Practical Manual

Veterinary Medicine
Paper -1
Department of Veterinary Medicine

Compiled by : Dr. Shrikrushna Dhule

Dr. Anand Parikh
Name: __________________________________________________
Roll No : ________________________________________________
Reg.No : ________________________________________________
Batch No : ______________________________________________

MB Veterinary College
Affiliated to Rajasthan University of Veterinary & Animal Science, Bikaner
Recognised by Govt. of India and VCI (Veterinary Council of India), New Delhi
 Certificate

This is to certify that the practical exercises duly signed were

performed in the subject of VETERINARY MEDICINE
by
Mr./Ms.
_________________________________________________
Roll No.__________________________________________
Reg. No. _________________________of 4th Year
B. V. Sc. & A. H. class during academic year 202__- 202__

Course Instructors Professor and

Head

Internal Examiner External Examiner

 Index
Sr.
Name of Practical Page Date Signature
No.

1 Collection of history and general clinical examination

Collection, preservation, packing and dispatch of samples

2
from clinical cases

3 Nasogastric and Oro-gastric intubation in animals

4 Oxygen therapy in Veterinary Practice

5 Gastric and peritoneal lavage

6 Collection and examination of cerebrospinal fluid

7 Blood transfusion

8 Special examination of cardiovascular system

9 Special examination of respiratory System

10 Special examination of gastrointestinal system

11 Examination of urinary system

12 Neurological examination in animals

13 Examination of sensory organs

14 Electrocardiography

15 Ultrasonography

16 Echocardiography

17 Endoscopy

18 Collection and examination of peritoneal fluid

Peritoneal dialysis
19

20 Lymphnode biopsy and bone marrow aspirate

21 Method of medication

22 Diseases estimation
 Practical I -Collection of history and general clinical examination

What is history?
• History is a bunch of question asked by physician to animal owner regarding animal illness
toderive any diagnosis.

➢ Collection of history is an art since the medical science evolved.

➢ It is very important to collect right information from the animal owner as animal can’t
expresstheir selves.
➢ Clinician diagnosis is mostly depend upon the accurate history derived about illness of
animalsfrom owner.
➢ Few owner keeps record of everything about their animal health while few hardly give
anyattention to their animal.
➢ So, it is very important for veterinary physician to select its bunch of questionnaires to
achievecomplete set of history.

History is divided under three sub categories

1. Present History – regarding for the problem on the day of presentation at clinic or motto
behindvisiting the clinic
2. Past History- regarding animal illness of past time which has any impact or correlation on
today’sanimal health
3. General or Environment History – regarding surrounding environment history where
animallives or general history like vaccination or deworming etc.

Thinks to be remember while taking history

• First understand the knowledge status or education status of animal owner
• Use minimum technical terms
• Use local language
• Use words of vernacular language
• Ask question in chronology
• Avoid repetition of same question
• Be polite and gentle
• Avoid scolding or commenting any other than animal illness
• Share importance of peculiar history for better diagnosis

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General Examination of animal
General Examination includes two major sub categories
1. Distinct Examination
2. Close Examination
Distinct examination:
➢ It is actually a bird view on general status of animal
➢ It represent distinct look of animal about its
o Posture
o Gait or condition of its locomotor system
o Skin coat appearance
o Faeces or urine
o Ocular or nasal discharge
o Wetting of muzzle
o Body condition score
o Body symmetry or face symmetry
o Presence of any wound
o External parasite
o Any obvious swelling

➢ Distinct Examination gives idea about overall animal health at a glance and it gives hint
tophysician to ask select its bunch of questionaries’ for particular case.
➢ Sometime alone distinct examination may leads to false diagnosis.
➢ After every distinct examination close examination of animal is must to avoid any false diagnosis

Close examination:
➢ Close examination start with accessing basic body parameter like body temperature,
respirationrate, pulse rate, etc.
➢ Few more close examination includes ocular or vaginal or penile mucous membrane
examination, lymph node palpation, accessing of degree of dehydration by skin fold test etc.
➢ Followed by close examination of different body systems as per need of that animal
illnessshould be proceed
➢ Digestive system 1.Perform basic examination like palpation
➢ Respiratory system percussion, auscultation as per need
➢ Urinary system 2.Perform laboratory examination like blood,
urine skin scraping etc.
➢ Nervous system 3.Perform special examination like radiography
➢ Reproductive system or endoscopy, ultrasonography to arrive
➢ Skin confirmatory diagnosis
➢ Musculo skeletal system

2
Practical 2: Collection, preservation, packing and dispatch of samples from
clinical cases

Collection of samples
➢ Collection of proper biological sample without any secondary contamination is a
basicneed for any laboratory examination
➢ In veterinary practice we have to collect blood, serum, faeces, urine, milk, skin
scraping,ascitic fluid, peritoneal fluid, rumen fluid and biopsy etc.
➢ Veterinarian should be aware of standard methods for collect all this biological samples.
➢ Veterinarian should know what type of material or accessories is required for collection
ofdifferent samples

Collection of blood
Materials:
➢ Scissors
➢ Disposable syringe and needle or Vaccutainer & collection assembly
➢ Cotton wool
➢ Spirit or alcohol or povidone iodine
➢ Anticoagulant vial of choice

Collection site and size of needle

Species Primary site of blood Size of needle
collection (gauge)
Canine Cephalic vein, Saphenous vein, 20 G, 22 G, 24 G
Jugularvein
Feline Middle thigh vein, Jugular vein 22 G, 24 G
Caprine Jugular vein, ear vein 18 G, 20 G
Ovine Jugular vein 18 G , 20 G
Equine Jugular vein 16 G, 18 G, 20G , 22
G
Avian Jugular vein, Wing vein tuberculin syringe- needle
or22 G, 24 G
Cameli Jugular vein 16 G, 18 G, 20 G
ne
Bovine Jugular vein, ear vein, tail vein 16 G, 18 G, 20 G
Bubalin Jugular vein, ear vein, tail vein 16 G, 18 G, 20 G
e
Porcine Anterior vena cava, ear vein 20 G, 22 G

3
Method of blood collection.
• Clip the site of blood collection with scissor
• Apply Spirit or alcohol or povidone iodine on clipped area to remove any microbial
contamination.
• Allow site to air dry for few seconds
• Apply pressure or tourniquet 3-4 inch above the blood collection site for few seconds
• If animal is dehydrated or in shock condition then apply digital pressure for more time
• Once raise the vein with blood then feel the vein with your finger balls and penetrate
needlein the vein carefully, gently withdrawn the plunger or connect vaccutainer
• Blood will come if needle is present inside vein
• If you don’t get blood then try to redirect needle without withdrawn of full needle
• Always collect blood at a stretch
• Once proper amount of blood is withdrawn apply cotton wool on site and remove needle.
• Apply cotton wool for few seconds until blood oozing out stops
• Transfer collected blood into anticoagulant vial quickly and mix the vial twice gently
toprevent clotting
Preservation of blood:
Different anticoagulant or preservatives should be as per need of laboratory examination
Type of Dose rate Mechanism of action Laboratory test
anticoagulant

Tri- Sodium citrate 1.0 ml per 9.0 ml It forms double salt of For blood
(3.8 to 4.5 % w/v blood Ca-Na citrate transfusion, CBC ,
solution) DLC
EDTA (K2 & K3 1-2 mg /1 ml blood It chelates blood Best for blood auto
salts of Ethylene calcium analyzer, CBC, DLC
Diamine Tetra acetic
acid)
Heparin 0.1-0.2 mg/ml of Biological Not suitable for DLC
blood anticoagulant, anti- because creates
prothrombin, anti- clumping, blood
transfusion
thrombin and anti
throplastin activity

Sodium fluoride 6-10 mg / ml of Inhibitory action on Blood glucose

blood glycolytic
decomposition of
blood sugar by RBC
Potassium and 0.5 ml / 5 ml blood Forms calcium MCH, MCHC, MCV
aluminum oxalate oxalate
(2:3)

4
Packing & Dispatch of blood:
• Blood vial should be marked with “Case ID, Species and Date of collection” at least
for easy sorting at laboratory level.
• Blood vial should be sent along with full detail history, age, sex, breed, species,
possibleor suspected diagnosis, differential diagnosis and list of test to be performed.
• Blood vial should not be agitated vigorously to avoid erythrocyte lysis.
• It should be kept at refrigeration temperature (@ 5°C) to prevent further deterioration
untilall laboratory test should be carried out.

Collection of faeces
Materials:
➢ Full hand sleeves
➢ Small hand gloves
➢ Rectal swab
➢ Plastic container of 25 to 100gm capacity or plastic zipper bag
➢ Lubricants

Method of collection:
For large animal:
➢ Faeces of large animal should be collected from rectum directly to avoid any
secondarycontamination
➢ First wear full hand gloves
➢ Apply little quantity of liquid paraffin and make cone with finger
➢ Gently dilate rectal sphincter and insert hand inside rectum
➢ By scooping action collect at least 25 to 100 gram feces and kept in plastic
containerdirectly
➢ For already defecated or empty rectum cases 5 to 25 gram faeces from top of dung
pileshould be collected
For small animal:
➢ First wear the small hand gloves.
➢ Apply little quantity of liquid paraffin on middle finger and gently insert into rectum.
➢ Try to collect feces by scooping manner and transfer into plastic container.
➢ For very small animal like kitten or pup rectal swab or cotton swab soaked into water
canbe used (only useful for rapid direct fecal examination).
➢ Smearing of rectal swab on all body or majority body of rectum is necessary to
collectparasitic ova.

Preservation of faeces:
➢ Ideally faeces should be checked rapidly without addition of any preservatives.
➢ But in case of longer examination time equal quantity of 10% buffered formalin should
bemixed with feces for routine parasitic ova or whole parasite detection.
➢ For further longer storage 70% alcohol can also be used.
➢ For detection of cyst potassium dichromate can be used.

5
Dispatch of faeces
• Plastic bag or container should be marked with “Case ID, Species and Date of collection”

• container should be sent along with full detail history, age, sex, breed, species, possible
or suspected diagnosis, differential diagnosis and list of test to be performed.
• Plastic bag or container should be packed with adhesive tape or sealing tape to avoid any
leakage of sample.
• Plastic bag or container should be sent along with another paper comprise of full detail
of history, age, sex, breed, species, possible or suspected diagnosis, differential diagnosis
andlist of test to be performed.

Collection of Urine
Materials:
➢ Male Urinary catheter or Female urinary catheter
➢ Syringe with 20 or 22 G needle
➢ Lubricants
➢ Full hand sleeves or small hand gloves
➢ Plastic container of 25 to 50 ml capacity
➢ Plastic bag

Method of collection:
By massage of urinary bladder:
➢ In cow and buffalo one can give per rectal massage to urinary bladder to stimulate
urinationand collect urine into clean and dry plastic container directly
➢ For 24 hours collection plastic bag can also be applied over the urethra or vulvar region
ofanimal and tie with ropes on back region.

By catheterization:
➢ During catheterization strict aseptic protocol should be followed to avoid
anybacterial contamination of UTI
For male animal:
➢ For male animal plastic catheter is available with different size diameter
➢ Diameter of catheter should be chosen as per urethral diameter of animal for
whomcatheterization is going to be performed
➢ Usually for small animal like dog and cat 3-0 to 4-0 size is ideal
➢ In absence of animal specific catheter baby nasogastric tube of same size can also be used
➢ One assistant should withdraw the penile mucosa for exposure of glans penis.
➢ First lubricate the catheter tip and insert into urethral opening and keep moving
untilbladder felt or urine is start to come out from another end.
➢ Once urine is coming out from another end attach empty syringe and collect urine inside.
➢ Transfer urine into plastic container and labelled it.
➢ One assistant should open the vulvar lips for better visualization of urethral opening

6
 ➢ For female animal catheterization usually stainless steel made catheter is used.
For female animal:
✦One assistant should open the vulvar lips for better visualization of urethral opening
✦For female animal catheterization usually stainless steel made catheter is used.
➢ In absence of stainless steel catheter plastic sheath of artificial insemination can be
usedafter cutting of laboratory end.
➢ First wear full length sleeves or small hand gloves and enter into vulvar region.
➢ One should search the urethral opening on ventral floor of vagina
➢ Once urethral opening is found guide catheter with your another hand.
➢ Try to pass gently inside urethral opening to avoid any damage.
➢ Forceful entrance should always be avoided.
➢ Once urine is coming out at another end collect into plastic vial.

By cystocentesis:
➢ For small animal like dog or cat where catheterization is not possible due to
urolithiasisthen at last resort cyctocentesis should be performed.
➢ For that first palpate the bladder from outside
➢ Shave the area and prepare aseptically for cystocentesis.
➢ Take new syringe with 20 or 22 G needle and gently puncture it.
➢ Withdrawn the plunger and urine will be collected into syringe.
➢ Transfer into plastic container and apply digital pressure on punctured site.

Preservatives for urine:

• Usually urine should also be proceed immediately like feces without addition of
anypreservatives.
• But in case of storage requirement one can use following preservatives
• One single drop of 40% formalin is enough for one litre of urine preservation
• One can make top layer of toluene on urine for longer storage
• Thymol @ 0.1 gram per 100 ml of urine
• One drop of phenol for 10 ml of urine
• Boric acid @ 1gram per one litre of urine
• Chloroform @ 5 ml per one litre of urine
• It should be kept at refrigeration temperature (@ 5°C) to prevent further deterioration
untilall laboratory test should be carried out.

Dispatch of urine:
• Plastic container should be marked with “Case ID, Species and Date of collection” at
leastfor easy sorting at laboratory level.
• Plastic container should be sent along with full detail history, age, sex, breed,
species,possible or suspected diagnosis, differential diagnosis and list of test to be
performed.
• Plastic bag or container should be packed with adhesive tape or sealing tape to avoid
anyleakage of sample.

7
 • Plastic bag or container should be sent along with another paper comprise of full detail
of history, age, sex, breed, species, possible or suspected diagnosis, differential diagnosis
andlist of test to be performed.

Collection of skin scraping

Materials:
➢ Blunt scalpel blade
➢ Mineral oil or liquid paraffin
➢ Small hand gloves
➢ Clean Paper
➢ Scissors

Method of collection:
➢ Typical lesion or sites should be selected before performing skin scraping examination
➢ More than one site should be scraped to get complete idea of skin pathology

Direct skin scraping examination:

➢ If more hair is then clip the hair with scissors first
➢ Take small quantity of mineral oil or liquid paraffin on one slide
➢ Dip the blade into mineral oil or liquid paraffin.
➢ Hold the lesion with first index finger and thumb of one hand
➢ With another hand scraping of skin should be done
➢ After few scraping transfer scraped material on slide
➢ Scraped until fresh blood is oozing out
➢ Usually try to collect epidermal debris as much as you can
➢ Usually deep scraping is required for mites infestation like sarcoptes & Demodex
➢ For fungal infection few hair should also be collected

For KOH digestion method:

➢ If more hair is then clip the hair with scissors first
➢ Hold the lesion with first index finger and thumb of one hand
➢ With another hand scraping of skin should be done
➢ Keep one paper below the scraping area for collection of epidermal debris
➢ After few scraping transfer scraped material on paper
➢ At the end of scraping fold the paper and labelled it.

