - press down the tongue, also see hard & soft palate and tonsils (in
semilunar folds).
● Nasopharynx - symmetry and synchronous movement of arytenoids,
● Rima glottis
● Colour, capillaries and defamation of mucus membranes.
● Tonsils between oral and laryngeal cavity - need to depress tongue (also see hard and
soft palate)
Trachea – External examination – inspection, palpation, auscultation – minimum of three
positions. Further exams are x-ray, endoscopy, tracheal fluid sample and analysis.
Examination methods of the thorax.
Inspection, palpation, percussion, auscultation
Further – x-ray, ultrasound (rare), BAL (bronchial fluid sample (and analysis)– via endoscope
or trans-tracheal wash), thoracentesis, biopsy, scintigraphy, lung function, blood test/acid-
base tests
Inspection:
● Chest - skin, size, bi-lateral symmetry – Ru slight left side bigger ok as rumen, local
deformities – e.g spinal prob such as lordoiss will change shape of chest too. Also
long coat may make exam difficult so palpate. Oedema in chest can collect ventrally
and change the shape.
● Respiratory movement
o Frequency. Increase – tachnpnoe – normal if excitement, work, obesity, high
temp, pregnancy. Abnormal – fever, hypoxia, hypercapnia (high CO2), pain
in respiratory organs. Decrease – bradypnoe – abnormal – CNS probs, severe
pain, barbiturate toxicosis, shock
o Rhythm –normally inspiration is a bit longer than expiration. Held inspiration
– narrowed upper airway or high ab pressure (pregnancy, ascites etc), Held
expiration – decreased lung elasticity, microbronchitis, shorter
inspiration/expiration – pain, asymetric breathing – pain in one lung lobe,
intermittent inspiration – long, exhausting work, normally during excitement.
Abnormal – pain in chest.
o Type – normally costabdominal in horses, dogs and cats. Ruminants is mainly
abdominal. Abnormal costal –prob with diaphragm, abdominal pain and
increased pressure- preg, ascites etc. Narrowed upper airway or compression
of lung. Abnormal abdominal – painful chest diseases or paralysis of
intercostal muscles.
o Depth – normal is medium deep. Shallow – painful diaphragm/chest. Deep –
exercise, hypoxia, characteristic sign of dyspnoea.
Palpation:
● Temp of skin, symmetry, palpate intercostal spaces up to down looking for pain
● Fremitus pectoralis – can find during dry pleurisy, bronchitis, fibrinous pericarditis,
stenotic cardial valve/valve insufficiency
● Painfulness
● Deformities
Auscultation – mainly indirect (also direct):
Front to back. From up to down. In each third of the thorax. In a quiet environment. At least 5
places put stethoscope. Can say hear ‘normal respiratory sounds’
Percussion:
Acoustic and to localise pain. Acoustic – info on surrounding tissues, localise lung borders,
assessment tissue density (7cm ) and lesions (5cm).
Finger to finger in small animal and hammer & plessimeter is large animals. Can determine
caudal borders of the lungs, gas contents and comparative percussion.
Normal percussion sounds:
● Small animals – sharp, high/low, resonant and long.
● Large animals – sharp, low, resonant and short.
Examination of the respiration (breathing).
By respiratory movements: Watch for a couple of cycles
● Frequency. Increase – tachnpnoe – normal if excitement, work, obesity, high temp,
pregnancy. Abnormal – fever, hypoxia, hypercapnia (high CO2), pain in respiratory
organs. Decrease – bradypnoe – abnormal – CNS probs, severe pain, barbiturate
toxicosis, shock
● Rhythm –normally inspiration is a bit longer than expiration. Held inspiration –
narrowed upper airway or high ab pressure (pregnancy, ascites etc), Held expiration –
decreased lung elasticity, microbronchitis, shorter inspiration/expiration – pain,
asymetric breathing – pain in one lung lobe, intermittent inspiration – long,
exhausting work, normally during excitement. Abnormal – pain in chest.
