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Physical Exam of the Dog and Cat

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by

Hanson Tan

on 20 September 2012

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Transcript of Physical Exam of the Dog and Cat

Physical Examination of the Dog and Cat There is no specific manner or order in which the physical exam is to be performed on either the dog or cat. What is essential is that every major body system and then part is covered in a consistent and logical approach. I have outlined in this presentation just one way in which this can be achieved through the arrows and each time the "next" button is clicked you will be directed to a new body system. Each section is divided into several elements that should be covered together in the physical exam, and these can be explored outside of the set path by simply clicking on the content to zoom in. The smaller arrows indicate the differences that are apparent between the dog and cat. You can return to the overview of my presentation by clicking the "home" button located on your left. Click "next" to continue. Initial Approach Planning There are three main components of performing a complete and thorough physical examination:
Inspection
Palpation
Auscultation Dog Dogs generally have a good attention span so the physical exam can often be conducted in one session
Also are highly food motivated, so treats should be used to reward good behaviour and regain attention Cat Most cats will tolerate a physical examination but their attention span is shorter than most dogs so often the examination will have to be broken up

Their behavioral signs of distress may also be more subtle and should be observed very closely Observation Demeanour
Asses body condition score and gather weight
Alertness
Signs of low visual acuity (eg bumping into walls)
Any other obvious signs of disease such as sneezing, coughing, exudates etc) Remember that anything observed here should be explored in further detail during the relevant component of the physical exam Restraint
Establish some form of contact with the animal and approach with caution
Offer the back of your hand to assess the degree of friendliness of the animal
Once no aggression is shown, a pat on the head is good and gently hold animal underneath the head - this way control of the head is achieved and the dog is unlikely to do damage to yourself or the owner
Transitioning to gentle but firm restraint is key
Especially fractious dogs should be muzzled if necessary Dog Cat When beginning, you should stand either behind or next to the cat
Restraint and/or support should be applied to the body remembering not to restrain the cat from the front limbs Initial Measurements Whilst the animal is initially restrained, it is prudent to gather measurements of both the respiration rate and temperature. RR can be calculated through counting the respiratory movements over 15 seconds and then multiplying by 4. Temperature can be ascertained by gently inserting the thermometer carefully into the
anus of the animal for approximately a minute. By taking these values early on in the consultation, any elevations of these parameters due to the stress of the physical exam can be avoided.

Remember that temperature and RR can also be elevated through simple physiological processes such as excitement.

Temperature taking in cat though is usually left to the final stages of the exam due to their more fractuous nature. Cat Normals Temperature: 38.7-39.2°C Respiration Rate: 20-32 breaths/minute Heart Rate: 120-200 beats/minute Dog Heart Rate: 70-90/100-160 beats/minute
for large and small breeds respectively Respiration Rate: 20-32 breaths/minute Temperature: 37.8-39.2°C Normals Head Eyes Cornea Check for clarity and shape Sclera
Be sure to observe colour:
Yellowing can be indicative of jaundice
Reddening can be indicative of a possible bleed or inflammation Conjunctiva Elevate the upper eyelid to expose the conjunctiva, checking for any discharge whilst also ensuring there is no paralysis or spasming of the eyelids Nictitating Membrane To expose the nictitating membrane, gently put pressure over the top and bottom eyelid (denoted by the * in the photo) and retract the eyeball with care. Observe:
size
shape
colour
surface Pupil Check pupil size for symmetry whilst also inspecting the anterior chamber for cellular deposits. If an abnormality is detected here, further testing can be conducted eg. pupillary light reflex Iris Check iris for uveitis through any evidence of colour change which can be indicative of early uveitis Lymph Node Palpate lymph nodes along the ramus of the mandible and take a reasonably deep amount of tissue and sift through till the gland is located. Assess size and shape. Distinguished from the mandibular salivary gland as it is smaller, firmer and more craniolateral in both species. Submandibular Lymph Nodes Nose • Inspect the nares for ulceration or pigmentation
• Check for external nasal discharge and symmetry Dog Discharge obvious if present Cat • Cats being more fastidious groomers, any discharge is more difficult to evaluate
• So its presence is significant Ears Compare the size, shape, skin and colour of both ears Dog • Check smell (if abnormal may indicate bacterial or fungal infection)
• Observe the external ear canal and use otoscope only if abnormality detected eg erythema, excessive wax Note the appearance of healthy ears. There is a lack of wax buildup, discharge and skin trauma. Cat • In a cat, when examining the external ear canal, gently insert the otoscope into the ear canal

• Visualise the tympanic membrane which should be intact, opalescent and contain no signs of discharge or erythema Mouth To open the mouth of both species (as demonstrated in the photos):
• Place thumb and middle finger in the space between the dorsal and ventral teeth
•Tilt head upwards
•Then using your free hand, gently pull down on the mandible by applying pressure with two fingers on the incisors

