Chapter 16 Testing Testing.
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Transcript of Chapter 16 Testing Testing.
Chapter 16 Testing Testing Physical Examination Terms
Physical Examinations are performed to assess a patientscondition.
Medical Records are important written documents. assessment =
evaluation of a condition an examiner's evaluation of the disease
or condition based on thepatient's subjective report of the
symptoms and course of theillness or condition and the examiner's
objective findings, includingdata obtained through laboratory
tests, physical examination,medical history, and information
reported by family members andother health care team members
signalment = description of the animal example of a signalment:
12-yr-old, F/S DLH 2-yr-old Arabian colt 4-mo-old barrows Bell Work
Monday, Feb 3 What do the following abbreviations stand for?
MM CRT HR RR PE History obtaining information useful in formulating
a diagnosis andproviding medical care to thepatient. Signalment
Chief complaint (what is wrong) Duration of complaint (how long)
Past medical problems Medications (including OTC, Holistic herbs,
Supplements) Diet Review of all organ systems (brief or extensive?)
Vital Signs Vital signs are parameters taken from the animal to
assess itshealth. Temperature (T) febrile versus afebrile pyrexia
Hypothermia Where measured:Rectal vs ear canal vs other? Pulse (P)
Weak (heart failure, low blood pressure, shock) Strong Bounding,
Regular, Irregular Where measured: femoral artery most common
Respiration (R) Fast (panting) Labored (increased effort to
breathe-heart disease/ cant getenough oxygen) Abdominal (pleural
effusion-lungs are impaired) How measured Vital Signs Heart Rate
Blood Pressure Too high Too low
Rhythm- irregular Sounds whooshing, muffled, non existant Blood
Pressure Too high/ Too low Unstable 150/95( / )Systolic/Diastolic
Cardiovascular, renal, ocular pressure Vital Signs Mucous Membranes
Capillary Refill Time Pink (bubble gum)
White pale Blue cyanotic Red- (bright red or brick red) Yellow -
jaundiced Capillary Refill Time 1-2 seconds is normal 2 seconds
(greater than 2 seconds) slow, dehydration, shock, poor perfusion
Types of Examination Auscultation Palpation (NOT
palpitation!)
the act of listening to body sounds Heart, gut sounds, lungs
Palpation (NOT palpitation!) examination by feeling Limbs, abdomen
Percussion examination by tapping the surface to determine
densityof a body area For example, since the heart is not resonant
and the adjacentlungs are, when the examiner's fingers strike the
chest over theheart the sound waves will change in pitch. Shock
Lack of adequate blood volume to perfuse the bodystissues.Results
can be fatal as multiple organs fail. Symptoms: Mm = pale, white,
gray Hr=very high (or very low) Rr=very high or very slow and
labored Difficulty breathing Pulse is weak and very high Confusion,
stupor, weak, depressed Examples Blunt trauma Penetrating trauma
Poison/toxin
HBC, high rise syndrome Penetrating trauma Gunshot, knife, stick
impalement Poison/toxin Hyperthermia/hypothermia Bloat Massive
infection (septic shock) How shock is treated Shock is called
hypovolemic shock decreased bloodvolume (blood and fluid /plasma)
Heart is unable to pump blood to the tissues To correct hypovolemia
you must replace the blood/fluid Medications to increase blood
pressure Dopamine, epinephrine, norepinephrine Determine the order
of triage for the following critical cases:
8 yr, M/N dog, HBC.Has a wound in back left leg.MM arepink and the
dog is walking. 4 yr, M/N cat.Extremely weak and not walking.Hx
ofstraining in the litter box the day prior and not passing urine.
