Clinical Examination of Animals

1. Clinical Examination of Animals US 5179 and refer to NZVA Guide to Standard Procedures

2. Clinical examination • Performed to determine the patient’s general condition. All findings must be recorded

3. Parts of the examination • Systematic (top to toe / nose to tail) approach so that nothing is missed. • The main parts of the examination are: • Collection of history from owner • Physical examination • A) Distant • B) Close

4. History • Name • Age • Species, colour and breed • Sex and if neutered • State of Oestrus/Pregnancy • General health • diet, • past medical problems, • vaccinations • current weight (and has it changed recently)

5. History • They can’t speak – so the owners have to speak for them…. Find out what they think is wrong…if anything! • Prompt the owner – ASK about specific issues (change in water consumption, for instance) that they might not otherwise bring up or think about.

6. History- what is useful to know? • Past history, e.g. Vaccinations, previous illness? • Nutrition e.g. is the animal eating, what is being fed? • What signs? Any vomiting, diarrhoea, coughing, sneezing, skin abnormalities? How long have these been present? • Breeding history- any litters?

7. Approximate Age • Be able to identify the patient as either: • Juvenile- under 1 year • Adult 1yr to 7 • Senior 7+

8. Gender/Sex • Be able to identify the patient as either: • Male • Female

9. Distance examination • Species and BREED • You should be able to identify common breeds, or tactfully obtain this information from the owner.

10. Distant Examination Watch them as they approach you or while in a cage….

11. Temperament & Demeanour Temperament –timid or aggressive Demeanour – bright and alert or dull and depressed?

12. Temperament • Good • Bad

13. How would you approach these dogs?

14. Demeanour – some terms • Demeanour • Happy and relaxed • Anxious but approachable • Aggressive • Alert or lethargic • Normal • Alert • Bright • Responsive • Relaxed • Comfortable • Abnormal • Dull • Depressed • Unresponsive • Tense • Restless

15. Demeanour

16. Posture • Recognise abnormal posture and why is it abnormal. • E.g. Reluctance to lie down • Causesinclude pain, anxiety, dyspnoea • Praying position • E.g. sternal recumbency with the forelimbs extended and slight elevation of the abdomen. • Causes include abdominal pain.

17. Gait • Recognise lameness, and identify which is the affected limb.

18. Abnormal and obvious injuries • Recognise any abnormalities such as head tilts or obvious injury. • Use correct anatomical terms and classification of wounds/ haemorrhage etc.

19. Body Condition • This shall be described as: • Emaciated • Within normal range • Obese • With long coated breeds, this should be done as part of the closer examination once distance observation is complete.

20. Body Scoring

21. Emaciated…Too thin What Body Score on 1-5 scale?

22. State of body coat • Be able to make accurate observations, without attempting diagnosis e.g. • Matted • Shiny • Greasy • Excessively scurfy (dandruff) • Areas of alopecia (baldness and hair loss)

23. Vision and hearing • Observe the patient for any signs that vision or hearing may be impaired such asdifficulty negotiating objects or lack of response to loud noises.

24. Respiration Rate • Respiration Rate as breaths/minute and “character” – shallow or deep etc. • This is ideally taken from a distance when the patient is at rest or relaxed. • It should not be taken whilst the patient is asleep, panting or overexcited.

25. Respiration rate • One respiration is regarded as one inspiration and one expiration; you may count either inspiration or expiration. • Assess how deep it is and note any difficulty or noisy breathing. • Can be counted by careful observation of the patient or by gently resting the hands on either side of the thorax.

26. Respiration rate • The patient’s respiration rate shall be taken over a period of one full minute and recorded as “respirations per minute”. • Normal rates are: • Cat : 20 – 30 /min • Dog : 10 – 30/ min Note – panting is common in dogs, but not in cats.

27. Abnormal respiration • Dyspnoea - difficulty in breathing • Apnoea – absence of breathing

28. Close Examination

29. Hands on examination • A routine is important when conducting a clinical examination and it should be consistent with all patients. • The exam should begin at the head and work back to the tail. • Begin at arms length, evaluating that both sides of the body are the same (symmetry) or looking for any obvious abnormalities.

30. The Nose • Normal:  Moist and clean • Note the nature of any discharge and whether one side (unilateral) or both sides (bilateral) • Abnormal: • Dry or cracked • Nasal Discharge • Bleeding • A moist, clean nose is a sign of a healthy dog or cat. • Note that dry hot weather can dry out noses

31. Mouth • Including teeth / mucous membrane colour and capillary refill time

32. Teeth • Condition or absence of teeth • Presence of any deciduous (baby) teeth • Amount of tartar present (mild , moderate, heavy) • Presence of gingivitis (inflamed gums) or infection (absent, mild, moderate, severe) • Presence of halitosis (bad breath)

33. Lips • Including lip folds for any dermatitis

34. Mucous Membrane Colour (MM) • The MM colour is checked using the gums. • Comment on the colour and moistness of the membranes and see if they are within normal limits.

36. Mucous Membrane Colour Pale –anaemia, shock Blue (cyanosis) - shortage of oxygen

37. MM colour • Brick red – • Causes include early shock, hyperexcitability, sepsis, fever. • Yellow (jaundice) - (picture shows a horse) • Causes include liver or blood disorders • Red/brown spotting – usually a sign of clotting or bleeding disorders caused by a platelet disorder, or Rat bait/warfarin poisoning

38. Capillary refill time (CRT) • Press gently on gums • The capillary refill time is the time taken for the blanched area of gum to return to the same colour as the rest of the gum. • Normal capillary fill time is less than 2 seconds.

39. Eyes Note any redness (conjunctivitis) Describe any discharge. Watery or dry? Mucous or pus?

40. Ears • Inspection of vertical canal for excessive wax or discharge, smell or inflammation (redness) • Examination of pinnae (outer ear)

42. Sub Mandibular • Prescapular • Axillary • Inguinal • Popliteal Lymph Nodes

43. Lymph Nodes • Always feel both sides of these at the same time to compare where possible • Sub mandibular

44. Lymph nodes - cranial Pre scapular Axillary

45. Forelimbs • Feet/paws • Nails/claws

46. Thorax (chest) Back (Dorsum) and Spine • Wounds • Lumps • Areas of pain

47. Hydration • Check the state of hydration • by checking the skin tenting time across shoulder blades • check how moist mucous membranes are • any sunken eyes?

48. Skin and coat • Any matting • Excessive scurf • Alopecia • Greasiness • Other – flea dirt

49. Heart rate • The heart is recorded as “beats per minute” • The heart rate may be taken over 15 seconds and multiplied up to give a “beats per minute rate” • The rhythm of the heart (e.g. weak, strong, regular, irregular) should also be assessed.

50. Pulse rate • The patient’s pulse rate is taken from a suitable artery, e.g. femoral artery and recorded as a “beats per minute” rate. • Count for 15 or 30 seconds and multiply to get the “per minute” rate. • The character and rhythm of the pulse (e.g. weak, strong regular, irregular) should also be recorded.