Further Relevant Principal Symptoms
2. General Examination 3. Lymph Node Biopsy
• Cytology
• Leishmania amastigote
• Tumour cytology
• Bacterial/Fungal/Protozoal Culture 4. X-Ray Study
• Thorax
• Abdomen
• Spine 5. Blood Tests
• Hct, Ery, Leuc
• Diff BC (+ Cytology)
• TP, Alb, Glob
• Serum electrophoresis
• GPT, AP, Urea, Crea, BG
• FIP Profi le [Cat]
– TP
– Alb/Glob Ratio – Bili/GOT
– Serum electrophoresis
MICROBIAL SEROLOGY
• FeLV-/FIV Antigen [Cat]
• Toxoplasma Antibodies
• Ehrlichia Antibodies [Dog]
• Leishmania Antibodies [Dog]
• Brucella Antibodies [Dog]
• Lyme Borreliosis Antibodies [Dog]
• Canine Herpes virus Antibodies [Dog]
IMMUNOSEROLOGY
• ANA Test
• Rheumatoid factor 6. Urinalysis
• Urine dip stick
• Specifi c gravity
• Urine sediment
• Bence-Jones Proteins 7. Further Tests
• Bone marrow biopsy/cytology
• Ultrasound
• Arthrocentesis/Synovial analysis
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Oedema, subcutaneous
Extravascular collection of fl uid in subcutaneous tissues
Common Causes
Dog Cat
++ Lymphoedema ++ Lymphoedema
+ Congestive heart failure + Congestive heart failure
Localised Oedema
↑ Hydrostatic Pressure
• Venous Thrombosis
• Tumours (esp Mammary)
• Arteriovenous Anastomosis Disturbance of the Localised Permeability
• Trauma
• Surgical procedure
• Burns
• Cellulitis/Abscess
• Tumours
• Insect bite/sting
• Vaccine reaction
• Snake Venom
• Lymphangitis
• Lymphangioma/-sarcoma Generalised Oedema
↑ Hydrostatic Pressure
• Right Sided Heart Failure
• Biventricular Congestive Heart Failure
• Right atrial/Vena cava Obstruction
– (Dirofi laria sp. [esp Dog])
– (Angiostrongylus sp.
[Dog]) – Tumours – Thrombosis
• Overinfusion in case of Oliguria/Anuria
• Hypoalbuminaemia
↓ Oncostatic Pressure (Hypoalbuminaemia)
• Hepatic cirrhosis/portocaval Shunt
• Exsudative body cavity eff usion
• Cachexia/Marasmus
• Protein-losing enteropathy
• Protein-losing nephropathy
• Burns
Permeability Disturbances
• Septicaemia/Endotoxaemia
• Vasculitis
– FIP Coronavirus [Cat]
– Canine Coronavirus [Dog]
– Septicaemia/Endotoxaemia – Polyarteritis nodosa – Allergy
– Lupus erythematosus
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– Rheumatoid Arthritis – Uraemia
– Tumours
– (Ehrlichia sp. [Dog]) – (Rickettsia sp. [Dog])
• Trauma
• Burns
• Snake Venom Lymphoedema
• Lymphostasis/Lymphatic obstruction
– Trauma
– Infi ltrating Tumours – Lymphangioma/-sarcoma – Lack of exercise
• Congenital aplasia of lymphatic vessels
Myxoedema
• Hypothyroidism [Dog]
Diagnostic Approach Oedema, subcutaneous 1. Case History
2. General Examination 3. X-Ray Study
• Thorax
• Abdomen 4. Blood Tests
• Hct, Ery, Leuc
• TP, Alb, Glob
• GPT, AP, Urea, Crea, BG
• Diff BC
• FIP Profi le [Cat]
– TP
– Alb/Glob Ratio
– Bili – GOT
– Serum electrophoresis MICROBIAL SEROLOGY
• FeLV-/FIV Antigen [Cat]
• Dirofi laria Antigen [Dog]
Ultrasound
• Heart (Doppler Echocardiography)
• Abdomen Further Tests
• Lymphangiography
• Faecal Examination
Sleep Disturbances
Insomnia: Sleeplessness/Nocturnal Unrest
Hypersomnia: Lethargy/Excessive Sleep/Somnolence
