Semiotic Approach to Digestive Symptoms 2024/2025 PDF

Semiotic approach to digestive symptoms CurricularUnit: Integrated Clinical Reasoning I Teacher: Beatriz Duarte Bilhastre, DVM, MSc Year: 2024/2025 Main sources: KEY WORDS Halitosis → Unpleasant breath odor Dysphagia → Difficulty swallowing Odynophagia → Painful swallowing Regurgitation → Pass...

Semiotic approach to digestive symptoms CurricularUnit: Integrated Clinical Reasoning I Teacher: Beatriz Duarte Bilhastre, DVM, MSc Year: 2024/2025 Main sources: KEY WORDS Halitosis → Unpleasant breath odor Dysphagia → Difficulty swallowing Odynophagia → Painful swallowing Regurgitation → Passive and retrograde movement of ingested material Vomiting → Expulsion of gastric, and occasionally intestinal, contents through the mouth Selective or capricious appetite → Interest in or consumption of only highly palatable foods Perversion of appetite → Habit of ingesting non-food substances Inappetence → Partial or diminished interest in food KEY WORDS Coprophagia → Habit of eating feces Anorexia → Total disinterest in food (absence of hunger) Diarrhea → Abnormally increased frequency, liquidity, or volume of feces Hematemesis → Presence of blood in vomit Melena → Presence of digested blood in feces Hematochezia → Presence of fresh blood on the surface of feces Dyschezia → Pain during defecation KEY WORDS Constipation → Fecal retention Obstipation → Severe fecal retention, clinically intractable Tenesmus → Difficulty or inability to defecate or urinate Ictericia → Yellowing of mucosa and sclera due to bile pigment deposition  CLINICAL EXAMINATION – DIGESTIVE SYSTEM Animal Identification Consultation Date, name, species, breed, sex, age, owner’s name, owner’s details Anamnesis Informations about: the animal, environment, diet and clinical signs General Physical Examination Body condition, weight, body temperature, behaviour and attitude, cardiorespiratory auscultation, discharges (nasal, ocular), mucosas, abdominal conformation and simetry Specific Physical Examination Evaluation and location of specific clinical signs: vomiting, diarrhea, regurgitation, constipation, etc… Abdominal palpation: cranial, middle and caudal, abdominal percussion and abdominal auscultation Complementary Exams Laboratory tests – Complete blood count, biochemical profile, parasitological tests, evaluation of abdominal effusion. Imaging – x-ray, ultrassound, endoscopy and exploratory laparatomy  ANIMAL IDENTIFICATION Species: Frequent digestive pathologies in dogs VS cats (gastric torsion, FIP, etc.) Sex: Unsterilized females: vomit – pyometra Non-sterilized males: tenesmus – benign prostatic hyperplasia Age: Youth: congenital diseases (vascular abnormalities, shunts; viral diseases in puppies (parvovirus, distemper), foreign bodies Adults: inflammatory bowel diseases Seniors: malignant neoplasms Breed: German Shepherds: Exocrine pancreatic insufficiency Siamese: inflammatory bowel diseases  ANAMNESIS Reason for Consultation: 1) Identify the main complaint (commonly vomiting, diarrhea, loss of appetite). Duration: How long has it been happening? Frequency? Progression – worsening or improvement? Intensity? Characteristics? Previous treatments: Have any treatments been administered? Which ones? Did they help or worsen the condition? 2) Indoor vs. Outdoor: Urban vs. rural area (access to toxins, foreign objects) 3) Vaccination and deworming status: Internal and external  ANAMNESIS Diet: Type: Dry, wet, or homemade? Any changes (gradual or sudden)? Access to trash? Snacks? Water intake: Normal, decreased, increased? Changed daily? Type of container? Appetite: Normal, decreased, increased, coprophagia, pica? Feces characteristics: Volume, consistency, color, odor, presence of mucus, presence of undigested food. Frequency (normal, decreased, increased) and posture when defecating (painful, prolonged?). Vomiting: Ask if vomiting is present, frequency, content, associated signs (drooling, nausea, etc.), and relation to food or water intake. Medical history: Previous illnesses? Treatments? Use of