● Type – normally costabdominal in horses, dogs and cats. Ruminants is mainly
abdominal. Abnormal costal –prob with diaphragm, abdominal pain and increased
pressure- preg, ascites etc. Narrowed upper airway or compression of lung. Abnormal
abdominal – painful chest diseases or paralysis of intercostal muscles.
● Depth – normal is medium deep. Shallow – painful diaphragm/chest. Deep – exercise,
hypoxia, characteristic sign of dyspnoea.
Horses look at flank but can be hard to see breathing.
The origin of the normal and abnormal respiratory sounds, the normal respiratory
sounds.
Origin of sounds – airflow from higher to lower pressure and narrowing of the airway – get
turbulence. Turbulence depends on diameter of airway and speed of airstream. Sound –
regular combo of frequencies, noise has no periodic character. Resonant sound from lung to
chest wall diminishes as some of it is reflected due to acoustic impedance (density of material
x speed of sound). If impedance is similar e.g. chest wall and infiltrated lung we get a large
sound as lots of it is transmitted. If the impedance is not similar e.g. chest wall and healthy air
filled lung then the sound is diminished. Origin of respiratory sound is the upper airways. Get
a weak stenotic noise from nose and pharynx, and a weak blow noise from turbulence before
the bifurcation of trachea. Alveoli and bronchi don’t give respiratory sounds. After
bifurcation it is a laminar flow so no vibration.
Different sounds due to different species, size, configuration of thorax and distance between
major bronchi and thoracic wall:
● Dog and cat – strongest inspiratory and expiratory. Small dog may have a bronchial
character
● Horse. Big animal with big lung so almost silent. Soft I, weak E
● Cattle – strong rugged blow like Inspiration, weak E,
● Pig – strong rugged I, strong blow like E
● Rabbit like dog and cat but not as strong
● Birds – strong and blow like
Physiological sounds
● Normal (physiological) respiratory sounds: soft blowing sound. Stronger in
carnivores and can be bronchial like. Cattle – more of a strong, rugged sound. Similar
to air sucking ‘f’ sound
● Bronchial sound. Strong, audible blowing sound. An ‘h’ sound during
inspiration/expiration. Normal above trachea. Condition – lung contains less air
● Bronchial like sound: Deeper, stronger, harsher than the bronchial sound. ‘F’ and ‘h’
sounds together. Normal for small dogs and cats above heart base as bifurcation is
close to thorax.
Bronchial sounds are produced by the stenotic effect of the larynx, trachea and bronchi.
Passages start to get narrow and get a vortex like effect. Is audible over larynx and trachea,
particularly in small animals. Abnormal if can be heard [over lungs – i.e more caudal] when
peri-bronchial tissue has less air – so in the case of bronchitis, pneumonia, neoplasms.
Alterations of the normal respiratory sounds.
Not normally heard, describe place, strength, type, respiratory phase when heard.
Adventitious Respiratory Sounds
Non Musical sounds (wet) – usually at end of inspiration. Not enough gas – fluid instead
● Crepitation. Sounds like hair rubbing, Found in broncho-pneumonia
● Crackling. Sounds like burning wood. Found in broncho-pneumonia
● Rattling. Sucking coke with a straw. Found if moving fluid in trachea or bnonchi e.g
lung odema. Severe – need immediate treatment – oxygen and furosemide.
Musical sounds (dry)
Obstructive lung diseases – with active expiration.
● Whistling. High sound. Accelerated airflow
● Wheezing – low sound. Vibration of airway walls - COPD
Other Abnormal sounds heard over thorax
● Stridor – upper airway stenosis – usually hear above larynx. May even feel it. May
need oxygen and intubation if tracheal collapse
● Rubbing – dry pleuritis. Like snow crackling. Stop breathing to tell if heart or pleura
is the cause– if heart will get stronger if no breathing.
● Splashing – gas and fluid movement – Traumatic pericarditis in cow.
● Metallic – aspiration pneumonia
Dyspnoe.
