Management of Disease - Small animal Flashcards
What does SOAP stand for
Subjective exam
Objective exam
Assessment of findings
Plan of action
Describe how you would go about the subjective part of the exam
do not touch the animal, assess body condition score and demeanor, also good to take the respiratory rate during this time too. Ask the owner about the animal’s age, breed, use (if any), sex
Ask the owner if the animal has been eating, drinking, urinating and defeacating and find out as much as you can about the presenting problem from the owner
When examining the head and neck what should you look for?
· Posture of head and neck
· Symmetry of musculature - lack of tone could signify nerve damage
· Discharge; nasal, ocular, ear
Assess function of cranial nerve
When examining the eyes what should you look for?
· Look for abnormalities
· Look at the size and shape of the eye
· Is there any ocular discharge
Is the eye position normal
When examining the nose what should you look for?
· Is there any discharge
· Check airflow from both nostrils
· Is there any pain
· Is there any swelling, depigmentation or asymmetry
· Listen for stertor - noisy/ laboured snorting sound while trying to breathe through nose
De-pigmentation, pain and unilateral blocked nose is common in aspergillus fungal infections
Unilateral obstructed airflow can also be due to a tumour or a foreign body
When examining the mouth what should you look for?
· Lip symmetry
· Mucous membrane colour - white signifies anaemia, purple can indicate endotoxaemia
· Capillary refill time - slow cpr signifies poor perfusion
· Check hydration status
· Look for masses or ulceration
· Check teeth for tartar, fracture or periodontal disease - gingivitis in cats can be indicative of FIV or calicivirus
· Check the tongue for ulceration and paralysis or deviation - latter two could be due to cranial nerve damage
· Assess the pharynx
Look for general trauma, neoplasia or inflammation
When examining the ears what should you look for?
· Check for haematomas - could be due to trauma, head shaking due to an ear infection or could indicate something more serious like a coagulopathy
· Look for neoplasia
· Look for hyperplastic change
· Check for any discharge, if present is it purulent, ceruminous or haemorrhagic
· Use an otoscope to assess the ear canal
Look for presence of parasites
When examining the neck what do you look for?
· Palpate the larynx and trachea – check for a cough response, signifies inflammation, common sign of kennel cough
Palpate the thyroid glands, the lymph nodes ( should always be sampled if enlarged) and the jugular veins - engorged jugulars could signify heart failure - right sided congestive
Name the three main palpable lymph nodes and where to find them?
Popliteal - on the hind limb just above the knee on the caudal surface of the limb
Pre-scapular - just before the cranial border of the scapula
Sub mandibular - along the lower jaw line
When examining the abdomen what do you look for?
· Palpate normal structures - in a cat useful to assess kidneys; if one is abnormally small good indicator of kidney disease, if abnormally large could be due to cysts or a tumour
· Is there ascites, check for a fluid thrill
· Palpate to assess body condition
· Is there abdominal distension – what is the cause; torsion, pyometra, pregnancy, organomegally, ascites (often due to right sided heart failure)
Note: German sheperds have abnormally large spleens
Describe the position of the palpable abdominal organs
- liver sits under the costal arch, hard to feel unless enlarged
- stomach and spleen - left cranial
- kidneys, left is more caudal and easier to feel than right which sits by rib cage
- small intestine - majority of the abdomen should feel gas and fluid filled
- colon usually contains faeces, the descending part sits on the caudal left hand side
bladder sits in the caudal part of the abdomen assess it’s size, shape and turgidity
when examining the skin what would you look for?
· Check for dermal and subdermal masses
· Look for external parasites
· Is there alopecia if so what is the likely cause?
· Look for areas of inflammation and erythema
· Assess any lesions; are they scaly and crusty with evidence of hyperkeratosis or are they pustules nodules or vesicles
what is the normal respiratory rate for a dog and cat?
dogs - 10-40
cats - 20-40
when examining the cardiorespiratory system what would you look for?
· Auscultate the chest for abnormal sounds e.g. crackles, wheezes, stertor or stridor
· Auscultate the trachea for upper airway noise and harshness
· High resp rate could be due to asthma, pneumonia, bronchitis or from pulmonary oedema due to congestive heart failure (hear lung crackles)
· Inspiratory dyspnoa - signifies a upper respiratory problem
· Expiratory dyspnoea - signifies a lower respiratory tract problem
· Auscultate the heart, listen for extra heart beats, arrhythmias, murmurs, muffled heart sounds, identify first and second heart sound and if there are abnormalities try to associate with one or the other
· Muffled heart sounds are likely due to a pericardial or pleural effusion
· Check the femoral and peripheral pulses to check they match heart rate, that there is symmetry of the pulse in both sides of the body and that the pulse is strong.
Uneven pulses often signifies a thromboembolism
Where should you place your stethoscope to hear the different valves
On the left side over rib spaces 3,4 and 5 you can here the pulmonic, the aortic and the mitral valve
on the right side you can hear the tricuspid valve over rib space 4
What is the normal heart rate for a dog and cat
Dog Heart Rate: 70-140
Cat Heart Rate: 145-200 - get incredibly stressed in the vets so can be very high but still normal
What is the normal rectal temperature of a cat and dog?
· Ensure it makes contact with the rectal wall
· Normal rectal temp for a cat: 38-39.5
Normal rectal temp for a dog: 37.5 – 39
when examining the urogenital tract what should you look for?
· Check for discharge
· Check symmetry and firmness of the testicles, ensure there are two!
· Check for evidence of trauma or any masses
· Check for masses of the mammary glands, is there any discharge or swelling?
· Check the colour of the urogenital organs
· Cryptorchid = undescended testicle
Anal sac tumours often cause excessive drinking due to the tumours often release calcium which increases thirst
What should your list for differential diagnoses be?