Preservation and dispatch of sample:

➢ Scraping should be sent with folded paper
➢ Folded paper should be marked with “Case ID, Species and Date of collection” at least for easy
sorting at laboratory level.

8
 ➢ Folded paper should be sent along with another paper comprise of full detail of history,
age, sex, breed, species, possible or suspected diagnosis, differential diagnosis and list of
test to be performed

Collection of Milk sample

Materials:
➢ Plastic vial of 15 ml capacity
➢ Hand gloves
➢ Povidone iodine or 70% alcohol
➢ Towel

Method of collection
➢ Udder on animal should be washed with warm lukewarm water
➢ Remove all debris material and dry with clean towel
➢ Apply 70% alcohol or povidone on all teats and allow to air dry for few seconds
➢ First label the tubes as per anatomical teat position (like LH, RH, LF, RF)
➢ Start milking of animal and remove first 2 to 4 stream of milk in another vessel
anddiscard it
➢ After that collect milk into specific plastic vial according to its labelling
➢ Try to avoid touching of vial with any animal skin to prevent any
secondarycontamination
➢ Close the vial immediately

Preservatives and dispatch of milk samples

• Milk can be preserved by adding of boric acid powder @ 1 gram per 1 liter milk
• Milk vial should be kept on refrigeration temperature (@ 5°C) to avoid
decompositionuntil proceed or it should be sent on ice to maintain temperature.
• Plastic vial should be marked with “Case ID, Species and Date of collection” at least
foreasy sorting at laboratory level.
• Plastic vial should be sent along with full detail history, age, sex, breed, species,
possibleor suspected diagnosis, differential diagnosis and list of test to be performed.
• Plastic vial should be packed with adhesive tape or sealing tape to avoid any leakage
ofsample.
• Plastic vial should be sent along with another paper comprise of full detail of history,
age, sex, breed, species, possible or suspected diagnosis, differential diagnosis and list of
test tobe performed.

9
General guideline for dispatch of samples
• Only samples should be kept in primary box (with ice or coolant if required) and sealed
tightly to avoid any leakage
• Primary box should be kept into secondary box which also contain detail history sheet
inplastic bag.
• History sheet should be packed such a way to avoid wetting while transport
• Remaining space should be filled with any filler material like thermocol sheet or paper
toavoid seepage of sample
• On secondary box name and address of receiver and dispatcher along with date should
bewritten
• Also use words like “ Handle with care”, “ Glass material inside”, “Keep
upright”,“Biological material” on secondary box for better handling while
transportation

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 Practical 3: Nasogastric and Oro-gastric intubation in animals
.

Nasogastric intubation in equines

Indications:
• Nasogastric intubation is generally done in equines in veterinary practice due
toits anatomical characteristics.
• It usually done to gastric decompression to relieve excess gas, fluid (such
asenteral reflux) or gastric impaction in case of colic in equines.
• Nasogastric intubation is also done for administration of fluids,
medications,nutritional gruel or supplements to orphanage foal
• To relieve esophageal obstructions

Complications
• Trauma to the nasal mucosa and turbinates, resulting in epistaxis.
• Rhinitis from long-term placement of the nasogastric tube.
• Necrosis of the nasal mucosa when a large bore tube is kept indwelling
forextended period of time.
• Pharyngitis/laryngitis resulting from trauma following attempts to have the horse
swallow the nasogastric tube or from long-term placement of the nasogastric tube.
• Aspiration pneumonia from inadvertently administering liquid through
tubepassed into the trachea instead of the esophagus.
• Esophagitis or esophageal rupture following excessive force applied when
tryingto relieve an esophageal obstruction.

Materials:
➢ Naso gastric tube of different diameter
➢ Lubricants
➢ Nasogastric pumps
➢ Funnel

Method of intubation:
1. On same side of standing or opposite side of standing intubation can be done.
However,same side intubation is widely practiced.
2. The distance from the nostril to the pharynx can be judged approximately by
measuringthe distance from the nostril to the lateral canthus of the eye and tube should
be marked.
3. Place the right hand over the bridge of the horse’s nose and insert the right thumb into the external
nares, slightly elevating the alar fold.
4. With the left hand, the lubricated nasogastric tube is advanced into the ventral
meatususing the thumb in the nostril to guide it ventro-medially.
5. Once the tube reaches the pharyngeal area, judged by distance, swallowing is required
toadvance the tube into the esophagus.
6. Flexion of the horse’s head promotes swallowing of the tube

11
 7. Then advance the further length of tubes
8. Judging by the length of tube passed, one can estimate that the stomach has been reached.
9. Correct positioning of the tube in the esophagus must be assessed before pouring
anyliquid into animal
10. This can be done by following method:
• Palpating the tube on the left side of the neck as it passes down the esophagus
• Noting the increased resistance to passage of the tube into the esophagus
ascompared to that of the trachea
• By keeping another end of tube in water for bubble absense
• By smelling the gastric contents
• By auscultating the sound
11. After assuring tube into stomach one can lower another end of tube to ground level
tocheck gastric reflex.
12. One can also attach funnel and pour medication, fluid etc.for oral nutrition
13. One can also fix another end on head with adhesive tape for further use of tube.
14. To remove the tube, the end of the tube should be kinked off or occluded to prevent
accidental spillage of its contents into the trachea and nasal passage as the tube is
beingwithdrawn

Oro-gastric intubation in large animal:

Indications:
• Passing of stomach tube is a very useful clinical procedure in cattle,
buffaloesand camels for
• Oral administration of medicines
• Oral administration of large quantities of fluids and electrolytes
• Providing nutritional support to the sick cows, buffaloes and camels
sufferingfrom
• anorexia
• Treatment of acute tympany and choking
• Withdrawing ruminal fluid for analysis or transfer to other animals
sufferingfrom disturbance of ruminal microflora (transfaunation) due to use
of antibiotics

Materials:
➢ Probang or flexible stomach tube
➢ Lubricants
➢ Mouth gag (optional)
Method:
1. A flexible tube with about one inch internal diameter for adult cows, buffalos and camels.
2. The required length of the tube can be estimated by measuring the distance from
themouth of the animal to the left flank
3. Restrain the animal preferably in a travis
4. Apply a small amount of a lubricant (e.g. paraffin) to the tip of tube.
5. Open the mouth of the animal from its commissure with fingers of both hands and

12
 placepipe in the mouth over the base of the tongue. (optionally on can place mouth gag
also)
6. Pass the stomach tube and advance it upto the pharynx region
7. A slight resistance is usually felt when the stomach tube reaches the back of the pharynx.
8. The animal will usually show a swallowing reflex at this time and move the stomach
tubeforward into the esophagus when the animal shows this reflex.
9. Confirm the presence of the stomach tube in the esophagus by palpation slightly on
theleft side of the neck.
10. Entry into the rumen is indicated by strong smell of rumen gases and rumen fluid
11. After confirming the entry of stomach tube into rumen, attach the funnel, dose syringe
orstomach pump carrying the drug or fluid to be administered.
12. To remove the tube, the end of the tube should be kinked off or occluded to prevent
accidental spillage of its contents into the trachea and nasal passage as the tube is
beingwithdrawn

Oro-gastric intubation in canine

Indications:
➢ To relieve Gastric Dilation & Volvulus in canine
➢ To perform gastric lavage in poisoning cases
➢ To provide fluid or nutrition
➢ To push soft foreign body in stomach

Materials:
➢ Roll of 2" tape or Mouth gag
➢ Stomach tube
➢ Lubricants

Methods:
1. For oro-gastric intubation, a large bore gastric tube is selected and a length is
measuredfrom the dog's nose to the last rib.
2. A roll of 2" tape is placed in the dog's mouth and the tube is gently passed through
thetape roll and into the dog's esophagus.
3. Passage can be facilitated by using a small amount of lubricant on the end of the tube
4. Changing the position of the dog (from sternal to sitting to standing to standing with
feetelevated) can often help get the tube through the cardia into the stomach.
5. Once in the stomach, the other end of the tube should be submerged in a bucket of
waterto roughly estimate successful gas decompression.
6. For gastric lavage fluid should be administrated and while it stomach size should
bemonitored
7. While removing tube end should be kinked off to prevent aspiration pneumonia

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 Practical 4: Oxygen therapy in Veterinary Practice
.

• Oxygen therapy denotes the delivery of high concentrations of oxygen into the
respiratory system to increase the oxygen levels in the blood so that more oxygen
reachesat tissues level
• Oxygen therapy is indicated for any patient presented in respiratory distress.
• Animal in severe distress require oxygen supplementation immediately, before
attemptsto identify the cause
• Oxygen therapy is given to animal by invasive and non-invasive method.

Indications of Oxygen Therapy:

➢ Head trauma
➢ Cardiovascular resuscitation.
➢ Shock
➢ Dyspnoea or hypoxia
➢ Sepsis
➢ Oxygen supplementation should be provided to the animal which has oxygen
saturation(SaO2) or pulse oximetry reading (SpO2) is less than 93%
Or
Which has arterial partial pressure of oxygen (PaO2) less than 80 mm Hg

OXYGEN SUPPLEMENTATION METHODS

➢ Oxygen can be supplied from various sources like centralized in-house oxygen,
portableoxygen tanks and anesthetic machines.
A. Flow-By Oxygen
➢ A dog receives flow-by oxygen to allow for examination and monitoring.
➢ Flow-by oxygen is fairly non-stressful for the patient and is achieved by holding the
oxygen supply tubing near the patient’s nostrils or mouth and using high flow rates
(2-15L/min).
➢ This may mildly increase the patient’s percentage of inspired oxygen concentration
from21%-25% to 40%, with flow rates of 2 to 3 L/min if the tubing is held adjacent to
or within 2 cm of the patient’s nostrils.
➢ However, this method requires the tubing to be held in place and therefore is best
suitedfor short time periods
➢ Mask oxygen can be used on any patient that will tolerate the mask and should be
avoided in distressed patients, as persistent attempts to place the mask over the muzzle
can increase stress.
➢ This technique requires minimal equipment and can be quite effective in
recumbentpatients (eg, those animal recovering from anesthesia or sedation)
➢ It also allows for delivery of oxygen supplementation while the patient is being
handledfor examination and treatment.
➢ With a tight-fitting mask at high oxygen flow rates (8-12 L/min), oxygen
concentrationsof 50% to 60% can be achieved.

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 ➢ Care must be taken to ensure the mask is not tight enough to cause rebreathing of
carbondioxide and consequent hypercarbia.

C. Oxygen Hood
➢ An oxygen hood can be created by using oxygen tubing to supply oxygen to an
Elizabethan collar covered with plastic wrap, leaving 2.5 to 5 cm open at the top of
theElizabethan collar to allow for carbon dioxide and water vapor elimination.
➢ This allows the animal to be visible and can minimize stress.
➢ Oxygen concentrations of ≈30% to 40% with flow rates of 0.5 to 1 L/min are
possibleafter the hood has been initially filled with oxygen at a higher rate (1-2 L/
min).
➢ This technique is not tolerated by all animals but can be effective for oxygen delivery
insome, especially if oxygen cages are not available.
➢ The humidity and temperature in the enclosed space of the Elizabethan collar
mayincrease rapidly.
➢ Therefore, frequent monitoring of the animal is required and the duration for which
thistechnique can be used may be limited.
➢ Additionally, carbon dioxide can accumulate if the hood is not vented properly.

D. Oxygen cages
➢ Oxygen cages are among the easiest methods of oxygen administration. However,
theyisolate the patient, which sometimes makes it difficult to examine, monitor, and
treat these dynamic cases.
➢ For some patients (eg, stressed cats), isolation from a strange environment and
humansmay be beneficial.
➢ Initial crisis management of animals in respiratory distress may require high
oxygenconcentrations (up to 90%) until the patient has been stabilized.
➢ It should be possible to reach 100% oxygen.
➢ Oxygen cages may be associated with inappropriate patient warming and
secondaryhyperthermia (ice packs in the cage can help control temperature)
➢ Pediatric incubators, into which oxygen is piped, provide a suitable alternative for
cats,small dogs, and neonates
➢ Oxygen sensors can measure the oxygen concentration in incubators or other
makeshiftoxygen cages.

E. Nasal Oxygen
➢ For more prolonged oxygen supplementation, nasal oxygen can be provided with
nasal oxygen prongs manufactured for human patients or by placing a catheter in one
or bothnostrils and suturing or gluing it in place.
➢ Nasal prongs penetrate ≈1 cm into both nostrils and typically work well in large-
breeddogs that are relatively immobile.
➢ Nasal prongs likely supply oxygen levels similar to those supplied by the flow-
bytechnique
➢ Nasal catheters can also be used instead of nasal prongs in dogs or cats

15
➢ Any type of catheter can be used for this purpose, but 5-8 French red rubber
urinarycatheters or soft feeding tubes are more common.
➢ The catheter should be premeasured from the nostril to the medial canthus of the
eye.This will place the tip of the catheter into the nasopharynx.
➢ A few drops of a local anesthetic (eg, topical 2% lidocaine) should be placed in
thenostril.
➢ The tip of the tube should be lubricated with lubricating jelly or lidocaine gel.
➢ The tube should be placed medially to the premeasured length then sutured at the alar
fold of the nostril and again on the side of the patient’s face or over the top of the head.
➢ An Elizabethan collar is often needed to prevent the patient from rubbing out the catheter.
➢ Brachycephalic breeds are poor candidates for nasal oxygen supplementation
because catheter prongs cannot be adjusted to fit comfortably on their faces

Other Considerations

➢ If the animal is in severe respiratory distress or has an upper airway obstruction, it

maybe necessary to secure an airway by intubating with an endotracheal tube
➢ If being provided for more than a few hours, oxygen should be humidified (ie,
saturatedwith water vapor) to prevent desiccation of the airways
➢ Patients receiving oxygen therapy should be monitored closely using physical
examination parameters such as respiratory rate and effort, mucous membrane color,
andheart rate, as hypoxemia can cause tachycardia
➢ Pulse oximetry or arterial blood gas analysis can be used to confirm the patient
isoxygenating at an acceptable level with oxygen supplementation

16
 Practical 5 : Gastric and peritoneal lavage
.

Gastric Lavage in small animals

➢ Gastric lavage involves placing a tube through the mouth (oro-gastric intubation)
orthrough the nose (nasogastric) into the stomach.
➢ Toxicants are removed by flushing saline solutions into the stomach, followed by
suctionof gastric contents.