Dyspnoe – difficulty in respiration – compression/obstruction of air passages or decreased
lung compliance. Muscles do work more forcibly during respiration – particularly when
working (less at rest). Inspiratory, expiratory or mixed
Inspiratory – prolonged and laboured inspiration. Extension of head and neck, nostrils flared,
labial respiration, spreading of scapula, exaggerated intercostal activity, sunken flanks and
sagging belly. Caused by:
● Narrowed upper airway (stridor)
● Pneumothorax
● Pleural effusions
● Diffuse pneumonia
● Lung neoplams
Expiratory – prolonged and laboured expiration. Extension of head and neck, work of
abdominal muscles is more severe, can see a heave line in abdomen. Caused by:
● Compression/obstruction of lower air passages
● Microbronchitis
● Pulmonary emphysema
● Fibrous pleuritis
● Neoplasm in pharynx and larynx
Mixed – forced inspiration and expiration. Causes:
● Decreased compliance
● pulmonary oedema
● Pulmonary emphysema
● Compressed diaphragm
Abnormal breathing – cheyne stokes, kassmuel, biot.
Adventitious respiratory sounds.
Non Musical sounds (wet) – usually at end of inspiration, sometimes beginning of inspiration
- not enough gas – fluid instead
● Crepitation. Sounds like hair rubbing, Found in broncho-pneumonia
● Crackling. Sounds like burning wood. Found in broncho-pneumonia
● Rattling. Sucking coke with a straw. Found if moving fluid in trachea or bnonchi e.g
lung oedema
The bronchial breathing sounds, the bronchial tone of the lung sounds, alteration of
the bronchial breathing sounds.
Physiological sounds
● Normal (physiological) respiratory sounds: soft blowing sound. Stronger in
carnivores and can be bronchial like, particularly brachiocephalic dogs. Cattle – more
of a strong, rugged sound. Similar to air sucking ‘f’ sound
● Bronchial sound. Strong, audible blowing sound. An ‘h’ sound during
inspiration/expiration. Condition – lung contains less air
● Bronchial like sound: Deeper, stronger, harsher than the bronchial sound. ‘F’ and ‘h’
sounds together. Carnivores.
Bronchial sounds are produced by the stenotic effect of the larynx, trachea and bronchi.
Passages start to get narrow and get a vortex like effect. Is audible over larynx and trachea,
particularly in small animals. Abnormal if can be heard [over lungs – i.e more caudal] when
peri-bronchial tissue has less air – so in the case of bronchitis, pneumonia, neoplasms.
The pleural friction rub, splashing, fluid tinkling sounds.
Musical sounds. Obstructive lung diseases – with active expiration. Vibration between the
open (inspiration) and closed state (expiration)
● Whistling. High sound. Accelerated airflow
● Wheezing – low sound. Vibration of airway walls - COPD
Other Abnormal sounds heard over thorax
● Stridor – upper airway stenosis
● Rubbing – dry pleuritis – rubbing of pleural surfaces or pericardium. To tell
difference stop breathing – if pericardium will be stronger, pleural will stop.
● Splashing – gas and fluid movement – pleuritis, pericarditis
● Metallic – fluid drops on fluid - aspiration pneumonia
Percussion of the thorax. The origin, characteristics and parts of the percussion
sound.
Origin: Acoustic percussion – create sound waves. Condition of surrounding tissues -
paranasal sinuses, thorax (also lung borders), abdomen, subcutaneous emphysema.
Assessment of tissue density to 7cm, assessment of a lesion at least 5cm diameter.
Pain percussion – localisation weak/superficial or strong and deep.
Components of percussion sound are:
● Crackling sound of tapping hammer and plessimeter
● Sound of thoracic wall/wall of any organ
● Resonant sound of gas containing tissue (e.g lung)
Main characteristics:
● Volume/loudness – amplitude of vibrations - from strong/sharp to weak/dull
● Frequency – number of vibrations per minute – high to low
● Resonsense – homogenous/non homogenous. From resonant to dampened
● Duration – short to long
