Clinical Propedeutics: Digestive, Reproductive & Urinary Systems (Dog & Cat) 2024-2025 PDF

CLINICAL PROPEDEUTICS MC3: DIGESTIVE, REPRODUCTIVE AND URINARY SYSTEM DOG AND CAT 2024-2025 Ayla Del Romero Martínez, DVM, PhD, GpCert(SAS) Medicine and Surgery Department  Methodic, ordered and complete (always start at the mouth-craneal) CLI...

CLINICAL PROPEDEUTICS MC3: DIGESTIVE, REPRODUCTIVE AND URINARY SYSTEM DOG AND CAT 2024-2025 Ayla Del Romero Martínez, DVM, PhD, GpCert(SAS) Medicine and Surgery Department  Methodic, ordered and complete (always start at the mouth-craneal) CLINICAL HISTORY: SIGNALMENT: Species, Breed, Age ANAMNESIS: – Feeding and water: quantity, quality, appetite, thirst, mastication, salivation, swallowing… – Vomit and/or diarrea: quantity , quality… – Management: changes in diet, foreign body…  Lips position (Facial paralysis) EXTERNAL INSPECTION Cheilitis / Wounds Trismus or lockjaw Difficulty in opening the mouth Sialorrhea / Ptyalism Tongue exposition Tumors ¿HOW TO OPEN THE Manageable animal: MOUTH? Hands on jaw and mandible. Fingers pressing lips towards teeth. Dangerous animal: Sedation. Gauze bandage to help. Cat: Similar to dog. Hand holding Lavín et al. 2006 the head. Index holding jaw.  MUCOUS MEMBRANES INTERNAL INSPECTION TONGUE TEETH HARD PALATE SOFT PALATE SALIVARY GLANDS PHARYNX AND TONSILS  P R C P I Color: Inflammation: - General (stomatitis) - Local (gingivitis , Glossitis…) Epulis (benign tumor) MUCOUS MENBRANE Melanoma (malignant tumor)  Size: Macroglossia / Microglossia Inflamation: Glossitis (Pine Procesionary…) Wounds / Traumatisms… Paralysis (N. XII, hypoglossal) TONGUE Foreign body…CATS  FRACTURES: Traumatisms CLEFT PALATE: (PALATOSCHISIS) - Congenital - Difficulty suctioning - Communication with nostril SOFT PALATE: Elongated (Brachycephalic) PALATE 9 10  DECIDUOUS/ TEMPORAL Teething Tooth decay: localized and progressive disintegration ,bacterial acids. DENTAL CALCULUS: - Periodontal disease: Gingivitis and Periodontitis - Difficulty chewing - Halitosis Abnormal color TEETH Enamel hipoplasia (distemper) Weathering/fractures (playing with stones) Lavín et al. 2010 Lavín et al. 2010  PAROTID MANDIBULAR Lavín et al. 2010 SUBLINGUAL SALIVARY GLANDS ZYGOMATIC ü SECRETION ALTERATIONS: – DISMINISHED (HYPOSIALIA): ü Dehydration ü Drugs (atropine) ü Panting, mouth breathing… – INCREASED: ü PTYALISM : – Stomatitis / Gingivitis / Glositis – Foreign body – Drugs – Intoxications – SIALORRHEA (Drooling): ü Mandible fracture ü Foreign body ü Facial paralysis… ü SALIVARY GLANDS: ALTERATIONS – INFLAMMATION (SIALADENITIS) – SIALOCELE o MUCOCELE (Saliva acummulation) – Trauma – Foreign body – Sialolith or salivary duct stone ü RANULA (sublingual gland mucocele) ü PHARYNX AND TONSILS (Digestive and Resp. system) INSPECTION AND PALPATION – INFLAMMATION: Lavín et al. 2010 Lavín et al. 2010 Size Sensibility Temperature – NEOPLASIAS – FOREIGN BODY Lavín et al. 20010 – PHARYNX REFLEX (deglution, IX and X) ü ESOPHAGUS ü