Gums are pink. 2 yr, F/S Golden Retriever.Playing in the backyard
and cameinside with a swollen face.Difficulty breathing, gums are
palepink.Dog is a little depressed but alert, HR is 120, RR
ispanting 7 week old Chihuahua puppy.Hasnt eaten all day.Wobblywhen
walking, T=99.9, mm=pale pink.No hx of vomiting ordiarrhea
Instruments used in Physical Exam
Stethoscope Parts of stethoscope Diaphragm Bell earpieces
Auscultating body sounds Heart Lungs Digestive system Borborgamus
Ileus Otoscope Light and an ear speculum
Battery operated Allows visualization of theear canal Also allows
visualization ofother areas Ophthalmoscope Used to look at the
retina Laryngoscope View the pharynx Assists in lowering
epiglottis
Access to trachea for intubation Speculum Ehances visualization of
an opening Many kinds of specula
Ear speculum (cone) Mouth speculum Centrifuge Spins fluid samples
(blood,urine, feces in solution) toseparate fluid fromheavier solid
particles Should always be acounterweight to balance
Microhematocrit Centrifuge
Small thin tubes of blood Separates red blood cells (heavier) from
the plasma Hematocrit = Ratio of red blood cells in blood Normal
would be >40% Also called PCV Refractometer Measure specific
gravity of
(concentration of solutes) in body fluids such as urine. Soap: A
way to organize Subjective Objective Assessment Plan Subjective
Personal Opinion Open to interpretation
Definition of Subjective Personal Opinion Open to interpretation
Not necessarily facts Something perceived by someone else (client)
This section should capture your subjective evaluation of the
animal, herd,or problem, the clients observations, the client can
be asked directedquestions about any complaints current or
reportedly resolved -- andask appropriate follow-up questions and
document all responses. (e.g. BAR bright, alert, responsive;
depressed; improving; getting worse,no change, etc.) Objective
Definition of Objective Facts
Unbiased or uninfluenced by another person including yourself It is
what it is This section is compiled from the physical exam and
diagnostictest or procedures; it typically summarizes measurable
data (e.g. rectal temperature, blood glucose, echocardiography,
etc.) Assessment Evaluation Judgement
This section is an analysis of the subjective and objective data
For this component, the veterinarian pulls together the subjective
information gathered during the interview with the client and the
objectivefindings of the physical exam (and, possibly, laboratory
or other studyresults) and consolidates them into a short
assessment. The assessment portion usually shows processes by which
you arrived at aconclusion or diagnosisIncludes rule outs Is
written very specific and concise Plan Detailed Decisive Action (or
no action)
A plan would include anything that will be done as aconsequence of
the assessment and could include: Laboratory tests,
hospitalization, treatment, medications,follow up instructions to
client, next appointment Some videos, PE
https://www.youtube.com/watch?v=LF1bd-JYhyo
Animated dog exam https://www.youtube.com/watch?v=O6uUNmZiLZY(30
min long-cow) https://www.youtube.com/watch?v=gdx3DhmtadA Cow exam
For fun (11 minvet student)
https://www.youtube.com/watch?v=DTv7AByGKI4 Bell Work Monday, Feb
10 An example of a subjective component of a SOAPwould be: An
example of an objective component of a SOAPwould be: The assessment
portion would include: The plan would include: Tomorrow: Tuesday in
the Lab
You might want to bring an old shirt to coverclothing There will be
a short worksheet-You will need tohave a pen or pencil Be aware
that you may need to assist a classmate ifthey unexpectedly get ill
Be interested!Not grossed out!Yes, stuff smells,but you may never
see the inside of a cow stomachagain! Bell Work Tuesday, Feb 18
What is a disease? What makes it a disease?
