VETERINARY MEDICINE: Clinical Examination

And Making a Diagnosis Part 2

Clinical Examination Of the Individual Animal a clinical examination has three parts:
• History
• Animal
• Environment
The usual admonition is that one should collect a comprehensive history and perform a complete physical
examination when investigating disease in an individual animal. This approach, in which one gathers all
pertinent or potentially pertinent information before attempting to arrive at a diagnosis, is often taught to
veterinary students as well as medical colleagues, but does not represent the behavior of experienced
clinicians.

History Taking
In veterinary medicine, history taking is often the most important of the three aspects of a clinical
examination. The importance of the results obtained by examination of the animal and the environment is
liable to be modified by a number of factors. Nevertheless, history taking is an important key to accurate
diagnosis in veterinary medicine, and to be worthwhile it must be accurate and purposeful. A fit for purpose
history requires the focused collection of data that progressively increase or decrease the likelihood of a
diagnosis. Collection of information that does not address a clinically relevant question (hypothesis) is a waste
of time and resources. The history can often indicate that special attention should be paid to the examination
of a particular system in the animal or a particular factor in the environment.

HISTORY-TAKING METHOD
Good communication skills are an essential component of successful history taking and are increasingly taught
as part of a veterinary curriculum. Some suggestions are presented here as guidelines that might prove useful
to the clinician. The veterinarian should establish the context for the consultation and ensure that the
environment in which it occurs is safe, professional, and allows for effective interaction with the client and
examination of the animal. This includes an introduction so that both parties are aware of the other’s roles
and responsibilities. The next step is to establish rapport with the client. Importantly, this allows the client to
identify the reasons for the consultation. Recall that the role of a veterinarian in clinical practice is, in most
instances, to solve the owner’s problems or address his or her concerns. A focus solely on the animal will not
necessarily result in a good outcome for the owner. The owner or attendant must be handled with diplomacy
and tact. The use of non-technical terms is usually essential, because livestock owners can be confused by
technical expressions or reluctant to express themselves when confronted with terms they do not understand.
The veterinarian must be aware of the vernacular associated with particular breeds or uses of animals and
should be able to communicate in these terms. Statements, particularly those concerned wiith time, should be
tested for accuracy and precision. If a detailed cross-examination of the owner seems likely to arouse some
antagonism, it is advisable for the veterinarian to forego further questioning and be content with his or her
own estimate of the dependability of the history. The clinician must try to separate owners’ observation from
their interpretations. Absence of a sign can only be determined by inquiring whether or not it occurred. Simply
asking for a complete history of what has happened almost invariably results in an incomplete history. The
clinician must know the right questions to ask; this knowledge comes with experience and familiarity with
disease. Owners seldom describe clinical signs in their correct time sequence, and part of the clinician’s task is
to establish the chronology of events. For completeness and accuracy in history taking the clinician should
conform to a set routine. The system outlined next includes animal data, disease history, and management
history. The order in which these parts of the history are taken will vary. Generally it is best to take the disease
history first. The psychological effect is good: the owner appreciates the desire to get down to the facts about
his or her animal’s illness.

ANIMAL DATA
If records are to be kept at all, even if only for financial purposes, accurate identification of the animal is
essential. An animal’s previous history can be referred to, the disease status of a herd can be examined, and
specimens for laboratory examination can be dispatched with the knowledge that the results can be related to
the correct animal. Accurate records are also necessary for the submission of accounts for veterinary services
rendered, and the details of the owner’s address and of the animals examined and treated must be accurate.
These points might have no importance in establishing the diagnosis, but they are of primary importance in
the maintenance of a successful practice. The relevant data include the following:
• Owner’s name and initials
• Postal address and telephone number
• Species, type, and breed (or estimate of parentage in a crossbreed)
• Sex, age, name or number, and body weight
• If necessary, a description, including color markings, polledness, and other identifying marks, of the animal
The ability to retrieve and summarize this information on an individual farm basis is a major step forward in
providing optimal veterinary service to livestock herds, regardless of their size and complexity.

