Approach to the acute abdomen

Acute abdominal pain is a clinical sign associated with several underlying disease processes, many of which can be life threatening. Abdominal pain requires efficient diagnostic evaluation to determine the appropriate course of treatment. Definitive treatment involves medical and/or surgical management. The emergency clinician must be well versed in the diagnostic approach to these patients to facilitate appropriate therapy.     

Clinical epidemiology

Rational clinical practice requires deductive particularization of diagnostic findings, prognoses, and therapeutic responses from groups of animals (herds) to the individual animal (herd) under consideration This process utilizes concepts, skills, and methods of epidemiology, as they relate to the study of the distribution and determinants of health and disease in populations, and casts them in a clinical perspective.

We briefly outline diagnostic strategies and introduce a measure of agreement, called kappa, between clinical diagnoses. This statistic is useful not only as a measure of diagnostic accuracy, but also as a means of quantifying and understanding disagreement between diagnosticians. It is disconcerting to many, clinicians included, that given a general deficit of data on sensitivity and specificity, the level of agreement between many clinical diagnoses is only moderate at best with kappa values of 0.3 to 0.6.

Sensitivity, specificity, pretest odds, and posttest probability of disease are defined and related to the interpretation of clinical findings and ancillary diagnostic test results. An understanding of these features and how they relate to ruling-in or ruling-out a diagnosis, or minimizzing diagnostic errors will greatly enhance the diagnostic accuracy of the practitioner, and reduce the frequency of clinical disagreement. The approach of running multiple tests on every patient is not only wasteful and expensive, it is unlikely to improve the ability of the clinician to establish the correct diagnosis.

We conclude with a discussion of how to decide on the best therapy, a discussion which centers on, and outlines the key features of, the well designed clinical trial. Like a diagnosis, the results from a clinical trial may not always be definitive, nonetheless it is the best available method of gleaning information about treatment efficacy.

     

Four cats with fungal rhinitis

Fungal rhinitis is uncommon in the cat and cases of nasal aspergillosis-penicilliosis have been rarely reported. Signs of fungal rhinitis include epistaxis, sneezing, mucopurulent nasal discharge and exophthalmos. Brachycephalic feline breeds seem to be at increased risk for development of nasal aspergillosis-penicilliosis. Computed tomography (CT) imaging and rhinoscopy are useful in assessing the extent of the disease and in obtaining diagnostic samples. Fungal culture may lead to false negative or positive results and must be used in conjunction with other diagnostic tests. Serological testing was not useful in two cats tested. The cats in this study were treated with oral itraconazole therapy. When itraconazole therapy was discontinued prematurely, clinical signs recurred. Hepatotoxicosis is a possible sequel to itraconazole therapy.     

Serology as an aid to diagnosis: uses and abuses

The importance of correct interpretation of serological test results, common sources of error and problems associated with tests are discussed. In bovine brucellosis, a disease which is ideally suited to serological diagnosis, foetal contact with infection may cause the calf to be a serologically negative carrier. The immune tolerant animal resulting from foetal contact with virus is a major problem in the serological detection of border disease. In Johnes' disease and to a lesser extent in Brucella ovis and leptospiral infections, problems associated with sensitivity and specificity of the tests are stressed. Serovar specificity, cumbersome test procedures and negative tests in the incubation period cause difficulty in the interpretation of serological test results for leptospirosis. The importance of clinical examination, herd histories and alternative diagnostic procedures is important in all diseases. Wherever possible, flocks or herds should be maintained in specific disease-free state. Selection of stock from accredited herds or flocks is the most certain method of buying non-infected animals.     

