The structure of the small animal consultation.

OBJECTIVES: To analyse the structure of small animal consultations in order to increase understanding of the consultation processes, locate decision-making in the wider practice context and stimulate further research. METHODS: Analysis of 48 video-recorded consultations from first opinion small animal practices. These consultations were time and thematically coded in order to enable analysis. RESULTS: The mean length of the recorded consultations was 11 minutes and 45 seconds with a range of 4-28 minutes. Analysis indicates that both the clinical tasks and communication taking place in the consultation are often performed in an iterative and interactive fashion in contrast to the sequential methods frequently being taught. CLINICAL SIGNIFICANCE: This study shows that the consultation is a complex process that is often performed in an iterative and interactive fashion and that may be difficult to complete within the 10 minutes frequently allocated. This warrants further research.

Routine health screening: findings in apparently healthy middle-aged and old cats.

STUDY RATIONALE: Veterinary practitioners often perform geriatric health screening in cats. Unfortunately, scientific information regarding clinical and laboratory abnormalities and normal blood pressure values in elderly cats is scarce. This prospective study evaluated routine health screening tests in apparently healthy middle-aged and old cats. PROTOCOL: One hundred cats of 6 years and older underwent blood pressure measurement, physical examination, blood and urine analysis, indirect fundoscopy and bilateral Schirmer tear tests. FINDINGS: Mean systolic blood pressure (SBP) was 133.6 ± 21.5 mmHg. Increased SBP (>160 mmHg) was observed in eight cats, submandibular lymphadenopathy in 32, gingivitis in 72, heart murmur in 11, thyroid goitre in 20, increased creatinine in 29, hyperglycaemia in 25, increased total thyroxine in three, feline immunodeficiency virus positivity in 14, crystalluria in 41, borderline proteinuria in 25 and overt proteinuria in two. Mean tear production was very similar for both eyes and none of the cats had ocular lesions secondary to hypertension. CLINICAL SIGNIFICANCE: Old cats (>10 years) had significantly higher SBP, heart rate, murmur frequency, thrombocyte count, urine protein:creatinine ratio and serum urea and bilirubin concentrations, and significantly lower body condition score, haematocrit, albumin and total calcium concentrations than middle-aged cats (6-10 years). The common occurrence of physical examination and laboratory abnormalities in apparently healthy old cats underlines the need for regular health checks and the development of age-dependent laboratory reference intervals.

An approach to imaging algorithms for equine lameness diagnosis.

Tremendous growth and advancement in equine diagnostic imaging necessitates a systematic approach to the application of these modalities to lameness diagnosis. This systematic approach must include attention to the history, physical and clinical examinations, and parameters set forth by the client. It also must include an understanding of which imaging modality is most appropriate given the details of the case. This article presents a basic framework with an underlying algorithmic foundation that can be applied when selecting imaging modalities during lameness evaluation and includes case examples demonstrating application of the approach.

[Examination of horses with acute colic: clinical and legal aspects]. / Untersuchung des akut kolikkranken Pferdes - klinische und forensische Aspekte.

The article provides hands-on advice and scientific background information regarding the management of the equine acute colic patient. It summarizes essential information on the patient's history, clinical examination, and legal aspects. The scope of the history is based on the clinical appearance of the patient. In horses with violent and barely controllable signs of pain, it is limited to colic-associated information such as onset, course and severity of colic signs, and the last time of defecation, as well as prior therapeutic intervention. In these patients, the clinical examination is focussed primarily on the assessment of cardiovascular parameters, rectal temperature, and the patient's behaviour. The nasogastric intubation is an essential part of the examination of a horse with colic to prevent a gastric rupture due to gastric distension. Transrectal palpation is equally important and should always be performed unless there are important reasons to object to this procedure. In most cases, a thorough patient history and clinical examination of an acute colic patient allows the examining veterinarian to make a tentative diagnosis and a prognostic evaluation. This helps with the decision to start a conservative or a surgical therapy. Due to the existing obligatory documentation requirement and the duty to inform patient owners, it is of utmost importance to promptly document one's findings, therapeutic measures, consultations, and information of the patient owner in written form. This supports further therapy and it can also be of relevance in a potentially resulting lawsuit.