DISEASE HISTORY
History taking will vary considerably depending on whether one animal or a group of animals is involved in the
disease problem under examination. Generally, in large animal work, all disease states should be considered
as herd problems until proved to be otherwise. It is often rewarding to examine the remainder of a group and
find animals that are in the early stages of the disease.
• Present Disease
Attempts should be made to elicit the details of the clinical abnormalities observed by the owner in the
sequence in which they occurred. If more than one animal is affected, a typical case should be chosen and the
variations in history in other cases should then be noted. The behavior of animals before death and the period
of time elapsing between the first observable signs and death or recovery are important items of information.
Prior surgical or medical procedures, such as castration, docking, shearing, or vaccination, may be important
factors in the production of disease.
• Morbidity, Case Fatality, and Population Mortality Rates
The morbidity rate is usually expressed as the percentage of animals that are clinically affected compared with
the total number of animals exposed to the same risks. The case fatality rate is the percentage of affected
animals that die. An equally important figure is the proportion of animals at risk that are clinically normal but
show abnormality on the basis of laboratory or other tests.
• Prior Treatment
It is important to determine whether the animal has had any previous treatment for this condition
administered by the owner or another veterinarian. Exact details of the preparations used and doses given can
be of value in eliminating some diagnostic possibilities. They could be of importance when assessing the
probable efficiency of the treatment and the significance of clinical pathologic tests, and in prescribing
additional treatment. Drug withdrawal regulations now require that treated animals or their products, such as
milk, be withheld from slaughter or market for varying lengths of time to allow drug residues to reach
tolerable limits. This necessitates that owners reveal information about recent treatments.
• Prophylactic and Control Measures
It should be ascertained whether preventive or control procedures have already been attempted. Spread of
the disease can result from failure of the hygiene barrier at any one of a number of such points. When written
reports are available they are more reliable than memory.
• Previous Exposure
The history of the group relative to additions is of particular importance in establishing the animal’s exposure
to the following risk factors:
• Is the affected animal an established member of the group, or has it been introduced, and if so how long
ago?
• If the affected animal has been in the group for some time, have there been recent additions?
• Is the herd a closed herd or are animals introduced at frequent intervals?
A reverse situation may occur in which imported animals have no resistance to endemic infection in the home
herd or have not become adapted to environmental stressors, such as high altitudes, high environmental
temperatures, and particular feeding methods, or are not accustomed to poisonous plants occurring in the
environment.
• Transit
The possibility of infection during transit is always a potential risk, and presale certificates of health may be of
little value if an animal has passed through a sale barn, a show, or communal trucking yards while in transit.
Highly infectious diseases may be transmitted via trucks, railroad cars, or other accommodation contaminated
by previous inhabitants. Transient introductions, including animals brought in for work purposes, for mating,
or on temporary grazing, are often overlooked as possible vectors of disease. Other sources of infection are
wild fauna that graze over the same area as domestic livestock and inanimate objects such as human
footwear, car tires, and feeding utensils.
MANAGEMENT HISTORY
The management history includes nutrition, breeding policy and practice, housing, transport, and general
handling. It is most important to learn whether or not there has been any change in the prevailing practice
before the appearance of disease. Because a disease has occurred when the affected animals have been
receiving the same ration, deriving from the same source over a long period, suggests that the diet is not at
fault, although errors in preparation of concentrate mixtures, particularly with the present-day practice of
introducing additives to feeds, can cause variations that are not immediately apparent.

Nutrition
The major objective in the examination of the nutritional history is to determine how the quantity and quality
of the diet the animals have been receiving compares with the nutrient requirements recommended for a
similar class of animal. Attention should be paid to both the macronutrients and micronutrients. Malnutrition
can involve underfeeding, overfeeding, or deficiency or excess of micronutrients. In some situations it will be
necessary to submit feed and water samples for analyses to assess quality and adequacy of feed.
• Reproductive Management And Performance
— In the examination of a single animal the breeding and parturition history might suggest or eliminate
some diagnostic possibilities. For example, pregnancy toxemia occurs in sheep in late pregnancy,
whereas ketosis in dairy cows occurs primarily 2 to 6 weeks after parturition. Acute septic metritis is a
possibility within a few days after parturition in any species but unlikely several weeks later.
• Climate
— Many diseases are influenced by climate. Foot rot in cattle and sheep reaches its peak incidence in
warm, wet summers and is relatively rare in dry seasons. Diseases spread by insects are encouraged
when climatic conditions favor the proliferation of the vector.
Internal parasites are similarly influenced by climate. Cool, wet seasons favor the development of
hypomagnesemia in pastured cattle. Anhidrosis in horses is specifically a disease of hot, humid countries. The
direction of prevailing winds is important in many disease outbreaks, particularly in relation to the
contamination of pasture and drinking water by fumes from factories and mines and the spread of diseases
carried by insects.
• General Management
— There are so many items in the proper management of livestock that, if neglected, can lead to the
occurrence of disease that they cannot be related here; animal management in the prevention of
disease is a subject in its own right and is dealt with in all parts of this book.
Some of the more important factors include the following:
• Hygiene, particularly in milking parlors and in parturition and rearing stalls
• Adequacy of housing in terms of space, ventilation, draining, and situation and suitability of troughs
• Opportunity for exercise
• Proper management of milking machines to avoid udder injury
The class of livestock under consideration is also important; for example, enterotoxemia is most common in
finishing lambs and pigs, parturient paresis in milking cows, obstructive urolithiasis in lambs and steers in
feedlots, and pregnancy toxemia in ewes used for fat lamb production.