Diagnostic ultrasonography of equine limbs

In our 3 years of clinical experience, we have found that diagnostic ultrasound provides the veterinarian with a valuable diagnostic tool. It allows the clinician to quantify morphologic change that has occurred as a result of soft-tissue injuries, even when the clinical findings are ambiguous or insufficient. In cases in which aggressive postinjury therapy has been instituted prior to presentation, diagnostic ultrasound is often the only noninvasive method that can ascertain the extent of the horse's injury. Diagnostic ultrasound provides the technology to detect injuries before they become permanently debilitating, because lesions as small as 1 mm in diameter can be detected. Prior to diagnostic ultrasound, the severity of many injuries was underestimated. In such cases, if the horse responded favorably to symptomatic therapy, the client would resume training. The result was often debilitation. Diagnostic ultrasound also enables the clinician to demonstrate visually to the client the location, size, and extent of lesions in the limb. One of the more gratifying effects of a sonographic study is the client's acceptance of the presence and extent of the injury after visualizing it. We have found that the old adage "a picture is worth a thousand words" is generally the rule in obtaining the proper course of therapy for the horse. The ability to make hard copies of sonograms enables the clinician to morphologically evaluate the rate of healing. He can accurately determine the effectiveness of a therapeutic regimen and ascertain when optimal healing has occurred. Diagnostic ultrasound can provide the researcher with an invaluable tool to document and quantify soft-tissue disease. We anticipate that, in the future, the sonographic appearance of recovered tissues will be correlated with new data on the healing process and the effectiveness of various therapies. The material presented above has covered the value of diagnostic ultrasound in major clinical situations related to equine lameness. Other applications, the discussion of which is beyond the scope of this article, include evaluation of the pastern for injuries to the SDF, DDF, and oblique sesamoidean ligament, and evaluation of the navicular bursae. Examination of muscles for hematomas, abscessations, and tears has also been accomplished ultrasonographically. Diagnostic ultrasound has facilitated study of the trochanteric and bicipital bursae, blood flow through arteries, and structures above the carpus and hock. Obviously, the clinical potential of diagnostic ultrasound is limitless.(ABSTRACT TRUNCATED AT 400 WORDS)     

Otic cytology in health and disease.

Accurate characterization of the primary cause and perpetuating factors is essential for successful management of ear disease in dogs and cats. Cytology is a simple, rapid, and practical diagnostic test that should be performed routinely on any and all patients presented for clinical signs consistent with otitis externa. In combination with clinical signs, otoscopic evaluation, and diagnostic testing of primary disease, serial cytology enhances the ability of veterinarians to diagnose secondary infections, monitor progression of disease, evaluate response to therapy, and make appropriate management decisions. Cytologic specimens should be evaluated for the presence, numbers, and characteristics of three key features: yeast, bacteria, and leukocytes. More than five yeast organisms or more than 25 bacteria per high-powered field is suggestive of significant microbial activity warranting therapeutic intervention. The presence of leukocytes, particularly with phagocytized bacteria, indicates "true infection" rather than overgrowth; if suppurative discharge is present, systemic therapy is needed. Cytology combined with culture and susceptibility is the best method for identification of bacterial overgrowth and infection; however, if only one test can be performed, always choose cytology. Culture results assist in the selection of appropriate antibiotic therapy, but cytology determines whether systemic antibiotics are indicated, which organisms are most significant, and when therapy can be discontinued.     

Clinical approach to prostatic diseases in the dog

In small animal practice, prostatic diseases are increasingly encountered. All dogs may experience prostatic disease, but particular care should be addressed to breeding dogs, in which prostatic affection may lead to decrease in semen quality and fertility. The most common prostatic disease is the benign prostatic hyperplasia (BPH) followed by prostatitis, prostatic neoplasia and prostate squamous metaplasia. These diseases do not have pathognomonic symptoms, therefore, making a correct diagnosis may not be easy. An accurate clinical examination and a correct diagnostic protocol are essential in order to begin the most appropriate treatment, and also to do a good prophylaxis where it is possible. BPH therapy is usually recommended when mild‐severe signs are present or if symptoms disturb the patient. New therapeutic approaches, both medical and surgical, allow to maintain fertility in most animals with prostatic disorders. Prostate cancer is relatively infrequent. Elective therapy is the surgical one, but it is considered palliative and can result in important post‐operative complications. The aim of this paper is to lay down the most appropriate diagnostic process describing the aetiologies of prostatic disease, their symptoms, the right investigative tools and therapy.     

Serology as an aid to diagnosis: uses and abuses

The importance of correct interpretation of serological test results, common sources of error and problems associated with tests are discussed. In bovine brucellosis, a disease which is ideally suited to serological diagnosis, foetal contact with infection may cause the calf to be a serologically negative carrier. The immune tolerant animal resulting from foetal contact with virus is a major problem in the serological detection of border disease. In Johnes' disease and to a lesser extent in Brucella ovis and leptospiral infections, problems associated with sensitivity and specificity of the tests are stressed. Serovar specificity, cumbersome test procedures and negative tests in the incubation period cause difficulty in the interpretation of serological test results for leptospirosis. The importance of clinical examination, herd histories and alternative diagnostic procedures is important in all diseases. Wherever possible, flocks or herds should be maintained in specific disease-free state. Selection of stock from accredited herds or flocks is the most certain method of Guying non-infected animals.     

The anatomy, physiology, and diseases of the avian proventriculus and ventriculus.

Diseases affecting the proventriculus and ventriculus often present with similar clinical signs. It is important for the avian practitioner to be familiar with these diseases, their prevalence, and the species most commonly affected to judiciously prioritize the appropriate diagnostic techniques. A basic understanding of the anatomy and physiology of the proventriculus and ventriculus is useful in integrating the pathophysiology and clinical signs associated with variable disease processes. It is also essential to evaluate radiographs and endoscopic images, perform diagnostic techniques, make a diagnosis, and provide appropriate therapy.     