anti-inflammatories? Anorexia VS. Polyphagia: Anorexia: Complete loss of appetite or disinterest in food Hyporexia or inappetence: partial loss of appetite or decreased food consumption Normorexia: normal appetite ANOREXIA + WEIGHT LOSS = PROBABLE SYSTEMIC DISEASE Polyphagia: increased appetite or food intake often secondary to hormonal pathologies Body Condition - Assessment Halitosis Unpleasant odor from the exhaled air Tartar/Gingivitis is the most common cause!! Uremia Coprophagy! Uremic: kidney disease Sweet (apple): Diabetic ketoacidosis Ptyalism/Sialorrhea Excessive salivation Most frequent causes: Inability to swallow saliva (pain) Nausea (hepatic encephalopathy) Hyperthermia Toxic Seizures Dysphagia Pain and difficulty swallowing They have difficulty in grasping, chewing, choking, drooling; Cause: foreign body, pain, neoplasia, trauma, esophageal motility changes Inspect oral cavity palpation cervical region most causes are detected on physical examination OFFER FOOD AND OBSERVE THE ANIMAL'S BEHAVIOR!! Regurgitation Retrograde and passive elimination (NO ABDOMINAL EFFORT) through the esophagus Elimination time after ingestion is variable – it can be immediate or take a few hours Form of food content is typically tubular and ALWAYS with undigested food Regurgitated content NEVER features bile Regurgitation of only solid and non-liquid content (esophageal obstruction) may occur Typically there is WEIGHT LOSS and INCREASED APPETITE Owners very often confuse it with vomit!! Vomiting, regurgitation and reflux Veterinarians in general practice frequently assess animals whose owners report they are vomiting. The causes and consequences of vomiting can range from clinically inconsequential to life threatening. In contrast, regurgitation is a much less common clinical sign. Almost invariably, the patient who is truly regurgitating as their primary clinical problem will have serious disease. Gastric reflux can also be confused with vomiting and has different implications for the animal that need to be recognised. It’s essential that the veterianian has a robust and rapid way to assess patients during the initial consultation so that rational decisions can be made about appropriate diagnostic and/or therapeutic plans. Vomiting vs. Regurgitation Vomiting Regurgitation Neurologically complex process resulting from the Passive process, which involves the retrograde synchronised activity of a number of abdominal, movement of food and fluid from the oesophagus, pharyngeal and thoracic structures. pharynx and oral cavity without the initiation of reflex neural pathways other than the gag reflex. Coordinated in the medulla oblongata and cannot occur without a functional vomiting centre. Aspiration pneumonia is a common sequela. Abdominal effort prior to bringing up material; induced or exacerbated by alterations in food preceded by hypersalivation – manifested by consistency and exercise and facilitated by licking of lips and repeated swallowing. The gravity when the head and neck are held down vomiting may be projectile. and extended. Vomiting vs. Regurgitation Vomiting Regurgitation Character of the vomit: food partially digested or Often gag (material accumulates in the pharynx.) contains bile Reflux is often watery and low in volume but acidic, behaviour indicating local irritation. pH of the vomitus: Acid or pH-neutral pH of the vomitus: ph neutral Animal developed a cough at the same time it started ‘vomiting’, : aspiration can occur Note: Patients who have experienced serious vomiting of acid gastric contents may develop a secondary oesophagitis and present with signs suggestive of both vomiting and regurgitation or reflux. Usually, vomiting will have been the first sign noted. Animals that ingest caustic or irritant material causing oesophagitis and gastritis may also present with signs of both vomiting and regurgitation. Vomiting vs. Gastric reflux Gastric reflux Retrograde movement of food and fluid from the stomach into the oesophagus. This material may then travel some or all of the way to the pharynx and