Indications:
Gastric lavage is unlikely to be justified unless the following criteria are met:
✓ If ingested material is highly toxic
✓ If patient presents within 10–30 min of ingestion
✓ If poison is not effectively adsorbed by activated charcoal
✓ If poison is not rapidly absorbed from the stomach
✓ If poison is likely to be soluble in the lavaging fluid

Contra-indications:
Gastric lavage should not be used with toxicants such as the following:
➢ Petroleum distillates (e.g., gasoline, furniture polish)
➢ Corrosives (strong acids, strong bases) (e.g., drain cleaner)
➢ CNS stimulants, because the act of vomiting may trigger convulsions
➢ Rapidly absorb toxicant like ethanol
Unless a secure (intubated) airway has been established, gastric lavage should not be used in
thefollowing patients:
➢ Those who are unconscious
➢ Those with impaired airway reflexes

Adverse effects:
➢ Aspiration of lavage into lungs
➢ Mechanical injury caused by placement of the gastric tube
➢ Endotracheal placement (into the trachea and thus into the lungs) of gastric tube
➢ Electrolyte imbalance
➢ Tension pneumothorax
➢ Tachycardia and ectopic beats
➢ Triggering or exacerbation of cardiac arrhythmias
➢ Hypothermia (If lavaging fluid is not appropriately warmed)

17
 Materials:

➢ Mouth gag
➢ Lubricant
➢ Orogastric tube
➢ Warm lavage fluid (e.g., tap water) in a bucket
➢ Activated charcoal pre-drawn in 60 ml syringes ready for administration (Dose: 1-5 g/
kgof charcoal)
➢ Stomach pump (or funnel)
➢ Endotracheal tube
➢ Anesthesia machine or ambu bag
➢ IV catheter supplies
➢ Sedatives
➢ Anti-emetic (e.g., ondansetron, maropitant)

Method or procedure of gastric lavage

1. The patient should have IV access established, and then sedated and intubated with
anendotracheal tube and connected to an ambu bag or anesthesia machine.
2. A potent anti-emetic (e.g., maropitant, ondansetron, etc.) should be given as part of
thepre-medication to prevent secondary aspiration.
3. The patient should then be placed in either sternal or right lateral recumbency.
4. An appropriately sized oro-gastric tube should be pre-measured to the last rib (so
youknow the maximum distance to insert the tube) and marked with adhesive tape.
5. A mouth gag should be placed in the patient.
6. The tip of the oro-gastric tube should be lubricated and passed into the stomach
usinggentle, twisting motions.
7. Appropriate placement of the oro-gastric tube should be confirmed to ensure that it is
notin the airway; once this has been done, warm water should be infused via a stomach
pump (or funnel).
8. 5–10 mL/kg amounts of lavage fluid can be used for lavage.
9. Attempt to recover the lavage fluid by gravity, emptying it directly into the empty
bucket.While lavaging, make sure to frequently palpate the stomach for over-distension.
10. Physical manipulation to massage/agitate the stomach is necessary to help break up
stomach contents or bezoars. This will allow small material to be removed via the
oro-gastric tube.
11. Perform several lavage cycles (>5-10) to evacuate stomach contents and
maximizedecontamination.
12. Most of the lavage liquid should be removed prior to activated charcoal administration.
13. Make sure to evaluate the gastric lavage fluid for presence of toxicants (e.g., pills,
plantmaterial, etc.).
14. This can potentially be saved for diagnostic evaluation or toxicology testing if
maliciousor unknown poisoning is suspected.
15. Before removing the oro-gastric tube, administer activated charcoal (with a cathartic)

18
 via the tube, and flush it with additional water (or by blowing forcefully into the tube)
to clear it out.
16. Kink the tube (to prevent lavage fluid from being aspirated) prior to immediate
removalof the tube. Once kinked, the tube should be removed quickly in one sweeping
movement.
17. Ideally, maintain the patient in sternal (or slightly elevated) recumbency (with the
headelevated) to prevent aspiration

Peritoneal lavage in small animals

➢ Peritoneal lavage is a diagnostic, surgical procedure performed to establish whether

thereis any free floating fluid (usually blood) in the abdominal cavity.
➢ A peritoneal lavage is used relatively secondary diagnostic tool followed
byultrasonography or radiography

Indications:
For diagnosis of
✓ Localized or generalized septic or nonseptic peritonitis
✓ Neoplasia
✓ Abdominal hemorrhage
✓ Lymphatic obstruction or chylous effusions
✓ Ruptured intestine
✓ Biliary tract rupture
Materials:
➢ Specialized catheters designed for fluid collection
➢ 14-gauge, 2.5- to 5.5-inch, over-the-needle catheter for large dogs
➢ 18-gauge, 2-inch catheter for cats and very small dogs
➢ Sterile scalpel blade or scissors
➢ 2 ml 2% lidocaine (without epinephrine)
➢ Urinary catheter
➢ 20 ml/kg warm sterile saline
➢ Sterile injection cap
➢ Sterile collection system (preferred) or syringe

Procedure of peritoneal lavage

1. Drain the urinary bladder before performing peritoneal lavage to avoid any trauma
tourinary bladder
2. Clip the ventral midline and cleanse with a disinfectant scrub.
3. Specialized catheters designed for fluid collection through peritoneal lavage
are available.
4. Alternatively, one can use a 14-gauge, 2.5- to 5.5-inch, over-the-needle
catheter.
5. Making three or four fenestrations at the distal third of the catheter with a sterile
scalpelblade or scissors may facilitate drainage of fluid.

19
 6. After the ventral abdomen is prepared, inject 2 ml of 2% lidocaine at the
predeterminedcatheter site, 2 to 3 cm caudal and lateral to the umbilicus.
7. Make an incision in the skin
8. Insert a catheter through incision into the peritoneal cavity and advance it caudo-
dorsally to the region of the urinary bladder.
9. When 50% of the catheter has penetrated the peritoneal cavity, advance the catheter
offthe stylet while simultaneously withdrawing the stylet to minimize puncture of
intra- abdominal structures.
10. After removing the stylet, infuse 20 ml/kg of warm sterile saline through the catheter.
11. Occlude the catheter with a sterile injection cap and gently roll the animal laterally
backand forth to distribute the saline throughout the abdominal cavity
12. After distributing the fluid, return the animal to lateral recumbency and attach a
sterilecollection system or syringe to the catheter.
13. Gravity flow through a sterile collection system is preferred, as aspiration by
syringeoften results in occlusion of the catheter with intra-abdominal fat or
omentum.
14. Collecting less fluid than the amount infused is common and is not a concern as long
asat least 5 to 10 ml is collected for diagnostic sampling.

Laboratory examination:
➢ Peritoneal fluid should always be evaluated cytological and followed by bacterial
cultureand ABST should be done
➢ Biochemical analysis should be performed, but dilutional effects of the infused fluid
mustbe considered when interpreting results.

Interpretation:
➢ Presence of bacteria and degenerative neutrophils is a hallmark of septic inflammation
➢ Bilirubin crystals indicative of biliary tract rupture
➢ Cytological findings of neoplastic cells indicate neoplasia
➢ Fat droplets and mature lymphocytes is evident in chylous effusions
➢ Presence of rbc or blood indicative of trauma or rupture

20
 Practical 6: Collection and examination of cerebrospinal fluid
.

➢ CSF is the ultrafiltrate that is produced when blood passes through the choroid plexus.
➢ Red cells, white cells, platelets, most of the proteins (immunoglobulins, albumin), and
mostdrugs cannot pass through the choroid plexus.
➢ Therefore CSF is colorless and transparent.
➢ It is produced at a rate of 0.05 ml/min in dogs and 0.02 ml/min in cats.
➢ It circulates from the ventricular system to the subarachnoid spaces of the brain and
spinalcord.

Indications:
➢ Seizures
➢ Suspected Intracranial lesion like Neoplasia
➢ Increased Intracranial pressure
➢ Circling movement
➢ Encephalitis
➢ Diagnosis of multifocal etiology or unknown etiology of brain disease

Collection of Cerebrospinal fluid

➢ CSF can be obtained either via cerebellomedullary cisternal puncture or via
lumbar puncture. The cisternal tap is technically easier to perform, but a lumbar puncture
is betterfor the diagnosis of primary lumbar spinal cord disease
Materials
➢ Spinal needles.
o For most patients, a 22-gauge, 1.5-inch disposable spinal needle with a stylet can
beused for cerebello-medullary cisternal taps.
o Needles 2 to 3.5 inches in length are used for lumbar taps and may be used
forcerebello-medullary cisternal taps in large dogs.
➢ Clear glass or plastic collection tubes

Procedure for collection

➢ The CSF is collected from two sites,
➢ Cisterna magna or atlanto-occipital puncture or cisternal tap in horse, cat and dog.
➢ Sub lumbar or lumbosacral puncture in cow, sheep and goat

Cisternal Tap
➢ The clinician should wear sterile gloves for this procedure
➢ Position the patient in lateral recumbency.
➢ The nose should be flexed and the dorsum flush with the edge of the table. It is
sometimeshelpful to pull the ears down toward the face.
➢ Clip an area large enough to identify landmarks.
➢ For a cisternal tap, midline landmarks are the occipital protuberance and the dorsal

21
 spinous process of the axis.
➢ Lateral landmarks are the wings of the atlas.
➢ Prepare the clipped area using aseptic technique.
➢ Palpate the wings of the atlas with the thumb and middle finger and palpate the
occipitalprotuberance with the index finger, making a triangle.
➢ The middle of the triangle should approximate the cerebellomedullary cistern.
➢ Insert the needle in the middle of the triangle.
➢ As the needle is advanced, a "pop" will be felt as it passes through the dorsal
atlantooccipital membrane (durameter) and then a slight loss of resistance will occur as it
enters the subarachnoid space.
➢ Remove the stylet, and observe for CSF flowing into the needle.
➢ If this does not occur, replace the stylet and advance the needle 1 to 2 mm at a time, each
time checking for CSF flow.
➢ A technician may occlude the jugular veins to enhance CSF flow, but proceed with
caution: the increase in intracranial pressure may result in clinical deterioration if the
animal has a tumor or other space-occupying mass.
➢ Collect the CSF in a glass vial or plastic test tube.
➢ EDTA tubes are generally not necessary, as CSF should not clot.
➢ One to 2.0 ml of CSF in two tubes is sufficient for analysis.

Lumbar Puncture
➢ Position the patient in lateral recumbency with the dorsum flush with the table.
➢ The sternum should be elevated so that it is at the same level as the dog's vertebral column.
➢ Landmarks for lumbar puncture include the dorsal spinous process of L6.
➢ The region should be clipped and prepared using aseptic technique.
➢ Insert the needle just lateral to the most caudal aspect of the L6 spinous process.
➢ Angle the needle tip about 10 degrees cranially and about 3 degrees medially.
➢ Advance the needle slowly, with the needle tip just contacting the bone of the lateral
aspectof the L6 dorsal spinous process as the needle is advanced.
➢ The goal is to enter the interarcuate space between L5 and L6 on the midline with
theneedle tip passing just cranial to the base of the L6 dorsal spinous process.
➢ Pelvic limb muscles often twitch visibly when the subarachnoid space is entered
➢ It is possible in some cases to collect CSF from the dorsal subarachnoid space if very
delicate technique is used; however, in most cases the needle is advanced through the
spinalcord until bone is contacted on the floor of the vertebral canal.
➢ Then the needle is backed up 1 or 2 mm into the ventral subarachnoid space, where the
fluid is collected.
➢ Remove the stylet. If there is no CSF flow, replace the stylet and withdraw the needle
afew millimeters at a time and check again for CSF flow

22
Protocols or things to be kept in mind
➢ The pathologist should be informed of the CSF collection site, as protein content and
cellcounts can vary according to location.
➢ Make only two attempts at a cisternal tap.
➢ If both attempts are unsuccessful, consider a lumbar tap or try again in 24 hours
becauseeach attempt at obtaining CSF could increase the risk for blood contamination.
➢ Occluding the jugular veins may enhance CSF flow.
➢ Do not attempt to aspirate with a syringe from the collection site.
➢ Hyperflexion of the neck may actually decrease the ability to gain access to the
subarachnoid space.
➢ Flexing the extended pelvic limbs cranially for the lumbar tap slightly expands
theinterarcuate space to allow passage of the needle.

Examination of Cerebrospinal fluid

➢ Normal CSF should be colorless, odorless, and clear.
➢ Remember, CSF should be collected in 2 tubes.
➢ One can be sent as is to a laboratory for quantitative protein analysis; the other should
besent for cytologic evaluation.
➢ Once in a collection tube, any cells in the CSF will be destroyed in a matter of hours
dueto the low oncotic pressure.
➢ This can be avoided by adding 2 drops of the patient's own serum to 1 ml of CSF.
➢ Cell counts can easily be done in any practice using a simple glass hemocytometer. It is
important to count both red and white blood cells.
➢ For better cell concentration sedimentation technique can be performed for this a
sedimentation chamber can be made by cutting a plastic tube 1 inch from the top to form
acylinder.
➢ Apply Vaseline or paraffin wax around one of the edges of the cylinder and adhere it to a
glass slide.
➢ Place 0.5 ml of CSF in the chamber and wait 30 minutes to allow any cells to settle on
thebottom.
➢ Use a pipette to remove the supernatant, quickly air dry the slide, stain, and examine.

23
A. Physical examination
Parameters Observation Inference
Colour Clear, watery andtransparent Normal

Red
Puncture of blood vesselduring
collection
Dull red / brownish Yellow
Intracranial hemorrhage,
cranium fracture
(xanthochromic)
Presence of bile pigments
(jaundice), hemorrhage.
Grayish or greenish
Due to infection leading topus
formation

Turbidity Clear, transparent Normal

Hazy, ground glass like Presence of cells/ white clots

Cloudy/purulent appearance (pleocytosis)
Encephalitis, bacterial
meningitis.

Puncture of blood vessel

Red turbid during collection.

Coagulation No coagulationCoagulation Normal

Presence of abnormal
amount of proteins
especially fibrinogen in
Blood (in large quantities) cases of meningitis

Internal hemorrhage or
improper collection.

B. Chemical
ExaminationProteins:
➢ Normal protein content of CSF is 12-40 mg/100 ml and most of it is albumin.
Glucose:
➢ The quantitative estimation of CSF glucose is done by the Folin – Wu technique. The
concentration of the glucose in CSF is approximately 60-70 % of blood glucose level
andranges from 40-80 mg/100 ml in normal CSF
➢ The glucose level in CSF depends upon the
o Blood glucose levels,
o Selective permeability of the blood to CSF barrier,
o Presence or absence of glycolytic barrier.

24
 ➢ An increased glucose level in the CSF is termed as “hyperglycorrhacia” and is seen in
association with any disease having a hyperglycemia (Diabetes mellitus), encephalitis,
spinal cord compression, brain tumors or brain abscess.
➢ A decreased glucose level in the CSF is termed as ‘hypoglycorrhacia’ and is associated
with systemic hypoglycemia or acute pyogenic infection.

Chlorides:
➢ Normal CSF values in domestic animals ranges between 650-850 mg/100ml.
➢ Lower values are seen in pyogenic meningitis, protracted vomiting, advanced
pneumonia, hypochlorimia, while normally higher values of chlorides in CSF are
recorded than in serum.

Sodium:
➢ Slightly higher in CSF than in blood in salt poisoning cases.

Cholesterol:
➢ Hemorrhages in the CNS, tumors, meningitis and brain abscess lead to an increase
incholesterol content.
➢ Usually normal cholesterol level is very low and values recorded in Horse: 0.36 -
0.55mg/dl and Goat: 0.51 mg/dl.

Calcium:
➢ Normally the calcium is lower in CSF than in serum. Increased level of protein
boundcalcium in CSF indicates disturbance in blood brain barrier.