Acute pancreatitis attributed to dietary indiscretion in a female mixed breed canine.

A female, mixed-breed dog was presented with signs of abdominal discomfort and vomiting of 24 h duration following an episode of dietary indiscretion. Clinical signs, previous medical history, and diagnostic tests supported a diagnosis of acute pancreatitis. Specific and supportive treatment was instituted, and clinical signs resolved 10 d after presentation.

Long-term outcomes of thigh circumference, stifle range-of-motion, and lameness after unilateral tibial plateau levelling osteotomy.

Our study evaluated thigh circumference (TC), stifle range of motion (ROM), and lameness in dogs one to five years after unilateral tibial plateau levelling osteotomy (TPLO). We hypothesised that TC, stifle ROM, and lameness would not be different to the unoperated limb (control), one to five years after surgery. Patients that were one to five years post-TPLO were reviewed and were included if they had a unilateral TPLO, and no additional clinical evidence of orthopaedic disease. Standing mid-thigh TC measurements and stifle extension and flexion angles were made in triplicate. Clinical lameness was graded blindly. Data were evaluated statistically using paired t-tests for TC and stifle flexion and extension. Significance was set at p <0.05. Twenty-nine dogs met the inclusion criteria. Mean results for the surgery limbs and control limbs were 39.5 +/- 5.5 cm and 40.1 +/- 5.6 cm for TC, 36.6 +/- 6.8 degrees and 28.6 +/- 4.3 degrees for stifle flexion, and 155.2 +/- 6.6 degrees and 159.8 +/- 4.9 degrees for stifle extension, respectively. The mean TC for the operated limb was 98.5% of the control limb. A significant difference was found between the operated and the control limbs for all measurements. Time after surgery had no apparent affect on outcome. Four of 29 dogs (14%) exhibited some lameness in the TLPO limb during evaluation (one dog was 1 to 2 years postoperative and three dogs were 2 to 3 years postoperative). These results indicate that TC and stifle ROM in the TLPO limb do not return to control-limb measurements one to five years after a TPLO surgery. The clinical significance is unknown as TC returned to 98.5% of control, and the source of lameness in the lame dogs was not identified.

A practical approach to diagnosing and managing ear disease in dogs.

Entire books have been written on the subject of canine ear disease. Rather than attempt to present all the available information here, I am providing an overview of how I diagnose and manage ear disease in dogs. It is critical to appreciate that ear disease is only a clinical problem (no more specific than pruritus) and that steps must be taken to prevent otitis externa from progressing to proliferative otitis. BOX 1 summarizes step-by-step approaches to specific clinical scenarios.

The diagnostic approach to fever of unknown origin in cats.

Fever is a common clinical sign in cats, but its cause is not always apparent. This article presents a thorough overview of physical examination findings and diagnostic tests that can help guide diagnosis of the underlying condition.

Diagnostic sampling and establishing a minimum database in exotic animal toxicology.

A toxicologic diagnosis is based on knowledge of the circumstances surrounding a particular case, knowledge of the clinical symptomatology, receipt and evaluation of proper specimens by a qualified laboratory, and judicious interpretation of the laboratory results. Failure to have all necessary ingredients can result in a wrong or missed diagnosis. Many veterinary toxicology laboratories can detect suspected toxicants in feed, tissue, and environmental samples at extremely low concentrations. The ability to detect toxicants at such low levels has often outpaced the ability of the diagnostician to interpret the analytic findings. This article provides guidelines for acquiring a good history, collecting appropriate samples for analysis, and selecting a veterinary analytic laboratory to maximize the probability of making a correct toxicologic diagnosis.

