Vet. Clinical Examination And Diagnosis PDF

VET..CLINCAL EXAMINATION AND DIAGNOSIS INTRODUCTION DIAGNOSIS: It is recognition the name of disease through detection of internal &external changes on animal (an accurate diagnosis leads to accurat&correct treatment) Disease: Any deviation from normal physiologi...

VET..CLINCAL EXAMINATION AND DIAGNOSIS INTRODUCTION DIAGNOSIS: It is recognition the name of disease through detection of internal &external changes on animal (an accurate diagnosis leads to accurat&correct treatment) Disease: Any deviation from normal physiological condign or inability of the animal to perform the normal physiological function SIGNS OF DISEASE (SYMTOMS) Any evidence that indicate the presence of disease. N.B: each disease has specific clinical signs which result from any functional disturbance that lead to dynamic disturbance Types: 1-subjective signs: they are the sings which can not be observed by the clinician but can be expressed by the patient e.g; colic&back pain 2-objective signs: they are the signs which observed by any person. e.g: diarrhea& nasal discharge 3-clinical signs: they are the signs which are discovered by the clinician through various methods of examination e.g: abnormal respiratory sounds&abnormal heart sounds *PROGNOSIS: it is the out come &termination of the disease It may be favorable or unfavorable  Clinical examination of individual animal *The clinical examination of the animal includes: 1- Case history 2- Examination of the environment 3- Examination of the patient. 1-Case history *It is the information that can be obtained&collected from the owner *Items: 1) history taking 2) Disease history 3) General history (managmental history) (1) History taking A-Manner of history taking -The owner must be handled with diplomacy or intelligence. -Avoid using of technical terms during dealing with the owner&try to use terms that the owner can understand it. -Avoid asking the unrequired question to obtain accurate information. -Do not depend on the owner observation completely. -Record the obtained information in a medical record B- Patient identification 1- Owner date: include the name, address, and telphone number This data help in follow up the case. -In case of infectious disease, it is very important to perform prophylactic measures 2-Animal data: (a) Species: there are certain disease which are confined to certain species of animals (species specifity for disease) Eg: *F.M.D "specific for cloven footed animals" *vesicular stomatitis "specific for equine&cattle"while sheep and goat are resistant *traumatic pericarditis "specific for ruminant only" *pregnancy toxemia "specific for sheep" *African horse sickness "specific for horse" N.B / it is very important to be familiar with species to be aware of drug sensitivity & other complication. (b) Breed: has hereditary predisposing factor for certain disease such as * Abomasal displacement commonly occurs in highly producing dairy cattle *Orbital carcinoma (cancer of eye): commonly occur in cattle with white head than cattle with pigmented head. (c)Age (age specific disease) * Young animals are more susceptible to be infected with infectious agent than adult animals due to ill-developed immune system. e.g.: * neonatal diarrhea (in 1st week is E.coli) (in 2nd & 3rd week is salmonella) * Traumatic pericarditis "is a disease of adult cattle" * Rickets "is disease of young age" while osteomalacia "is a disease of adult" * Tuberculosis "is a disease of adult animals" (d)Sex (sex related disease) This is duo to anatomical & physiological difference between male & femal. e.g.: In females ---- mastitis, pyometra & milk fever are commonly occur In male ------ urolithiasis is commonly occur N.B / the sex are very important to avoid drug that affect on pregnancy or that causing abortion e.g: dexamethasone, Mg. sulphat………. etc. (E) Pregnancy and lactation state There are number of metabolic diseases related to pregnancy & parturation e.g.: * Milk fever: occur in highly producing dairy cattle, 12 hr around time of parturition * Ketosis: occur in 1st 2 weeks of calving * Hypomagnesaemia: occur in 1st 2 months of lactation * Hypophosphatemia: occur in 1st 2 weeks of calving * Pregnancy toxemia in sheep: occur in last 2 weeks of pregnancy (F) Body weight * This helps in determination the dose of the drug * This also helps in assessment the state of development & nutrition comparing with other healthy animals of the same age & environmental condition (G) Special identifying marks (For complete identification of the animal) This include: color pattern & special features as ear tags and neck band.  (2)Disease history This history includes 2 main items: 1-Past history 2- Present history 1- Past history 1- Previous disease e.g: pox (it affects the animal one time only) 2- Previous vaccination & its time (this to know the post vaccinal reaction) 3- Previous treatment - It is essential to determine if there is any treatment has been given to the animal and, if so, the nature of the drug &its dose. - It is also help in determine the withdrawal time e.g.: some anthelmentic drugs such as phenothiazin derivatives lead to red urine, so it may be confused with other diseases that cause red urine as babesia 4- Prophylactic&control measures e.g: in case of bovine mastitis, careful questions should be directed to the methods of disinfection of the udder, type of the disinfectant & its concentration 5- Newelly purchased animals (Imported animal ) Careful attention should be paid to any recently introduced animals from outside sources; this is due to the possibility that these animals might be a carrier of a disease 2-Present history 1-The owner complaint -It is necessary to let the owner to discus the problem as he observed to obtain the information that you need. 2-Questions about the case, this includes: a- The onset &duration of the disease b- The progress of the problem C- Presence of other cases in the farm or not D- If the owner has the similar clinical signs with their pets. e.g :- If both dog and owner are scratching suggest sarcoptic mange. E- Morbidity rate: (%) Numbers of the diseased animals / total numbers of the animals F- Mortality rate: (%) Numbers of the dead animals / total numbers of the animals G- Case fatality: (%) Numbers of the dead animals / numbers of the diseased animals e.g:*F.M.D in adult (high morbidity & low mortality) *F.M.D in young (high morbidity & high mortality) *Cattle plague (high morbidity & high mortality) *Brucella species (high morbidity in form of storm of abortion) *Clostridial diseases (cause sudden death) (3)General history 1-Nutrition: * Type of the food * Quantity of the diet (over feeding or under feeding) * Quality of the diet (good or bad) * Change in the diet (it should be gradually) * The availability of the drinking water. 2-Breeding history: You must ask about the internal breeding that leads to congenital defects in the newly born animals 3-Housing: * Avoid the over crowding * Provide good hygienic measures including proper ventilation to avoid occurrence of the respiratory diseases. 4-Transportation and mixing of animals. Prolonged continuous transportation is considered risk factor to diseases as pneumonia &shipping fever. 2-Examination of the environment The examination of the environment is a necessary part of any clinical investigation due to the possible relation-ship between the environmental factors and the incidence of the disease. The environment may be out door environment (for animal raised on pasture )or indoor environment (for animal housed in door ). A- Out door environment. The examination should include the following items: 1- Food&water supply (A) Food supply *Quantity of the diet: The feeding of animal uncontrolled so animal may expose to many deficiency diseases according to soil content. e.g : sandy soil has copper &cobalt deficiency. *Quality of the diet: the diet is examined for its constituents, presence of any fungal growth which leads to G.I.T disturbance. e.g: Poor made silage (ketogenic diet) leads to ketosis. *Sudden change in diet. *Type of food: (roughage or concentrate) Green fodder: important source of vit. A. Young grass: decrease Mg level: so hypomagnesaemia occur. Cruciferous plant as turnip: hypophosphatemia. b) Water supply: -Quality of drinking water: the water must be free from any source of contamination with organic or inorganic substance and also must be free from infectious agent. -Source of the drinking water: fresh water or artesian water (fluorine deficiency) or stagnant water (algae & fasciola) or ponds (source of neurotoxic & hepatotoxic substances). - Amount of the drinking water. 2- Topography&soil type -Sandy soil: copper & cobalt deficiency -Muddy (damp): associated with outbreak of coli-form mastitis in dairy cattle & foot rot in sheep. 