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Physical Exams

At the Village Veterinary Clinic of Hamburg we recommend physical exams yearly for dogs and cats. There are many things that we can pick up on during your pet’s physical. It is always best to find something early!

Veterinarians increasingly rely on the most advanced technology and equipment to make diagnoses. One thing that will always be necessary, however, is the physical examination. Certainly, many diseases cannot be found on examination alone, but the ability to touch, feel, look, and listen are irreplaceable skills that will keep professionals at the forefront of veterinary medicine.

Here are 5 conditions that can be diagnosed using the hands, eyes, and mind:

  1. Oral Disease 

Studies have shown the connection between periodontal disease and systemic health, so recognizing and treating dental, periodontal, and other oral diseases appropriately has a positive effect on patient health and longevity. A dental cleaning can go far beyond merely helping a patient’s bad breath.

Malocclusions, neoplasia, stomatitis, trauma, and eosinophilic granuloma complex are other important diseases that can be recognized on a physical examination. We also take a quick look under the tongue. During the examination, veterinarians grade tartar buildup and chart any potential extractions before scheduling dental procedures.

  1. Otitis 

An otoscopic examination or evaluation of the ears is performed on every patient. Otitis or inflammation of the ear is a sign of an underlying disease. Most commonly causes are allergic disease or parasites (Demodex, Otodectes, Sarcoptes spp) But other possibilities are foreign bodies, neoplasia, and autoimmune diseases. The veterinarians will look for whether swelling, redness, odor, discharge, and pain prevent visualization of the tympanic membrane (or the ear drum), and palpate the canal externally to check for canal thickening or ossification (hardening of the canal).

In acute cases, the inner ear pinna (ear flap) and ear canal are usually red and swollen, and ulcerations, excoriations, and crusts may be present. In chronic cases, ears can have hyperkeratosis (we describe this as “elephant skin”), and hyperpigmentation (skin darkening). The ear can also have such severe swelling that it actually swells closed (temporarily or permanently).

  1. Certain Ocular Disorders 

Several structural components of the eye should be evaluated on physical examination, including both external (conjunctiva, eyelid) and internal (anterior chamber, lens, fundus) areas.

Ocular diseases can be divided into primary ocular disease and secondary ocular disease caused by a systemic disease. The most common primary disorders that can be diagnosed during a physical examination include conjunctivitis, anterior uveitis, cataracts (needs to be differentiated between nuclear sclerosis), entropion, distichiasis (eyelashes are forming in an abnormal area around the eye), corneal ulcers, and fundic abnormalities.

Secondary systemic diseases range from systemic hypertension to infectious agents to neoplasia. If an abnormality is present, the next step is to identify the disease process.

  1. Heart Murmurs & Arrhythmias 

Owners cannot pick up their pet’s heart murmur or arrhythmia at home, making the physical examination even more critical. Heart murmurs are caused by the vibration of cardiac structures or turbulent blood flow, which may originate from structural heart disease or normal physiological phenomena. Arrhythmias are caused by abnormalities in the electrical conduction of the heart. It is also important to differentiate a sinus arrhythmia from a pathologic arrhythmia, as a patient with enough vagal tone for a sinus arrhythmia is not in congestive heart failure.

Soft murmur likely indicates mild disease and a higher grade murmur severe disease, we grade heart murmurs between 1 and 6, 1 being a mild or quiet murmur, 6 being very loud and severe. There are many factors to be taken into consideration when determining a murmur, such as age, physical condition, other disease conditions occurring. All these are important to evaluate and discuss, and do possible further diagnostics if necessary. Typically a thoracic x-ray is the first step when evaluating a murmur.

A diagnosis is often more complicated in cats: Many may have heart disease but no murmur, and many others (especially older cats) have murmurs with no apparent heart disease. Studies have reported the prevalence of murmurs in healthy cats as high as 21%. X-rays and echocardiograms are usually the diagnostics of choice when it comes to cats and heart disease.

  1. Anemia 

Anemic patients can be recognized by the presence of pale to white mucous membranes. On physical examination, all the areas that represent the patient’s ability to perfuse his or her body’s periphery should be checked, including the mucous membranes, sclerae, and any thin areas of skin (eg, inner pinnae).

Normal gums should be pink with a quick capillary refill time, and different colors represent different disease states. Anemia, the most common detectable condition, is represented by membranes that are pale pink to white; dark purple to brown membranes can represent intracardiac shunting of blood, methemoglobinemia, or lung disease; gray membranes may indicate cyanosis; and yellowish or icteric membranes may indicate liver disease or hemolysis.

Anemia can be divided into 3 broad categories: blood loss, lack of red blood cell production, or destruction of red blood cells. The primary differentials for blood loss include external or internal bleeding, including gastrointestinal (GI) bleeding. Owners are often unaware of chronic GI blood loss (often times the problem remains a silent, until it unfortunately makes your pet very ill). Lack of red blood cell production is generally related to chronic diseases such as renal disease or neoplasia. Destruction, or hemolysis, generally leads to jaundice and pale mucous membranes; causes include primary immune-mediated or secondary hemolytic anemia, infectious diseases, drug reactions, and septicemia. The prognosis and treatment of all these conditions vary greatly, and further diagnostic work-up is indicated.

- Article courtesy of Veterinary Team Brief, May 2014

If you have any questions related to this article please call the Village Veterinary Clinic of Hamburg! Thank you!

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