CHAPTER 16 Testing Physical Examination Terms Physical Examinations

CHAPTER 16 Testing

Physical Examination Terms Physical Examinations are performed to assess a patient’s condition. Medical Records are important written documents. � assessment = evaluation of a condition � an examiner's evaluation of the disease or condition based on the patient's subjective report of the symptoms and the patient's subjective report course of the illness or condition and the examiner's objective findings, including data obtained through objective findings laboratory tests, physical examination, medical history, and information reported by family members and other health care team members signalment = description of the animal example of a signalment: 12 -yr-old, F/S DLH 2 -yr-old Arabian colt 4 -mo-old barrows

Bell Work Monday, Feb 3 What do the following abbreviations stand for? MM CRT HR RR PE

� History obtaining information useful in formulating a diagnosis and providing medical care to the patient. Signalment Chief complaint (what is wrong) Duration of complaint (how long) Past medical problems Medications (including OTC, Holistic herbs, Supplements) Diet Review of all organ systems (brief or extensive? )

Vital Signs Vital signs are parameters taken from the animal to assess its health. � Temperature (T) febrile versus afebrile pyrexia Hypothermia � Pulse (P) Weak (heart failure, low blood pressure, shock) Strong Bounding, Regular, Irregular � Where measured: Rectal vs ear canal vs other? Where measured: femoral artery most common Respiration (R) Fast (panting) Labored (increased effort to breathe-heart disease/ can’t get enough oxygen) Abdominal (pleural effusion-lungs are impaired) How measured

Vital Signs Heart Rate � Too high � Too low � Rhythm- irregular � Sounds – whooshing, muffled, non existant Blood Pressure � Too high/ Too low � Unstable � 150/95 (130 -180/ 60 -95) Systolic/Diastolic � Cardiovascular, renal, ocular pressure

Vital Signs � Mucous Membranes Pink (bubble gum) White – pale Blue – cyanotic Red - (bright red or brick red) Yellow - jaundiced � Capillary Refill Time 1 -2 seconds is normal <1 second (less than 1 second) >2 seconds (greater than 2 seconds) slow, dehydration, shock, poor perfusion

Types of Examination Auscultation � the act of listening to body sounds Heart, gut sounds, lungs Palpation (NOT palpitation!) � examination by feeling Limbs, abdomen Percussion � examination by tapping the surface to determine density of a body area For example, since the heart is not resonant and the adjacent lungs are, when the examiner's fingers strike the chest over the heart the sound waves will change in pitch.

Shock Lack of adequate blood volume to perfuse the body’s tissues. Results can be fatal as multiple organs fail. Symptoms: � Mm = pale, white, gray � Hr=very high (or very low) � Rr=very high or very slow and labored � Difficulty breathing � Pulse is weak and very high � Confusion, stupor, weak, depressed

Examples Blunt trauma � HBC, high rise syndrome Penetrating trauma � Gunshot, knife, stick impalement Poison/toxin Hyperthermia/hypothermia Bloat Massive infection (septic shock)

How shock is treated Shock is called hypovolemic shock decreased blood volume (blood and fluid /plasma) Heart is unable to pump blood to the tissues To correct hypovolemia you must replace the blood /fluid Medications to increase blood pressure � Dopamine, epinephrine, norepinephrine

Determine the order of triage for the following critical cases: 8 yr, M/N dog, HBC. Has a wound in back left leg. MM are pink and the dog is walking. 4 yr, M/N cat. Extremely weak and not walking. Hx of straining in the litter box the day prior and not passing urine. Gums are pink. 2 yr, F/S Golden Retriever. Playing in the backyard and came inside with a swollen face. Difficulty breathing, gums are pale pink. Dog is a little depressed but alert, HR is 120, RR is panting 7 week old Chihuahua puppy. Hasn’t eaten all day. Wobbly when walking, T=99. 9°, mm=pale pink. No hx of vomiting or diarrhea

