VETERINARY MEDICINE: Clinical Examination

And Making a Diagnosis Part 3

EXAMINATION OF THE ENVIRONMENT

An examination of the environment is a necessary part of any clinical investigation beause of the possible
relationship between environmental factors and the incidence of disease. A satisfactory examination of the
environment necessitates an adequate knowledge of animal husbandry and, with the development of species
specialization, it will be desirable for the veterinarian to understand the environmental needs of a particular
species or class of farm animal.

OUTDOOR ENVIRONMENT
• Topography and Soil Type — The topography of grasslands, pastures, and wooded areas can contribute to
disease or inefficient production and reproduction. Flat, treeless plains offering no protection from wind
predispose cattle to lactation tetany in inclement weather. Low, marshy areas facilitate the spread of insect-
borne diseases and soil-borne infections requiring damp conditions, such as leptospirosis; Johne’s disease and
diseases associated with liver fluke infestation and lungworm pneumonia are more prevalent in such areas.
Rough grasslands with extensive wooded areas can have an adverse effect on reproductive performance in
beef herds because of the difficulty the bulls have in getting to the females during peak periods of estrus
activity.
• Stocking Rate (Population Density) — Overcrowding is a common predisposing cause of disease. There may
be an excessive buildup of feces and urine, which increases the level of infection. The relative humidity is
usually increased and more difficult to control. Fighting and cannibalism are also more common in
overcrowded pens than when there is adequate space for animals to move around comfortably. The detection
and identification of animals for whatever reason can be difficult and inaccurate under crowded conditions.
• Feed and Water Supplies
— Pasture and Feed
- In pastures the predominant plant types, both natural and introduced, should be observed
because they are often associated with certain soil types and may be the cause of actual
disease; the high estrogen content of some clovers, the occurrence of functional nervous
diseases in pastures dominated by Phalaris aquatica and perennial rye grass, and the presence
of selective absorbing converter plants on copper-rich and selenium-rich soils are all examples
of the importance of the dominant vegetation. The presence of specific poisonous plants,
evidence of overgrazing, and the existence of a bone-chewing or bark-chewing habit can be
determined by an examination of the environment.
— Water
- The drinking water supply and its origin may be important in the production of disease. Water
in ponds can be covered with algae containing neurotoxins or hepatotoxic agents, and flowing
streams might carry effluent from nearby industrial plants. In a feedlot, water can suddenly
become unavailable because of frozen water lines or faulty water tank valves. This should not
 go unnoticed if one recognizes the anxiety of a group of cattle trying to obtain water from a dry
tank.
• Waste Disposal
The disposal of feces and urine has become a major problem for large intensified livestock operations. Slurry is
now spread on pastures and may be important in the spread of infectious disease. Lagoons can provide ideal
conditions for the breeding of flies, which can be troublesome to a nearby livestock operation. The inadequate
disposal of dead animals also can be an important factor in the spread of certain diseases.