Name some animal diseases. Pathogenic Organism and Disease
Terms
microorganism that produces disease A living organism of
microscopic dimensions Not all microorganisms are pathogens The
microorganism in the pictures is not a pathogen- does not produce a
disease, in fact Pathogenic Organism and Disease Terms
deviation from normal infectious disease noninfectious disease
contagious (communicable) disease iatrogenic disease idiopathic
disease Kochs germ Theory (simplified)
Defines an infectious disease The infectious agent should be
detectable in sick animals butnot healthy animals It should be
possible to isolate and culture (grow) theorganism Organisms taken
from the culture and introduced into ahealthy animal should cause
the same disease The same organism should be isolated from the
second animalas well Infectious Disease Caused by microorganisms
that gain entry into theanimals body How does a microorganism gain
entry? Transmission Bloodborne blood/ body fluids Airborne
respiratory droplets Fecal-oral transmission eating, drinking,
licking contaminatedfood, water, objects Vector-borne- bloodsucking
arthropods (insects such asmosquitoes, ticks, mites) that carry the
disease from one to another Direct contact Bell Work Wed Feb 19
True or False
A pathogen is a microorganism that produces disease. True Not all
microorganisms are pathogens. True-example of microbes in rumen
Transmission has to do with whether or not a disease isdisease.
False-transmission has to do with how a microorganism gains entry
According to Kochs Germ Theory (aka Kochs Postulates) ahealthy
animal could become sick if a pathogen from a sickanimal were
introduced into the healthy animal. Assignment: due Wed Feb
19
Find an example of each of the following: A bloodborne disease
(keyword-secretions) Felv, FIV, FIP, Canine Herpesvirus (CHV), An
airborne disease Kennel Cough, Feline Viral Rhinotracheitis A
vector-borne disease Heartworm, WNV, (Hantavirus, plague-animals as
vectors) A disease transmitted by the fecal- oral route Parvovirus,
roundworms, Cryptosporidosis Direct contact- touch, bite, scratch
Anthrax, coronavirus, mersa Bloodborne disease Example: Hepatitis B
and C in humans FIV, FIP, FeLV
Definition:Disease-producing microorganisms transmitted by means of
blood, tissue, and bodyfluids containing blood Blood borne
transmission is also considered Direct (or Indirect Contact?)Could
be Droplet? Transmission of Pathogens Potential exposure occurs
through contact with blood, bloody saliva, vaginal
secretions,semen, and other potentially infectious bodily fluids.
Sources of Infection Pathogens can be transmitted through open
cuts, blisters, sores, acne, body piercings,new tattoos, amniotic
fluid, joint fluid, brain and spinal cord fluid, fluid from
aroundthe heart, and body cavity fluid. Example:Hepatitis B and C
in humans FIV, FIP, FeLV Contagious vs Noncontagious
Contagious diseases are spread animal to animal Contagious diseases
are also called communicablediseases and are spread through direct
or indirectcontact An inanimate object that is contaminated with
acontagious disease is called a fomite Fomites are sources of
infection for other animals Water and food bowls, kennels, clothing
and shoes Not all infectious diseases are contagious Tetanus
Infectious Diseases 4 classes of agents (an agent is something
thatproduces an effect) Bacterium/Bacteria Virus/Viruses
Fungus/Fungi Parasites 1. Bacteria Staphylococci- (cocci means
round) round, clusters
Skin infections, wounds, food poisoning Streptococci-round, chains
Strangles Bacilli rod shaped anthrax Spirochetes spiral
Leptospirosis Endospore oval body inside, resistant clostridium
Rickettsia rod shaped, small ehrlichia Examples of Infectious
Bacterial Diseases
Rabbit Pasteurella (Snuffles) Tuleremia (vector-ticks,flies) Horse
Tetanus Strangles Cat Enteritis Cystitis Swine Yersinia Cattle E
Coli Mastitis Anthrax Canine Leptospirosis (Lepto) Ehrlichiosis
(Tick Fever) BordatellaBronchiseptica (kennelcough) 2. Examples of
Infectious Viruses
Cattle Bovine Viral Diarrhea(BVD) Cats Feline Panleukopenia