nasopharynx and may be inhaled, causing acid damage to mucosae it contacts. Vomiting vs. Coughing Coughing Usually is followed by gagging. Cat owners in particular may confuse vomiting and coughing in their pets. Owners are often unable to differenciate... Ask specific questions: Amount of effort involved; Character of vomitus; If still uncertain, the veterinarian may need to observe the animal. Even with veterinary obser- vation, it is difficult and sometimes impossible to differentiate reflux and regurgitation without fluoroscopy. Patients with nausea, vomiting and gastric dysmotility are predisposed to reflux, as are brachycephalic breeds.  Vomit stages Nausea Retching Vomiting  Gastric tone is reduced, duodenal and proximal jejunal tone is increased and duodenal contents reflux into the stomach. Nausea depressed, hypersalivates and as a result may exhibit repeated swallowing and/or lip-licking behaviour. Note: If signs of nausea and food aversion persist once vomiting is controlled Ondansetron (drug that has great efficiency against nausea) Unproductive effort to vomit, also known as ‘dry heaves’. Retching  1) Epiglottis is closed and the soft palate presses up against the nasopharynx. 2) The abdominal muscles and the diaphragm contract. The contraction of the abdominal muscles is usually visible to an observant owner. Vomiting 3) The cardia then opens, the pyloric stomach contracts and vomiting occurs. 4) Reverse peristalsis, cardiac rhythm disturbances and increased colonic motility may also occur during the vomiting process. Note: The closure of the epiglottis and pressing of the soft palate up against the nasopharynx protect against aspiration of gastric contents.  Haematemesis Persisten vomiting of fresh or digestive blood. The cause may be primary GI disease or secondary GI disease. Primary GI causes: Neoplasia; Lymphoma, adenocarcinoma, leiomyoma and leiomyosarcoma; Gastric foreign body; Severe inflammatory disease. Secondary GI causes: Coagulopathy; NSAIDs; Hepatic disease; Hypoadrenocorticism; Gastrinoma; Mast cell tumour (non-GI location); Trauma; Renal failure; Systemic inflammation (pancreatitis, sepsis); Extreme exercise (sled dog racing).  Diagnostic approach to the patient reported to be vomiting History and physical examination findings If indicated by the history and/or physical examination, investigate Ask yourself these questions: secondary GI disease with appropriate Is this patient vomiting or regurgitating? diagnostic tools such as: Does this patient have primary or secondary GI disease or I can’t tell? Biochemistry; What system is involved and how? Haematology; Urinalysis. Causes of Regurgitation Diarrhea Alteration in the normal pattern of defaecation, resulting in the passage of soft, unformed stools with increased faecal water content and/or increased frequency of defecation. It is important to consider: The animal’s previous pattern of defecation; Frequency of defaecation The nature of feces Accute diarrhea Require little diagnostic intervention and resolve with or without symptomatic treatment. Chronic diarrhea (lasts for more than three weeks or intermittent diarrhea over a period of one month or more). Can be a diagnostic challenge and the source of much frustration for the client and veterinarian. The animal may not be particularly unwell, and the diarrhea may be chronic but intermittent and may respond partially but not entirely to different therapeutic interventions. Classification of diarrhea Large bowel diarrhea: Fresh blood Mucus Small amounts of faeces. Note: Diarrhea may have features of both small and large bowel, which indicates either primary small bowel with secondary effects on the lower bowel or diffuse disease involving both the small and large intestine. Question the owner about: Consistency of the faeces; Colour Frequency Presence of blood or mucus. Significant weight loss, loss of appetite or vomiting. Classification of diarrhea Causes Diarrhea due to primary GI disease is more common than diarrhea due to secondary GI disease. In animals with secondary GI disease, with the exception of exocrine pancreatic insufficiency and some dogs with hypoadrenocorticism, diarrhea is not usually the primary presenting complaint. Constipation Infrequent defecation with the presence of dry and hard faeces; Constipation (inability to pass faeces) Distinguish tenesmus from constipation/constipation Cause: opioid drugs, inadequate cleaning of the gravel, diet, neoplasia, hip fractures, hip dysplasia, etc IMPORTANT → physical examination to identify the cause Rectal palpation!  