Triage and approach to the acute abdomen

The presentation of a patient with acute abdominal pain often is both a diagnostic and therapeutic challenge for the veterinary practitioner. Rapid physical examination and assessment of the patient's cardiovascular status are critical to initiating appropriate and often aggressive medical management as diagnostic tests are being performed. A number of diagnostic tests can be performed, including complete blood count, serum biochemistry profile, serum amylase and lipase, abdominal radiographs, abdominal ultrasound, abdominal paracentesis or diagnostic peritoneal lavage, cytology, and fluid analysis. In some cases, surgical exploration may be indicated, depending on each patient's clinical signs and response to therapy. Of the most important aspects of medical management of the patient with acute abdominal pain is to maintain oxygen delivery to tissues and to treat aggressively for pain or discomfort. The initial triage and approach to the patient with acute abdomen are discussed.     

Lumbosacral disease.

Careful clinical and neurologic evaluations are the foundation on which a diagnosis of lumbosacral disease is based. Appropriate use of ancillary diagnostic aids will confirm the diagnosis and allow appropriate treatment to be instituted.     

Pleuropneumonia

The historical, clinical, diagnostic, and therapeutic aspects of pleuropneumonia are reviewed with emphasis placed on aggressive treatment and ultrasound diagnosis. The common sequelae are described, and appropriate treatment recommendations are included. A favorable prognosis may be expected for horses receiving long-term treatment.     

Lameness originating from the proximal metacarpus/tarsus: A review of local analgesic techniques and clinical diagnostic findings

Accurate diagnosis of conditions of the equine proximal metacarpus and metatarsus presents a clinical challenge. Diagnostic analgesia of this region is nonspecific, which may lead to incorrect interpretation of blocking patterns, potentiating incorrect diagnoses and treatment. Results of local analgesia should be examined carefully during clinical lameness evaluations due to the possibility of diffusion of local anaesthetic solution and inadvertent intrasynovial injection. Supplementary diagnostic analgesia of surrounding anatomic regions and advanced diagnostic imaging, particularly magnetic resonance imaging, are recommended for most accurate diagnosis of lameness. Failure in response to therapy in cases where supplementary diagnostic analgesia and advanced diagnostic imaging have not been performed should prompt the clinician to broaden the approach to better characterise the site of pain.     

Diagnostic testing for fungal diseases.

Fungal infections can be challenging to diagnose, and accurate interpretation of laboratory data is important to ensure the most appropriate treatment for the patient. An overview of the nonspecific diagnostic aids and specific fungal diagnostics is presented. Additionally, a brief summary of the role of free-living saprophytes and pathogenic dimorphic fungi is discussed in relation to exotic animals seen in veterinary practice. The important fungal diseases are reviewed with reported prevalence, hosts and with specific diagnostic testing recommendations.     

Fish, amphibian, and reptile analgesia.

Pain perception and appropriate behavioral responses are important for survival. The conservation of the opioid ligand and receptor suggests evolution of opioid receptors mediating antinociception throughout vertebrate phylogeny. Fish, amphibians, and reptiles have appropriate neurologic components, display the appropriate behavior in response to a painful stimulus, and possess antinociceptive mechanisms to modulate pain. Because pain perception in these species is therefore likely to be analogous to that of mammals, invasive and painful procedures should always be accompanied by appropriate analgesia and anesthesia. Although specific doses have not been established in clinical trials, clinicians should attempt to provide lower vertebrates with appropriate analgesia during painful procedures. Further experimental and clinical investigations are necessary to expand the current veterinary literature in the area of pain and analgesia in lower vertebrates such as fish, amphibians, and reptiles.     

Critical care of pet birds. Procedures, therapeutics, and patient support.

Critically ill birds must be recognized, accurately assessed, and provided rapid appropriate treatment. This article presents a method of assessment and supportive care for critically ill birds. A problem-oriented approach based on clinical signs is presented, accompanied by suggested diagnostic tests. Techniques used to treat critically ill birds are also discussed.     

Antibody-mediated retinopathies in canine patients: mechanism, diagnosis, and treatment modalities.