INDOOR ENVIRONMENT
There are few aspects of livestock production that have aroused more interest, development, and controversy
in the last few years than the housing and environmental needs of farm animals. Several textbooks on the
subject have been written, and only some of the important items will be mentioned here, with the aid of some
examples. The effects of housing on animal health have not received the consideration they deserve, partly
because of insufficient knowledge of animals’ environmental needs and partly because there has been a
failure to apply what is already known.
• Hygiene
One of the first things to observe is the level of sanitation and hygiene, which is usually a reliable indicator of
the level of management; Poor hygiene is often associated with a high level of infectious disease. For example,
the incidence of diarrhea in piglets may be high because the farrowing crates are not suitably cleaned and
disinfected before the pregnant sows are placed in them. A similar situation applies for lambing sheds, calving
pens, and foaling boxes. An excessive buildup of feces and urine with insufficient clean bedding will result in a
high level of neonatal mortality. The methods used for cleaning and disinfection should be examined carefully.
The removal of dried feces from animal pens that have been occupied for several months is a difficult and
laborious task and often not done well. Undue reliance may be placed on the use of chemical disinfectants.
• Ventilation
Inadequate ventilation is considered to be a major risk factor contributing to the severity of swine enzootic
pneumonia in finishing pigs. The primary infection has a minimal effect on the well-housed pig, but inadequate
ventilation results in overheating of the barn in the summer months and chilling and dampness during the
winter months. This commonly results in subclinical and clinical pneumonia, which severely affects productive
efficiency. Similarly, in young calves, which are raised indoors in most of the temperate zones of the world,
protection from the cold during the winter is necessary. The effects of enzootic pneumonia of housed calves
are much more severe when ventilation is inadequate than when the calves are comfortable and have clean,
fresh air.
• Flooring
The quality of the floor is often responsible for diseases of the musculoskeletal system and skin. Poorly
finished concrete floors with an exposed aggregate can cause severe foot lesions and lameness in adult swine.
Recently calved dairy cows are very susceptible to slipping on poor floors in dairy barns, which is a common
cause of downer cow syndrome.
• Floor Plan
The floor plan and general layout of an animal house must be examined for evidence that the routine
movements of animal attendants, the movements of animals, and feeding facilities may actually be spreading
disease. Communal gutters running through adjacent pens may promote the spread of disease through fecal
or urinary contamination. The nature of the partitions between pens, whether a solid or open-grid type, may
assist the control or spread of infectious.
• Lighting
The amount of light available in a barn should be noted. With insufficient light it may be difficult to maintain a
sufficient level of sanitation and hygiene, sick animals may not be recognized early enough, and errors in
management are likely to occur.

EXAMINATION OF THE ANIMAL

Clinical examination is a key component in any diagnostic process. More is missed by not looking than by not
knowing, and care should be taken to ensure that clinical examinations are appropriate for the task at hand.
Clinical examinations aid in the identification of abnormalities in form and function of the animal, provide
invaluable information regarding the cause of the disease, help to define the severity of the disease, and aid in
monitoring the progression of the disease. A complete clinical examination of an animal includes, in addition
to history taking and examination of the environment, physical and laboratory examinations. A complete
clinical examination of every animal is unnecessary because of the simplicity of some diseases and, as with
history taking, a more ore targeted approach is favored by experienced clinicians. However, a general clinical
examination of every animal is necessary, and the inexperienced clinician should spend as much time and
effort as is practicable and economical in carrying it out. This will help to avoid the sort of embarrassing error
in which a calf is operated on for umbilical hernia when it also has a congenital cardiac defect.

GENERAL INSPECTION (DISTANT EXAMINATION)