DAMNIT - V: Degenerative, developmental Autoimmune, anatomic anomalies Metabolic, mechanical Nutritional, neoplastic Inflammatory, infectious Toxic, traumatic Vascular
What is gastritis
vomiting and / or diarrhoea
Causes of non-fatal, self limiting acute gastritis
uncomplicated parasitism dietary indiscretion dietary sensitivity food poisoning scavenging drug therapy - corticosteroids, chemo, digoxin hairballs
causes of gastritis secondary to extraintestinal/ systemic disease
systemic infection e.g. lepto, distemper
metabolic disorders e.g. uraemia, hypoadrenocorticism
causes of severe, possibly life threatening gastroenteritis
enteric infection - salmonella, enteroviruses
heamorrhagic gastroenteritis
intestinal obstruction - foreign body, intussusception, volvulus
Questions involved in decision making with gastroenteritis patient
is emergency treatment needed - shock, dehydration, electrolyte imbalance
is there an underlying non-enteric cause
is surgery needed
is hospitalisation needed
is an infectious cause likely
will symptomatic treatment be sufficient e.g. are the clinical signs non-specific
what are the clinical signs of gastroenteritis
vomiting
diarrhoea +/- blood, mucous
tenesmus
abdominal pain
what is haematochezia
fresh blood in faeces, often due to colitis
causes of colitis
protozoal infection - giardia, cryptosporidium
dietary indiscretion
whipworm (trichuris vulpis) infection
What is tenesmus
excessive straining for a poo
Further tests which can help diagnose the cause of gastritis
haematology and biochemistry urinalysis faecal sample bacterial culture PCR Virology imaging - radiograph, ultrasound
Name some general symptomatic treatments which can be done to try and improve gastritis
anthelmintics anti-diarrhoeals anti-metics dietary restriction discontinuation of any medications probiotics
What drugs can be used for gastritis and their indications/ contraindicaations
anti-inflammatories - NSAIDs and corticosteroids contraindicated, little indication for use
anti-emetics - can act centrally, peripherally or both, maropitant usual drug of choice. DON’T give if suspicious of intestinal obstruction
mucosal protectants and antacids - indicated in persistent vomitting or with GI ulceration
Anti-diarrhoeals - often in combination with antibiotic products. Absorbents/ protectants bind excess water and toxins and protet the mucoasa. Motility modifiers e.g. opioids slow down gut motility by reducing secretions and peristaltic contractions. contraindicated with infectious causes where toxins need to be flushed out the body
antibiotics - contraindicated, can harm normal gut flora and selects for antimicrobial resistance
When is it ok to use antibiotics in gastroenteritis
if a specific bacteria has been identified to be causing a problem
when the mucosa is severely damaged and animal is at risk of bactereamia and sepsis
if patient is pyrexic
if patient has evident leucopenia or neutropenia
what antibiotics can be used for anaerobes
metronidazole and clindamycin
what antibiotics can be used for gram -ves
fluoroquinolones
aminoglycosides
what is a probiotic
a living organism which exerts health benefis beyond that of normal nutrition
what is a prebiotic
assists the health and generation of beneficial gut flora
How are gastric foreign bodies treated
induce vomiting - if object is smooth and non-corrosive and has recently been ingested
allow natural passage if the foreign body is small, non-toxic - observe strictly and if not passed in 48 hours re-visit
endosopic removal
surgical removal
Name viruses which can cause gastritis
enteric viruses: parvovirus coronavirus feline panleukopenia feline enteric coronavirus
non-enteric viruses:
canine distemper
feline infectious peritonitis coronavirus
feline Leukaemia virus
Describe the features of parvovirus
CPV-2 is the major cause of haemorrhagic gastritis
very resistant in the environment
transmitted faeco-orally
infects rapidly dividing cells
if infected in-utero the virus attacks the myocardium cells leading to myocarditis and often sudden death
puppies infected young often get generalised infection and get cardiomyopathies and die
dogs infected between 6 weeks and 6 months have haemorrhagic diarrhoea due to intestinal crypt necrosis and severe dehydration. Virus replicates in the tonsils, regional lymph nodes which results in viraemia.
Describe the features of feline panleukopenia
can cause cerebellar hypoplasia in kittens if infected in utero
causes similar symptoms to canine parvo
Describe the features of canine coronavirus
virus infects mature enterocytes causing mild catarrhal diarrhoea
with feline coronavirus there is a risk of mutation into FIP
name some bacteria associated with gastritis
invasive - damage mucosa: - salmonella - campy - yersinia - ETEC non-invasive - attaches to mucosal surface - E.coli - clostridium
what are the predisposing factors to bacterial gastro infection
young dogs stress immune suppression overcrowding poor hygiene
Describe the features of canine haemorrhagic enteritis
unknown aetiology
can affect all ages and breeds
clinical signs include sudden onset of vomiting +/- blood which may be perceeded by diarrhoe a few hours later which is severe and haemorrhagic
see marked haemoconcentration due to rapid fluid loss fromt he gut
treat with aggressive fluid therapy, withhold food and water, give broad spec antibiotics
what are the 2 forms of Leishmania
promastigote - infectious stage, in vector
amastigote - intracelluar phase, in host
what is the vector for leishmania
phlebotamus sandfly female
what sppecies can leishmania infect
dogs, cats, rodents, marsupials -also zoonotic
describe the life cycle of Leishmania
sandfly feeds and injects promastigotes into the dog
the promastigotes are phagocytosed and it is within these immune cells the promastigotes moult into amastigotes which then multiply and infect other phagocytes
the sanfly picks up amastigotes when it feeds where they become promastigotes in the gut and migrate to the probiscus to infect other hosts