Tenesmo/Dyschesia Unproductive and repeated effort to defecate Dyschesia (PAIN and difficulty passing stool) Animal expresses URGENCY to defecate Animal assumes posture to defecate and after eliminating a small amount of feces maintains the same posture in common effort blood and mucus appear in the feces Cause: obstructive or inflammatory injury to the rectum or distal colon (colitis, perianal hernias, or prostate disease) Tenesmus can also be of urinary origin at the physical examination inspect the perianal region, rectal and abdominal palpation Hematoquezia Presence of live blood in feces (traces of blood) Often associated with tenesmus and dyschesia Melena Melena: presence of digested blood in the feces (black tar-like stools) to the oxidation of hemoglobin Origin: → Hemorrhage of gastric/duodenal origin → Swallowing blood from the oral cavity or pharynx → Respiratory tract hemorrhage can originate from diet (red meat) or iron supplementation Always ask the owner about the administration of NSAIDs or Corticosteroids Abdominal pain → Distention of viscera (stomach, intestine, uterus, gallbladder or bladder) → Peritoneal inflammation, digestive disruption, vascular disorders (thrombosis) and cause abdominal pain DIFFICULT TO DISTINGUISH BACK PAIN: tense animal, in kyphosis and vocalizes on abdominal palpation They can adopt the "pray" position, tachycardia, weak pulse, increased CRT IMPORTANT EVALUATION AND CLASSIFICATION OF ACUTE ABDOMEN AT EXPLORATORY LAPAROTOMY (except in pancreatitis) Abdominal distension Increased abdominal contour Causes: Ascites (frequent) Pregnancy Hepatomegaly Splenomegaly Gastric dilation/torsion Peritonitis Obesity Intestinal obstruction Ictericia Yellow coloration of mucous membranes, skin, and sclera due to the accumulation of bilirubin in the tissues Classification: Prehepatic (hemolytic diseases) Hepatic (hepatitis) Posthepatic (bile flow obstruction) Also evaluate the color of urine for bilirubinuria PHYSICAL EXAMINATION – DYGESTIVE SYSTEM 1) Examination of the oral cavity and pharynx Oral cavity starts at the lips and goes to the entrance of the pharynx. Clinical signs of oral cavity and/or pharyngeal changes: → Halitosis; → Ptyalism or sialorrhea → Oral hemorrhage → Gripping disorders → Anorexia → Difficulty opening the mouth → Dysphagia → Animals in pain: Depression, inappetence and occasionally, fever. Anamnesis!! → IMPORTANT!! - Evolution - Duration of clinical signs - Possibility of ingestion of a foreign body (bones, threads, toothpicks) or access to toxic or caustic substances Examination: Evaluate: Oral mucosa, lips, gums and teeth. Elevation of the upper lip to assess for lesions, masses, ulcers, coloration, and hydration of the mucous membranes Lips should be evaluated for symmetry, movement, color, inflammation, ulceration, or deformation. Open the mouth carefully!! (PAIN!) → Evaluate temperament (AGGRESSIVE – UNDER SEDATION) Put yourselves in front of the animal, with their index finger and thumb open their mouth and with the other hand pull the jaw down. Evaluate teeth, tongue, hard palate, soft palate, pharynx, and tonsils PHYSICAL EXAMINATION – DYGESTIVE SYSTEM Evaluate: dentition, tongue (coloration, foreign bodies), hard and soft palate (length and conformation, congenital anomalies (cleft palate or elongated soft palate), masses, pharynx and larynx.  