Sleep attacks: Bouts of periodically recurring sleeping episodes Syncope: Spontaneous, reversible and short acting loss of consciousness
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Coma: Deep unconsciousness with resistance to external stimuli Narcolepsy: Transient sleep attack (can be aroused)
Cataplexy: Sudden and severe loss of muscle tone
Insomnia
• Congestive Heart Failure
• Arterial Hypertension [esp Cat]
• Respiratory Disease
• Painfulness
• Pruritus
• Hyperthyroidism [Cat]
• Drugs
– Aminophylline – Caff eine – Amphetamines – Vitamin C – Glucocorticoids
• Central nervous Disease
• Seizures
Sleep Attacks
• Narcolepsy
• Cataplexy
• Syncope
• Seizures Hypersomnia
• Systemic Disease
• Chronic Renal Failure
• Hypothyroidism [Dog]
• Central nervous Disease
• Electrolye Imbalance
• Coma
• Shock
• Drugs
– Sedatives/Anaesthetics – Anticonvulsants – Antihistamines
Diagnostic Approach Sleep Disturbances
1. Case History
2. General Examination 3. Neurological Examination 4. X-Ray Study
• Thorax
• Abdomen 5. Blood Tests
• Hct, Ery, Leuc, Hb
• TP, Alb, Glob
• GPT, AP, Urea, Crea, BG
• Na, K, Ca
• Diff BC
MICROBIAL SEROLOGY
• FeLV-/FIV Antigen [Cat]
FUNCTION TESTS
• T4, fT4
• TSH-/TRH Stimulation test [Dog]
• T3 Suppression test [Cat]
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6. Urinalysis
• Urinary output/
volume
• Urine dip stick
• Specifi c gravity
• Urine sediment
Mucous Membrane Colour, abnormal
Alteration of the physiological mucous membrane colour (pink)
Pallor Shock
• Hypovolaemic Shock
• Anaphylactic Shock
• (Septic/Endotoxic Shock)
• Cardiogenic Shock
• Neurogenic Shock Anaemia
• Haemolytic Anaemia
• Blood Loss/Anaemia
• Aplastic Anaemia/Bone marrow failure
• Nutritional Anaemia Red
Ocular Disease
• Conjunctivitis/Keratitis
• Uveitis
• Glaucoma
Other Causes
• Excitement
• Septicaemia
• Polycythaemia
• CO Intoxication Yellow
Icterus/Jaundice
• Prehepatic Icterus
• Hepatocellular Icterus
• Posthepatic Icterus Blue
Cyanosis
• Central Cyanosis – Heart Disease – Respiratory Disease – Pulmonary Disease – Other Diseases
• Peripheral Cyanosis
• Venous Thrombosis
Shock
Life-threatening circulatory failure with hypoperfusion and hypoxic cellular damage as a result of hypoxia
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Clinical Shock Symptoms:
Pale mucous membranes (not with septic shock, not in decompensated shock)
Weak pulse (hypotension) Delayed capillary refi ll time Tachycardia Tachypnoea
Hypothermia (Hyperthermia with septic shock) Low peripheral body temperature
Oliguria Thirst
Hypovolaemic Shock Blood Loss
• Traumatic Organ/ Blood Vessel Rupture
• Epistaxis
• Coagulopathy
• Bleeding Ulcer
• Bleeding Tumour
• Gastrointestinal haemorrhage
• Bleeding Urinary Tract Plasma Loss
• Extensive Burns
• Extensive Wounds
• Protein-Losing Enteropathy (esp Parvovirosis)
• Protein-Losing Nephropathy
• Chronic fi stula
• Eff usion into body cavity Fluid Loss
• Vomitus
• Diarrhoea
• Diuretics
• Fever
• Eff usion into body cavity
Septic/Endotoxic Shock Bacteriaemia
• E. coli
• Staphylococcus sp.