Instruments used in Physical Exam Stethoscope � Parts of stethoscope Diaphragm Bell earpieces � Auscultating body sounds Heart Lungs Digestive system Borborgamus Ileus

Otoscope � Light and an ear speculum Battery operated � Allows visualization of the ear canal Also allows visualization of other areas

Ophthalmoscope � Used to look at the retina

Laryngoscope � View the pharynx � Assists in lowering epiglottis Access to trachea for intubation

Speculum � Ehances visualization of an opening � Many kinds of specula Ear speculum (“cone”) Mouth speculum

Centrifuge � Spins fluid samples (blood, urine, feces in solution) to separate fluid from heavier solid particles � Should always be a counterweight to balance

Microhematocrit Centrifuge � Small thin tubes of blood � Separates red blood cells (heavier) from the plasma � Hematocrit = Ratio of red blood cells in blood Normal would be >40% Also called PCV

Refractometer � Measure specific gravity of (concentration of solutes) in body fluids such as urine.

Soap: A way to organize Subjective Objective Assessment Plan

Subjective Definition of Subjective � Personal � Opinion � Open to interpretation � Not necessarily facts � Something perceived by someone else (client) This section should capture your subjective evaluation of the animal, herd, or problem, the client’s observations, the client can be asked directed questions about any complaints – current or reportedly resolved -- and ask appropriate follow-up questions and document all responses. (e. g. BAR – bright, alert, responsive; depressed; improving; getting worse, no change, etc. )

Objective Definition of Objective � Facts � Unbiased or uninfluenced by another person including yourself � It is what it is This section is compiled from the physical exam and diagnostic test or procedures; it typically summarizes measurable data (e. g. rectal temperature, blood glucose, echocardiography, etc. )

Assessment Evaluation Judgement This section is an analysis of the subjective and objective data For this component, the veterinarian pulls together the subjective information gathered during the interview with the client and the objective findings of the physical exam (and, possibly, laboratory or other study results) and consolidates them into a short assessment. The assessment portion usually shows processes by which you arrived at a conclusion or diagnosis…Includes “rule outs” Is written very specific and concise

Plan Detailed Decisive Action (or no action) A plan would include anything that will be done as a consequence of the assessment and could include: Laboratory tests, hospitalization, treatment, medications, follow up instructions to client, next appointment

Some videos, PE https: //www. youtube. com/watch? v=LF 1 bd. JYhyo � Animated dog exam https: //www. youtube. com/watch? v=O 6 u. UNm. Zi LZY (30 min long-cow) https: //www. youtube. com/watch? v=gdx 3 Dhmt ad. A � Cow exam For fun (11 min…vet student) � https: //www. youtube. com/watch? v=DTv 7 ABy. GKI 4

Bell Work Monday, Feb 10 An example of a subjective component of a SOAP would be: An example of an objective component of a SOAP would be: The assessment portion would include: The plan would include:

Tomorrow: Tuesday in the Lab You might want to bring an old shirt to cover clothing There will be a short worksheet-You will need to have a pen or pencil Be aware that you may need to assist a classmate if they unexpectedly get ill… Be interested! Not grossed out! Yes, stuff smells, but you may never see the inside of a cow stomach again!

Bell Work Tuesday, Feb 18 What is a disease? What makes it a disease? Name some animal diseases.