Then observe the following: Under tongue By pressing in between the intermandibular space and elevating the tongue, look carefully for masses such as foreign bodies, neoplasms and inflammatory lesions Gingiva Observe for:
• Erythema
• Ulceration
• Icterus
• Recession
• Moisture
• Capillary Refill Time (should be <2 in both species) Important as can be a strong indication of periodontal disease Teeth Observe for:
•Calculus
•Number
•Wear Neck Thoracic Inlet • Check for jugular venous distension or pulsation
•If unable to visualise jugular vein, simply wet the hair over the vein to allow for clearer observation Cat • Often seen in cats with non-cardiogenic pleural effusions, high output heart failure or right-sided heart failure Trachea Palpate on each side with thumb and forefinger from base of the mandible to the thoracic inlet, feeling for: Thyroids • Compare the size and shape of both to confirm any enlargement or shrinkage
• This is usually done by palpating with the thumb and forefinger adjacent to the trachea right down to the region of the thoracic inlet Dog Thyroids are non-motile and enlargement is felt as a stationary mass Cat Thyroids are more motile are so are usually cannot be palpated unless enlarged, which would be then a significant finding and felt as a thyroid “flick” Larynx •Check larynx for size and making sure there are no irregular lumps or bumps
• Gentle palpation will elicit a single cough in most animals (any more than 1-2 is considered abnormal suggestive of increased tracheal sensitivity) Musculature Observe for symmetry to check for mass lesions and muscle atrophy Dorsal Surface Skin Coat • Using a flea comb, brush cranially and caudally to check for:
• Fleas
• Excessive shedding
• Flea dirt (shake comb over white paper to examine dirt) Dog Usually have more dirt and dust in their coat due to their relative lack of grooming Cat As cats are fastidious cleaners, evidence of fleas and flea dirt can be difficult to find. • Palpate with hair going against the grain and away from the coat to reveal the skin• Examine for:
• Erythema (focal, multifocal, diffuse etc.)
• Papules, pustules, wheals, collarettes and other epidermal defects
• Subcutaneous and deep masses
• Altered fragility or thickness Both may be done in conjunction with each other Limbs Lymph Nodes Prescapular • Located underneath the brachiocephalic muscle, medial to the point of the shoulder
• Take again two fingers, pressing your index finger into the thoracic groove and sift through the muscle until the lymph node can be palpated (kidney bean size)
• Check both sides for symmetry Inguinal Usually paired, it is situated in the fat that fills the gap between the medial surface of the thigh and pelvic cavity. Note that it is not usually palpable in health Popliteal Single node found between the two heads of the gastrocnemius muscle. Roughly the size of a lima bean Axillary Usually a single node, found 2-5cm caudal to the point of the shoulder and therefore is most easily felt by palpating the thorax just underneath the shoulder. Check for size and shape. Joints • Check joint function through flexion and extension of the limbs
• Evaluate for any pain, swelling or capsule thickening Musculature Start with the forelimbs, checking the infraspinatus and supraspinatus muscles

• Palpate for symmetry and no abnormal bumps over the bones or skin
• Then stand up the dog/cat so that superficial evaluation of the muscles can continue
• Assess side of the trunk, then the rear end and hind-limbs
• Palpate each limb separately Thorax Observation Check first for respiratory movements, making sure both inspiratory and expiratory actions are normal. Observe:
• Depth of breathing
• Rate of breathing
• Abdominal effort
• Mouth breathing Dog Dogs often mouth-breath in health, usually associated with exercise or anxiety and should be distinguished from dyspnoea. Cat Listen to the respiratory sounds to determine if there is any wheezing, audible stridor or stertor. Cats also rarely exhibit mouth-breathing, often compensating for decreased respiratory function by simply moving less, therefore a sign of severe dyspnoea. Auscultation • Begin by placing the stethoscope over the cardiac apex beat (located at the 6th intercostal space at the level of the costochondral junction) on the left side
• Normal “lub-dub” sounds should be heard
Listen to assess:
• Murmurs
• Rhythm abnormalities (eg gallop)
• Heart rate
• Size Heart Dog In middle to large breed dogs it will be possible to auscultate several sounds. Remember that the mitral, pulmonary and aortic valves are all best auscultated on the left.