INSPECTION AND PALPATION ü EXTERNAL – DEGLUTION CONTRAINDICATIONS!! – INCREASED SIZE: Foreign body Dilatation Tumors ü INTERNAL – “Probing” – Endoscopy  MH ü ABDOMEN E v PARADIGM (external projection internal organs): Ø EPIGASTRIUM CRANEAL Parachondria (L and R) Xiphoid R. Ø MESOGASTRIUM E Flanks (L and R) M Umbilical R. H Ø HYPOGASTRIUM Inguinal R. (L and R) Prepubian R. CAUDAL ü ABDOMEN: PARADIGM 2D ü ABDOMEN – INSPECTION: 3D: shape and volume SIMETRICAL: both sides INCREASES ( dyspnoea by pressure) – GENERALIZED: » Solids: food, tumors. » Liquids : Ascytes, pyometra » Gas : barrel abdomen » LOCALIZED: » Hernias, tumors, bruises, abscesses (puncture) » Edema (lower parts): heart problems, hypoproteinemia DECREASES: malnutrition, malabsorption. ü ABDOMEN – EXTERNAL PALPATION: ü Standing/ one-two hands ü Total area: ü Dorsal / Ventral ü Cranial / Caudal ü Viscera, faeces, tumors.. Lavín et al. 2010 ü Abdominal wall tension: ü Dephensive mechanism---à relaxed ü Increased: Table shaped abdomen (pain) ü Peritonitis ü Gastric or intestinal meteorism ü Foreign body ü Gastritis In physiological conditions: ü Hepatitis Palpable organs: Lavín et al. 2010 ü Pancreatitis... BLADDER AND INTESTINES ü ABDOMEN SUCUSION TEST PALPATION AND AUSCULTATION: Presence of free fluid in the abdominal cavity. One hand extended on one side, hit the abdomen with the other. --à ”ABDOMINAL FLUID WAVE" Lavín et al. 2010 ü ABDOMEN – PERCUSSION (limitted value): digital-digit MATT (LIVER) Lavín et al. 2010 SUBMATT (GENERAL) Lavín et al. 2010 ü ABDOMEN – AUSCULTATION (stethoscope) Borborigms: – Increased: » Hypermotility Lavín et al. 2010 » Enteritis » Diarrhea – Decreased: » Hypomotilidad » Paralytic ileus ( i.e.:Parvo) » Constipation, obstruction, impaction ü ANUS/RECTUM ü INSPECTION/PALPATION (RECTAL EXAM) Index or little finger ü Evaluate: ü Sphincter (agenesis, tonicity) ü Rectal Mucous (tumors, polyps) ü Prolapse ü Prostate ü Anal glands (fistulas) Lavín et al. 2010 ü PRUEBAS COMPLEMENTARIAS: DECOMPENSATION IF CHANGES IN PRESSURE!! – PUNCTURE (Abdominal paracentesis) : üDiagnostics üTreatment (dyspnea, diaphragm pressure) – RX: üPlain üContrast – ULTRASOUND – ENDOSCOPY – BIOPSY – LAPAROTOMY – CT / MRI  CLINICAL PROPEDEUTICS REPRODUCTIVE AND URINARY SYSTEM DOG AND CAT 2024-2025 Ayla Del Romero Martínez, DVM, PhD, Gp-Cert(SAS) Medicine and Surgery Department ü CLINICAL HISTORY: ü SIGNALMEN ü ANAMNESIS: – General status: attitude… – Water intake ( i.e. POLYDIPSIA) – Urine quantity (i.e. POLYURIA) – Urine characteristics (i.e.HEMATURIA…) – Sexual and reproductive behaviour – Drugs (Corticoids…)  POLYURIA: increased URINE VOLUME F y V ABNORMAL URINATION Ii.e.: diabetes mellitus. POLAQUYURIA/FREQUENCY: increased frequency micturition F i.e. Cystitis, Urethritis OLIGURIA: decreased VOLUME F y V i.e,.: Dehydration ANURY: no urination i.e.: urethral obstruction, bladder obstruction NONE DYSURIA: difficult urination i.e.: renal infarction, pelvis obstruction STRANGURY: painful and slow