The importance of a distant examination of the animal cannot be overemphasized, and yet it is often
overlooked. Apart from the general impression gained from observation at a distance, there are some signs
that can best be assessed before the animal is disturbed. The proximity of the examiner is particularly
disturbing to animals unaccustomed to frequent handling.
• Behavior and General Appearance
The general impression of the health of an animal obtained by an examination from a distance should be
assessed according to the following sections.
• Voice
Abnormality of the voice should be noted. It may be hoarse in rabies or weak in gut edema; there may be
continuous lowing in nervous acetonemia or persistent bellowing indicative of acute pain. Soundless bellowing
and yawning are commonly seen in rabid cattle, and yawning is a common sign in animals affected with
hepatic insufficiency.
• Eating
The appetite of the animal can be assessed by observing its reaction to the offering of feed or by the amount
of feed available that has not been eaten. It is important to determine the total amount of feed that the
animal is eating per day. In an animal that has retained its appetite, there may be abnormality of prehension,
mastication, or swallowing and, in ruminants, of belching and regurgitation.
• Defecation
In constipation and rectal paralysis or stenosis, the act of defecation may be difficult and be accompanied by
straining or tenesmus. when there is abdominal pain or laceration of the mucocutaneous junction at the anus,
defecation may cause obvious pain. Involuntary defecation occurs in severe diarrhea and when there is
paralysis of the anal sphincter. Consideration of frequency, volume, and character of feces is given later.
Constipation must not be mistaken for scant feces, particularly in mature cattle with diseases of the
forestomachs and failure of movement of ingesta in a caudad direction.
• Urination
This may be difficult when there is partial obstruction of the urinary tract and painful when there is
inflammation of the bladder or urethra. In cystitis and urethritis there is increased frequency with the passage
of small amounts of fluid, and the animal remains in the urination posture for some time after the flow ceases.
Incontinence, with constant dribbling of urine, is usually caused by partial obstruction of the urethra or
paralysis of its sphincter. If the animal urinates during the visual inspection, a sample of urine should be
obtained, examined grossly, and submitted for urinalysis.
• Posture
Abnormal posture is not necessarily indicative of disease, but when associated with other signs it may indicate
the site and severity of a disease process. One of the simplest examples is resting of a limb in painful
conditions of the extremities; if a horse continually shifts its weight from limb to limb it may indicate the
presence of laminitis or early osteodystrophia fibrosa.
• Gait
Movements of the limbs can be expressed in terms of rate, range, force, and direction of movement.
Abnormalities may occur in one or more of these categories. For example, in true cerebellar ataxia all qualities
of limb movement are affected. In louping-ill in sheep it is the range and force of movement that are
excessive, resulting in a highstepping gait and a bounding form of progression; in arthritis, because of pain in
the joints, or in laminitis, because of pain in the feet, the range is diminished and the animal has a shuffling,
stumbling walk. The direction of progress may be affected. Walking in circles is a common abnormality and is
usually associated with rotation or deviation of the head; it may be a permanent state as in listeriosis or occur
spasmodically as in acetonemia and pregnancy toxemia. Compulsive walking or walking directly ahead
regardless of obstructions is part of the dummy syndrome mentioned earlier and is characteristic of
encephalomyelitis and hepatic insufficiency in the horse.
• Body Condition
The animal may be in normal bodily condition, or obese, thin, or emaciated. The difference between thinness
and emaciation is one of degree: the latter is more severe but there are additional signs that are usually taken
into consideration. In an emaciated animal the coat is poor, the skin is dry and leathery, and work
performance is reduced. Thin animals, on the other hand, are physiologically normal. The difference between
fatness and obesity is of the same order. Most beef cattle prepared for the show ring are obese. To inject
some degree of numerical assessment it is now customary in all farm animal species and in horses to use body
condition on a scale of 1 to 5 or preferably 1 to 10.
• Body Conformation
The assessment of conformation or shape is based on the symmetry and the shape and size of the different
body regions relative to other regions. An abdomen that is very large relative to the chest and hindquarters
can be classified as an abnormality of conformation. To avoid repetition, points of conformation are included
in the description of body regions.
• Skin
Skin abnormalities can usually be seen at a distance. They include changes in the hair or wool, abnormal
sweating, the presence of discrete or diffuse lesions, and evidence of soiling by discharges and of itching. The
normal luster of the coat may be absent. It may be dry as in most chronic debilitating diseases or excessively
greasy as in seborrheic dermatitis. In debilitated animals the long winter coat may be retained past the normal
time.

INSPECTION OF BODY REGIONS (PARTICULAR DISTANT EXAMINATION)