Determination of enzymes:
➢ Increased levels of CSF GPT: 20.1(9-46 unit) and GOT: 13.7 (2-32 units) have been
observed in dogs suffering from distemper with involvement of CNS, purulent
meningitisand cerebral infarction.
➢ Lactic dehydrogenase enzyme level of CSF are also increased in bacterial meningitis,
metastatic carcinoma, lymphoid tumor, subarachnoid hemorrhage and cerebral infarction.
➢ A marked elevation in the CPK (creatinine phosphokinase) is also seen in
certain neurological conditions.

25
 Sr Tests Observation Interpretation
No
1
Slight foam that Normal Protein levels
Foam test disappears after
fewminutes
Take CSF in test tube and shake at
least for 5 minutes Protein
More foam that level
remains longer time Increased

2 Sulfosalicylic acid test (SSA) Increase in

the Presence of proteins
3 ml of 3% SSA + 1 ml CSF Mix turbidity
Allow to Stand
3 Nonne - Apelt test White to grayish Presence of
ringat junction of increasedamounts of
1 ml saturated ammonia solution two fluids globulin in CSF
+ which is seenin
1 ml CSF Do not mix. Encephalitis,
Allow to stand Meningitis,
Neoplasia,
4 Pandy test Hemorrhage,
Hydrocephalu
1 ml saturated phenol or Pandeys, White cloudy s
reagent (Pandy‘s reagent is prepared orturbid Toxoplasmosi
by dissolving 10 grams of pure sPneumonia
phenol in 150 ml of distilled water) Uremia
+
1-2 drops of CSF Shake

C.Cytological examination
➢ The total cell counts of the CSF must be estimated within 30 minutes of collection,
sincethe cells degenerate rapidly.
➢ The estimation of the number of cells is done as for the determination of WBC’s of
theblood. The total number of cells which are obtained are then multiplied by 0.6 to
get number of cells in one cu mm of the CSF.

Normal counts:
➢ Cattle, sheep and pig 0 - 15 cells/ cu mm
➢ Dog up to 25 cells/cu mm
➢ Horse up to 23 cells/cu mm

26
 ➢ Pleocytosis or increased number of WBC’s are seen in inflammatory conditions of
brain,spinal cord or meninges, abscess of brain or spinal cord encephalitis, chronic
inflammatory conditions, toxic or degenerative conditions.

Differential Count:
➢ Prepare the smear from CSF, dry it and stain with leishmans stain, examine under
microscope.
➢ Neutrophilia indicates pyogenic or bacterial infection, abscesses in brain, bacterial
meningitis, encephalitis and hemorrhage, while lymphocytosis is observed in uremia,
toxemia, chronic viral and fungal infection.

Bacteriological examination
➢ It is carried out when the CSF cell count and protein contents are high. The organisms
areisolated in CSF and identified by cultural methods.

27
 Practical 7: Blood transfusion

➢ The use of blood transfusions in veterinary practice has increased dramatically in

recentyears.
➢ Practitioners therefore need to be able to collect and administer blood safely when
atransfusion is indicated.
➢ One of the major obstacles to blood transfusion in veterinary practice is the absence
ofappropriate donor animals.
➢ Identification of possible donors in advance of blood requirements allow life-
savingtransfusions to be administered quickly and safely.

Indications:
➢ Acute blood loss
➢ Coagulopathy
➢ Anaemias.
➢ Hb less than 4- 5% (estimated PCV less than 15%)
➢ Hypovolemic or hemorrhagic Shock

Selection of donor
➢ Dog and cat must Have good general health and free from any disease
➢ A minimum weight is required dog must weight at least 25 kg and cats at least 4.55kg
theseweight
➢ 1 to 8 year age
➢ Donor PCV should be at least 40% for dog and 35% for cat
➢ All blood donors should have been vaccination as per schedule including rabies and
DHPPiL (distemper,hepatitis ,leptospira parainfluenza ,parvo virus )for dog and rabies
andRCP (rhinotrachetis ,calci,panleukopenia) for cats
➢ Blood should not be donated until 11 days after a dog or cat is vaccinated
➢ Ideally cross-match canine donor and recipient or use a DEA 1.1 and 1.2 negative donor
Collection of blood
➢ Blood can be collected from a donor every 4-6 wks
➢ Dog and cat can donate 10% of their total blood volume with no adverse effect
➢ When over 10% of the blood volume is to be collected intravenous fluids should ideally
beadministered in order to prevent hypovolemia
➢ The total volume in cat and dog is approximately 66ml/kg and 90 ml/kg body
weightrespectively
➢ Blood collected from easiest and safest sites is jugular vein and saphenous vein
➢ Large bore needle should be used

28
Anticoagulant:
If the blood is for immediate use
➢ Sodium citrate as 3.8% solution : 1ml solution for 9 ml blood
➢ Heparin as 1% solution @ 625 IU for 50 ml of blood

For storage purpose

➢ ACD (Acid citrate dextrose) and CPD (Citrate phosphate dextrose) are a choice of
anticogulant

Composition of ACD
➢ Trisodium citrate : 13 gm
➢ Citric acid :4.2 gm
➢ Dextrose 14.2 gm
➢ D.W 1000 ml
➢ Dose rate : 49ml for 350ml of blood

Composition of CPD
➢ Trisodium citrate 26.5 gm
➢ Citric acid :3.15 gm
➢ Sodium dihydrogen phosphate :2.22 gm
➢ Dextrose :25.5 gm
➢ D.W 1000ml
➢ Dose rate :75ml per 500ml of blood

Performing a cross-
matchMajor cross-
match
➢ Donor blood in EDTA anticoagulant is centrifuged at 3000 rpm (1000 g) for 10 minutes.
➢ The supernatant (Plasma and buffy coat layer) is removed and the erthrocytes are
washedby resuspension in saline.
➢ The cells are recentrifuged and the supernatant removed
➢ The erythrocytes are resuspended in saline to make a 3 to 5 per cent solution.
➢ Two drops of cell suspension are placed in contact with heparinised plasma from
therecipient (one or two drops) either on a slide or preferably in a test tube or well plate.
➢ The cell/plasma mixture is assessed for haemolysis (diffuse reddening of solution
whichfails to settle out) or agglutination (granular appearance)

Minor cross – match:

➢ The minor cross match is performed in the same say, using recipient cells and
donorplasma.

29
Material requirement:
➢ IV Catheter or scalpvein
➢ 1 inch and ½ inch adhesive tape
➢ Blood collection bag or sterile glass bottle
➢ Blood transfusion I/V set
➢ Anticoagulant
➢ 20 ml Syringe

Guidelines for blood collection:

Canine blood:
Blood collection by transfusion bag (for long storage)
➢ Infusions of crystalloid fluids should be administered to donor over 45 minutes at two
tothree times the volume of blood collected (optional)
➢ Depending on individual preference, position the dog in either lateral recumbency or
thesitting position
➢ Aseptically prepare a jugular vein and apply xylocaine gel to the skin over the vein
➢ Place the needle of the blood bag into the jugular vein and allow blood to flow into
theblood bag while gently mixing the contents of the bag.
➢ The blood bag should be held well below the level of the patient to allow gravity
toenhance flow rate.
➢ If the flow rates are slow, consider occluding both jugular veins.
➢ Ideally, weigh the bag during collection (See right) to ensure that the appropriate
volume is not exceeded (100 ml weighs approximately 100 g). Where possible, attempt
to collect the appropriate amount of blood (500 ml) for the volume of anticoagulant in
the bag (63 ml)

Blood collection by glass vial (for immediate use)

➢ Prepare 20 ml or 50 ml collection syringe (i.e wet the syringe with heparin or ACD
orCPD) and flush a small amount of anticoagulant into a 20 gauge butterfly catheter.
➢ Place an intravenous catheter into a saphenous vein and collect the blood in it
➢ Transfer collected blood into sterile glass vial and keep stirring of it gently
➢ In the meantime other syringes of blood should be withdrawn and transfer to sterile
glassvial.

How much blood should be transfuse?

Blood volume to be transfused = K x Weight (kg) x (Required PCV – Recipient(PCV)
—————————————-
PCV of donated blood
K=66 for cat 90 for dog

30
 Guidelines for infusion of blood
➢ The blood should be infused slowly (80-100 drops/min) I/V with a sterile hypodermic
needle of 20G in dog and 18 G in cattle and horse
➢ Before administration ,stored blood should be warmed to body temperature
➢ The bags should be inverted gently several times to re-suspend the red cell but should
notbe shaken violently
➢ Obtain pre-transfusion body temperature, heart rate, mucous membrane color,
capillaryrefill time and respiratory rate
➢ Given 1/4th of total volume during 1st hours
➢ Then given ½ of remaining blood volume in next hours
➢ Administer transfusion at an appropriate rate according to the patient’s condition.
➢ 2 ml /kg /hour for patients with heart disease or renal failure
➢ 5 to 10 ml /kg /hour for normo-volaemic patients
➢ Monitoring of transfusion patients should be given thought and attention.
➢ Constant monitoring is advisable over the initial 30 minutes of a transfusion for
anyadverse reaction of blood transfusion

SIGNS OF A POTENTIAL TRANSFUSION REACTION:

o Urticaria (especially in dogs)
o Erythema or pruritus
o Vomiting
o Vocalisation (Cats)
o Pyrexia
o Depression
o Dyspnoea, tachynoea or coughing
o Trachycardia or bradycardia
o Tremors or convulsions
o Shock, Cardiopulmonary arrest
o Anorexia (Delayed)
o Jaundice (delayed)

➢ These type of reaction respond well with an early attempt and large doses of
o Adrenaline (1:1000) 2 5-8 ml/ IM
o Corticosteroid @3-5 I/m
o Chlorphenaramine maleate @5-10ml I/M
➢ Transfusion of large volume of blood with ACD or CPD may cause citrate toxicity
o Administrate Calcium gluconate I/V
➢ For heparin toxicity
o Protamine sulphate should be administrated

31
 Practical 8- Special examination of cardiovascular system
.

• Normal heart sounds, its location, physiological mechanism behind it

• What is murmur and its classification, its location, physiological
mechanismbehind it
• Biochemical test done for examine heart
• Radiographic examination
• Cardiovascular system has two primary functional units a heart and blood vessels. To
provide a proper blood supply to each organ is its cardinal function. That’s why two type of
common failure will produce a) pump failure and b) circuit failure.
• Acute heart failure, congestive heart failure, cardiac enlargement, pericarditis, myocarditis,
endocarditis, valvular disorders, shock, edema, cardiac arrhythmia are the common problems
of animals with compromised cardiovascular system.
• Canine parvo virus, FMD, Traumatic pericarditis, Dirofilaria immitis, babesia gibsoni,
Ascitisare the common conditions associated with cardiovascular system.
• Bacteria most often isolated from affected animals include Streptococcus, Staphylococcus,
Klebsiella spp, and Escherichia coli, although a host of other bacterial species may be
involved.
• In Veterinary practice dog and cats were common species subjected to cardiac examination
frequently.

❖ Clinical signs of cardiovascular disease and location of heart in different species

In small animals there are no clinical signs in the early and middle stages of the diseases.
Animalmay produce different clinical and physical symptoms according to pathogenicity of
affection
➢ Coughing more than usual (during or after exercise or more at night time)
➢ Exercise intolerance
➢ Increased or labored respiratory rate
➢ A swollen belly (ascites)
➢ Fainting because of blocked blood flow to the brain
➢ Change in tongue or gum color to bluish gray because of poor oxygen flow
➢ Weight loss as your dog loses her ability to store healthy fat
➢ Restlessness at night
➢ Anorexia or Inappetance

Auscultation of heart:
• Primary cardiovascular examination is beginning with auscultation of heart.
• The stethoscope is an acoustic medical device for auscultation or listening to the
internalsounds of an animal body.
• The stethoscope was invented by Rene Laennec in 1816.
• It has a small disc-shaped resonator that is placed against the chest, and two
tubesconnected to earpieces.
• Stethoscope has three main parts a) chest piece b) ear piece and c) rubber tubes.Chest piece has
two parts a) Bell and b) Diaphragm The bell transmits low frequencysounds, while the
diaphragm transmits higher frequency sounds

32
 The Apex Beat
• The apex beat is an impact vibration produced at the start of ventricular contraction
asthe heart hits the chest wall.
• In the normal dog it is palpated on the left side, ventrally in about the fifth
intercostalspace. The apex beat should be identified by palpation before the heart is
listened to.
• It is important in lesion localization because the mitral valve lies close by and S1
isloudest at this point.
• The apex beat (mitral valve area) should be palpated and the heart rate measured
eitherby cardiac auscultation or palpation of the femoral pulse.
• The femoral pulses should be palpated in each hindlimb and compared for
fullness,sharpness and regularity.
• Next the femoral pulse should be palpated simultaneously with cardiac auscultation
inorder to detect pulse deficits due to arrhythmias.
• Each valve should be ausculted in the order Mitral, Aortic, Pulmonic (acronym
MAP).Some palpate the apex beat (mitral valve area) and move cranially from there.
• However, if you wish to auscult in a particular intercostal space it is easier if you
startcounting spaces from the last rib (13th) cranially

Basic Cardiac Function

• The cardiac cycle consists of two phases: Systole (ventricular contraction) and
diastole(ventricular relaxation).
• At rest, systole occupies one-third of the cardiac cycle while diastole occupies two-
thirds of the cardiac cycle.
• The normal rhythm (Poodle example) originates from the sino-atrial node. When the
rhythm is completely regular (the timing of the heart sounds remain in a uniform,
repeating cycle) it is called a normal rhythm.
• Sinus rhythm refers to the normal rhythmic contractions of the heart initiated after
the sino-atrial node discharges. It may be completely regular or the interval between
beatsmay wax and wane.
• This is referred to as sinus arrhythmia and is normal in dogs

Audible Sounds Detected During Auscultation

• Research has revealed that there are four main sounds produced during the
cardiaccycle of which only the first and second are normally heard in canines.
• The third and fourth heart sounds are pathological if ausculted.

Normal
• S1 - The first heart sound (lub) is the result of the closure of the left and
rightatrioventricular valves (mitral or bicuspid and tricuspid valves respectively).
• S2 - The second heart sound (dup) is the result of the closure of the pulmonic
andaortic (semilunar) valves.
Pathological
o S3 - The third heart sound is the result of the addition of more blood into a
partiallyfilled ventricle thus creating turbulence and sound waves.
o S4 - The fourth heart sound is the result of atrial contraction. Although S4 is
labelledthe fourth heart sound; if present; it will be heard at the start of the cardiac
contraction cycle.

33
 The First and Second Heart Sounds
• S1 (S1) is slightly longer in duration and of lower pitch than S2 (S2).
• More reliable clues are the timing of the sounds and that S1 is louder than S2 when
youlisten at the apex beat

The Third and Fourth Heart Sounds

• In canines, the third and fourth heart sounds (S3 and S4) are not heard in normal
animals and their presence is an indication of pathology.
• The presence of S3 is often associated with dilated cardiomyopathy (DCM) or
chronic volume overloads due to acquired mitral insufficiency while S4 is associated
with hypertrophic cardiomyopathy, pressure overloads (semilunar valvular stenosis)
orchronic hypertension.
• Since S3 and S4 are both low frequency sounds, they are best heard with the
stethoscope bell.