• Salmonella spp.
• Pseudomonas sp.
Risk Factors
• Abscesses
• Urinary Tract Infection
• Bile Duct Infection
• Pneumonia
• Peritonitis
• Pyometra
• Haemorrhagic Gastroenteritis
• Gastric Dilation/Volvulus [Dog]
• Ileus
• Surgery
• Immunosuppression
• Hypercortisolism (Cushing’s Disease) [Dog]
• Tumour Disease
• Venous Catheter
• Diabetes mellitus
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Anaphylactic Shock
• Drugs – Penicillins – Cephalosporins – Sulfonamides – Local anaesthetics – Dextranes – Organ extracts – Vaccines
– Iodine Preparations – Vitamin K1 (i.v.) – Radiographic Contrast
Medium
– Hyposensitisation antigens – Blood Transfusion
• Insect /Snake Venoms
• Toxic Plants Cardiogenic Shock Congenital Heart Disease
• Patent ductus arteriosus (PDA)
• (Sub)Aortic Stenosis
• Pulmonary Stenosis
• Atrial Septal Defect (ASD)
• Ventricular Septal Defect (VSD)
• Valve dysplasia
• Tetralogy of Fallot
• Endocardial Fibroelastosis Myocardial Disease
Primary Cardiomyopathy
• Dilated Cardiomyopathy
• Hypertrophic Cardiomyopathy [esp Cat]
• Restrictive Cardiomyopathy
• Secondary Cardiomyopathy
• Metabolic Causes
– Hyperthyroidism [Cat]
– Hypothyroidism [Dog]
– Hypo-/Hyperkalaemia – Hypo-/Hypercalcaemia – Diabetes mellitus
– Hypercortisolism (Cushing’s Disease) [Dog]
– Uraemia
– Renal Hypertension – Glycogen Storage Disease
• Alimentary Causes
– Taurine Defi ciency [esp Cat]
– Carnitine Defi ciency [esp Dog]
• Viral Myocarditis – Parvovirus
– Distemper Virus [Dog]
– Herpes Virus
• Bacterial Endo-/Myocarditis – Aerobics/Anaerobics – Lyme Borrelia sp. [Dog]
– Endotoxaemia
• Mycotic Myocarditis – Cryptococcus sp. [Cat]
• Parasitic Myocarditis – Toxoplasma sp.
– (Hepatozoon sp. [Dog]) – (Trypanosoma sp. [Dog])
• Immunoreactive Myocarditis – Polyarteritis nodosa – Lupus erythematosus
• Toxic Myocarditis/
Myocardosis – Doxorubicin – Heavy metals
• Traumatic Myocarditis – Contusion
– Atrial Rupture Heart Valve Disease
• Mitral Valve Insuffi ciency – Dysplasia
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– Endocarditis – Fibrosis
– Functional dilation of the annular ring
• Valvular Stenosis of the Pulmonary Artery
• Tricuspid Valve Insuffi ciency – Dysplasia
– Endocarditis – Fibrosis
– Functional dilation of the annular ring
• Valvular Aortic Stenosis
• Papillary Muscle Rupture Pericardial Disease
• Viral Pericarditis
– FIP Coronavirus [Cat]
• Bacterial Pericarditis – Streptococcus sp.
– Staphylococcus sp.
– E. coli – Pasteurella sp.
– Mycobacterium sp.
– Actinomyces sp.
– Nocardia sp.
• Mycotic Pericarditis – Cryptococcus sp.
• Parasitic Pericarditis – Toxoplasma sp.
• Traumatic Pericarditis/
Pericardial Rupture
• Pericardial Tumours – Haemangiosarcoma – Heart Base Tumour
(Chemodectoma) – Thyroid Carcinoma – Mesothelioma – Lymphosarcoma – Tumour Metastasis
Diagnostic Approach Shock
1. Case History
2. General Examination