Inspection of the oral cavity: Tongue and Feline oral cavity cleft palate lip injuries (arrows) caused by abrasive (arrow) material Lesions at the base of the tongue (arrows) caused by a linear foreign body. Mass in the soft palate region (arrow) ORAL CAVITY: WHAT TO CHECK? Breath (Halitosis): Normal. Acidic or sour odor (possible poor digestion). Uremic odor (kidney disease). Putrid odor (food residues, cavities, gastritis, etc.). Green apple odor (ketoacidosis). Oral mucosa: Check for coloration, moisture, lesions (ulcerations), foreign bodies, or masses. Gums: Look for signs of inflammation, ulceration, foreign bodies, or masses. Teeth: Assess positioning, occlusion, coloration, enamel quality, fractures, or calculus (tartar). Tongue: Evaluate mobility, consistency, lesions, masses, or foreign bodies at the base of the tongue. Hard or soft palate: Inspect for lesions, foreign bodies, excessively long soft palate, or palatal fissures. Pharynx and tonsils: Check for inflammation, purulent discharge, masses, foreign bodies, or symmetry. 2) Examination of the salivary glands Parotid, mandibular, sublingual, and zygomatic responsible for the production and secretion of saliva. Main clinical signs of changes in the salivary glands: 1) Halitosis 2) Ptyalism 3) Sialorrhea 4) Painful swallowing 5) Gagging 6) Appetite changes Normally, only the mandibular gland is palpable. When altered, all may be enlarged on palpation. Causes of swelling in salivary glands: Abscesses or neoplastic masses can cause swelling in cervical, submandibular, or mandibular regions. Swelling can range from soft/fluctuant (e.g., mucoceles) to firm/hard (e.g., neoplasms), and may or may not be painful on palpation. Definition and types of salivary accumulations: Mucocele, sialocele, or ranula: Accumulation of saliva in subcutaneous or submucosal tissue, often under the tongue, secondary to duct obstruction or gland rupture. These conditions are a common clinical sign of salivary gland disorders. Ranula: Mucocele: 3) Examination of the esophagus Disorders of the esophagus: 1) Motility disorders (+++ more frequent!) Congenital or acquired megaesophagus 2) Obstructive disorders can occur progressive weight loss with evident appetite! Foreign bodies, strictures, neoplasms 3) Inflammatory disorders Esophagitis, gastroesophageal reflux... 4) Congenital disorders Vascular anomalies Main clinical signs of changes on the esophagus: - Regurgitation - Dysphagia - Odynophagia - Repeated swallowing - Gagging - Excessive salivation Anamnesis: - Ask about the animal's ability to feed itself (grasping and swallowing food) - Dysphagia occurs shortly after eating/ingesting liquids/solids and how long after. - Sialorreira may be evident! EXAMINATION OF THE ESOPHAGUS: 1) Inspection and palpation of the oral and pharyngeal regions. 2) The normal esophagus can be palpated in the left cervical region, in the jugular fold. Palpation of the esophagus from the glottis and down the esophagus. Is there any mass or 3) The dorsal displacement of the animal's head foreign body? Pain on palpation? allows for better palpation of the structure. 3) Examination of the esophagus Endoscopic examination makes it possible to identify and Endoscopic image of the esophagus. sometimes remove oesophageal foreign bodies that are Organ dilation and hemorrhagic lesions: not detected on physical examination. megaesophagus. 4) Examination of the abdomen Lateral view of the abdomen divided into fields: D = dorsal; M = medial; V = ventral; 1 = diaphragm; 2 = stomach; 3 = liver; 4 = spleen; 5 = small intestine; 6 = large intestine; 7 = descending colon; 8 = straight; 9 = bladder; 10 = kidney. Under normal conditions, the abdomen is divided into three regions: 1) Epigastric region: liver, stomach, pancreas, kidneys, and spleen 2) Mesogastric region: intestines, ovaries, and ureter 3) Hypogastric region: bladder, prostate, urethra and rectum 4) Examination of the abdomen Inspection Observe carefully, evaluating the shape and perimeter (symmetry), volume and abdominal shape. Increased abdominal volume, pregnancy, ingestion of large amounts of food, accumulation of free fluid (ascites). Abdominal palpation Abdominal palpation is a key part of physical examination. Ideally performed with the animal in a quadrupedal position but can also be done with the animal sitting, in lateral recumbency (right or left), or with the forelimbs suspended to improve organ access.  