Normal Resting Heart Rate Values for Canines

• The "normal" heart rate for canines varies with the age, physical size, breed, level of
arousaland physical condition of the animal
• Smaller dogs have faster heart rates than larger ones.
• Compare the recordings from an adult Poodle with that from a Greyhound, and use
yourwatch to practice taking the heart rate.
• As a general rule, clinicians will take the heart rate over a period of 10 or 15
secondsdepending on how tachycardic the animal is.
• If you have difficulty counting the faster rate try counting in tens and remembering
everyset of ten by extending a finger.

Arrhythmias
• An arrhythmia or dysrhythmia is a deviation from the regular rhythm.
• In dogs this may be normal or abnormal and may result from abnormal cardiac
impulseformation, conduction, rate or regularity.
Regularity
• Regularity refers to the predictability of an arrhythmia.
• Some arrhythmias occur in a predictable fashion and are said to be regularly irregular.
• These rhythms may be normal (e.g. sinus arrhythmia) or pathological.
• In others the onset of the next beat is completely unpredictable and the rhythm is said to
beirregularly irregular (e.g. atrial fibrillation).
• Irregularly irregular rhythms are pathological in origin.
Classification of
Arrhythmias
Origin
• Supraventricular arrhythmias arise from the atria or AV node whereas ventricular
arrhythmias arise from the ventricles.
Rate
• Arrhythmias with slow rates are bradyarrhythmias while those with fast rates are
tachyarrhythmias.
Regularity
• Fibrillation is a rapid, irregular, chaotic rhythm while tachycardia is a rapid but
regularrhythm.
Murmurs
• Murmurs are sounds produced by turbulent blood flow.

34
 • Rapid flow, a wide vessel, low blood viscosity and an uneven or constricted vessel wall
allpredispose to cardiac murmurs.
• They can be physiological, for example high blood flow though the aortic outflow tract.
Pathological murmurs reflect heart disease, for example degeneration and roughening of
avalve surface.
• Veterinarians require a uniform method of describing murmurs to facilitate
communicationbetween each other via a common understanding.
• Five parameters have been developed that serve to describe all of the important aspects
of a murmur. Of the five parameters, the most important ones are position in the cardiac
cycle,intensity, duration and pattern of intensity.
• The point of maximal intensity (PMI) identifies the location where the murmur is heard
loudest and is often described using the valve location nearest (e.g. Mitral valve area).
• On the following page is a table summarizing the parameters and their descriptions
• In dogs, systolic or continuous murmurs are more common than diastolic murmurs
(diastolic murmur example).
• In describing the duration of murmurs, pan refers to a murmur that obliterates both
heartsounds either through systole or diastole but does not obliterate any heart sounds.
• Holo refers to a murmur that lasts throughout stystole or diastole but does not
obliterateany heart sounds.
• A continuous or machinery murmur (example) lasts throughout most or all of systole
anddiastole and may or may not obliterate heart sounds.
• Early- and late- describe murmurs that are positioned closer to one heart sound than
toanother.
• Crescendo, decrescendo or diamond are terms that describe the intensity profiles
ofmurmurs as increasing, decreasing or increasing and then decreasing in loudness.
• Musical and blowing and are terms used to describe the frequency profile of a murmur.
• Grade refers to the absolute intensity of murmurs determined on a 6 point scale where
the higher the grade the more severe the murmur (Example: Grade 2 versus a grade 5
regurgitant murmur).
• Localization of the murmur to systole or diastole is less consistent.
• A clue is the timing of the heart sounds (systolic murmurs occur in the short pause),
however loud murmurs can be perceived as being of longer duration than they really are.
• Another useful method is to palpate the pulse during auscultation. Pan- or holo-systolic
murmurs should be heard coincident with the pulse wave.
• First of all the stethoscope should be moved around to all the valve areas on each side of
the thorax in order to ascertain where the PMI is located and which; if any; valve is
involved.
• With the location of the PMI known the murmur's intensity may be accurately graded
andthe character and quality judged.
• Finally, by simultaneously ausculting the PMI and palpating the femoral pulse an
accurate indication of the position and duration of the murmur within the cardiac cycle
may be obtained.
• Additionally, note that by examining the animal as soon as it enters the exam room or
when it is stressed, the probability of detecting a transient or subtle murmur increases
because the intensity increases in accordance with the sympathetic effects of stress.

The Most Common Murmurs Afflicting Dogs and their Features

In order of prevalence:
Mitral Regurgitation

35
 • Mitral Regurgitation, the result of mitral insufficiency, allows backflow of blood into the
left atrium.
• Typical features of mitral regurgitation include a normal to increased arterial pulse, a
PMI located at the left apex, a plateau or decrescendo quality and systolic position in the
cardiaccycle.
• Mitral regurgitation is most often the result of acquired valvular disease (e.g. mitral
valveendocardiosis) and is usually observed in older dogs.
Patent Ductus Arteriosus
• Patent ductus arteriosus (listen to a PDA) results when the ductus arteriosus fails to close
properly (functional closure normally occurs by 72 hours after birth while anatomic
closureis complete within the first few weeks).
• PDA is therefore most commonly seen in young dogs with a higher prevalence in
purebredsand females.
• This murmur will feature an increased arterial pulse, a normal to increased venous pulse,
a PMI located at the left base and a machinery or continuous quality as it is present
throughout most or all of systole and diastole.
Tricuspid Regurgitation
• Tricuspid regurgitation, the result of tricuspid insufficiency, allows backflow of blood
intothe right atrium.
• Like mitral regurgitation, tricuspid regurgitation is most often caused by acquired
valvulardisease and is usually observed in older animals.
• Features of a tricuspid regurgitant murmur include an increased venous pulse, a PMI
located at the right apex, a plateau or decrescendo quality and a systolic position in the
cardiac cycle

36
 Practical 9- Special examination of respiratory System
.
Principle manifestations of respiratory insufficiency
1. Hyperpnoea, dyspnoea.
2. Cyanosis.
3. Cough.
4. Nasal discharge.

The main methods of examination of respiratory system are inspection, palpation,

percussionand auscultation
Inspection
• Determines the respiratory movement, rhythm, quality and type of respiration. Symmetry
and form of thorax are also determined by inspection.
Palpation
• Sensitivity of the larynx, trachea and thorax are determined by palpation.
Percussion
• Used to determine the physical condition of the lungs and pleura.
Auscultation
• For detection of the condition of mucosa, lumen of trachea and bronchi changes of
alveoli,pleura and the presence or absence of exudate.

Other methods of examination

1. Other methods are also used for examination of the respiratory system such as, X-rays
and bronchoscopy. These methods are of great importance in the diagnosis of various
forms of pneumonia and pleurisy in all species of domestic animals. Emphysema and
tuberculosis are also diagnosed using these methods.
2. Rhinoscopy and laryneoscopy for examination of the nasal cavity and pharynx.
3. Microscopic examination of nasal discharge, swabs, sputum, faeces (lung worm).
4. Paracentesis of thoracic cavity is of value when fluid is present in the thoracic cavity
fordrainage, treatment and cytological examination.

Routine examination of respiratory

system
Nasal discharge and expired air
➢ In healthy animals, small amount of mucous is found in the nasal cavity. In equine,
following severe exercise, watery mucous can be seen dripping from the nostrils.
➢ Pathologically, may contain detached destroyed tissues, transudate, blood or saliva.
Unilateral nasal discharge is seen in unilateral localized affection of the nose or
adjacent structure. Bilateral nasal discharge occurs in bilateral affection of the
bronchi,diseases of pharynx, oesophagus and stomach (vomiting).
➢ The amount of nasal discharge increases in acute nasal catarrh, malignant head
catarrh in ruminants and swine infectious rhinitis. Reduced amount is noted in chronic
catarrh of upper respiratory tract (URT), bronchitis and pneumonia and in pulmonary
tuberculosis in ruminants.

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 ➢ The consistency depends on the pathological changes; serous discharge which is
watery in consistency, colourless, transparent is seen in acute diseases of respiratory
tract. Secondary infection may turn it into mucous or mucopurulent discharge.
➢ Seromucoid discharge is slightly more viscous than serous discharge. It maybe
colourless or greyish in cases of late stages of acute nasal catarrh or bronchitis and
laryngitis. The colour is derived from presence of small numbers of leukocytes in the
discharge.
➢ Purulent discharge is liquid, non-transparent, yellow or greenish in colour. It is
present in cases of abscesses opening in the respiratory tract. Bloody discharge is a
main sign of trauma of capillaries of URT, pulmonary infarction, haemorrhagic
diathesis in horsesand in anthrax in ruminants.
➢ All the above-mentioned types of discharge have no characteristic odour except for
purulent discharge, which has a characteristic rancid odour.
➢ In pulmonary oedema, haemorrhage and chronic bronchitis, nasal discharge
maycontain air, which results in the foamy character of the discharge.
➢ In diseases or paralysis of the pharynx, nasal discharge maybe mixed with saliva and
food particles.
➢ Microscopical examination of the nasal discharge detects epithelial cells, leukocytes,
erythrocytes, fibrin, elastic fibers, crystals of fatty acids, parasitic ova, fungi and
various microorganisms. Elastic fibers are seen in pulmonary gangrene and opened
tuberculous nodules.

Examination of the nostrils and nasal mucous membranes

• This is preferably carried out in daylight to facilitate detection of the color of
mucousmembranes.
• Nasal mucous membranes may become hyperaemic in acute nasal catarrh (rhinitis).
• Cyanosis maybe seen in venous congestion, cardiac insufficiency, dyspnoea,
disturbance of gas metabolism accompanying insufficient oxidation of the blood.
• Anaemia results in pale mucous membranes. Chronic nasal catarrh also results in
palemucous membranes.
• Jaundice (yellowish discoloration of mucous membranes) is seen in hepatic
diseases,acute infectious anaemia and leptospirosis.

Other lesions or abnormalities of nasal mucous membranes

➢ Wounds resulting from trauma.
➢ Ulcers resulting in loss of epithelial layer and tissue destruction as seen in acute or
chronic nasal catarrh or haemorrhagic diathesis in equines. In these cases the ulcers are
superficialwhereas deep ulcers are seen in glanders.
➢ Neoplasia as in sarcoma and carcinoma.
➢ Oedema of the nasal cavity in severe diseases (malignant head catarrh in cattle).
➢ Facial nerve paralysis in horses results in a change in the shape of nostrils, as they
becomeelongated and drawn downwards.

Examination of the para-nasal sinuses

• Inspection, palpation and percussion are all useful in examination of para-nasal sinuses.
In special cases, rhino-laryngeoscopy and X-rays are also used

38
• Inspection reveals uni- or bilateral enlargement or asymmetry of the head in cases of
acutesinusitis.
• Tumors may also result in asymmetry of sinuses.
• Rickets and osteomalacia both cause bony deformities.
• Palpation is useful in determining the sensitivity and consistency of bones. In
acuteinflammation the examined area is hot and painful.
• Normal sinuses give tympanic sound on percussion; dull sound is heard if the sinuses
arelargely filled with exudate, in cases of bone degeneration and tumors.

Examination of the larynx and trachea

• Inspection is used to detect enlargement of the area of larynx and trachea through
edematous swelling. Inflammatory swelling at the area of larynx is seen in cases of severe
form of laryngitis, anthrax in ruminants, malignant oedema and atypical forms of strangles
inhorses.
• Traumatic pericarditis in ruminants may cause non-inflammatory oedema in the
submaxillary space that may extend to the area of larynx and trachea.
• In sheep, oedematous swelling is often seen in helmenthiasis (Dictycaulus and
Fascioliasis).
• In cases of increased sensitivity of the larynx (laryngitis), cough is induced by applying
pressure on the first three tracheal rings. Pressure on tracheal rings results in irritation of the
larynx and therefore results in induced cough reflex.
• Bronchial sound is heard by auscultation over the area of the trachea; this sound is also
referred to as tracheal, laryngeal and bronchia sound.
• In cases of bronchitis or trachitis, the sound is intensified.
• Stenosis of URT in cases of laryngeal oedema and tumours results in stenotic sounds.
• If the larynx or trachea is filled with liquid exudate, rales also are heard.
• The character and strength of rales vary according to the amount and type of exudate.
• Laryngeoscopy is helpful for detection of tumours, oedema and character of mucous
membranes.

Cough
• This is a reflex action to irritation of respiratory passages due to any cause.
• Examples of causes or inducers of cough are dust, inspiration of food particles,
inflammation of mucosal lining, inhalation of various gases (chlorine or ammonia), or from
exposure to cold.
• Cough described based on strength and character. Strong cough occurs when inspiration
is deep.
• Weak cough occurs in difficult expiration where the animal is unable to cough actively;
this is seen in pulmonary emphysema, pneumonia and exudative pleuritis.
• Character of cough depends on production of exudate and could be described as either
moist (productive) or dry (unproductive) cough.
• Moist cough is seen in acute inflammatory conditions of the respiratory tract where there
is accumulation of a large amount of mucous.
• Dry cough occurs in chronic respiratory diseases or in acute dry bronchitis.
• Frequency of cough depends on the degree of irritation of mucous membranes; it may be
single, continuous or periodic.
• Cough may also be painful or painless. It is painful in acute laryngitis, tracheitis,
bronchitis, pleuritis and peritonitis. In chronic inflammation of URT, cough is painless.
However, evaluation of pain in animals is often very difficult as this is a subjective sign.

39
Examination of sputum
• Mucous and other inflammatory substances are expelled out of the respiratory system via
the mouth or the nostrils following productive cough. These expelled materials are termed
sputum.
• Microscopic or bacteriological examination of sputum is helpful in detection of causative
agents of the respiratory infection or disease. Sputum is collected by inducing cough
artificially or by introduction of a swab.

Examination of the thorax

• The thorax must be first examined by inspection to assess its form and shape. Unilateral
narrowing of the thorax occurs in pleuritic diseases after absorption of exudate whereas
bilateral narrowing occurs in tuberculosis, and in rickets.
• Bilateral enlargement (barrel shape) of the thorax is seen in bilateral alveolar
emphysema,and bilateral exudative pleuritis.
• Unilateral enlargement of the thorax maybe seen in unilateral exudative pleuritis,
pneumothorax and unilateral pneumonia.
• Palpation for assessing the sensitivity of the thorax and its temperature. Hotness and pain
occurs in acute inflammatory conditions and pleuritis.
• Direct or indirect percussion is an important method of examination in small and large
animals (dogs, cats, and ruminants, equines respectively).
• For percussion of thorax, the vet must first determine the area of percussion. Figure 1
diagrammatically illustrates the area of lung percussion. Students must refer to their tutors
for identification and labeling of the diagram and write percussion areas in different animal
species.

Area of lung examination

• On percussion of the thoracic wall, the area must be divided into upper, middle and
lowerthirds.
• The most intensive pulmonary sound is heard on percussion of the middle third where
thethoracic wall is somewhat thin, curvature of the ribs is large and airwaves are deep.
• In the upper third, the heavy musculature hinders clear resonant sound of the lungs.

Changes in area of percussion

• Increased area of percussion is seen when the size of lung tissue increases, presence
of large amount of air in the lungs as in alveolar emphysema, various forms of
pneumoniaand in cases of unilateral pneumonia and pneumothorax there is a unilateral
increase inthe area of lung percussion.
• Decreased area of lung percussion is seen in animals with acute gastric dilatation,
tympany of the intestine, ruminal tympany and in cases of presence of fluids in the
thoracic cavity.
• Normally in most animal species percussion over the lung area results in resonant sound;
in very small animals it is more of a tympanic sound.

