Introduction

• The presence of disease is revealed by

certain changes in the structure and function
of the living organism. Such changes, which
may be qualitative, quantitative or both, are
described as signs of disease or symptoms,
and the process of deducing from the nature
of the disease that is present is described as
making a diagnosis.
 Cont.
• The purposes of making a diagnosis include being
able
– to recommend specific treatment,
– to provide an accurate prognosis, and
– to make recommendations for cost effective control and
prevention of new cases when groups of animals are at
risk

• Inadequate examination of these may lead to

error.
Types of Diagnosis
1- Differential diagnosis:
It is a list of diseases that might have resemble
clinical findings
2- Tentative diagnosis:
It is the suspected diagnosis based on history or
initial clinical examination
3- Presumptive diagnosis:
It is usually made after considering several
differential diagnosis and the collection of further
clinical and laboratory information.
:Definitive and etiological diagnosis -4
It is the identification of the specific cause of a
disease based on interpretation of clinical
laboratory findings
:Open diagnosis -5
In open diagnosis, the clinical abnormalities
are detected but their cause cannot be
.determined
:Undetermined diagnosis -6
In many cases a diagnosis cannot be made
even with extensive epidemiological findings
 Prognosis
A prognosis is a prediction about the future clinical
course of a disease with or without treatment .
The prognosis may be:
Excellent:
When the animal need no treatment, but the
owner need advice for management.
Good:
When the animal will recover and return to normal
within hours, and may be without treatment
 Clinical examination
•The most common reason for the clinical examination of the individual
animal is to make a clinical diagnosis so that effective treatment can be
given and control procedures instituted.
•The clinical examination of the individual animal must be rapid,
complete, economical and highly accurate. However, a thorough
examination may take considerable time and reexamination of an
individual animal may be necessary in order to make a diagnosis. "More
mistakes are made for not looking than for not knowing".
•The problems associated with the clinical examination and making a
diagnosis include:
•1. Preconceived ideas about the diagnosis. Experienced veterinarians
tend to make a diagnosis based on the recognition of a few reliable
epidemiological and clinical findings.
• 2. Incomplete history and incomplete clinical examination.
An incomplete history and failure to detect the abnormalities
which are not readily obvious are major causes of
misdiagnosis.
• 3. Incorrect interpretation of the clinical findings. A
knowledge of the pathophysiology of systemic medicine is
necessary to accurately interpret abnormalities.
• 4. Failure to consider all of the diagnostic possibilities. This is
becoming a major problem because of the ever increasing
number of possibilities generated by the recognition and
description of diseases.
• When diagnosis is not obvious, a systematic clinical
examination is necessary in order to achieve a high degree of
accuracy.
• A complete clinical examination consists of four
parts:
1. Taking the History.
2. Examination of the Environment (including the
remainder of the herd).
3. The Actual Clinical Examination(patient).
4. The Use of the Laboratory.
 History taking
• History-taking is an important key to accurate
diagnosis in veterinary medicine.
• Some guidelines of history taking are:-
1. The veterinarian should introduce himself or
herself to the owner, and the usual greetings of the
day will help to establish a relationship.
2. The owner or attendant must be handled with
diplomacy and tact.
3. Test statements for accuracy, particularly those
concerned with time, by restating the facts to the
owners and asking them to confirm them.
4. Distinguish the owner’s observations from
interpretations. A statement that the cow has
diarrhea may, on closer questioning, mean the feces
were soft but also scant, which is an important
distinction.
5. Assume the leadership role and ask appropriate
questions in a logical sequence.
• The system outlined includes
• patient data,
• disease history
• management history
• patient data
The relevant data include:
o Owner's name and initials
o Postal address and telephone number
o Species, type, breed (or estimate of
parentage in a crossbred)
o Sex, age, name or number, body weight o
If necessary, a description, including color
markings, polledness and other identifying
marks, of the patient.
• Disease history
Present diseases
Prophylactic and control measures
Morbidity, case fatality and population mortality
rates
previous exposure
Prior treatment
Previous disease
Culling rate
Transit
MANAGEMENT HISTORY
• The management history includes
nutrition,
breeding policy and practice,
Transport and general handling
Hygiene, particularly in milking parlors and in
parturition and rearing stalls
Adequacy of housing in terms of space, ventilation,
draining, situation and suitability of troughs
Opportunity for exercise
Proper management of milking machines to avoid
udder injury
• Examination of the environment
– Topography and soil type
– Stocking rate (population density)
– Feed and water supplies
– Waste disposal
– INDOOR ENVIRONMENT(floor plan,
hygiene, ventilation, lighting and flooring)
 EXAMINATION OF T HE PATIENT
• The examination of a patient consists of
three parts:
– distant examination or general
inspection
– particular distant examination of body
regions
– close physical examination.
EQUIPMENT NEEDED FOR CLINICAL EXAMINATION
The equipment required includes
• a stethoscope with the characteristics described
earlier
• a watch with a second hand
• a thermometer –
• a flashlight or penlight
• a plexor and pleximeter for acoustic percussion and
to test reflexes in a neurological examination
• an ophthalmoscope and otoscope
• a ruler and flexible tape measure marked in
centimeters for the measurement of lesions
• gloves and protective sleeves for oral, rectal and
vaginal examinations
• a hoof knife for the examination of feet in large
animals
• a pair of hemostats for a neurological examination
• paper and pen for recording information
• a camera to photograph affected animals and the
environment if civil litigation is a possibility
• pail, soap, water, and paper towels
• hypodermic needles and tubes for blood sampling
• sample containers and bags for collection of urine and
feces
• cotton-tipped swabs for nasal and ocular discharges.
 Distant examination or general inspection