Antibody-mediated retinopathies may be widely present among the canine population. Early diagnosis and appropriate treatment are essential for visual preservation and reversal of blindness in these patients. The principal purpose of this review is to describe the mechanistic basis, clinical signs, diagnostic methods, and treatment options for retinal diseases causing sudden onset of blindness with absence of typical signs of intraocular inflammation or retinal degeneration-sudden acquired retinal degeneration syndrome and immune-mediated retinitis.     

Mandibular squamous cell carcinoma in a 5‐year‐old Tennessee Walking Horse

Squamous cell carcinoma (SCC) is the second most common neoplasm reported in the horse, but occurs rarely in the oral cavity. Clinical signs may be insidious in onset and mimic other non‐neoplastic processes, thus delaying appropriate treatment. Timely evaluation and advanced diagnostic imaging may offer the opportunity to initiate definitive treatment. This report describes a young gelding with mandibular SCC that was evaluated for mandibular swelling failing to respond to symptomatic therapy.     

Analgesia and sedation in the critically ill

Objective: To summarize the challenges to recognizing pain in critically ill patients, the rationale for treatment even in the absence of signs of pain, and the therapeutic options available in the intensive care environment. Etiology: Pain is one of many stressors challenging the critically ill patient, and may in turn be multifactorial in nature. Common causes include local and systemic inflammation, injuries, diagnostic and therapeutic procedures, immobilization, and thrombosis. Diagnosis: Critically ill animals with pain may not demonstrate overt behavioral or physiologic signs of distress. Therefore, pain must be assumed to be present for animals whose condition puts them at risk. Therapy: Currently available analgesic and sedative drugs and methods of delivery are described. Several useful analgesics and sedatives may be co‐administered as fluid additives to provide continuous therapy. Prognosis: There is growing evidence that the neuroendocrine stress response to severe injury or illness may become sufficiently intense to contribute to morbidity and mortality. Many therapeutic analgesic and sedation options provide good control of pain and stress, and in some circumstances this may improve the outcome of critical illness.     

Pancreatitis in cats: diagnosis and management of a challenging disease

Feline pancreatitis can be a very difficult disease to diagnose and often requires a combination of clinical suspicion, appropriate physical examination findings, elevations in serum feline pancreatic lipase immunoreactivity, and changes on abdominal ultrasonography consistent with pancreatic disease. The diagnostic difficulties encountered are related to a lack of specific and readily attributable clinical signs in cats. The sensitivity and specificity of the diagnosis of pancreatitis are highest when a combination of tests is utilized; but even when such tests are employed, the diagnosis is still problematic, especially in cats with chronic pancreatitis. Therapy is symptomatic and focuses on maintaining fluid volume, controlling pain and vomiting, preventing infection, and adjusting to changes in the cat's condition as they occur.     

Inflammatory disease of the central nervous system

Inflammatory diseases involving the central nervous system can be difficult to diagnose and frustrating to treat. The clinician can maximize successful treatment of these patients by recognizing the clinical signs in the early stages of disease, following a logical diagnostic plan to identify the specific etiologic agent involved, and formulating an appropriate and aggressive therapeutic plan. Treatment will not always be successful owing to lack of effective treatments and irreversible neurologic damage.     

The avian neurologic examination and ancillary neurodiagnostic techniques: a review update.

The purpose of this article is to guide the avian clinician in the assessment of neurologic function in birds. Physical and neurologic examinations that evaluate cranial nerves, postural reactions, and spinal reflexes identify neurologic dysfunction and the corresponding anatomic location of the lesion. Ancillary diagnostic tests, such as cerebrospinal fluid analysis, diagnostic imaging, muscle and nerve histology, and electrodiagnostics, are tools to confirm and clarify conclusions from the neurologic examination and to identify the cause of disease. Once the disease location and pathologic process have been identified, appropriate treatment and prognosis may be provided.     

Diagnosis of upper respiratory tract diseases in the performance horse.

Wastage of performance horses because of respiratory dysfunction is common. Appropriate identification of the disease is paramount for treatment recommendations. Diagnostic modalities for upper respiratory tract dysfunction include a thorough physical examination, radiographic evaluation when appropriate, and upper respiratory tract endoscopy. Anatomical deviations or structural are easily identified during resting evaluation, while exercise testing is often necessary to assess thedynamic properties of the upper airway. Utilizing the many diagnostic tools available allows the clinician to make an accurate diagnosis and recommend appropriate treatment.     