40
 Abnormal percussive sounds
1. Loud resonant sound (e.g. emphysema and pneumothorax).
2. Tympanic sound; when a part of lung tissues are surrounded by solidified tissue or
exudate,which isolates it from its environment. This occurs in the following conditions
a) In early and late stages of fibrinous pneumonia.
b) In catarrhal pneumonia.
c) In pulmonary oedema and atelectasis
d) In presence of small or large tumors which surround lungs
e) In prolapse of the bowel into the thoracic cavity in diaphragmatic hernia.
3. Dull sound is heard when lung tissue becomes dense. This occurs in
a) Pneumonic hepatization
b) Tuberculosis and metastatic pneumonia
c) Tumors.

Notes of practical importance

• Changes in the character of the percussion sound is detectable only when a lesion is
present in a considerable size and is superficially situated.
• A pain reaction maybe produced by percussion. This is indicated by the animal
kicking or biting or even shying away from the examiner; vocalization in cases of
dogs and cats.
• Percussion may also induce cough in cases of pneumonia, bronchitis and pleurisy.
• Differentiation between increased density of the lungs and that due to the presence of
fluid in pleural sacs is determined as follows
• Increased density of the lungs in pneumonia, the area of dullness has an irregular
outline, the cardiac impulse is palpable, heart sounds are clearly audible outside the
cardiac area, abnormal bronchial or other sounds are often heard during auscultation
(rales or frictional sounds).
• Presence of fluid in the pleural cavity (e.g. exudative pleurisy, hydrothorax) results in
an area of dullness that has a horizontal delimitation, which changes when the
postureof the animal is altered.
• Auscultation is carried out to assess sounds produced during breathing when the air
enters the lung. The sound normally heard on the healthy lung is termed vesicular
murmur. This sounds like the soft pronunciation of the letter. It begins with the
inspiration, increasing as the inspiration continues, becomes fainter and shorter
havingthe character of a softly aspirated at expiration.

An exaggerated vesicular murmur occurs

a) If the respiration is intensified.
b) Physiological or pathological dyspnoea.
c) In bronchitis where the lumen of the bronchi are either swollen, or filled with exudate.

A diminished vesicular murmur occurs in

1.Thickened, swollen or neoplastic thoracic wall.
2.In severe bronchitis.
• Complete absence of vesicular murmur occurs if plural exudate or tumours have
replaced the lung tissue. Rarely occurs in severe vesicular pulmonary emphysema, or
complete occlusion of a bronchus preventing access of air into a certain portion of

41
 thelung.

Rales
• These are abnormal respiratory sounds indicate presence of respiratory disease; if
thebronchi or a cavern in the lung contain movable exudate. Types of rales include:
1. Moist rales
• If the bronchi contain light fluid (pus, liquid exudate or blood). Bronchitis with
varyingdegrees result in moist rales.
2. Crepitant rales
• Fine cracking noises. They originate from a separation at respiration of the adhering
walls of the bronchi and vesicles. They appear in bronchitis, pulmonary oedema and
in early stages of fibrinous pneumonia.
3. Dry rales
• In cases of swelling of mucous membranes, or presence of tough bronchial secretion
ofsmall quantity.
• These result in rough mucous membranes, projecting irregularities, which vibrate
during inspiration and expiration.
• Sounds maybe humming, hissing or whistling in character. Dry rales are seen in
chronic bronchitis, compression of the bronchi by nodules (tuberculosis, chronic
pneumonia) and tumours.
• Presence of peristaltic sounds in the thoracic cavity indicates ruptured diaphragm and
protrusion of the intestine into the thoracic cavity. In contrast to the lung sounds, they
are not synchronous with inspiration and expiration.
4. Pleuritic frictional sounds
• In cases of surface of pleura becomes rough and dry due to presence of inflammatory
deposits, frictional sounds are heard. Pleuritic frictional sounds occur in dry or
fibrinous pleuritis only. It is most frequently heard in contagious pleuro-pneumonia
ofhorse and ox.

Rales Frictional sounds

More pronounced at inspiration than Heard at both inspiration and expiration

expiration regularly (i.e. associated with
respiratory cycle).

Removed or modified by cough Cough does not affect its presence

42
 Practical 10-Special examination of gastrointestinal system
.

Examination of the Mouth

CavityClosure of the mouth:
• In healthy animals lips close completely the mouth cavity. Incomplete closing of the
mouthcleft is due to a bilateral or unilateral paralysis of the facial nerve.
• Permanent opening of the mouth (drooping of the lower jaw) is observed in:
a) Trigeminal paralysis (rabies).
b) Strong swelling of the tongue and presence of foreign bodies in the mouth cavity.
c) During rachitic affection.
• The temperature of the mouth cavity:
• It is elevated in fever and in local inflammations of the m.m.; stomatitis and pharyngitis.
Secretion of saliva:
• Diminished secretion of the saliva occurs in all acute febrile condition diseases,
severeintestinal affections and colic.
• Increased quantity of saliva in the mouth is either the result of difficult swallowing of
thenormal saliva or occurrence of abnormal conditions such as
1. Simple catarrhal or traumatic stomatits.
2. Diseased teeth.
3. Secondary stomatitis as in cases of foot mouth disease. Rinder pest,
malignantcatarrhal and indigestion.
Color of the mucous membranes:
• The color of the mucous membranes of the buccal cavity may show the following
abnormalities
a) Haemorrhagic: Seen in anthrax, cattle plague, malignant head catarrh in
cattle,swine plague or it may be of traumatic cause.
b) Yellow color; is seen in piroplasmosis or other forms of severe forms of
severeictrus and infectious encephalomyelitis.
c) Blue discoloration: Occurs in pneumonia, heart diseases, collapse and bad
ventilation.
Odour from the mouth:
Abnormal odors of the mouth cavity
• Acetone indicating acetonaemia.
• Sweet due to decomposed food particles, epithelial cells or saliva and in the course
ofstomatitis.
• Putrefied odour produced by decomposition of nitrogenous substances and in uraemia.
• A carious odour produced by suppurative processes in bones especially in alveolar
peri-ostitis.
Occurrence of macroscopic pathological changes:
1. Redness and swelling of the mucous membrane as caused by trauma or caustics
e.g.chloral hydrate or other drugs.
2. Clamminess of the buccal mucous membrane occurs in digestive disorders (loss
of appetite).
3. Vesicles in foot and mouth disease and vesicular stomatitis.
4. Punctiform haemorrhages occurs in morbus macular and leukaemia.
5. Actinomycotic processes render a render a swollen and hard tongue.
6. Swelling and blue discoloration in sheep suffering from catarrhal fever.

43
Foreign bodies:
• Are common in horses, dogs and cats, rare in other animals; they consist of pieces of
bones,needle, etc.
• Condition of the teeth of companion animals (horses, dogs and cats) is of particular
importance on account of the frequent occurrence of diseases and malformations of these
organs, carious incisors and molars occur in dogs in the course of rachitis, distemper,
anemia and stomatitis.

Examination of the throat and esophagus

• Throat and esophagus are examined by inspection and palpation.
Inspection
• Diffuse swellings in the region of the pharynx (outside) occur in pharyngitis.
• Circumscribed swelling indicate the presence of abscesses, tumors.
• Impacted foreign body accompanied by outer enlargement, salivation and regurgitation
offood.
• Stenosis of esophagus is accompanied by swelling anterior to the lesion when the
animaleats.
• In case of diverticulum (dilatation) swelling at the site of the lesion when the animal
eats,it is reduced by pressure and disappears spontaneously after short time.
Palpation
• Increased temperature and sensitiveness indicate acute inflammation which may be
circumscribed (development of abscess) or diffuse (pharyngitis).
• The consistency is firm and painful in abscesses formation. Circumscribed painless
swelling of firm consistency indicate the presence of foreign body and actinomycosis in
cattle.
• Palpation of the esophagus serves to detect the presence of foreign body mostly observed
in cattle, esophageal dilatation or stenosis.
Special methods of examination
• Introduction of probing in helpful in causes of esophageal obstruction.
• Roentgenoscopy and rentography may help in diagnosis of the condition of the teeth, the
presence or absence of foreign body.
The abdomen
inspection
• The volume of circumference of the abdomen in domesticated animals is subjected to
great variations and it must always be considered in connection with the general condition
of the animal. Inspection of abdomen reveals a depression in the upper part of the flank
hunger hallow or paralumber fossa, which is seen in ruminant.
• Abnormal dissension of the abdomen may be due to
a) Pregnancy; the increase is bilaterally and primarily in the posterior third of the abdomen.
In the cow frequently more on the right than on the left side. Palpation of the fetus by
rectalpalpation make definite diagnosis.
b) Accumulation of abnormal quantities of food in the digestive tract: The increase is due to
either overfeeding or to accumulation of food or water during inactivity of
gastrointestinal tract as in acute intestinal obstruction or constipation. In this case by
percussion we observe that the normal tympanic tone is replaced by a dull one. This is seen
in the cecum and colon(horse), in rumen and reticulum (ruminants).
c) The accumulation of gasses produced by fermented food. The dissension is in an upward
direction and the hallow of the flank is raised.
d) Accumulation of fluid (transudate of exudate) in the peritoneal cavity. In this case the
dissension is in downward direction and bilateral with fluctuation. By percussion a dull

44
 area bounded by horizontal line is seen, by changing the position of the animal this
boundary line changed.
e) Tumors in the abdomen, liver; (Ecchinococcous and carcinoma), spleen (leukaemia),
glands etc.
f) Hydropsy of the fetal membranes and pyometra.
g) Retention of urine.
h) Localized increase in the abdomen is seen in case of hernia (abdomen, naval, inguinal);
tumors or abscesses.

External palpation
• The object of palpation ascertains the consistency of the gastrointestinal tract and
howeveror not painful condition exists.
Palpation of the rumen (hard-elastic)
• Before feeding, palpation at the area of hunger fossa seems to be embedded inward
andpalpation of the lower part show somewhat hard consistency.
• After feeding hunger fossa is raised and elastic as a result of accumulation of gasses in
theupper compartment of the rumen.
• In cases of ruminal tympany and impaction, the hunger fossa is severely increased in
sizeand elastic, reaches a level above the hip.
• Deep palpation may fails to depress the hunger hallow inwardly. In cases of impaction
thehunger hallow May also increase in size, be doughy or hard in consistency.
• By deep pressure, the abdominal wall presses inwardly but returns very slowly
outwardly;in addition the area is painful.
• Palpation of the horse stomach may not be of value as horse stomach is
comparativelysmall and even when filled does not always come into with floor of the
abdomen.
• Palpation of the stomach in dogs.
• External palpation help in determining the consistency of the gastric contents.
Anotherobject of palpation is to ascertain painful conditions or abnormal sensitiveness.
Special interpretation
• Healthy horses are sensitive for deep palpation and may show pain, which not so show in
cattle.
• In cattle, sensitiveness to pressure between the 6th and 8th rib (opposite the reticulum)
points to possibility of an injury to the diaphragm from a foreign body that penetrated the
reticulum.
• In acute affections of the true stomach, cattle show symptoms of pain on palpation of the
right flank.
• In cattle, when intussusceptions of the small intestine exists it is also attended
with symptoms of pain.
• Foreign bodies in the intestine of dogs produce symptoms of pain when pressure is exerted.
Percussion of the abdominal cavity
• The stomach and the intestine contain, as a rule, large gas filled chambers surrounded
bythe organ and by the fodder mass.
• By percussion of the air containing cavities a tympanic sound is heard. Percussion
ofhunger hallow in cattle produces a tympanic sound.
• In tympany the sound is highly tympanic while in impaction the sound is dull.
Auscultation of the abdomen
• The sound heard at auscultation of the abdomen are produced by the inward movement
ofthe solid; liquid and gaseous contents of the bowels.
• These sounds can be heard by listening at the wall of the abdomen either directly or

45
 by .using instruments (stethoscope).
• Direct auscultation is performed mainly in dog and cat. The character of the sounds
arelow; sluggish; active; limited or absent.
• Increased peristaltic activity occurs chiefly in catarrhal enteritis, in spasmodic colic,
earlystages of volvulus intussusception or strangulated hernia.
Decreased peristaltic activity is observed with:
1. Obstructions, accumulations and later stage of tympnay.
2. Permanent diarrhoea if the intestinal contents are quantitatively small.
3. Severe inflammations (enteritis, peritonitis), intestinal paralysis. Sounds of
peristaltic activity will be vivid and loud in all cases of mild irritation, especially those
due to the feeding of fodder possessing a mild laxative effects; grains; wheat; bran etc.
• The ringing intestinal sounds form a special qualitative variety.
• They originate in cases of gaseous dissension of the intestine where the above situated
intestinal segments (mesenterium) propel their fluid content towards the tensioned
intestinal sounds indicate that an intestinal segment is at, rest, and that its wall extended
bygases.
Auscultation of the rumen
• Auscultation of the rumen help in recognizing the rate, quality and rhythm of the normal
ruminal movements. The ruminal movements arise from the churning action of the organ.
• The rate of ruminal movement in health animals is 2-5 in cattle, 3-6 in sheep, 2-4
movements every two minutes in goats.
• It decreases in cases of rumen atony; diseases of reticulum, omasum and abomasum;
impaction and late stage of tympany; also in severe feverish conditions and in traumatic
reticuloperitonitis.
• Increased rate is seen in early stage of digestive disorders such as tympany and the form
ofvagus indigestion with hypermotility.
Absence of movements occur in the following:
1. Severe dilation of the rumen with gases (tympany) or with food (impaction).
2. Toxic conditions.
3. The quality could be described as strong in healthy animals, weak in cases of
ruminal atony and very strong as in early stages of digestive disorders such as tympany
and vagusindigestion with hypermotility.
Rectal palpation
• By rectal examination is meant the process of palpating the anterior of the abdomen by
means of head (in large animals) of finger (in small animals) introduced through the anus.
• Remarks in rectal examination
o Fingernails must by kept short.
o The hand and arm are lubricated with soap, oil etc.
o The fingers must be pressed to form a cone and the hand must be introduced with
rotatory movement. Palpation is made by closed fingers, force must be avoided.
o Perform back racking (empty rectum from faecal contents).
o When the animal strains relax immediately the arm and push it backward in order
not to rupture the bowel.
Important points of rectal examination
• Presence of the faeces or its absence, proliferations in the wall (polyps, hemorrhoids),
paralysis of the rectum (common in mare), laceration or rupture of the wall.
• The colon has irregular loops on the right and left in front of and within the pelvic cavity.
• It is as thick as the arm, carries bands and succulations and usually contains balls of
faeces. It can be grasped by the hand and moved easily in all directions on account of its
long mesentery.