Pathogenic Organism and Disease Terms Pathogen � microorganism that produces disease A living organism of microscopic dimensions Not all microorganisms are pathogens The microorganism in the pictures is not a pathogen-does not produce a disease, in fact…

Pathogenic Organism and Disease Terms Disease � deviation from normal infectious disease noninfectious disease contagious (communicable) disease iatrogenic disease idiopathic disease

Koch’s “germ” Theory (simplified) Defines an infectious disease � The infectious agent should be detectable in sick animals but not healthy animals � It should be possible to isolate and culture (grow) the organism � Organisms taken from the culture and introduced into a healthy animal should cause the same disease � The same organism should be isolated from the second animal as well

Infectious Disease Caused by microorganisms that gain entry into the animal’s body How does a microorganism gain entry? � Transmission Bloodborne – blood/ body fluids Airborne – respiratory droplets Fecal-oral transmission – eating, drinking, licking contaminated food, water, objects Vector-borne- bloodsucking arthropods (insects such as mosquitoes, ticks, mites) that carry the disease from one to another Direct contact

Bell Work Wed Feb 19 True or False � A pathogen is a microorganism that produces disease. True � Not all microorganisms are pathogens. True-example of microbes in rumen � Transmission has to do with whether or not a disease is disease. False-transmission has to do with how a microorganism gains entry � According to Koch’s Germ Theory (aka Koch’s Postulates) a healthy animal could become sick if a pathogen from a sick animal were introduced into the healthy animal. True

Assignment: due Wed Feb 19 Find an example of each of the following: A bloodborne disease (keyword-secretions) � Felv, FIV, FIP, Canine Herpesvirus (CHV), An airborne disease � Kennel Cough, Feline Viral Rhinotracheitis A vector-borne disease � Heartworm, WNV, (Hantavirus, plague-animals as vectors) A disease transmitted by the fecal- oral route � Parvovirus, roundworms, Cryptosporidosis Direct contact- touch, bite, scratch � Anthrax, coronavirus, mersa

Bloodborne disease Definition: Disease-producing microorganisms transmitted by means of blood, tissue, Definition: and body fluids containing blood Blood borne transmission is also considered Direct (or Indirect Contact? ) Could be Droplet? Transmission of Pathogens Potential exposure occurs through contact with blood, bloody saliva, vaginal secretions, semen, and other potentially infectious bodily fluids. Sources of Infection Pathogens can be transmitted through open cuts, blisters, sores, acne, body piercings, new tattoos, amniotic fluid, joint fluid, brain and spinal cord fluid, fluid from around the heart, and body cavity fluid. Example: Hepatitis B and C in humans FIV, FIP, Fe. LV

Contagious vs Noncontagious Contagious diseases are spread animal to animal Contagious diseases are also called communicable diseases and are spread through direct or indirect contact � An inanimate object that is contaminated with a contagious disease is called a “fomite” Fomites are sources of infection for other animals Water and food bowls, kennels, clothing and shoes Not all infectious diseases are contagious � Tetanus

Infectious Diseases 4 classes of agents (an agent is something that produces an effect) � Bacterium/Bacteria � Virus/Viruses � Fungus/Fungi � Parasites

1. Bacteria Staphylococci- (cocci means round) – round, clusters � Streptococci-round, chains � Leptospirosis Endospore – oval body inside, resistant � anthrax Spirochetes – spiral � Strangles Bacilli – rod shaped � Skin infections, wounds, food poisoning clostridium Rickettsia –rod shaped, small � ehrlichia

Examples of Infectious Bacterial Diseases Swine � Yersinia � � (Snuffles) � Tuleremia (vectorticks, flies) E Coli Mastitis Anthrax Canine � Leptospirosis (Lepto) � Ehrlichiosis (Tick Fever) � Bordatella Bronchiseptica (kennel cough) Rabbit � Pasteurella Cattle � Horse � Tetanus � Strangles Cat � Enteritis � Cystitis

2. Examples of Infectious Viruses Cattle � Bovine Viral Diarrhea (BVD) Cats � Feline Panleukopenia � Calicivirus � Feline Leukemia Virus � Feline Immunodeficiency Virus Rabies - Rabies most warm blooded animals Dogs � Parvovirus � Distemper Horses � West Nile Virus � Equine Encephalomyelitis

Bacteria vs viruses Is a living cell Prokaryote cell – No Nucleus Made up of cytoplasm, DNA, ribosomes, flagella