urination i.e.: prostatic problems KIDNEYS URETERS BLADDER URETHRA üKIDNEYS: DOGS: – INSPECTION: RK: ventral lumbar muscle (T13-L2) LK: more caudal (L2-L4) ü Signs Lavín et al. 2006 ü Antialgic postures – PALPATION: CATS: easy to palpate ü Size (RK: L1-L3 / LK: L2-L5) ü Shape Do not mistake with f.b. or tumors! Lavín et al. 2006 ü Consistency ü Pain ü BLADDER: NORMAL URETERS CANNOT BE EXPLORED BY PALPATION PALPATION (distended): ü Gentle (risk of rupture) ü Abdominal pain ü Degree of distension ü Distension causes: Lavín et al. 2010 – Blood clots – Uroliths (FLUTD) – Urethral traumatism – Prostate problems – Torsions – Sphincter paralysis – Neoplasias  URETHRA INTRAPELVIC PERINEAL PENILE URETHRAL ORIFICE VOIDED CATHETERIZATION CYSTOCENTESIS URINE COLLE TION ü INSPECTION/PALPATION (Limitations): FLEXIBLE RIGID DIAGNOSTIC ENDOSCOPY TREATMENT BIOPSY ü INSPECTION/PALPATION (Lateral decubitous) – SCROTUM: ü SIZE: ü Asimmetry Lavín et al. 2010 ü Light (Physiological) ü Increased: Orchitis, Neoplasias… ü Decreased: Atrophy ü Tª ü PAIN ü INFLAMMATION ü EDEMA ü SKIN ü INSPECTION/PALPATION ABDOMINAL ü TESTICLES/ EPIDIDIME – SIZE / VOLUME: Ø MICRORQUIDIA (decrease in size) Ø CRYPTORCHYDISM ü Congenital (interrupted descent) ü Acquired ü Unilateral Ø MACRORQUIDEA ü Bilateral (increased size) Ø MONORCHIDY ü Orchitis (absence of a testicle) ü Neoplasia Ø ANORCHIDEA ü Hydroceles (absence of both testicles) ü Hematoceles... SYMMETRY INGUINAL (light physiological difference) ü INSPECTION/PALPATION ü TESTICLE/ EPIDIDIME – POSITION – SENSIBILITY (Non painful) – CONSISTENCY (Firm and eslastic): – Soft – Infections – Abscesses – Hard/Fibrous – Inflammation – Degeneration – Neoplasias – MOVILITY / ADHERENCESS (movable) ü INSPECTION/PALPATION üPREPUCE: – Dermatological problems – Adherences – Hematomas – Abscesses – Neoplasias – Inflammation: POSTHITIS – PHIMOSIS: prepucial orifice estenosis – PARAPHIMOSIS: permanent exteriorization of the penis ü INSPECTION/PALPATIOM üPENIS (Externalize) Lavín et al. 2010 Lavín et al. 2010 Lavín et al. 2010 PRIAPISM BALANITIS Permanent erection Gland inflammation NEOPLASIAS HEMATOMAS Benign / Malign HEMORRAGE…  Difficult micturition and üPROSTATE Tenesmus PALPATION: Rectal exam – Size – Shape – Consistency – Pain … PROSTATITIS BPH PROSTATIC CYSTS NEOPLASIAS ABSCESSES ü FEMALE – EXTERNAL INSPECTION: ü ABDOMEN (size) ü VULVA: Antomy Mucosa…color Adherences/ Wounds Stenosis Prolapse / Hyperplasia / Neoplasia Lavín et al. 2010 Lavín et al. 2010 Secretions Pyometra Hemorrage… ü FEMALE ü MAMMARY GLANDS – INSPECTION/PALPATION: – Size – Sensibility – Consistency – Temperature SKIN INFLAMMATION / HYPERPLASIA NEOPLASIAS PSEUDOPREGNANCY (lymphonodes) ü FEMALE INTERNAL INSPECTION: VAGINA VAGINOSCOPE / VAGINAL SPECULUM ENTRY REMOVING DESINFECTED LUBRICATED CLOSED SEMI-OPEN VAGINAL MUCOSA COLOR NEOPLASIAS INJURIES HYMEN ü BIOCHEMISTRY ü URIANÁLISIS ü RX (plain/contrast) ü ULTRASOUND ü ENDOSCOPY ü CITOLOGY ü BIOPSY Maurici Batalla [email protected]