Abdominal palpation: Palpation typically involves both hands, using the entire palmar region and fingertips. Begins with superficial palpation to help the animal relax, assessing: Cutaneous sensitivity. Muscle tone. Abdominal content. Identification of painful regions. Note: Strong muscular tension may indicate pain or a defensive response. Deep Palpation: Gradually increases pressure to evaluate deeper abdominal structures. Assesses: Shape, volume, sensitivity, and consistency of organs. Presence of abnormal structures or thickening of the abdominal wall. Evaluation of Lymph Nodes: Mesenteric and colonic lymph nodes are assessed. Palpable only when enlarged: Mesenteric nodes (medial mesogastrium). Right and middle colonic nodes (medial mesogastrium). Left colonic node (between mesogastrium and hypogastrium). Organ Palpation by Region: Epigastric Region: Empty stomach is not palpable; a distended stomach can be felt as an irregular, curved structure. Liver is normally not palpable unless significantly enlarged Mesogastric Region: Palpable structures: small intestine, large intestine, kidneys (especially in cats). Enlarged mesenteric lymph nodes. Hypogastric Region: Palpable structures include: Small part of the large intestine (descending colon and rectum). Small intestine. Enlarged uterus or prostate. Distended bladder. Palpation Insights: The stomach, liver, and other organs may only be identified under specific conditions (e.g., enlargement or distension). Proper palpation provides critical clinical information but requires: Attention to technique, patience, and anatomical knowledge. Poor technique yields limited diagnostic value.  A A – Palpation of the epigastric region B – Palpation of the mesogastric region B Deep abdominal palpation in a dog. Palpation of intestinal loops. Percussion of the abdominal region: In abdominal distensions caused by the accumulation of gases in the intestine, the sound produced by percussion is usually tympanic. Massive sound: Organs such as the liver and spleen Abdomen auscultation: Allows you to hear borborygmos (normal noises of the intestinal tract caused by the passage of gas and liquid) Strong and frequent borborygmos → intense motility Intestinal obstructions may occur wheezing Peritonitis: sound of rubbing in the liver, stomach, and spleen Pregnancy: auscultation of the heartbeat of the fetuses 4.1. Examination of the stomach Clinical signs of stomach changes: Vomiting Anorexia Melena Distension Abdominal pain Hematemesis Anamnesis: Origin of the process (primary – primary gastropathy or secondary – secondary to kidney disease, stress) Age, breed and temperament of the animal Nutritional, sanitary management (deworming) and environmental conditions Abdominal Percussion Purpose: Useful for identifying changes or increases in abdominal volume. The sound produced provides clues about the content of the area and helps delineate structures. Technique: Performed using the digitodigital technique (finger tapping). The patient is positioned in dorsal recumbency or lateral recumbency. Percussion is performed along three vertical lines on the mesogastric wall or in any region with altered anatomy; Sounds and Their Interpretation: Tympanic or resonant sound: Over air-filled organs like the intestines or stomach. Dull or solid sound: Over solid organs like the liver or spleen.  Abdominal Percussion Abnormal Findings: A circumscribed dull area in a region normally resonant may indicate: Fecal stasis. Muscle wall contraction. Displacement of solid organs. Dull sound over the stomach or intestines filled with liquid or solid material. Percussion in Abdominal Effusion: Lower areas: Dull sound (due to fluid accumulation). Upper areas: Tympanic sound (due to air). Example: In dorsal recumbency, dull sound is heard in the flank and tympanic sound in the epigastric region. Changing the animal's position alters the sounds if the fluid is free in the abdominal cavity. If the fluid is contained (not free), changing positions does not alter the sound distribution.  