Virus Not a living cell! But are considered alive because the reproduce, grow, develop, adapt, use energy sources from their environment Made up of genetic material/ nucleic acid (DNA or RNA) enclosed in a protein shell All sorts of shapes, but are extremely tiny/ cannot see with a regular microscope What about Retroviruses (Feline Leukemia and FIV): � https: //www. youtube. com/watch? v=e. S 1 GODin. O 8 w

Viruses insert their genetic material into a living cell The cell becomes the virus’ host The virus DNA/RNA becomes a part of the cells DNA so that during cell division the virus is being replicated and passed on Eventually the virus’ DNA takes over, completely changes the host cell/ kills it’s host cell and continues to replicate and create lots more viruses

Bacteria/Viruses Ribosomes: Present / Absent Living attributes: Living organism - Opinions differ on whether viruses are a form of life or organic structures that interact with living organisms. Number of cells: Unicellular; one cell / No cells; not living Structures: DNA and RNA floating freely in cytoplasm. Has cell wall and cell membrane / DNA or RNA enclosed inside a coat of protein. Treatment: Antibiotics / Vaccines prevent the spread antiviral medications help to slow reproduction but can not stop it completely. Enzymes: Yes / Yes, in some Nucleus: No / No Virulence: Yes / Yes Infection: Localized / Systemic Benefits: Some bacteria are beneficial (e. g. certain bacteria are required in the gut) / Viruses are not beneficial. However, a particular virus may be able to destroy brain tumors (see references). Viruses can be useful in genetic engineering. Reproduction: Fission- a form of asexual reproduction / Invades a host cell and takes over the cell causing it to make copies of the viral DNA/RNA. Destroys the host cell releasing new viruses. Size: Larger (1000 nm) / Smaller (20 - 400 nm Cell wall: Peptidoglycan/Lipopolysaccharide / No cell wall. Protein coat present instead.

Prions Are proteins Not alive They do not have DNA or RNA They have an ability to reproduce Can cause inherited or transmissible diseases

Prions Prion diseases are fatal and cause progressive, neurodegenerative problems literally, holes in the brain � The brain resembles a sponge / diseases are called spongiform � Examples of spongiform encephalopathies are…. 1) Scrapie…. in sheep and goats 2) BSE …. ”Mad Cow Disease” 3) Chronic Wasting Disease…wild deer and elk Transmitted by inherited disease, or ingested from tissue of infected animals (brain, spinal cord)

3. Examples of Infectious Fungi (mycoses) Dermatophytes (Ringworm) Thrush (? Fungus caused by anaerobic bacteria and mositure) Coccidioidomycosis (Valley Fever) � Blastomycosis (South East) Histoplasmosis Candida (yeast infection)

4. Examples of Infectious Parasites Heartworm (Dirofilaria immitis) Trichinella…Trichinosis Hookworm (Ancylostoma), Whipworm (Trichuris vulpis), Roundworm (Toxocara) Giardia (protozoan) Coccidiosis (protozoan)

Noninfectious Disease Classifications Classifying diseases helps aid the veterinarian in obtaining a diagnosis Helps the diagnostic process Clinical signs and symptoms could be the result of several different disorders � Differential diagnosis-a list of possible causes of disease � Rule Outs-ruling out possible causes of disease through diagnostic testing, observation, trial treatment

Non. Infectious Disease Classifications Metabolic-disruption of normal chemical reactions Metabolic � Anomalies – Congenital Birth Defects Anomalies � Traumatic reticuloperitonitis, high rise syndrome, sucking chest wound, diaphragmatic hernia, peritonitis, prolapsed uterus Toxins - ingestion, inhalation, contact Toxins � DJD (osteoarthritis), Bovine Spongioform Encephalopathy (BSE) Trauma – Trauma � Cleft palate, deaf, retinal dysplasia, dwarfism Degenerative – progressive, permanent, longterm deterioration Degenerative � Diabetes, hypothyroidism, hyperthyroidism, Cushings, Addisons Antifreeze, misapplication of flea and tick products, warfarin (rat poison), toads, OTC medications, illegal drugs, plants Immune � Immune Mediated Hemolytic Anemia (IMHA), System Lupus Erythematosus (SLE) Pruritis and Atopy (itchiness and hairloss) [allergies]