Calicivirus Feline Leukemia Virus Feline ImmunodeficiencyVirus
Rabies - most warm bloodedanimals Dogs Parvovirus Distemper Horses
West Nile Virus Equine Encephalomyelitis Bacteria vs viruses Is a
living cell Prokaryote cell No Nucleus
Made up of cytoplasm, DNA, ribosomes, flagella Virus Not a living
cell!But are considered alive becausethe reproduce, grow, develop,
adapt, use energysources from their environment Made up of genetic
material/ nucleic acid (DNA orRNA) enclosed in a protein shell All
sorts of shapes, but are extremely tiny/ cannotsee with a regular
microscope What about Retroviruses (Feline Leukemia and FIV):
https://www.youtube.com/watch?v=eS1GODinO8w Viruses insert their
genetic material into a living cell
The cell becomes the virus host The virus DNA/RNA becomes a part of
the cells DNA so that during cell division the virus is being
replicatedand passed on Eventually the virus DNA takes over,
completely changesthe host cell/ kills its host cell and continues
to replicateand create lots more viruses Bacteria/Viruses
Ribosomes: Present / Absent
Living attributes: Living organism - Opinionsdiffer on
whetherviruses are a form of life or organicstructures that
interact with living organisms. Numberof cells: Unicellular; one
cell / No cells; not living Structures: DNA and RNA floating freely
in cytoplasm. Has cell wall and cell membrane / DNA or RNAenclosed
inside a coat of protein. Treatment: Antibiotics / Vaccines prevent
the spread and antiviralmedicationshelp to slow reproductionbut can
not stop it completely. Enzymes: Yes / Yes, in some Nucleus: No /
No Virulence: Yes / Yes Infection: Localized / Systemic Benefits:
Some bacteria are beneficial (e.g. certain bacteria are required in
the gut) / Virusesare notbeneficial. However, a particular virus
may be able to destroy brain tumors (see references).Virusescan
beuseful in geneticengineering. Reproduction: Fission- a form of
asexual reproduction /Invades a host cell and takes over the cell
causingit to make copies of the viral DNA/RNA. Destroys the host
cell releasing newviruses. Size:Larger (1000nm) / Smaller ( nm Cell
wall:Peptidoglycan/Lipopolysaccharide / No cell wall.Protein coat
present instead. Prions Are proteins Not alive They do not have DNA
or RNA
They have an ability to reproduce Can cause inherited or
transmissible diseases Prions Prion diseases are fatal and cause
progressive,neurodegenerative problems literally, holes in the
brain The brain resembles a sponge / diseases are called spongiform
Examples of spongiform encephalopathies are. 1)Scrapie.in sheep and
goats 2)BSE .Mad Cow Disease 3)Chronic Wasting Diseasewild deer and
elk Transmitted by inherited disease, or ingested from tissue of
infected animals (brain, spinal cord) 3. Examples of Infectious
Fungi (mycoses)
Dermatophytes (Ringworm) Thrush (? Fungus caused by anaerobic
bacteria andmositure) Coccidioidomycosis (Valley Fever)
Blastomycosis (South East) Histoplasmosis Candida (yeast infection)
4. Examples of Infectious Parasites
Heartworm (Dirofilaria immitis) TrichinellaTrichinosis Hookworm
(Ancylostoma), Whipworm (Trichurisvulpis), Roundworm (Toxocara)
Giardia (protozoan) Coccidiosis (protozoan) Noninfectious Disease
Classifications
Classifying diseases helps aid the veterinarianinobtaining a
diagnosis Helps the diagnostic process Clinical signs and symptoms
could be the result ofseveral different disorders Differential
diagnosis-a list of possible causes of disease Rule Outs-ruling out
possible causes of disease throughdiagnostic testing, observation,
trial treatment NonInfectious Disease Classifications
Metabolic-disruption of normal chemical reactions Diabetes,
hypothyroidism, hyperthyroidism, Cushings, Addisons Anomalies
Congenital Birth Defects Cleft palate, deaf, retinal
dysplasia,dwarfism Degenerative progressive, permanent, longterm
deterioration DJD (osteoarthritis), Bovine Spongioform
Encephalopathy (BSE) Trauma Traumatic reticuloperitonitis, high
rise syndrome,sucking chest wound,diaphragmatic hernia,
peritonitis, prolapsed uterus Toxins - ingestion, inhalation,