• The general appearance of the animal should be noted and its:

– Behavior: such as separation from its group, respond to external stimuli,
excitation, depression, … etc.
– Posture: such as arching of the back, abduction of the elbows, elevation of
the tail, recumbency, … etc.
– Gait: such as lameness, stiff gait, walking in circles, … etc.
– Body condition: thin, modern, obesity, emaciation, … etc.
– Conformation: symmetry, shape and size of the different body regions.
– Skin: hair or wool changing, alopecia, hyperkeratosis, scabs, sweating, … etc.
– Eating: abnormalities of prehension, mastication, swallowing, … etc.
– Defecation: straining, diarrhea, color, … etc.
– Urination: pain during urination, color of urine, … etc.
– Voice: hoarse, weak, bellowing, yawing, … etc. Respiration: type, depth, rate,
rhythm, noises, … etc.
– External genitalia, orifices and mammary glands
 Particular distant examination of body regions

• Head
The facial expression may be abnormal, for
example
• the sardonic grin of tetanus owing to contraction
of the facial muscles
• the cunning leer or maniacal expression of rabies
and acute lead poisoning
• the open mouth of a dog with trigeminal nerve
paralysis.
• The symmetry and configuration of the bony structures of the
head are noted.
– Swelling of the maxillae and mandibles may occur in
horses with abscessed teeth. In cattle, enlargement of the
maxilla or mandible is common in actinomycosis
– Asymmetry of the soft structures may be evident and is
most obvious in the carriage of the ears, degree of closure
of the eyelids and situation of the muzzle and lower lip.
– Slackness of one side of the face and a
pulling to the other are constant features in
facial paralysis.
The carriage of the head is observed for
abnormalities
 rotation of the head and neck is usually associated
with defects of the vestibular apparatus on one
side
 deviation of the head and neck suggest unilateral
involvement of the medulla oblongata or cervical
spinal cord
• The eyes and eyelids are inspected from a dose
distance
– entropion is inversion of the eyelid
– ectropion is eversion of the eyelid.
– Ocular discharges are usually obvious.
– Spasm of the eyelids and excessive blinking
(blepharospasm) indincates pain or peripheral
nerve involvement.
– Prolapse of the nictitating membrane (third eyelid)
suggests central nervous system involvement, e.g.
tetanus.
• Neck
• Any enlargement of the proximal part of the
neck region must be more closely examined to
determine whether lymph nodes, salivary
glands (or guttural pouches in the horse) or
other soft tissues are involved.
• A prominent jugular pulse, jugular vein
engorgement and brisket edema may be
present.
• A cylindrical enlargement of the neck may be
due to esophageal distension.
• Thorax:
 Respirations Rate
 Rhythm (inspiratory, expiratory)
 Depth (shallow or deep)
 Type (abdominal or thoracic)
 Noises (coughing, sneezing, wheezing,
snoring, grunting)
• Abdomen:
– Contour
– Distended
– Gaunt
– Symmetry
 External Genitalia
 Mammary
 Gland
 Limbs
 Close physical examination
• The close physical examination consists of
• audiovisual inspection,
• palpation,
• ballottement,
• auscultation,
• Percussion
• tactile percussion,
• succussion and percussion
• simultaneous auscultation
 palpation
• The aim of palpation is to detect the presence of changes
in tissues, such as swelling, increased warmth or coolness,
and pain on palpation. The state of the structures
identifiable by palpation may be defined by the following
terms:
– • resilient
– • doughy -
– • firm –
– • hard -
– • fluctuating -
– • emphysematous -
• Ballottement
• Ballottement is a variation of palpation used
to detect floating viscera or masses in the
abdominal cavity. Using the extended fingers
or the clenched fist, the abdominal wall is
palpated with a firm push to displace the
organ or mass, then allowing it to rebound on
to the fingertips.
• Auscultation
• Auscultation is listening to the sounds
produced by the functional activity of an
organ located within a particular part of the
body, in order to assess its physiological state.
• It is used to evaluate the normal and
abnormal sounds of the respiratory tract,
heart and alimentary tract. Crepitating sounds
produced by abnormal joints may also be
heard by auscultation.
• Percussion
• Percussion is striking a part of the body in
order to obtain information about the
condition of the contiguous tissues and, more
particularly, the deeper lying parts.
• Method
– Finger-finger percussion
– Finger-pleximeter
– Pleximeter –hammer(plaxor)
• Types of percussion:
 Mediate percussion “acoustic percussion”
 Immediate percussion
• The quality of sounds produced by
percussion may be classified as
• resonant
• tympanic
• dull
• Succussion
• Succussion is the shaking or moving of an
animal from side to side while auscultating the
abdomen for evidence of fluid-splashing sounds
caused by fluid and gas-filled intestines or
viscera.
• Free fluid in the peritoneal cavity will usually not
result in fluid-splashing sounds using succussion
or ballottement because the cavity is under
subatmospheric pressure and there is a relative
absence of air space for the fluid to create a
splashing sound.
 The sequence of examination of body systems