3- Climate: many diseases are influenced by climate as: - Foot rot: wet weather & muddy condition under foot -Disease spread by insects: encouraged when the climatic condition favors the propagation of the vector such as * Ticks & lice: transmit the blood parasite. * Mosquito: transmit R.V.F., L.S.D and 3 day sickness 4- Waste disposal : The disposal of feces &urine to ovoid transmission of infectious diseases. B- Indoor environment :- 1- Feed &Water supply :- Feed supply : *Quantity of the diet: the housed animal is exposed to the risk of overfed or under fed. *Quality of the diet: the diet is examined for its constituents, presence of any fungal growth which leads to G.I.T disturbance. e.g: Poor made silage (ketogenic diet) leads to ketosis. *Sudden change in diet. *Type of food: (roughage or concentrate) Green fodder: important source of vit. A. Young grass: decrease Mg level: so hypomagnesaemia occur. Cruciferous plant as turnip: hypophosphatemia Water supply: -Quality of drinking water: the water must be free from any source of contamination with organic or inorganic substance and also must be free from infectious agent. -Source of the drinking water: fresh water or artesian water (fluorine deficiency) or stagnant water (algae & fasciola) or ponds (source of neurotoxic & hepatotoxic substances). - Amount of the drinking water. 2- Housing design & ventilation system a) Partitions: the tubular partitions between the pens are more likely to permit the spread of the infectious agent than the solid division. b) The quality of the floor: Slippery floor is associated with high incidence of truma & fructure c) Sanitation &hygiene: Excessive accumulation of the feaces & urine favor the spread &survival of the pathogenic bacteria d) Bedding: type, quantity & quality - Constant wetting of the bedding material under the animal lead to highly incidence of mastitis & foot rot. e) Periodical cleaning & disinfecion of the farm is necessary. f) The availability of the light is necessary because the light is important for synthesis of Vit D, reproductive performance & its germicidal power. g) Ventilation: the aim of ventilation is to replace the foul air with fresh air so, *Bad ventilation leads to stagnant foul air so, increase CO2, NH3, dust concentration: leads to lowering resistance of Resp. tract: high incidence of resp. tract diseases. *Over ventilation leads to chilling diseases. 2) Increase of ambient temperature: reduce feed intake, reduction of milk yield &metabolic rate. 3) Decreased temp + inadequate ventilation: important predisposing factor in spreading of enzootic pneumonia. 3- Population density (stoking rate): Number of animals should related to the space area The over crowd ness leads to the following: A- Fighting. B- Accumulation of excretions as manure and urine leading to spreading of infection. C- Increase the R.H. inside the building, so it is predisposing factor for respiratory diseases, also increases of CO2. D- Inaccurate identification of animals.  3- Examination of the patient A-General examination 1- General inspection 2- Clinical examination (physical examination) B-Special examination of the body systems A- General examination 1- General inspection It means examination of the animal from a distance using the sense of vision, the this examination should include: (1)Appearance Healthy cattle should have bright eyes; alert, glossy skin& the muzzle looks moist. Any deviation from this appearance indicate disease problem E g: the animals appear dull &depressed The muzzle become dry (2) The physical condition The body condition of the animal can be assessed by inspection or running the hand over the ribs, shoulder, pelvic bones& spinal vertebrae. (This in wooled animals) * This assessment &judgment depend on the bony prominence as ribs, scapula & os-coxe A- Normal: if all the bony prominence of the body is covered with well developed muscles B- Obese (fatty): if there is excessive deposition of the fat in certain areas of the body + complete absence of the bony prominence C- Thin (lean): if the bony prominence is visible * Physiologically: in case of some breed of dairy cattle * Pathologically: in case of malnutrition D- Emaciated (cachexic): there is very clear bony prominence + atrophy of the muscle + depression of the supra orbital fosse This appears in case of old age, heavy intestinal parasitism, chronic depilating disease such as T.B& neoplasm. (3) Mental status: the ability of the animal to respond to external stimuli, this response include movement of head, neck, eye, ear, and tail+ vocalization in dog * Alert animal (bright): it is the animal which normally responsed to the external stimuli * This response may be increase or decrease (a) Increase of response (excitation) *Exited: increase response to external stimuli *Hyper excitability: excessive response to normal stimuli and restlessness *Frenzy: its violent movement of animal regardless the surrounding atmosphere *Mania: its violent movement of animal regardless the surrounding atmosphere but associated with sensory movement as biting for itself or owner, licking of the wall and itself, bellowing, abnormal voice and apparent blindness e.g. Mania: rabies, encephalitis and acute lead poisoning Frenzy: hypomagnesaemia and acute colic of horse (b) Decrease of response (depression) *Dull: when the reaction to normal stimuli is sluggish and depressed (fever, toxemia and acidosis) *Semi coma: partial or mild degree of coma. *Coma: complete unconsciousness without any response to external stimuli. *Narcolepsy: uncontrolled desire for sleeping *Syncope: sudden collapse of animal due to brain anoxia or heart failure. 4-General behaviour * In case of herd or flock: separation of the animal from the rest of the herd may be an indication of the disease. * Careful observation of the animal for detection of any abnormal behaviour (any bad vices) as biting of another animal, licking of the wall& the ground, eating of the bone and feces. 5- Animal posture: it means the standing position of the animal. *Abnormal posture: - Abduction of elbow & extension of head and neck in cattle: indicates traumatic pericarditis or pleurisy. - Sternal recumbence: indicates hypocalcaemia (milk fever). - Frog like position (the 2 hind legs extended & reach the elbow) indicates bilateral hip dislocation (obturator nerve paralysis) -Dog setting position in horse: indicates gastric dilatation. - Arching of back, kicking at belly & periodical rolling in horse: indicates abdominal pain (colic) - Shifting of the weight from one limb to other in horse: indicates laminitis N.B/ kyphosis: it means dorsal bending of the vertebral column. Lordosis: it means ventral bending of the vertebral column. Scoliosis: it means lateral bending of the vertebral column. 6- Gait: it means the manner of walking of the animal. * Normal gait: straight direction. * Abnormal gait: - Walking in circle: listeriosis, pregnancy toxemia, otitis media, coenurus cerebralis and estrus ovis in sheep. - Stiffness of the movement& rigidity of the muscle: tetanus - Circumduction of the limb (weaving): shoulder rheumatism - Knuckling of the fetlock: nerve paralysis and white muscle disease - Ataxia (in coordination of the movement): cerebello-vestibular disease - Stumbling gait: arthritis& laminitis 7- Skin coat * Normal skin: shiny, smooth, elastic& has no corrugation or wrinkling * Abnormal: - Alopecia: zinc def., mange, ring worm…etc. -Wrinkling & loss of elasticity: indicates dehydration. - Dry, rough, lusterless, indicates nutritional deficiency. - Greasy hair: indicates seborrhea. - Hyperkeratinization of the skin (hyperkeratosis or parakeratosis) - Steely wool in sheep: indicates cupper deficiency. - Hyperkeratosis or parakeratosis: indicate nutritional deficiency of vitamin A or zinc 8- Respiration (type, count & depth) * In ruminants: abdominal respiration (so each raising & dropping of flank region considered one respiratory cycle. *In equine: costoabdominal respiration (so each raising & dropping of chest and abdominal muscles) considered one respiratory cycle. * In dog & cat: costal respiration (so each raising & dropping of costal muscles (considered one respiratory cycle). 9- Any discharge from natural orifices of body * Present or not. * If present you must determine its location (nasal, buccal, vaginal and lacrimal) * If present you must determine its nature (serous, mucoid, mucopurlant, purulent or bloody) *Also determine its volume (copius or scanty) *Also determine its site (unilateral or bilateral) 10- Prehension of the food Cattle: by tongue, equine: by lips, sheep& goat: by incisors and lips, Dogs: by canine if solid food& by tongue if liquid. * Any deviation from this normal state indicate lesion in the organ of the prehension. e.g: cattle: when eat by lips (there is lesion in the tongue as inflammation or vesicles) Equine: when eat by the tongue (there is lesion in the lips as vesicles) 11- Act of defecation & urination (a) The defecation: * Frequency of defecation: increase or decrease * Character of the feces: soft as in case of diarrhea or firm as in case of constipation. * Act of defecation: Normally in cattle: raising of the tail& abduction of the hind leg It may be (a) easy as in case of diarrhea or (b) difficult + Straining as in case of constipation. (b): The urination You must determine