Podiatry

Palmar heel pain can be divided into 5 groups, depending on the clinical signs and based on the horse's response to diagnostic analgesia. These groups include navicular pain; solar third phalanx, including the insertion of the deep flexor tendon; distal interphalangeal arthrosis, mixed pain (multiple structures), and palmar pain. Depending on the region of pain, different strategies can be used to treat the horse. Primary among these are reestablishing the biomechanics of the hoof and modifying the pain response of the horse.     

Equine infectious keratitis.

Corneal ulcers are one of the most common ocular disease presentations in the horse. With the use of correct diagnostic techniques and selection of an appropriate treatment regimen, most cases result in a satisfactory outcome. The eye does not respond well to inflammation, and in complicated ulcers, this should be managed aggressively using systemic NSAIDs with a high priority assigned to removing the infectious agent. Care needs to be taken to avoid topical or systemic corticosteroid use for the treatment of equine ocular disease, however, unless the clinician is completely sure that the corneal disease is not caused by an infectious process. The use of combination corticosteroid-antibiotic ophthalmic preparations without an appropriate treatment rationale can result in doing more harm than good. It is important to have a treatment plan and to monitor the elected treatment regimen. The clinician should decide on some objective criteria at initiation of treatment so that any changes are made rationally. This approach should also include consideration of early referral of the eye's care to a veterinary ophthalmologist.     

Lingual abscesses in three dogs

Lingual abscessation is a rare condition in dogs. Very little information is available on the diagnosis and treatment of lingual abscesses in the major surgical textbooks and current veterinary literature. The common clinical signs of lingual abscesses are macroglossia, hypersalivation and a reluctance to open the mouth, but these can vary depending on the time course of the disease and the location of the abscess. This article presents three cases of tongue abscess in the dog outlining treatment and outcomes. A thorough diagnostic work up, consisting of anamnesis, clinical and haematological examinations, oral inspection under sedation and the use of diagnostic imaging techniques should be mandatory before surgical exploration of the abscess. Surgery is followed by drainage and systemic antibiotics, complemented by systemic fluid support and pain management. Conservative management of lingual abscesses can be fatal. Sharp trauma from an unknown object is suspected to be the underlying cause for the abscesses in the present cases.     

Diagnostic approach to hematuria in dogs and cats.

Hematuria indicates the presence of urogenital disease in dogs and cats. Persistent hematuria (macroscopic or microscopic) should be evaluated to determine the source of bleeding and the underlying cause so that appropriate treatment can be recommended. Results of the history and physical examination often help to localize disease to the urinary tract (either upper or lower) or genital tract.Additional diagnostic evaluation, including laboratory testing(eg, urinalysis, urine culture), diagnostic imaging (eg, abdominal radiographs, ultrasound), and collection of tissues for cytologic or histopathologic evaluation, may be needed to identify the underlying cause. If a thorough evaluation fails to reveal the source or cause of hematuria, exploratory celiotomy should be considered,especially if idiopathic renal hematuria is possible.     

Ultrasound‐guided injections of the sacroiliac area in horses

Sacroiliac lesions are commonly suspected in sport‐ and racehorses. Injection of the sacroiliac (SI) area can be performed for diagnostic purposes and/or for treatment of SI pain. Because of the deep location of the SI joint, blind injections may be unsafe. The purpose of this paper is to present how to perform ultrasonographic guided injection of the SI area using cranial and caudal approaches. With this technique drugs can be injected close to the SI joint and technical errors (needle implantation in the sciatic nerve, injection in the vertebral canal or in the rectum) can be avoided.     

Principles and applications of radiation therapy

Radiation therapy is emerging as a beneficial and increasingly accessible treatment option for companion animals with cancer. Various types of radiation are available with different properties that may make one more suitable than another for treating a specific tumor type. Radiation therapy can be used as the sole treatment or as part of a multimodality treatment course to result in local or locoregional tumor control, or as palliative therapy for pain control. When radiation is a potential treatment option, it should be considered early in the decision-making process to ensure that the appropriate diagnostics and other treatment modalities are considered to provide the best potential outcome. This article is intended to provide an overview of the types of radiation therapy that are available, the indications, and the potential acute and late radiation side effects.