The sequence of examination of body systems or

regions described here is as follows:
• vital signs (temperature, pulse, respirations),
commonly referred to as the TPR
• peripheral circulation and state of hydration
• thorax, including the heart and lungs
• abdomen and gastrointestinal tract
• head and neck Clinical Pointer Be prepared with
sample tubes to collect urine if the animal urinates
spontaneously during the examination.
• urinary system
• reproductive tract
• mammary glands
• musculoskeletal system and feet
• skin including ears, feet, hooves, nails, and horns
• nervous system.
Body temperature
• Marked temperature variations are
an indication of a pathological
process:
• Hyperthermia
• Fever or pyrexia
• Hypothermia
• Levels of fever:
• Moderate fever: elevated ( 1.7 - 2.2 o c) above normal.
• Mild fever: elevated ( 1 o c) above normal.
• Sever fever: elevated ( 2.8 - 3.3 o c) above normal.
• Stages of fever:
• The increment or onset stage
• The fastigium or constant stage
• The decrement or defervescence stage
 hypothermia
• Circumstances that reduce the protective responses of
animals to cold environments include
• shearing, clipping or grooming
• inanition
• inadequate dietary carbohydrates and lipids
• general anesthesia
• hypocalcemia in cattle
• anemia
• dehydration
• hypoproteinenria
• administration of vasodilating agents
 Peripheral circulation and hydration

• The peripheral circulation and state of

hydration are determined by inspection
and palpation of the skin and the visible
mucosae and examination of the arterial
pulse and the state of the peripheral
veins
• Visible mucous membranes
– These include the mucosae of the conjunctivae,
nasal and oral cavities, vulva, and the prepuce.
– Monitoring the color and capillary refill time of the
oral mucous membranes is a useful aid in the
diagnosis and prognosis of animals with
hypovolemic and endotoxemic shock.
• Some of abnormalities which observed in mucous membranes can
be classified to:
– pallor of the mucous membranes may indicate anaemia caused by
direct blood loss or by haemolysis,
– a blue tinge may indicate cyanosis caused by insufficient oxygen in
the blood,
– a yellow color is a sign of jaundice,
– the mucosae may be bright red in febrile animals with septicaemia
or viraemia, Bright red coloration of the conjunctiva is often seen, in
cases of bovine respiratory syncitial virus infection.
– A cherry-red coloration may be a feature of carbon monoxide
poisoning.
– A greyish tinge in the mucosae in cases of toxaemia – such
membranes are sometimes said to be ‘dirty’.
– High levels of methaemoglobin, seen in cases of nitrate and/or
nitrite poisoning, may cause the mucosae to be brown colored
• Methods how to examine mucous membrane
by capillary refill time as follow:
✓ This is taken by compressing the mucosa of the
mouth or vulva to expel capillary blood, leaving a
pale area
✓ Recording how long it takes for the normal pink
color to return.
✓ In healthy animals, the CRT should be less than 2
seconds.
✓ A CRT of more than 5 seconds is abnormal, and
between 2 and 5 seconds may indicate a developing
problem.
 Arterial pulse
• This is taken at the
 middle coccygeal or facial arteries in cattle,
 Medial artery, transevese facial artery and maxillar
artery in the horse,

 the femoral artery in sheep, goats, dogs, and cats.