Toxicology of ferrets.

Because of their curious nature and small size, ferrets are at risk for various toxicoses. At present, there is not a great deal of information on specific toxicants in ferrets. This article initially reviews general consideration in treating poisoning in ferrets, such as obtaining history and decontamination. It then discusses some specific agents that appear to be common causes of poisoning in ferrets based on the experience of the ASPCA Animal Poison Control Center.

Poisonings in reptiles.

Reptiles are increasingly being kept as pets in American households. The basic principles of emergency medicine are the same for all species, but reptilian species present special diagnostic challenges to veterinary clinicians when they become ill. Reptiles in captivity can become accidentally poisoned in a variety of ways. Veterinarians treating small animal emergencies must make an effort to familiarize themselves with the large body of literature and resources that are developing regarding both nontraditional exotic companion species and advances in toxicology.

Approach to the respiratory patient.

Several challenges arise when evaluating a dog or cat with respiratory disease. The history can span a long period, and some owners may have a difficult time in recognizing or describing respiratory abnormalities. A good history and thorough physical examination are essential when evaluating the respiratory patient. There are some noninvasive diagnostics that can aid in the diagnosis of respiratory disease; however, other more invasive tests often require anesthesia, which can be a potential hazard with a respiratory patient. This article focuses on reviewing the function of the respiratory system and how best to identify and diagnose cats and dogs with respiratory disease by implementing a thorough history and physical examination as well as appropriate diagnostic testing.

Fine tuning the history and physical examination: correlations with miscellaneous techniques.

It may be unusual to think of a physical examination as a technique, but what better "instruments" do we have than our eyes, our ears, and our hands? Therefore, I will describe several "techniques" that I felt should be included in this journal, but that do not warrant an article of their own. This article will cover some parts of the routine physical examination, correct positioning of cats and consequences of bad positioning, radiographic techniques that will help diagnose heart failure more consistently, examination of dogs with lower airway disease, and examination of cats with aortic thromboembolism (ATE). Several "pearls" that may get lost in the other information is sprinkled throughout the article.

Animales envenenados: La experiencia de diez años del Servicio de Toxicologia de la Universidad de Murcia / Animals intentionally poisoned: the 10-year experience of the toxicology service of the University of Murcia

Se revisan los datos seleccionados de 10 años de análisis químico toxicológico realizados en el Servicio de Toxicología de Murcia (España), por la sospecha de envenenamientos en animales domésticos y silvestres. De los 123 casos seleccionados y confirmados como intencionados, se pudieron analizar 102 de los cuales 50 fueron positivos a envenenamiento, con un balance de 107 animales muertos. Plaguicidas, sobre todo insecticidas (72 por ciento) y rodenticidas (26 por ciento), fueron los más frecuentemente involucrados. Aldicarb (n=15), rodenticidas anticoagulantes (n=8) y estricnina (n=4) fueron los tóxicos más utilizados en la preparación de cebos para envenenamientos; también se encontró carbofurano, metomilo, endosulfán o paraquat. Siete de los nueve Laboratorios de Toxicología de las Facultades de Veterinaria de España coinciden en señalar que la creación de una red coordinada de colaboración entre dichos centros, mejoraría la calidad de los servicios ofertados. (AU)

Diagnostic toxicology for the food animal practitioner.

In most competent veterinary diagnostic laboratories, analytic findings are interpreted by a veterinary toxicologist to determine the significance of the finding in light of historical, clinical, and pathologic findings. A veterinary toxicologist also provides consultation about possible toxic rule-outs for a case, treatment of affected animals, and prevention of additional cases. Once all of the information is available, a complete summary of the findings can be provided to the client. When the procedures outlined herein are followed, including a systematic approach to collecting all the evidence (historical, clinical, pathologic, and analytic), using proper sampling techniques, and maintaining good communication among the clinician, client, and laboratory, the usefulness of the toxicology investigation is maximized.