the normal act of urination (according to the species) then determine if there is any deviation from the normal pattern or not. E g: * Painful urination associated with frequent urination, arching of the back & grunting sound (in case of cystitis & uretheritis). * Constant dribbling of the urine (in case of partial urethral obstruction) *Difficult urination (in case of complete obstruction of the urinary passage with calculi)  2- Physical examination The physical examination of animal is performed by means of the senses of vision, touch and hearing. This physical method includes the following: (1) Inspection (discussed previously) (2) Palpation * It is the method of determination the nature of tissue by application of light finger pressure to the body surface * Method of application: 1-Direct palpation (direct contact): by means of tips of finger or fest of hand 2-Indirect palpation: by means of probe this to avoid transport of skin lesion N.B/ - During palpation the animal should be kept in standing position - Palpation of internal organ can be performed efficiently in small size animals - Rectal palpation helps in detection of abnormalities of abdominal and urogenital organs * Items of palpation 1) Consistency of the organ A- Resilient (return of organ quickly to its normal consistency after removal of pressure). e.g.: normal constancy of rumen B- Doughy (by pressure there is an impression of finger on the organ e.g.: ruminal impaction S/c edema c- Firm (resist the pressure) e.g.: liver initial stage of abscess D- Hard (have bone- like consistency) e.g.: bone – liver cirrhosis (abnormal) E- Fluctuating (wave like movement produced by application of pressure) e.g.: haematoma & abscess (ripping) f- Emphysematous (crepitating or crackling sound) This due to accumulation of gases under the skin e.g.: s/c emphysema 2) Temperature of tissue *acute inflammation (local rise of temperature) *chronic inflammation (normal) *cold temperature of limb indicates gangrene. 3) Sensitivity (tenderness): Application of pressure leads to induction of pain as in case of pleurisy and pericardtitis. 4) Examination of pulse. (3) Percussion: * It means striking on any part of the body with a short below to enable the underlying organs to vibrate & produce an audible sound. -The percussion must be applied on a hollow organ. -The percussion is impracticable neither in sheep due to wool nor in pigs due to increased sub / cut fat. -The percussion sound is modified due to any abnormalities in the underlying organ. *Methods of percussion: 1-Direct method (finger – finger method) -Used in small animals by using both hands. -Place the middle finger of one hand on the animal & striking on it by the middle finger of the other hand. 2-Indirect method which used in large animals by using plexor & pleximeter, the pleximeter is fixed on the skin of animal and striking by the plexor. *Precautions: 1) The animal must be fixed and well secured. 2) The pleximeter is firmly fixed against boy surface so that no air space present between the pleximeter & the skin of animal. 3) The pleximeter or middle finger is placed on the intercostal space. 4) The hand using the hummer must be at higher level than the hand holding the pleximeter. 5) The movement of percussion hummer should come from the wrist, not from the elbow or shoulder. 6) The plexor should be made perpendicular to the pleximeter. 7) Percussion should be performed in a systemic manner (vertical & horizontal) *Sounds produced by percussion: a) Resonant sound: the sound which emitted when percussion on organ containing air. e.g.: lungs b) Tympanic sound (drum sound) this sound emitted from an organ containing gas under pressure e.g; sinus, rumen and cecum. c) Dull sound: this sound emitted from solidified organ contains no gas. e.g; liver, heart, bone, impacted rumen. (4) Auscultation: It means listening to the sound produced by the functional activity of the organ such as lungs, heart, trachea, rumen & intestine. *Methods of auscultation: 1-Direct method: is preformed by placing the ear in contact with the body surface over the organ to be examined. This method may be used in small animals, but it has also disadvantages such as: -Possibility of infection. -Presence of space between the ear & the skin. -difficulty of close contact with restless animal 2-Indirect method (for small & large animals) by using medical stethoscope which consist of chest piece connect to 2 ear – piece by rubber tube. N.B / avoid auscultation in air draught area, under stress factor, noisy place.