contact Antifreeze, misapplication of flea and tick products,
warfarin (rat poison), toads, OTC medications, illegal drugs,
plants Immune Immune Mediated Hemolytic Anemia (IMHA),System Lupus
Erythematosus (SLE) Pruritis and Atopy (itchiness and hairloss)
[allergies] NonInfectious Disease Classifications
Iatrogenic- a condition that develops as a result of treatment
Hyperadrenocorticism (Cushings)- can be caused by treatment for a
severeallergy problem Surgery-excision of Thyroid glad to treat
hyperthyroidism in catsparathyroidmay also be removed causing
iatrogenic hypoparathyroidism. Idiopathic- no explanation for
underlying cause of the disease Idiopathic seizures Idiopathic
renal hematuria Neoplasm - benign or malignant tumor Nutrition
Acute acidosis in ruminants, malnutrition, skeletal disease,
hypoglycemia,obesity 3 SEIZURE CASES Seizure Case 1: A 3 month old
male toy poodle.The dog is strictly a house dog and does not run
free,In addition to the seizures, it has had intermittent diarrhea
and is quite thin. Differential Diagnosis (DfDx): Developmental
Disorder- brain malformation Hypoglycemia-could be secondary to
poor diet, diarrhea, intestinal parasites Head Trauma- not likely
with indoor dog Toxins-potential for ingesting medications or
illegal drugs, chocolate Infectious causes of encephalitis-
Distemper Idiopathic epilepsy-very unlikely due to age of dog
Seizure Case 2: A 2 year old male golden retreiver.This dog is in
excellent physical condition and has been eating well.This dog is
free to roam the neighborhood and recently had one episode of
vomiting and one episode where it was limping and stiff. DfDx:
Idiopathic epilepsy-this is high on the list because of age and
breed of dog at the onset of seizures. Head Trauma-the recent
limping and stiffness raises this possibility Toxins- the list is
long, but possibilities include insecticides, chocolate Liver
Disease-definitely needs to be ruled out but dog has been doing
well otherwise Infectious Encephalitis Seizure Case 3: A 14 year
old female schnauzer.This dog had its first seizure and since that
time has not been acting normal.There has been some weight loss and
a poor appetitie, and the owners feel the dog can no longer see.The
dog is strictly an indoor dog with no history of trauma. DfDx:
Metabolic Disease-liver dx, hypogylcemia (insulinoma in the
pancreas), Diabetes Neoplasia- the age of the dog, the blindness,
lack of normalcy after the seizure make this a high likelihood
Ideopathic epilepsy-very unlikely with the age of the animal
Pathogenic Organism and Disease Terms
Disease terminology Transmission-how pathogens gain entry Morbidity
versus Mortality Morbidity- diseased animals Mortality diseased
animals that die Moribund near death Prevelance - amount/ number of
diseased at a given time (withina population) Susceptibility
lacking resistance Noscomial Infections Noscomial- hospital
(clinic) acquired infection
NosocomialinfectionAn infection occurring in a patient in a
hospital or otherhealthcare facility in whom it was not present or
incubating at the time ofadmission; or the residual of an infection
acquired during a previous admission.Includes infections acquired
in the hospital but appearing after discharge, andalso such
infections among the staff of the facility. (Synonym:
hospital-acquiredinfection Hygiene, cleaning, disinfecting,
antimicrobial, infection control, isolation Often resistant type,
ex: MRSA, Highly contagious potential for fatality ex: Parvovirus,
Distemper, respiratory viruses Prophylaxis Prophylaxis-prevention
of disease and spread of disease
Environmental-ventilation, cleanliness of facilities,
insects,cleanliness of objects (preventing fomites), bedding, pens
Health/ Nutrition (healthy animals remain resistant to most
diseases) Stress releases cortisol and epinephrine/lower immunity
Overcrowding, feeding frenzy, climate, noise, rough handling
Minimize exposure or susceptability to pathogens
Vaccinations-increase animals immunity Pets vs Herd, value/costs,
allergic reactions, fibrosarcoma Testing prior to obtaining