Palpation of an Empty Stomach: Normally cannot be palpated due to its location in the ventral epigastrium and obstruction by the ribs. Techniques to facilitate palpation: Insert fingers beneath the ribcage. Elevate the animal's forelimbs to move the stomach caudally. Findings During Palpation: Identification of: Food content. Foreign bodies. Abnormal gastric dilation or distension caused by gas, ingestion (gastric dilation/volvulus syndrome), or fluid Severe distension may allow palpation of the stomach in the mesogastric region. 4.2. INTESTINE – Main signs of gastrointestinal disease Weight loss, dehydration, vomiting, melena, flatulence, diarrhea, polyphagia or inappetence, abdominal discomfort, ascites, melena and haematochezia. Anamnesis: Acute or chronic process? Do you look for change in diet? Food intake overload Intestinal parasitism Neoplasms (intestinal lymphoma) Age (young +++ parasitic and infectious diseases) and breed of the patient; Seniors +++ Animals Seniors or Adults) Physical examination findings: - Malnourished, emaciated patient; - Poor quality and seborrheic coat - Apatic - Dehydration (depends on the severity and persistence of diarrhea and vomiting) Abdominal palpation can identify intra-abdominal masses, abnormal intestinal contents (gases, fluids, food, foreign body), thickening of the intestinal wall, and anatomical changes, such as intussusception, for example. In addition, it can reveal discomfort or tender points, which must be located and graduated. Clinical Manifestations: Common Symptoms: Diarrhea or constipation. Additional signs: Vomiting, tenesmus (straining to defecate), dyschezia (painful defecation), and hematochezia (blood in stool). Stress may trigger, worsen, or be associated with large intestine diarrhea in some cases. Vomiting: Occurs in ~30% of dogs with colonic alterations. Possible causes: Gastric involvement. Absorption of toxins. Stimulation of vagal receptors due to inflammation or distension. Characteristics of Feces and Defecation: Diarrhea (from large intestine): Small quantity of stool, ranging from watery to pasty, often with visible blood and mucus. Accompanied by tenesmus and dyschezia. Constipation or Obstipation: Indicators: Long intervals between defecation or absence of defecation. Hard stools and painful defecation. Possible Causes of Colonic Disorders: Dietary and Environmental Factors: Infections or parasitic causes (e.g., nematodes are common in canine colitis and can be ruled out with fecal exams). Diet changes or ingestion of abrasive substances. Coprostasis (fecal retention) associated with: Excess dietary fiber or bones. Inadequate water intake. Physical and Environmental Triggers: Abdominal distension, thin body condition, and dehydration are common signs in older cats with severe fecal retention. Painful defecation in animals with musculoskeletal or degenerative diseases (e.g., hip dysplasia). Voluntary fecal retention in cats if litter boxes are not adequately cleaned. Diagnostic Considerations: Rule out common causes (e.g., parasites, diet issues) before pursuing complex diagnostic tests!!! Diarrhea from the large intestine: Typically does not cause malnutrition or dehydration unless the disease is severe, chronic, or secondary to other organ disorders. Large intestine Clinical Assessment: Abdominal Palpation and Rectal Examination: Essential for evaluating colonic diseases. Normal colon diameter is larger than the small intestine but varies with fecal content. Cats may exhibit segmented fecal content, which becomes firm or stone-like in cases of obstipation. Palpation can detect: Foreign bodies, impaction, ileocolic intussusception, and wall thickening. Pain during palpation in abnormal conditions. Perianal Inspection: Check for inflammatory or neoplastic conditions before performing a rectal examination. Large intestine Rectal Palpation Procedure: Conducted with the animal in a standing position or lying on its right/left side. Use a lubricated, gloved index finger for gentle examination: Evaluate anal sphincter tone, stenosis, and irregularities. Assess rectal conditions: stenoses, foreign bodies, intraluminal masses, extraluminal lesions, and rectal wall changes. Examine fecal material for appearance, color, presence of bone fragments, foreign bodies, blood, or mucus.  