Non. Infectious Disease Classifications Iatrogenic- a condition that develops as a result of treatment � � Idiopathic- no explanation for underlying cause of the disease � � Hyperadrenocorticism (Cushings)- can be caused by treatment for a severe allergy problem Surgery-excision of Thyroid glad to treat hyperthyroidism in cats…parathyroid may also be removed causing iatrogenic hypoparathyroidism. Idiopathic seizures Idiopathic renal hematuria Neoplasm - benign or malignant tumor Nutrition – Nutrition � Acute acidosis in ruminants, malnutrition, skeletal disease, hypoglycemia, obesity

3 SEIZURE CASES Seizure Case 1: A 3 month old male toy poodle. The dog is strictly a house dog and does not run free, In addition to the seizures, it has had intermittent diarrhea and is quite thin. Differential Diagnosis (Df. Dx): Developmental Disorder- brain malformation Hypoglycemia-could be secondary to poor diet, diarrhea, intestinal parasites Head Trauma- not likely with indoor dog Toxins-potential for ingesting medications or illegal drugs, chocolate Infectious causes of encephalitis- Distemper Idiopathic epilepsy-very unlikely due to age of dog

Seizure Case 2: A 2 ½ year old male golden retreiver. This dog is in excellent physical condition and has been eating well. This dog is free to roam the neighborhood and recently had one episode of vomiting and one episode where it was limping and stiff. Dx: Idiopathic epilepsy-this is high on the list because of age and breed of dog at the onset of seizures. Head Trauma-the recent limping and stiffness raises this possibility Toxins- the list is long, but possibilities include insecticides, chocolate Liver Disease-definitely needs to be ruled out but dog has been doing well otherwise Infectious Encephalitis

Seizure Case 3: A 14 year old female schnauzer. This dog had its first seizure and since that time has not been acting normal. There has been some weight loss and a poor appetitie, and the owners feel the dog can no longer see. The dog is strictly an indoor dog with no history of trauma. Df. Dx: Metabolic Disease-liver dx, hypogylcemia (insulinoma in the pancreas), Diabetes Neoplasia- the age of the dog, the blindness, lack of normalcy after the seizure make this a high likelihood Ideopathic epilepsy-very unlikely with the age of the animal

Pathogenic Organism and Disease Terms Disease terminology � Transmission- how pathogens gain entry � Morbidity versus Mortality Morbidity- diseased animals Mortality –diseased animals that die Moribund – near death Prevelance - amount/ number of diseased at a given time (within a population) Susceptibility – lacking resistance

Noscomial Infections � Noscomial- hospital (clinic) acquired infection Noscomial Nosocomial infection—An infection occurring in a patient in a hospital or other healthcare facility in whom it was not present or incubating at the time of admission; or the residual of an infection acquired during a previous admission. Includes infections acquired in the hospital but appearing after discharge, and also such infections among the staff of the facility. (Synonym: hospital-acquired infection Hygiene, cleaning, disinfecting, antimicrobial, infection control, isolation Often resistant type, ex: MRSA, Highly contagious potential for fatality ex: Parvovirus, Distemper, respiratory viruses

Prophylaxis � Prophylaxis-prevention of disease and spread of Prophylaxis disease Environmental-ventilation, cleanliness of facilities, insects, cleanliness of objects (preventing fomites), bedding, pens Health/ Nutrition (healthy animals remain resistant to most diseases) Stress releases cortisol and epinephrine/lower immunity Overcrowding, feeding frenzy, climate, noise, rough handling Minimize exposure or susceptability to pathogens Vaccinations-increase animals immunity Pets vs Herd, value/costs, allergic reactions, fibrosarcoma Testing prior to obtaining Quarantine (incubation)