46
 • Base of the cecum is felt as a large rounded surface lying on the right side far forward in
the upper third of the abdominal cavity adjacent to the abdominal wall, not mobile.
• The ileum comprises the last three or four inches of the small intestine and have thick
wall.Could be easily palpable when full of food but could not be palpable when empty.
• It can be felt far forward in the upper third of the abdominal cavity as a firm thick walled
tube as the arm, when full, running horizontally or obliquely outwards from the left to
righttowards the head of the cecum.
• The jejunum usually cannot be palpated but in flatulence it is pushed upwards
and backwards. Loops of it are thick, smooth, thin walled circular in cross sections, mobile
andrun in spirals in parallel fashion.
• The duodenum is not normally palpable. Only last part in short bodied animals is
palpable; this is felt as smooth walled intestinal structure, so thick as the arm appearing
between the head of the cecum and the right abdominal wall and running to the left above
the head of the cecum, close under the dorsal wall of the abdomen towards the anterior
root of the mesentery.
• Spleen is generally palpable in horse. It is located by passing the fingers forwards from
the pelvis along the left wall of the abdomen. Near the costal arch, the fingers pass
between the abdominal wall and spleen.
Special methods of examinations of the digestive system
• Introductions of the stomach tube to diagnose esophageal obstruction, stenosis of its
spasms.
• Biochemical analysis of the stomach content as free acidity, enzymatic activity, etc., this
helps in diagnosis of some diseases of the stomach (gastritis), metabolic diseases and
toxicconditions.
• Ruminal juice is examined for: colour, odour, consistency, reaction, sedimentation,
nitrogenous compounds (total nitrogen, non protein nitrogen, ammonia), microscopic
examination of sediment for species examinations of bacteria of ruminal juice.
• It is graphic writing of the ruminal motility. It is to study the rate, height and rhythm of the
ruminal movement.
Exploratory puncture of the abdominal cavity
• Is directed towards the determination of the presence of abnormal contents in the free
part of the abdominal cavity. There might be exudate (peritonitis), transudate (ascitis),
blood (rupture of the spleen, liver, major vessels), gastrointestinal contents, urine (rupture
of theurinary bladder), (rupture of uterus), and ecchinococcus fluid.
Intestinal puncture
• In hemorrhagic infarction of the intestine the fluid obtained is red, contain high amount
ofprotein and small amount of digestive mass.
Endoscopy
• It means examination of internal organs by the help of X-ray. It is easily conducted in
smallanimals.
Laparoscopy
• It is used in diagnosis of pathological conditions of the abdominal cavity. It is used in
dogand cat.
Special pain tests for ruminants
In case of traumatic reticuloperitonitis and these are:
1. Pinching of the wither.
2. Stick methods.
3. Down hill.
4. Strong percussion on the reticulum (xiphoid cartilage).
5. Mine detectors.

47
 Practical 11-Examination of urinary system

• In the horse and cow only the left kidney is accessible for palpation from the rectum.
• The right kidney lies further forward and cannot be reached by the hand.
• In the horse, the left kidney extends back to about four inches behind the last rib and its
inner border is separated from the median line by about the same distance.
• In ruminants it is loosely suspended below the lateral processes of the first lumbar
vertebrae.
• Sometimes it may be shifted over to the right side. In dogs the kidneys lie in the lumbar
region.
• The manifestations of the urinary tract diseases include abnormal constituents and
appearance of urine, changes in the volume of daily urine flow and frequency, pain and
dysuria and uremia.

Palpation
External palpation of the kidneys in the horse is not performed due to the considerable thickness
and rigidity of the abdominal wall. Kidneys can be palpated through the abdominal wall in the
majority of small and medium sized dogs.
In sheep, goat and pigs, external palpation of the kidneys is of little value. In the cat, kidneys are
large and pendulous therefore easily palpable. Identification is aided by recognition of the hilus
on the attached border. In cattle, rectal palpation may help in examination of the kidneys.
During palpation, attention should be paid to the following
1. Relative size.
o Enlargement maybe due to hydronephrosis, certain forms of nephritis, neoplasm
and pyelonephritis
o Reduction in size occurs in advanced chronic interstitial nephritis.
2. Sensitivity to pressure.
o Pain reaction is seen in acute renal diseases but not in chronic cases.
3. Consistency
o Firm in pyelonephritis and tumours.
o Doughy in renal abscess
4. Condition of the surface.
o Loss of lobulation occurs in pyelonephritis.
o Localized tumours or abscesses cause irregular swellings of the renal surface.

Examination of the ureters, urinary bladder and urethra

1. Normal ureters are difficult to be palpated. In pyelonephritis, ureters appear as a flexible
tube,which may pulsate under pressure; calculi may also be palpable.
2. Empty bladder is soft pear shaped lying on the floor of the pelvis; over distended bladder
isa result of urethral obstruction. Ruptured bladder is permanently small and flabby.
Manipulation of bladder will reveal focal pain, any calculi, tumours and thickening of the
wall maybe bepalpable.
3. The urethra is of importance in male animals when the presence of calculi is suspected. The
urethra is examined by external palpation to detect urethral obstruction.

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 Urine analysis
Physical Examination of Urine
• Physical examination of urine includes assessment of color, clarity (transparency or
turbidity), and specific gravity.
• Normal urine color, which varies from colorless or pale yellow to dark yellow, is
associated with the presence of yellow pigments called urochromes, the end products of
hemoglobinbreakdown.
• Concentrated urine typically is darker than more dilute urine; however, color should not
beused to assess concentration.
• Abnormal urine colors include pink-red, red-brown, brown-black, yellow-orange, and
yellow-green.
• The most common abnormal urine color is red—usually associated with hematuria.
• Centrifugation of the urine sample separates the liquid from the solid components,
including red blood cells, and the supernatant becomes clear.
• If hemoglobinuria or myoglobinuria is the cause of the red discoloration, the urine
supernatant remains red after centrifugation.

Causes of Abnormal Urine Color

Pink-red Hematuria, hemoglobinuria, myoglobinuria

Red-brown Hematuria, hemoglobinuria, myoglobinuria

Brown-black Methemoglobin (from hemoglobin or myoglobin), bile

pigments
Yellow-orange Highly concentrated urine, bilirubinuria

Yellow-green Bilirubin, biliverdin

• Fresh, well-mixed normal urine should be clear or transparent to slightly cloudy.

• Cloudy urine usually is associated with presence of red blood cells, white blood
cells,epithelial cells, crystals, casts, bacteria, lipid, mucus, or semen within the urine
sample.
• Clear or slightly cloudy urine should not obviate microscopic examination of the
urinesediment as abnormal findings are still possible.
• Specific gravity, the ratio of the weight of a solution to the weight of an equal volume of
distilled water, is estimated using a refractometer.
• USG reflects the ability of the kidneys to concentrate and dilute urine compared with the
specific gravity of plasma.
• USG results must be interpreted in light of the patients hydration status, serum urea
nitrogen and creatinine concentrations, and recent fluid therapy and medication history.
• Because of species differences, refractometers should be calibrated specifically for dogs
and cats.
• For example, the USG of feline urine will likely be falsely high if measured with a

49
 refractometer calibrated for humans.
• Marked proteinuria and glucosuria have the potential to increase USG in dogs and cats;
for every gram of protein or glucose per dL of urine, the USG may increase by about
0.005.
• Because IV administration of hetastarch4 and iohexol can transiently but markedly
increase USG,5 urine-concentrating ability should not be assessed in dogs and cats that
receive thesedrugs

Category USG Interpretation

Hypersthenuria 1.030 in dogs; Urine is appropriately concentrated; appropriate renal

1.035 in cats* response to antidiuretic hormone
1/3 of the total nephron population is functional and
renal medullary hypertonicity is present
Range of >1.012 <1.030 in Urine is inappropriately dilute compared with plasma
minimal dogs May be normal in a well-hydrated dog or cat
concentration >1.012 <1.035 in Inappropriate in the face of dehydration or azotemia
cats
1.008 1.012 Urine has not been concentrated or diluted; specific
Isosthenuria indogs and gravity is similar to that of plasma
cats May be normal response to recent water intake or
fluidtherapy
Inappropriate in the face of dehydration or azotemia
Urine is dilute compared with plasma
Hyposthenuria 8. in dogs 1/3 of the total nephron population is functional
and cats Inappropriate in the face of dehydration or azotemia

Biochemical Assessment of Urine

• Urine is evaluated semi-quantitatively (negative, trace, 1+ to 4+ scale) using commercial
reagent dipsticks that undergo a color change reaction relative to the concentration of the
analyte in the sample.
• Well-mixed, uncentrifuged urine at room temperature is used to inoculate reagent pads;
refrigeration of urine may slow reaction time.
• The color change typically is evaluated visually, but automated dipstick readers
areavailable.
• The color change is time-sensitive, with color typically increasing beyond the ideal
reaction time. Dipstick reagent methodology is not consistent across products, so results
may vary.
• Grossly discolored urine may affect dipstick interpretation of reactions for bilirubin and
ketones. Results of dipstick biochemical analyses of nitrate, leukocyte esterase, and
urobilinogen are unreliable and should be ignored when assessing urine of dogs and cats

50
 Variable Normal Comments
Result

Glucose Negative Most commonly associated with hyperglycemia; may also berenal in origin and
associated with normoglycemia

Bilirubin Negative Low-level bilirubinuria normal in dogs

Ketones Negative -hydroxybutyrate not detected

pH 5.0-7.5 Dipstick results not precise

Protein Negative False-positive results common especially in cats

Heme Negative Can be positive without intact RBCs in sediment (ie, myoglobin, hemoglobin, or
due to red cell hemolysis in diluteor alkaline urine)

Erythrocytes 0-5/hpf Iatrogenic microscopic hematuria expected with cystocentesis

Leukocytes 0-5/hpf Usually neutrophils

Casts None Hyaline casts can be observed with proteinuria

Epithelial Variable Transitional epithelial cells most common

cells

Crystals None Influenced by urine temperature and pH

Bacteria None Air-dried sediment slides stained with Wright or gram stainincreases detection
sensitivity

Nitrite Unreliable

Leukocyte Unreliable
esterase

Glucose
• Glucose is a small molecule freely filtered through the glomerulus.
• Once filtered, glucose is usually completely reabsorbed from the glomerular filtrate by
theproximal convoluted tubular epithelia.
• The most common cause of glucosuria is hyperglycemia (eg, diabetes mellitus, stress
[especially in cats], glucose-containing fluids), resulting in glucose concentrations in the
glomerular filtrate that overwhelm the reabsorptive capacity of the proximal tubule.
• The renal tubular transport maximum measurements for urine glucose in the dog and cat
are approximately 180 to 220 and 260 to 280 mg/dL, respectively.
• Less commonly, glucosuria may be associated with tubular disease/damage and
decreased tubular reabsorption of the glucose normally present in the glomerular filtrate
(normoglycemic or tubular or renal glucosuria); examples include acute ischemic or
toxickidney injury and Fanconi syndrome in basenjis
Bilirubin
• Bilirubin is produced from hemoglobin by the reticuloendothelial system when senescent
red blood cells are destroyed.
• Bilirubin is conjugated with glucuronide in the liver and primarily excreted in bile.
• Conjugated bilirubin in plasma is filtered through the glomerulus and excreted in urine.
Canine kidneys can also metabolize hemoglobin and conjugate bilirubin; therefore, the

51
 renal threshold for bilirubin in dogs, especially male dogs, is low.
• Low-level bilirubinuria in concentrated canine urine (eg, trace or 1+ in hypersthenuric
urine) is likely normal because of the low renal threshold. A 2+ to 4+ bilirubin reaction
in canine urine, especially less concentrated urine, is more likely abnormal. In contrast,
bilirubinuria is never normal in cats; the renal threshold for bilirubin in the cat is
approximately 9 times higher than in the dog.
• The major rule-outs for bilirubinuria in dogs and cats are cholestatic disorders and
hemolysis. Additional rule-outs include fever and prolonged fasting.

Ketones
• Ketones (ie, -hydroxybutyrate, acetoacetate, acetone) are produced when normal energy
production shifts from carbohydrate to lipid metabolism as in diabetes mellitus,
starvation, low-carbohydrate diets, glycogen storage diseases, and hypoglycemic
disorders.
• Plasma ketones are excreted in the urine via glomerular filtration and tubular secretion;
however, ketone production is normally low, and ketonuria is not seen in healthy dogs
andcats.
• Because urine dipsticks are more sensitive to acetoacetate than to acetone (with an
approximately 10-fold sensitivity difference), and they do not detect -hydroxybutyrate,
themagnitude of ketonuria may be underestimated.
• Ketones are volatile and will diffuse into air if the urine sample is not sealed and
analyzedwithin 30 minutes.
• The most common cause of ketonuria in dogs and cats is diabetic ketoacidosis.

Heme (Occult Blood)

• Heme proteins in urine (from intact red blood cells, hemoglobin, or myoglobin) react
withperoxide in the dipstick reagent pad and cause a positive-reaction color change.
• Hematuria is the most common cause of a positive test, although in some cases of
hematuriaintact RBCs will not be observed in the urine sediment because of hemolysis.
• This is more likely to occur if the urine pH is very alkaline (>8) or the urine is very
dilute(USG <1.015). Normal canine and feline urine should be negative for heme protein,
but iatrogenic microscopic hematuria associated with cystocentesis may result in a
positive reaction for heme.

pH
• Normal urine pH in dogs and cats ranges from 5.0 to 7.5 and varies with type of
diet,collection time (eg, postfasting vs post-prandial), and systemic acid-base status.

52
 • Urine dipstick pH measurement approximates urine pH and is estimated to the nearest
0.5pH unit. A more precise urine pH can be obtained using a pH meter

Potential Causes of Aciduria Potential Causes of Alkalinuria

Meat protein-based diet Plant protein-based diet

Use of acidifying agents (eg, Postprandial alkaline tide

NH4Cl)

Metabolic acidosis UTI with urease-containing bacteria

Respiratory acidosis Urine sample exposed to air at room temperature

Paradoxical aciduria withalkalosis Use of alkalinizing agents (eg, NaHCO3)

Protein catabolic states Metabolic alkalosis

Ethylene glycol ingestion Respiratory alkalosis

Proteinuria
• It can be classified as physiologic or pathologic.
• Physiologic or benign proteinuria can be associated with changes in exercise level,
seizures, and fever and is typically low-level and transient.
• Pathologic proteinuria can be nonurinary or urinary in origin, and pathologic
urinaryproteinuria can be renal or nonrenal in origin.
• Renal proteinuria arises as a result of glomerular and/or tubular lesions and is
persistentand usually associated with a normal or inactive urine sediment.