As a general rule, as much of a clinical examination as possible should be performed before the animal is
handled. This is partly to avoid unnecessary excitement of the animal but also because some abnormalities are
better seen at a distance and in some cases cannot be discerned at close range. The general appearance of the
animal should be noted and its behavior assessed. Some time should also be devoted to an inspection of the
various body regions, which is a particular distant examination.
• Head
The facial expression may be abnormal. The rigidity of tetanus, the cunning leer or maniacal expression of
rabies, and acute lead poisoning are cases in point. The symmetry and configuration of the bony structure
should be examined. Doming of the forehead occurs in some cases of congenital hydrocephalus and in
chondrodysplastic dwarfs, and in the latter there may be bilateral enlargement of the maxillae.
• Neck
If there is enlargement of the throat this region should be more closely examined later to determine whether
the cause is inflammatory and whether lymph nodes, salivary glands, or other soft tissues are involved. Goiter
leads to local enlargement located further down the neck. A jugular pulse, jugular vein engorgement, and
edema should be looked for, and local enlargement caused by esophageal distension should be noted.
• Thorax
Respiration should be examined from a distance, preferably with the animal in a standing position, because
recumbency is likely to modify it considerably. Allowance should be made for the effects of exercise,
excitement, high environmental temperatures, and fatness of the subject. Respiratory Rate in normal animals
under average conditions the rate should fall within the following limits:
• Horses, 8 to 16 per minute
• Cattle, 10 to 30 per minute
• Sheep and pigs, 10 to 20 per minute
• Goats, 25 to 35 per minute
• Abdomen
Variations in abdominal size are usually appreciated during the general inspection of the animal. An increase
in size may be caused by the presence of excessive feed, fluid, feces, flatus, or fat and the presence of a fetus
or a neoplasm. Further differentiation is usually possible only on close examination. In advanced pregnancy,
fetal movements may be visible over the right flank of cattle. In severe distension of the intestines with gas,
the loops of intestine may be visible in the flank, especially in calves. Intestinal tympany usually results in
uniform distension of the abdomen, whereas fluid tends to result in increased distension ventrally.
• External Genitalia
Gross enlargements of the preputial sheath or scrotum are usually inflammatory in origin, but varicocele or
tumors can also be responsible. Degenerative changes in the testicles may result in a small scrotum.
Discharges of pus and blood from the vagina indicate infection of the genitourinary tract.
• Mammary Glands
A disproportionate size of the udder suggests acute inflammation, atrophy, or hypertrophy of the gland. These
conditions can be differentiated only by further palpation and examination of the milk or secretions.
• Limbs
General abnormalities of posture and gait have been described. Symmetry is important, and comparison of
the various aspects of pairs of limbs should be used when there is doubt about the significance of an apparent
abnormality. Enlargement or distortion of bones, joints, tendons, sheaths, and bursae should be noted as well
as any enlargement of peripheral lymph nodes and lymphatic vessels.

CLOSE PHYSICAL EXAMINATION

Some of the techniques used in making a close physical examination are set out in the following sections.
• Palpation
Direct palpation with the fingers or indirect palpation with a probe is aimed at determining the size,
consistency, temperature, and sensitivity of a lesion or organ. Terms used to describe palpation findings
include the following:
• Doughy: When the structure pits on pressure, as in edema
• Firm: When the structure has the consistency of normal liver
• Hard: When the consistency is bonelike
• Fluctuating: When the structure is soft, elastic, and undulates on pressure but does not retain the imprint of
the fingers
• Tense: When the structure feels like a viscus distended with gas or fluid under some considerable pressure
• Emphysematous: When the structure is puffy and swollen and moves and crackles under pressure because
of the presence of gas in the tissue
• Percussion
In percussion, the body surface is struck to set deep parts in vibration and cause them to emit audible sounds.
The sounds vary with the density of the parts set in vibration and may be classified as follows:
• Resonant: The sound emitted by organs containing air, e.g., normal lung
• Tympanitic: A drumlike note emitted by an organ containing gas under pressure such as a tympanitic rumen
or cecum
• Dull: The sound emitted by solid organs such as heart and liver
• Ballottement
Ballottement is a technique used to detect floating viscera or masses in the abdominal cavity. Using the
extended fingers or the clenched fist the abdominal wall is palpated vigorously with a firm push to move the
organ or mass away and then allow it to rebound on to the fingertips. Ballottement of a fetus is a typical
example; the fetal prominences can be easily felt by pushing the gravid uterus through the abdominal wall
over the right flank in pregnant cattle.
• Auscultation
Direct listening to the sounds produced by organ movement is performed by placing the ear to the body
surface over the organ. Indirect auscultation by a stethoscope is the preferred technique. A considerable
amount of work has been done to determine the most effective stethoscopic equipment, including
investigation of such things as the shape and proportions of bell chest pieces, the thickness of rubber tubes,
and the diameter and depth of phonendoscope chest pieces.
• Succussion
This technique, which involves moving the body from side to side to detect the presence of fluid, is an
adaptation of the previously mentioned method. By careful auscultation while the body is moved, free fluid in
the intestines or stomach will result in fluidsplashing or tinkling sounds.
• Other Techniques
Special physical techniques including biopsy and paracentesis are described under special examination of the
various systems to which they apply. With suitable equipment and technique, one of the most valuable
adjuncts to a physical examination is a radiographic examination. The size, location, and shape of soft tissue
organs are often demonstrable in animals of up to moderate size. Radiology, other than of limbs and
neonates, is not commonly practiced in larger animals. Ultrasound appears to have much more general
application but is beyond the scope of this book.