Quarantine (incubation) Zoonosis Zoonosis-disease that can be
transmitted betweenanimals and humans Hosts Vectors (carry)
Sentinels (watch/ warn) Zoonoses Zoonosis-disease that can be
transmitted between animalsand humans (under natural conditions)
How?Exposure of human to the infection of the animal If an animal
has a disease and a human could get it, the diseaseis said to be
zoonotic Transmission may occur through Direct contact with the
animal Through a vector such as fleas or ticks Through food
contamination Most at risk: young or immune suppressed (sometimes
old), alsooccupations that require working with diseased or
possiblydiseased animalssuch as veterinarians, lab researchers,
farmersand ranchers, slaughterhouses Examples Avian Flu Transmitted
by direct contact with infectedbirds/poultry In birds symptoms are
illness, decreased production,death In humans typical flu syptoms,
can be severe enough tocause death At risk population Backyard
flocks Poultry business Veterinarians Examples Visceral Larva
Migrans (larva of roundworms)
Fecal-oral transmission In animals (dogs) worms caninvade the
liver, the lungs, theuterusparasitic and rob the hostsfood In
humans the larvae migratethrough body tissues-lungs, liver,eyes
Dog, cat, racoon is host eggs pass through intestines,dogs ingest
(cycle) Zoonosis occurs when larvaeare unknowingly consumedby
humans Host A host is a person or other living animal that
contributes food and lodging to an infectious agent. *Primary host/
definitive host- organism / parasite gains maturity
*Secondary/intermediate host- organism/parasite is in a larval
stage *Transport host/ Vector a carrier in which the organism
remains alive but does not develop Example of a disease with an
intermediate host: Neospora Caninum coccidian parasite that causes
disease in cattle:Definitive host is dog/ coyote/ fox, intermediate
host is cattle:Oocysts in feces from dogs, cattle graze,
oocystfinish in cattle Vector /Carrier A vector is a carrier,
especially the animal thattransfer an infective agent from one host
to another Example:Heartworm Disease Vector is the mosquito Carries
the infective agent from one dog to another dog The dog is a host
to Heartworms because the Heartwormcompletes its growth cycle in
the dog Carrier does not become infected-no sign/symptoms of
infectiousdisease (the mosquito does not get Heartworm Disease)
Zoonosis Rabies Ringworm Toxoplasmosis Cats are host
Oocysts (eggs) pass through intestines Oocysts are
ingested-toxoplasma organisms can invadebrain, fetus (pregnant
women) Infected cats infect other animals oocysts form cysts
inmuscle tissue-if food animal, human can become infected Cats
become infected by eating rats Zoonosis West Nile Virus BSE Anthrax
Leptospirosis
Bartonella Henselae (bacteria (bacillus) that causes catscratch
fever) Equine Encephalitis Brucellosis Tuberculosis Avian Influenza
Etiology and Epidemiology
Epidemiology-study of relationships determining frequencyand
distribution of diseases disease etiology, outbreak investigation,
disease surveillance andscreening, biomonitoring, and comparisons
of treatment effects suchas in clinical trials. Etiology-study of
disease causes/origination The etiology of scurvy is a good
example. With scurvy, sailors goingto sea often lacked fresh
vegetables. Without knowing the precisecause, Captain James Cook
suspected scurvy was caused by the lackof vegetables in the diet.
Based on his suspicion, he forced his crewto eat sauerkraut, a
cabbage preparation, every day, but he hadno idea, precisely, why
it prevented scurvy. It was only about twocenturies later - in 1926
that it was discovered that it was the lackof vitamin C in a
sailor's diet that was the base cause of scurvy. Testing Methods
Endoscopy Centesis
visual examination of the interior of any cavityof the body by
means of an endoscope Centesis surgical puncture to remove fluid
for diagnosticpurposes or to remove fluid or gas Testing Methods
Imaging techniques radiography computed tomography
magnetic resonance imaging fluoroscopy ultrasound