Zoonosis Zoonosis-disease that can be transmitted between Zoonosis animals and humans Hosts Vectors (carry) Sentinels (watch/ warn)

Zoonoses � Zoonosis-disease that can be transmitted between Zoonosis animals and humans (under natural conditions) How? Exposure of human to the infection of the animal If an animal has a disease and a human could get it, the disease is said to be zoonotic 1. 2. 3. Transmission may occur through Direct contact with the animal Through a vector such as fleas or ticks Through food contamination Most at risk: young or immune suppressed (sometimes old), also occupations that require working with diseased or possibly diseased animals…such as veterinarians, lab researchers, farmers and ranchers, slaughterhouses

Examples Avian Flu � Transmitted by direct contact with infected birds/poultry � In birds symptoms are illness, decreased production, death � In humans typical flu syptoms, can be severe enough to cause death � At risk population Backyard flocks Poultry business Veterinarians

Examples Visceral Larva Migrans (larva of roundworms) Fecal-oral transmission In animals (dogs) worms can invade the liver, the lungs, the uterus…parasitic and rob the hosts food In humans the larvae migrate through body tissues-lungs, liver, eyes Dog, cat, racoon is host eggs pass through intestines, dogs ingest (cycle) Zoonosis occurs when larvae are unknowingly “consumed” by humans

Host A host is a person or other living animal that contributes “food and lodging” to an infectious agent. *Primary host/ definitive host- organism / parasite gains maturity *Secondary/intermediate host- organism/parasite is in a larval stage *Transport host/ Vector – a carrier in which the organism remains alive but does not develop Example of a disease with an intermediate host: Neospora Caninum coccidian parasite that causes disease in cattle: Definitive host is dog/ coyote/ fox, intermediate host is cattle: Oocysts in feces from dogs, cattle graze, oocyst finish in cattle

Vector / Carrier A vector is a carrier, especially the animal that transfer an infective agent from one host to another � Example: Heartworm Disease Vector is the mosquito Carries the infective agent from one dog to another dog The dog is a host to Heartworms because the Heartworm completes its growth cycle in the dog Carrier does not become infected-no sign/symptoms of infectious disease (the mosquito does not get Heartworm Disease)

Zoonosis Rabies Ringworm Toxoplasmosis � Cats are host Oocysts (“eggs”) pass through intestines Oocysts are ingested-toxoplasma organisms can invade brain, fetus (pregnant women) Infected cats infect other animals –oocysts form cysts in muscle tissue-if food animal, human can become infected Cats become infected by eating rats

Zoonosis West Nile Virus BSE Anthrax Leptospirosis Bartonella Henselae (bacteria (bacillus) that causes cat scratch fever) Equine Encephalitis Brucellosis Tuberculosis Avian Influenza

Etiology and Epidemiology-study of relationships determining frequency and distribution of diseases � disease etiology, outbreak investigation, disease surveillance and screening, biomonitoring, and comparisons of treatment effects such as in clinical trials. Etiology-study of disease causes/origination � The etiology of scurvy is a good example. With scurvy, sailors going to sea often lacked fresh vegetables. Without knowing the precise cause, Captain James Cook suspected scurvy was caused by the lack of vegetables in the diet. Based on his suspicion, he forced his crew to eat sauerkraut, a cabbage preparation, every day, but he had no idea, precisely, why it prevented scurvy. It was only about two centuries later - in 1926 that it was discovered that it was the lack of vitamin C in

Testing Methods Endoscopy � visual examination of the interior of any cavity of the body by means of an endoscope Centesis � surgical puncture to remove fluid for diagnostic purposes or to remove fluid or gas

Testing Methods Imaging techniques � radiography � computed tomography � magnetic resonance imaging � fluoroscopy � ultrasound