Dr. Lila Miller, D.V.M., ASPCA Sr. Director Animal Sciences & Vet Advisor
The Physical Examination
Veterinarians are taught that the most successful way to examine a patient is to establish a system and to stick to it. Owners tend to focus on whatever “chief complaint” brought them into the office, and if the veterinarian concentrates on that complaint, other more serious problems may be overlooked, or the problem may be misdiagnosed. A good example is the owner who insists that their cat is constipated and constantly straining in its litter box. Palpation of the abdomen may often reveal that the cat’s bladder was enlarged, and that the cat couldn’t urinate, much to the owner’s surprise. The problem in shelters is a little different because the owner is usually not present to give misleading information, but focusing on the chief medical problem may result in less apparent conditions that may be just as serious being overlooked.
Successful diagnosis also depends on the use of most of the senses. The technician or veterinarian should use their eyes, ears, nose and sense of smell and touch, to detect disease conditions. For example, a sneezing animal in the kennels might remain unidentified if it wasn’t heard, but traces of a mucus discharge around the nostrils will cast suspicion on the culprit. Tumors are often found by palpation, not visualization. This is especially true of small mammary gland tumors. A hasty physical exam might overlook an ear infection if the odor wasn’t recognizable.
The goal of the shelter in performing a physical examination often differs from that of the veterinarian in a private office. Diagnosis and treatment of disease conditions is the primary goal of the veterinarian in private practice. In the shelter, the goal may be to identify unhealthy animals so they may be isolated immediately to prevent disease spread, to identify adoptable animals, and to assist in the identification of animals for the lost and found department. The ultimate goal does not have to be diagnosis that leads to treatment. In many shelters suffering from overcrowding and low budgets, treatment is not an option for many of the animals, and so isolation of animals that appear sick is a priority. Because an actual diagnosis is not always the goal, non-veterinarians can develop the skill for examination simply with practice in learning to distinguish the normal from the abnormal.
The selection of an examination system is based on individual preference, or what one is most comfortable with. It may be a systems approach, grouping together examination parameters relating to respiratory, circulatory, musculoskeletal, nervous systems, etc., or a ” head to tail” approach, which is easier and most common.
When an animal is first brought into the exam room, its SIGNALMENT, GAIT and DEMEANOR should be observed.
The signalment is a complete description of the animal. It includes:
Sex (including neuter status!)
Age (if already known)
Name (if known)
Ears erect or ears down
Extra toes (Polydactyly)
Over or undershot jaw
Type of tail
At this point, it may be a good idea to check for any identification that would help reunite a lost pet with its owner. Although it may be convenient to do this later on during, the physical examination, doing it first establishes a routine so it won’t be overlooked. This task should be performed even if other intake personnel are responsible for doing it initially, as it is not difficult to miss a tattoo or misscan an animal when checking for microchips if the examination conditions are not good.
Check for: Tattoos-look on the abdomen, inner thighs and inner ears
Microchips-use a universal scanner and check over the entire body, as microchips can ml-rate from the site of original insertion.
Tags-cross reference for license, rabies and identification tattoos
Ear tipping on cats usually indicates the animal was spayed or neutered
When a dog or puppy enters the examination room, its GAIT should be observed as one of the first parts of the physical exam. Since cats are usually carried in boxes, the evaluation of the gait is more difficult. Cats should either be encouraged to walk, or their limbs carefully palpated for fractures, pain or other abnormalities before the physical exam is considered complete.
Evaluation of the gait is basically through observation for the following abnormalities:
The most common causes of limping are fractures, foreign bodies in paw, laceration of digital pad, bruising
Incoordination and unsteadiness on hind limbs
The most common causes of these signs are arthritis, hip dysplasia, spinal cord injury
Dragging a limb
This type of injury, with loss of sensation, is usually evidence of Nerve damage.
The animal should also be observed for its DEMEANOR when it first enters the examination room. The demeanor can give the first clues to the animal’s overall health. An animal that is hunched over, minimally responsive to external stimuli, walking slowly, has a scruffy hair coat and is slightly dehydrated is probably sick, even if no other symptoms can be found on the physical examination. On the other hand, the first impression of the animal’s behavior should never be the final one, as the shelter environment can be especially stressful the first day or so. The animal should be given a day or two to settle in. There should, however, be clues to the answers to some of the following questions by the time the physical examination is over:
Is the animal confident or timid?
Fearful or bold?
Aggressive or submissive?
Playful or quiet and subdued?
Depressed or bright and alert?
Friendly or withdrawn?
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