Understanding feline heartworm infection: disease, diagnosis, and treatment

Feline heartworm disease is a very different clinical entity from canine heartworm disease. In cats, the arrival and death of immature heartworms in the pulmonary arteries can cause coughing and dyspnea as early as 3 months postinfection. Adult heartworms suppress the function of pulmonary intravascular macrophages and thus reduce clinical disease in chronic feline heartworm infection. Approximately 80% of asymptomatic cats self-cure. Median survival time for symptomatic cats is 1.5 years, or 4 years if only cats living beyond the day of presentation are considered. Aberrant worm migration is more frequent than it is in dogs, and sudden death can occur with no prior clinical signs. The bacterial endosymbiont Wolbachia likely contributes to the inflammatory pathology of heartworm disease, but its role is not yet fully clear. Unfortunately, the diagnosis, treatment, and management of feline heartworm disease are far from simple. Antemortem diagnosis is hampered by low worm burdens, the frequency of all-male infections, and nonspecific radiographic lesions. It is up to the veterinarian to determine the correct index of suspicion and choose the right combination of diagnostic tests to achieve an answer. Treatment is symptomatic because adulticide therapy is risky and does not increase survival time. Despite the dangers of feline heartworm disease, less than 5% of cats in the United States are on chemoprophylaxis. It is important for veterinarians to take a proactive preventive stance because heartworm infection in cats is a multisystemic disease that has no easy cure.     

Efficacy of a commercial hydrolysate diet in eight cats suffering from inflammatory bowel disease or adverse reaction to food

Eight of 28 cats presenting with chronic vomiting and/or diarrhoea were diagnosed as suffering from chronic enteropathy. All cats had undergone a complete diagnostic work-up, including endoscopy. Histopathology findings varied from normal, eosinophilic, to lymphoplasmacytic gastroenteritis. On the basis of findings, the cats were diagnosed with inflammatory bowel disease (IBD) or an adverse reaction to food. A hydrolysed protein diet was used as sole therapy, and clinical signs resolved within 4-8 days in all eight cats. After 2 months the cats had gained weight. A challenge trial with their previous diet resulted in recurrence of the clinical signs, which resolved in seven cats when the test diet was reintroduced. We conclude that the hydrolysed protein diet used in the current study was effective in managing these cases.     

Nasal Mucosal Adenocarcinoma in a Pet Rabbit

A 6-year-old male rabbit (Oryctolagus cuniculus) presented with upper respiratory disease that was nonresponsive to antibiotic therapy. Computed tomography revealed a severe space-occupying lesion of the right nasal cavity, deviation of the nasal septum to the left, and narrowing of the left nasal cavity. An exploratory rhinostomy was performed for the purposes of diagnostic sample collection and to improve airflow as clinical signs of dyspnea were becoming more pronounced. The histopathologic disease diagnosis from the biopsy samples was nasal mucosal adenocarcinoma. Palliative rhinostomy provided only temporary improvement in airflow, and the patient was euthanized 3 days later. On necropsy, neoplasia was found to extend into the rhinopharynx. This is the first reported case of nasal mucosal adenocarcinoma in rabbits. This important differential diagnosis should be considered for any rabbit with clinical signs of upper respiratory disease that is nonresponsive to medical therapy.     

Feline herpesvirus.

Feline herpesvirus infection is extremely common and may lead to recurring ocular disease in the adult cat. Recognition of the history and clinical signs that are consistent with FHV-1 infection is critical because diagnostic tests may be negative. Although a variety of treatment options are available, no one therapy is successful in every cat, and a small percentage of cats respond poorly to any treatment.     

Contact transmission of vesicular stomatitis virus New Jersey in pigs

OBJECTIVE: To determine how viral shedding and development or lack of clinical disease relate to contact transmission of vesicular stomatitis virus New Jersey (VSV-NJ) in pigs and determine whether pigs infected by contact could infect other pigs by contact. ANIMALS: 63 pigs. PROCEDURE: Serologically naive pigs were housed in direct contact with pigs that were experimentally inoculated with VSV-NJ via ID inoculation of the apex of the snout, application to a scarified area of the oral mucosa, application to intact oral mucosa, or ID inoculation of the ear. In a second experiment, pigs infected with VSV-NJ by contact were moved and housed with additional naive pigs. Pigs were monitored and sampled daily for clinical disease and virus isolation and were serologically tested before and after infection or contact. RESULTS: Contact transmission developed only when vesicular lesions were evident. Transmission developed rapidly; contact pigs shed virus as early as 1 day after contact. In pens in which contact transmission was detected, 2 of 3 or 3 of 3 contact pigs were infected. CONCLUSIONS AND CLINICAL RELEVANCE: Transmission was lesion-dependent; however, vesicular lesions often were subtle with few or no clinical signs of infection. Contact transmission was efficient, with resulting infections ranging from subclinical (detected only by seroconversion) to clinical (development of vesicular lesions). Long-term maintenance of VSV-NJ via contact transmission alone appears unlikely. Pigs represent an efficient large-animal system for further study of VSV-NJ pathogenesis and transmission.     