Mitral Valve (left A-V valve): positioned ventrally in the 6th intercostal space

Aortic Valve: left 4th intercostal space, dorsal to the costochondral junction

Pulmonic Valve: left 3rd intercostal space dorsal to the sternum

Right A-V valve: right 4th intercostal space at the costochondral junction Note that these sounds will vary based on the size of the dog and the size of the heart. The size of the area over which a sound can be heard may indicate cardiac enlargement. Cat In cats, auscultation of the heart is quite different to dogs in that most cardiac murmurs in cats occur over the sternal or parasternal region of the chest Remember to also listen out for a “gallop rhythm” which is detected as the presence of an extra heart sound which is either an S3 or S4 gallop. If present it is indicative of an underlying cardiac disease Lungs • Respiratory sounds are best auscultated at the level of the tracheal bifurcation (roughly the 8th intercostal space in dogs and the 4th-6th intercostal space in cats)
• Should be able to evaluate the normal bronchial sounds, listening for stirdor, stertor, crackles and linear air sounds, tending to move the stethoscope to four different positions on both sides:

• Craniodorsally
• Cranioventrally
• Caudodorsally
• Caudoventrally Dog In medium to large breeds it is relatively easy to ausculate respiratory sounds from the relevant areas. However remember there is still the possibility of sound being resonated and reflected, especially in deep chested breeds. Cat • If the cat has a pleural effusion, lung sounds may be detected dorsally but not ventrally
• Presentation of pulmonary parenchymal disease may allow for detection of crackles
• If bronchial disease is present, wheezes may be detected and also expiratory dyspnoea (a hallmark of bronchial disease in the cat) Abdomen Observation • Check for any obvious distension
• If seen, the abdomen may be percussed to determine its nature (fluid, gas etc)
• Evaluate any protruding masses or shape irregularities Palpation • Standing behind the animal, begin at the centre of the abdominal cavity pressing gently against the abdominal wall with a rotating motion, relaxing the abdominal muscles and facilitating palpation • Palpate the right kidney at the caudal border of the ribs by reaching in towards the midline and grasping the kidney
• “Pluck” it from the abdomen and scoop the kidney into the palm of the hand to determine any abnormalities
• Renal cortex should be smooth and kidney firm on palpation
• Then palpate left kidney (simultaneously) located more caudally
• Evaluate for size and shape or any associated fluid structures eg polycystic kidney disease in cats Kidneys Intestinal Loops • At the mid-abdominal position, palpate the intestinal tract
• Reach cranially to grasp loops of the intestine and draw them ventrally
• Check for thickened loops of intestine, often seen in infiltrative intestinal disease
• Palpate the colon in the dorsal, caudal abdomen as a tubular structure Liver • Reach forward into the cranial abdomen to feel for any enlargement of the liver or any masses associated with the liver or spleen
• The caudal borders of the liver in most animals are not usually palpable
• By palpating the floor of the abdomen it may be possible to determine any splenic enlargement Bladder
• Bladder can be palpated in the caudal abdomen as a cystic structure that is flexible in both size and shape
• Possible to immobilise the bladder between the thumb and forefinger, a technique utilised for obtaining a urine sample through cystocentesis Femoral Pulse Best achieved through bilateral palpation, resting the thumb on the lateral thigh and the rest of the fingers against the medial thigh of the dog. Check the amplitude, strength and symmetry of the pulse Ventral Surface • Reach under the patient and lift both legs of the opposite side whilst supporting the flank with your other hand
• Gently lower into lateral recumbency Genitalia and Perineum • Carefully lift tail up and evaluate that there are no abnormalities around the anus
• Check that the muscosae is a normal pink colour and that there is no bleeding or other noticeable abnormalities Male Prepuce should be examined as well as expression and examination of the penis Female • In the female, examine each of the mammary glands and palpate to see if there are any associated masses
• Then check underneath the axilla for any lesions
• In the female the vulva and vestibule should be examined
• More invasive investigation should be commenced if disease is suspected eg vulval discharge Limbs • First examine the digits and the skin of the foot pads and digits looking for any erythema, cracking and lesions between the interdigital space
• Extend the nails and examine the nail bed areas for evidence of infection or immune-mediated disease
• Evaluate the joints individually to check for any pain on extension or flexion whilst also palpating for any thickening or effusions Blood Pressure • At times during the physical exam, it may be scrupulous to determine the cat’s blood pressure (less commonly in dogs as hypotension is rarer)
• Important for the diagnosis of systolic heart murmurs and for suspicions of thyroid or kidney disease
• Usually evaluated through the Doppler blood pressure sphygmomanometer
• Try to do this at the beginning of the examination as it is important to rule out stress
• Place the blood pressure cuff firmly midway between the carpus and the elbow
• Place the Doppler probe on the cats leg, wetting the hair with an alcohol swab underneath the metacarpal pad
• Position the probe over the digital artery
• Listen to the pulse whilst inflating the cuff until the pulse is no longer audible then slowly deflate the cuff and the BP at which you can first hear a pulse is the systolic BP of the cat
• Should be repeated 5 times at 30 second intervals, taking an average of those figures * * * * Point of shoulder Apex Beat
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