• The arterial pulse, examined for rate, rhythm,
amplitude, and quality.
• Procedure:
• Place the digits of fingers on the artery of
animals.
• Place the tip of the index / middle finger on
the artery and applying gentle pressure until
the pulse wave .
• Count the numbers of beats per minute,
which mean count up to 15 second and
multiply by four, notice the quality and rhythm
of pulse.
• factors influencing pulse
 Species
 Size
 Age
 Sex
 Parturition &Late stage of pregnancy
 Exercise
 Ingestion of food
 Posture
 Thorax
Heart auscultation
Auscultation is performed to determine the
• heart rate
• the character of normal heart sounds
• the presence of abnormal sounds
 Anatomical site of Heart auscultation
• Left side
– Intercostal
Spaces 3-5
– Behind the
elbow
– Normal
Rate?
• 48-84
Adults
• 70-100
Calves
• Normal Heart sounds
There are four normal sounds of the heart.
 First sound like “Lubb”: It is associated with
closure of atrioventricular valves (mitral and
tricuspid).
 Second sound like “Dubb”: It is associated
with closure of aortic and pulmonary valves.
 Third sound Associated with rapid filling of
the ventricle in early diastole.
 Forth sound Associated with atrial
contraction
• Abnormal Heart rate
• Tachycardia, or a marked increase in the
heart rate,
• Bradycardia,
• Abnormal heart sound
– cardiac Murmur
– Pericardial frictional rub
– Tinkling sound
– Muffled sound
• Heart rhythm: The normal rhythm of the
heartbeat is in three-time and described as
(LUBB-DUPP-pause).
• The first sound “LUBB” being dull, deep, long
and loud, and the second “DUPP” sharper and
shorter.
 Respiratory Rate and Lung Sounds
• Rate can be evaluated by
observation of chest
excursions
– Normal 26-50
• Sounds (triangle)
– Point of elbow
– T13 at Transverse
Processes
– Caudal to triceps
• Acoustic Percussion
– Dullness Dorsal to the
Heart Shadow?
• SQ Emphysema Dorsally?
– Reach up and feel for it
 Normal lung sounds
 Resembles a prolonged syllable "ch"
• Abnormal lung soung
 Rales
 Ephysematous
 Ribbing/frictional
 Rales:
Are sounds indicating the presence of fluid
(exudates, blood, and aspirated fluid) in the
bronchi and bronchioles.
Moist rales:
 Occur when mucus of relatively low viscosity is set in
motion by air passing through it.
 Like when air is blown from one end of a tube having
its other end in water.
It occurs in
 Bronchitis
 Pulmonary hemorrhage
 Bronchopneumonia and
 Aspiration of fluid
 Dry rales
 Heard when air is being forced through a partially constricted or
narrowed bronchial tube by
 Dry tenacious mucous or
 Sever swelling of the mucous membrane.
 The sound resembles
 Cracking, whistling or squeaking sounds.

 It occurs
 In early stages of acute or chronic bronchitis

 Spasm of bronchial muscles

 Pulmonary neoplasia or tuberculosis

 Distortion of the bronchi

• Emphysematous sounds
 It is a harsh and crackling sound.
 It simulates sound produced by crushing a sheet of
soft paper into a ball
• Occurs in
 Acute alveolar emphysema
• Rubbing/frictional sounds
– They are associated with
• Thickened pleura or pericardium.
• Early pre-exudative stage of pleurisy and pericarditis.
– They can be simulated by rubbing together two-
piece of dry leather.
 Abdominal Auscultation and Percussion