Congenital heart disease in the dog

The clinical findings and investigation of dogs with congenital cardiac disease is described and the role of diagnostic aids including radiography, electrocardiography and echocardiography is outlined. The physical findings, prognosis and therapy of the common defects are reviewed and their aetiology is briefly discussed.     

奶牛乳房炎的研究进展及防控措施

奶牛乳房炎发病率高且危害大,在奶牛养殖中属于常见疾病。该病主要是由于病原微生物入侵奶牛乳腺组织而引发的局部炎症,其不仅会造成奶牛产奶量降低,而且还会影响牛奶的品质。由于治疗过程中的兽药残留和由某些病原微生物感染引起的奶牛乳房炎治愈率低等问题,奶牛乳房炎的防治显得极为重要。从病原菌的种类、致病机理以及诊断方法和防控措施等方面介绍了奶牛乳房炎的研究进展,以期为奶牛乳房炎的科学防治提供参考。     

Measurements of the Accuracy of Clinical Diagnoses of Equine Neurologic Disease

Parameters for the accuracy of clinical diagnosis of neurologic diseases in the horse were determined from 210 horses in which a definitive pathologic diagnosis was confirmed. The overall efficiency of diagnosis for all diseases was 0.95 although the validity varied from 0.79 to 1.00, the sensitivity varied from 0.73 to 0.95, and the specificity varied from 0.88 to 1.00 for individual disease categories. Equine protozoal myeloencephalitis was overdiagnosed, whereas Eastern equine encephalomyelitis, equine degenerative myeloencephalopathy, and traumatic neurologic disease were underdiagnosed. The use of such measurements of accuracy of diagnosis parameters in clinical practice will allow new diagnostic techniques to be objectively evaluated, resulting in greater efficiency of diagnosis and therapy.     

Chemotherapy and radiotherapy for treatment of cutaneous lymphoma in a ground cuscus (Phalanger gymnotis)

A 15-year-old female ground cuscus (Phalanger gymnotis) was presented with an isolated ulcerated, nonhealing lesion on the lateral thorax. Histopathology and immunohistochemistry were diagnostic for cutaneous T-cell lymphoma with incomplete excision. Oral chemotherapy with CCNU (lomustine) resulted in clinical remission that lasted 255 days, with no appreciable toxicity. Tumor recurrence was treated with radiation therapy, which resulted in 120 additional days of clinical remission. Subsequently, the tumor developed at a distant site and the cuscus was humanely euthanized. A slight decrease in appetite early in disease progression was the only adverse effect noted throughout the treatment period. Oral, minimally invasive chemotherapy, and adjunct radiation therapy were viable treatment options for this ground cuscus and should be considered for treatment of neoplasia in other nontraditional species.     

Potpourri oil toxicity in cats: 6 cases (2000–2007)

Objective – To describe the clinical and laboratory features, treatment, and outcome of cats with a history of potpourri oil exposure. Design – Retrospective study. Setting – Veterinary teaching hospital. Animals – Six client‐owned cats. Measurements and Main Results – The medical records of animals with oral or lingual ulceration and exposure to potpourri oil from January 2000 to December 2007 were reviewed. Information obtained from the medical records included signalment, product to which the animal was exposed, clinical signs, physical examination findings, diagnostic test results, treatment, duration of hospitalization, and outcome. Six cats qualified for inclusion in the study; 3 were castrated males and 3 were spayed females. Age range was 0.3–3.6 years. All cats had severe oral and lingual ulceration. Additional clinical findings included hyperthermia, tachypnea, ptyalism, and lethargy. Treatment of these cats included IV fluids, analgesic therapy, antimicrobial therapy, and gastrointestinal protectants. Two of these cats received an esophagostomy tube for nutritional support. Duration of hospitalization was 0–5 days. All cats survived to discharge. Follow‐up for 3 cats revealed complete healing of the oral ulceration. Conclusions – Potpourri oil toxicity should be considered as a differential diagnosis in any cat with oral and lingual ulceration. Prognosis for recovery is good with supportive care.