Liver Clinical signs in Hepatic Disease: Dehydration, hypovolemia, hypoglycemia, neurological changes (hepatic encephalopathy), jaundice, petechiae and ecchymosis (coagulation disorder), vomiting, diarrhea, melena… Detailed History Taking: Important to inquire about exposure to drugs, toxins, or chemicals, and whether there are associated neurological disturbances related to feeding. Look for signs such as: Syncope (fainting), blindness, ataxia (lack of coordination), or episodes of coma—usually occurring after eating due to elevated ammonia and toxins. The liver’s inability to detoxify causes toxins to reach the systemic circulation, leading to neurological signs. Congenital Shunts (Portosystemic Shunts): In young animals, signs like lethargy, stunted growth, and transient neurological disturbances may indicate congenital shunting. Liver Epigastric region of the abdomen, slightly to the right underneath the costal arch Metabolic functions synthesis proteins, carbohydrates and fats, produces blood clotting factors, excretion of drugs and toxins, produces and secretes bile (stored in the gallbladder) Physical Examination… Physical examination: Animal may present ictericia and ascites → screen for heart disease and plasma protein level → evaluate abdominal fluid Ophthalmological evaluation of animals with canine infectious hepatitis Abdominal palpation - hepatomegaly VS micro-hepatopathy (difficult to palpate inside the costal arch) Complementary tests are essential for diagnosis, BUT ANAMNESIS AND PHYSICAL EXAMINATION ARE WHAT ALLOW LOCATING THE HEPATIC ORIGIN Pancreas Causes and Variability of Pancreatic Diseases: The pancreas can be affected by various types of lesions, which can be: Acute or chronic. Idiopathic (e.g., idiopathic acinar atrophy). Degenerative or neoplastic. Secondary to sepsis, abdominal trauma, or surgical manipulation. Anatomical Challenge: Due to the pancreas' morphology and location in the abdominal cavity, it is difficult to examine clinically. Its proximity to other organs like the liver, stomach, duodenum, kidneys, transverse colon, and proximal small intestine means these organs may also be involved if the pancreas is diseased. Pancreas Clinical Presentation: Exocrine Pancreatic Insufficiency (EPI): Commonly occurs in young dogs (especially German Shepherds). Symptoms include: Progressive polypagia (increased hunger). Pica (eating non-food items like feces). Weight loss despite a good appetite. Diarrhea with a sour odor, malformed stools, undigested food, and/or greasy appearance (steatorrhea). Pancreatitis (Acute): More common in middle-aged or older dogs, especially those that are obese or fed high-fat diets. Clinical signs: Depression, anorexia, fever, vomiting, abdominal pain, and occasionally diarrhea. Symptoms often follow the ingestion of a high-fat meal. Acute pancreatitis should be suspected when symptoms begin after a special event or dietary change. Pancreas Physical Examination: Pancreatic Disease Symptoms: EPI Patients: Generally alert and active but in poor condition, often thin with a poor coat quality. Perianal area may have an unpleasant odor and greasy fur. Acute Pancreatitis: May present with obesity, depression, fever, dehydration, and jaundice (if hepatic involvement is present). Abdominal Palpation: Pancreatic Inflammation: Due to the pancreas’ location, abdominal palpation is usually unhelpful. In cases of severe pancreatitis, the animal may show abdominal discomfort or pain when palpating the anterior abdomen. Adhesions: Inflammation may cause the pancreas to adhere to the mesentery, intestines, or abdominal wall, leading to a palpable mass in the cranial abdomen. MANY THANKS!