• Simultaneous
Auscultation
and Percussion
– “Pinging”
• Entire
Abdomen
• Palpation of rumen:
• in normal
• resilent palpation.
• in abnormal case it produces the following:
✓ Dopughy palpation: impaction
✓ Emphysematous palpation: tempany
✓ Painfull palpation: peritonitis, traumatic reticulitis
Auscultation
The intensity, duration and frequency of the
sounds should be noted (normal range
1-3/minute)
The sound has been described as a rasping
or crushing sound or as crackling rolling
thunder
Hypermotility — (more than five
movements every 2 minutes) is less common
and conditions include the development of
frothy bloat, and Johne’s disease.
Hypomotility — (less than one movement every 2
minutes)
occurs when a ration poor in fibrous structure is
fed, during forestomachs disorders (indigestion).
Rumenostasis may cause a free gas bloat
Associated with a number of conditions including
milk fever, carbohydrate engorgement( ruminal
acidosis) and painful conditions of the abdomen.
 Atony — absence of rumen movements — occurs
during severe forestomach disorders (traumatic
reticuloperitonitis, rumen acidosis, etc.).
• Rectal examination
• The internal abdomen like intestine and some organs
can be examined in large animals through rectum.
• The method and procedure for rectal palpation is by
 making cut and smooth the nail;
 wear shoulder long glove;
 lubricate;
 cone shape of the fingers;
 insert in rotating way; notice: the hand cannot open, or even
grasp organs inside.
 It’s necessary or possible to use tranquilizer to reduce the
sensitivity of the rectum in horse. In bloat case, the pressure
in the abdomen would be very high, so it would be diffi cult to
insert the hand inside.
 Urogenital
Cattle normally pass urine 8 to 12 times per day.
The average cow passes 6-12 litres of urine per day but it
depends on weight, diet, fluid intake and ambient temperature.
Urine is normally passed with ease and often after a resting
animal gets to its feet.
Gentle tickling of the perineum around the vulva or
prepuce with a piece of straw or the fingers may encourage
to urinate.
Cows and heifers arch their backs and stand with their hind
feet apart whilst urinating.
Male cattle pass urine less frequently and more slowly and
urine is passed either in a steady stream or in a pulsatile
manner whilst the animal maintains a normal standing
posture.
Any abdominal distension and ventral swelling observed,
possibly caused by leakage of urine
The skin covering areas of subcutaneous infiltrated by
urine leakage may become cold and necrotic
Vulva or prepuce is examined to see if blood or pus is
present.
The preputial hairs of male animals should be
examined.
 Numbers of small uroliths attached to the dry looking
hairs are often seen in animals which have or are at
risk of developing urolithiasis.
Vaginal examination by aid of speculum.
 Examination of the vagina for the presence of
discharges
External course of the penis should be followed by
palpation
 Rectal examination
The caudal pole of the left kidney should be palpated
Pain, enlargement or loss of the lobulated pattern of the
kidney may all indicate renal disease.
Pain on palpation of the bladder may be seen in cases of
cystitis or acute urinary retention.
Large quantities of free fluid in the abdomen can be
diagnosed by abdominoparacentecise
• Abnormality which associated with urinary
system are as:
• Frequency of urination
• Anuria and dysuria
• Haematouria
• Pyuria
 Peripheral Lymph Nodes
• Prescapular
• Prefemoral
• Supramammary
• Parotid
• Submandibular
 Examination skin
• Palpation can be used to assess the consistency of
lesions, the thickness, elasticity, and pain
• Every centimeter of the skin needs to be
examined
• The texture and elasticity of the skin must be
assessed by rolling the skin between the fingers
• The visual, tactile and olfactory senses are used to
see, feel and smell the lesions.
• Lesions may be primary or secondary.
• Primary lesions are the direct result of the skin
disease.
• Secondary lesions are mostly non-specific and result
either from further development of the primary
lesions or from self-inflicted damage.
• Primary lesions
• Macule – flattened area of colour change less
than 1 cm in diameter; no skin thickening
• Papule – flat circumscribed area, mostly
rounded and often rose with a necrotic center;
overall size less than 1 cm in diameter; may be
associated with the hair follicles
• Nodule – a papule more than 1 cm in diameter
• Plaque – solid raised flat topped mass more
than 1 cm in diameter
• Tumour – large nodular structure, often of neoplastic origin
• Vesicle – fluid filled blister less than 1 cm in diameter (vesicles
larger than 1 cm are called bullae)
• Pustule – pus filled vesicle

• Secondary lesions
• Scale – accumulation of loose, dry fragments of superficial skin
layers
• Crust – dried accumulation of debris including blood and pus
• Erosion – loss of superficial epidermal layers with intact inner
layers
• Excoriation – erosion or deep ulcer of traumatic origin
• Ulcer – deep erosion penetrating the epidermal basement
membrane
• Scar – fibrous tissue replacing damaged skin
• Fissure – split in the superficial skin layers often
caused by drying and thickening
• Keratosis – overgrowth of dry horny keratinized
epithelium
• Pigment changes – hyper- or hypopigmentation
• Alopecia – hair loss.