Microscopic Assessment
• The urine sample should be agitated gently before pouring off an aliquot for
centrifugationbecause cells, casts, crystals, and bacteria will undergo sedimentation if the
urine sample is left undisturbed.
• Low-speed centrifugation (1000-1500 rpm) for 3 to 5 minutes (using a standardized
technique) will minimize destruction of cells and casts.
• It is ideal to always centrifuge the same urine volume because the concentration of
elementsin the sediment is volume-dependent.
• Similarly, after centrifugation, the sediment should always be resuspended in the same
volume of urine.
• If normal laboratory procedure is to centrifuge 6 mL of urine but only 3 mL is available,
there would only be half of the sediment material in the 3-mL sample if it were
resuspendedin the normal volume of urine.
Urine Crystal photo

53
 Ultrasonography of the Urinary Tract

• The kidneys are paired structures located in the retroperitoneal space and surrounded
by adipose tissue. Normal kidneys are symmetric in size and shape; they can be oval
shaped in cats and bean shaped in dogs.
• The cranial pole of the left kidney is adjacent to the greater curvature of the stomach
and dorsomedial to the craniodorsal extremity of the spleen (seen cranial and lateral).
• In dogs, the right kidney is located more cranially than the left kidney and lies within
the renal fossa of the caudate lobe of the liver. In cats, the right kidney is often
separatedfrom the caudate lobe of the liver by retroperitoneal fat.
• The widely accepted normal ultrasonographic measurement for kidneys in a cat
varies between 3 and 4.3 cm in length. One report proposed that feline kidneys can
measure
3.2 to 4.1 cm in length, 2.2 to 2.8 cm in width, and 1.9 to 2.5 cm in height.
• Currently, there is no widely accepted method for determining ultrasonographically
normal kidney size for dogs. Ultrasonographic size is usually subjective.
• When viewing the kidneys in sagittal orientation, the renal sinus, medulla, and cortex
can be identified. The renal medulla is the least echogenic region, followed by the
renalcortex, and then the renal sinus with hyperechoic fat
• When assessing for changes of the renal parenchyma, the corticomedullary
distinction should be readily identified. At the corticomedullary junction, the
interarcuate vesselscan be identified normally in some dogs and cats.
• The normal renal cortex in dogs can be slightly hyperechoic to the liver.
• In normal cats, however, it is not unusual for the renal cortices to be isoechoic or
hyperechoic to the hepatic parenchyma. The renal medulla is homogeneous but often
has a coarser echotexture than the renal cortex.
• The renal vessels (artery and vein) can be seen entering the renal hilum. Within the
renal hilum, extending into the renal sinus, fat can be deposited (hyperechoic),
especially in cats.
• Normally, the renal pelvis is not dilated, but a small amount of anechoic fluid can
occasionally be seen; in the transverse plane, the pelvic width can measure up to 2
mmin dogs and 1.6 mm in cats
• Each kidney is evaluated in its long and short axis; these often correspond to the long
and short axis of the patient, although, in some cases, the kidneys are oriented
obliquely relative to the patient’s sagittal and transverse planes, requiring some
adjustment of the ultrasound imaging plane to obtain true renal sagittal and transverse
images.
• There are 3 renal imaging planes: 2 long axis (dorsal and sagittal) and 1 short axis
(transverse).
• Within the dorsal plane, the renal pelvis is located in the far field of the image, and
within the sagittal plane, the long axis of the kidney is seen but the renal pelvis is not.
• Typically, imaging the kidney from the lateral abdominal wall creates the dorsal
plane, and imaging the kidney from the ventral aspect of the abdomen creates the
sagittal plane

54
Left Kidney
• The left kidney is easier to localize than the right kidney because of its lateral
locationalong the mid abdomen.
• Occasionally, it is seen deep to the spleen (located in the near field).
• The transducer is initially placed in the left cranial abdomen and is moved
mediallyand caudally until the left kidney is visible in a long axis.

Right Kidney
• The right kidney is typically more difficult to image due to its craniodorsal location
inthe abdomen in dogs; it is especially difficult in deep-chested dogs.
• The transducer is placed in the right dorsolateral subcostal region to visualize the
rightkidney.
• However, a lateral approach through the 11th or 12th intercostal space might be
needed,especially in deep-chested dogs.
• Both kidney should be checked for presence of renal cyst, hydronephrosis,
cortico-medullary junction distinction, renal infarction, presence of urolith etc.

Urinary bladder
• Urinary bladder can be seen easily on mid ventral abdomen of pelvic cavity
• Urinary bladder should be checked for cystolith or cystitis
• Cystolith characterized by acoustic shadowing
• Cystitis is characterized by thickening of wall and hyper-echogenicity

Radiography of urinary system

Radiography
• Technicians can obtain abdominal radiographs without patient preparation and or
supervision.
• Radiographs provide a global image, are most valuable when clinical signs are vague
andprovide additional information secondary to urinary tract infection
• The radiograph can be examined later and can be shown to the client.

Positional Maneuvers.
• Comparison of right and left lateral views is useful when mineralization or calculi
aresuspected. Gravity plus a horizontally directed x-ray beam concentrate the calculi
or move intestines off the bladder.
• A lateral radiograph with the rear limbs pulled cranially helps evaluate the canine
maleurethra.

Additional Radiographs
• It help determine if a structure observed on the initial radiograph is artifact or pathologic.
• When a mineral opacity is seen which could represent urinary calculi, soft tissue
mineralization or foreign material a radiograph obtained after a time interval, or after an
enema can be useful.

55
Special Procedures:
Excretory Urography (EU, IVP)
• It evaluates renal and ureteral size, shape, and position.
• Quality is affected by glomerular filtration and urine specific gravity.
• Be cautious in patients with dehydration, diabetes, iodine allergy, proteinuria, and
renaland hepatic failure.
• Retching and/or vomiting during or immediately post contrast injection is common;
hivesis rare. Contrast induced renal failure is reported in dogs and cats.
• In any contrast reaction the patient should be fluid diuresed. Renal dysfunction does
notpredict undesirable reactions.
• A 12-hour fast, laxatives and/or enemas are recommended.
• Pre-injection radiographs ensure an empty GI tract and serve as a baseline.
• An intravenous bolus of water-soluble contrast media with an iodine content equivalent
to660 mg iodine/kg body weight is used.
• Non-ionic contrast may be substituted but is expensive and does not reduce
contrastinduced renal failure.
• Anesthesia (sedation) does not increase the risk and may facilitate patient
positioningreducing radiation exposure.
• These animals may still retch or vomit following contrast administration. Ventrodorsal
andlateral radiographs are taken immediately and at 5, 10, 20, and 30 minutes after
injection.
• Abdominal compression may be used to interfere with ureteral peristalsis and distend
therenal collecting system.
• If urine specific gravity is low administering a second or third dose of contrast
materialmay be helpful.
• Exceeding 1980 mg iodine/kg body weight offers no additional benefit.
• There is no correlation between serum urea nitrogen level and urogram quality.
• Increased urine specific gravity, false positive urine protein determinations, cellular
morphology changes, bacterial growth inhibition and unusual crystals occur after
contrastinjection.
• The EU may be combined with a pneumocystogram when ectopic ureters are suspected.
Contrast material may increase renal echo intensity and contrast induced diuresis causes
ureteral dilation; therefore the ultrasound exam precedes the contrast study.

Cystography
• A positive contrast, pneumo-, or double contrast cystogram may be used.
• Complications include bladder or urethral trauma or infection.
• Inflate the bladder slowly and stop when the distended bladder is palpated or the
animalexhibits pain or discomfort. Bladder ultrasound should precede cystography.
• Double contrast cystography is best for bladder evaluation.
• Empty the bladder, distend it with air and inject contrast (cat 0.5cc; large dog, 3cc)
throughthe urinary catheter.
• Lateral and VD views are adequate, obliques are often recommended.
• Bladder distention can mask signs of mild to moderate cystitis.

56
Positive-contrast cystography
• Hematuria or bladder rupture are contraindications for pneumo- and double
contrastcystograms. Positive-contrast cystography will delineate the rupture site.
• Empty the bladder and distend it with dilute contrast media (50 ml contrast with 250
mlsaline).
• Oblique views are recommended; lateral and VD views are sufficient.

Retrograde urethrography
• It will evaluate the entire urethra.
• Dilute contrast (1/2 cc/kg) with a maximum per injection of 20 cc in large male dogs
isused. Avoid producing air bubbles that may be mistaken for radiolucent calculi.
• Use a Foley catheter with the tip placed just beyond the urethral papilla in the female
orwithin the penile urethra in the male.
• Inject the contrast manually exposing the radiograph as the contrast is injected.
• Lateral and VD views should be obtained.
• A contrast injection precedes each radiograph. In male dogs the VD view should
beobliqued to avoid superimposition of the distal and proximal urethra.
• Bladder distension prior to urethrography is not recommended.
• Use sedation to avoid patient motion, facilitate urethral catheterization and decrease the
risk of infection. Complications include urethral trauma or infection.
• With urethral mucosal rupture or ulcer, contrast may enter the systemic circulation. This
is no problem when using positive contrast; using air, death from air embolism has
occurred.Retrograde urethrography has little value in evaluation of prostatic disease.

Vaginourethrography
• If ectopic ureter, urethral rectal or rectovaginal fistula is suspected, vaginourethrography
may be performed by placing a balloon tipped catheter into the vagina distal to the
urethralpapillae.
• The urethra will fill as contrast is injected.
• A nontraumatic forceps keeps the catheter in place and prevents contrast leaking.
Anesthesia is usually required.
Radiography of the urinary tract
Radiography remains an excellent method for surveying animals with urinary tract disorders and
is complimentary to the ultrasound examination.
Technical considerations
• Regular or high speed screens with long scale contrast if analog
• Digital images provide excellent scale of contrast and are equal or superior to analog
• Two views = standard, must make extra lateral to visualize os penis and urethral in males.

Conditions identified with survey radiography

• Renomegaly and decreased renal size
• Change in shape
• Solitary kidney
• Retroperitoneal swelling/loss of contrast
• Radiopaque urocalculi
• Bladder masses

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Excretory urographyIndications
1) Confirming rupture of the excretory pathway
• Pelvis, ureter and bladder
• Important in trauma cases
2) To determine renal size, shape and location
3) Confirm renal mass lesions suspected on survey radiographs
4) Visualization of the renal pelves, ureters and urinary bladder (ex. ectopic ureters)
5) Qualitative assessment of renal function
Contraindications
1) Dehydration, anuria, severe proteinuria and co-existing congestive heart failure are
themost important contraindications in veterinary medicine.
2) Hypersensitivity (rare).
Technique
1) Contrast media
• Ionic iodinated media
o Meglumine and sodium diatrizoates or iothalamates
o Dose = 400 mg iodine / lb BW, IV
• Non ionic iodinated media—expensive, carry less risk for hypersensitivity.
2) Two views-immediate, 5 min, 15 min, 30 min, 45 min. Oblique views for ureters.

Cystography
Includes pneumocystography, double contrast cystography (DCT) and positive contrast
cystography

Conditions identified
1) Bladder rupture (positive contrast)
2) Cystitis (double contrast)
3) Neoplasia
4) cystic calculi (double contrast)
5) Location of urinary bladder in relation to surrounding viscera, e.g. prostate
(pneumocystography). Defines prostate
6) Anatomic defects (double contrast)
Contraindications
1) Known hypersensitivity to iodinated contrast media (rare)
2) Known vascular lesion—pneumocystogram-risk for air embolism
Contrast media
• Air or carbon dioxide
1) Ionic iodinated media (sometimes diluted 50/50 w/ HOH)
2) Can also use non ionic, but more expensive
Notes
1) Balloon tipped catheters recommended
2) Distend urinary bladder fully and to effect, do not calculate dose and inject—palpate
whileinjecting and stop when distended. For instance fibrotic urinary bladders will not distend
normally.
3) For DCT, add air, then contrast medium to prevent air bubbles
4) Make x4 90 degree orthogonal projections for DCT.

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Urethrocystography Indications
1) Diagnosis of strictures, calculi, neoplasms and rupture of the urethra
2) Partial or complete urinary obstruction
3) Evaluation of the prostate
4) Contraindication-patient at risk for air embolism
Contrast media
1) Air, perform pneumocystogram first
2) Same as for cystogram
Notes
1) Best suited for males
2) Make radiographic exposure during mid-injection
3) Additional lesions may be identified with simultaneous pneumocystogram.

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 Practical 12-Neurological examination in animals

Step-by-Step: The Neurologic Examination

The neurologic examination is a series of observations and tests done to answer the following
fourquestions:
1. Is a lesion in the nervous system present?
2. Where is the lesion located (focal or multifocal)?
3. How severe is the lesion?
4. Is the disease worsening, improving, or staying the same? (serial neurologic examinations)

Materials
• Penlight
• Percussion hammer
• Pair of hemostatic forceps
• Neurologic examination form

Initial Observations & Cranial Nerves

• Mentation, head posture, and coordination and function of some cranial nerves can be
directly observed.
• The animal will sniff and eat if the olfactory nerves (CN1) are functional and will avoid
objects in a strange environment if the optic nerves (CN2), optic tracts, and occipital
cortexare intact.
• By observing reactions to sounds while the animal is sleeping, hearing (the cochlear
nervesCN8) can be evaluated
1. Menace response
• To evaluate the menace response, advance the hand toward the eye. A blink should be
observed, indicating that CN2, the facial nerves (CN7), and their connections in the brain
and brainstem are functional.
2. Pupillary light reflex
• Shining a light into one pupil causes constriction of the pupil tested (direct pupillary
lightreflex) as well as the opposite pupil (indirect pupillary light reflex).
• This test evaluates CN2, the oculomotor nerves (CN3), and their brainstem connections.
3. Examination of the pupils, eyelids, and eyeball position
• Pupil size and symmetry, eyelid aperture, and the position of the third eyelid are affected
by CN2, CN3, and sympathetic innervation to the eyes.
• Observe the position and movement of the eyeballs to evaluate the function of the
innervation to the extraocular muscles (oculomotor [CN3], trochlear [CN4], and
abducens[CN6] nerves) and associated brainstem structures.
4. Positional strabismus
• When the nose is elevated, the position of the eyeballs should be level if CN3, CN4,
CN6,the vestibular nerve (CN8), and their brainstem connections are normal.
• Positional strabismus (usually manifested as a ventral deviation of the eyeball on one
side)is an abnormal finding.
5. Temporal/masseter muscles
• Palpate these muscles for atrophy. Muscle atrophy indicates a lesion of the motor portion

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 of the trigeminal nerves (CN5), the associated brainstem region, and the muscles
themselves.
6. Jaw tone and range of motion
• Open the jaw to evaluate muscle tone and range of motion.
• Reduced muscle tone indicates a lesion of the motor portion of CN5 and the
associatedbrainstem region.
• Reduced range of motion usually indicates muscle disease.
7. Palpebral reflex, Aural reflex and Buccal reflex
• Touch the palpebrae, tickle the ears, and pinch the lips to elicit movement of these
structures to evaluate the three branches of the sensory portion of CN5, the motor portion
of CN7, and their caudal brainstem connections.
8. Physiologic nystagmus
• Move the head to the left, right, up, and down.
• Two to three rhythmical beats of the eyeballs should be observed with a fast phase in the
direction of the movement (normal physiologic nystagmus).
• This tests the function of CN8 and associated structures in the caudal brainstem and
cerebellum.
9. Swallowing
• Induce swallowing by external or internal palpation of the pharynx to evaluate the
glossopharyngeal nerves (CN9) and vagus nerves (CN10).
10. Trapezius muscle
• Palpate the trapezius muscle for atrophy. If atrophy is present, the patient may have a
lesionof the accessory nerve (CN11) or caudal brainstem.
11. Tongue
• Observe the tongue for appropriate movement and strength, and palpate it for atrophy or
hypertrophy (muscle disease) to evaluate the hypoglossal nerve (CN12) and caudal
brainstem.

Gait Evaluation & Postural Reactions

1. Hemistanding and Hemiwalking
• Evaluate the gait during walking, trotting, and galloping and while turning the patient
tothe left and right.
• Hemi•standing and hemiwalking (standing and walking on one side) isolates the left
andright sides to determine if one side is less coordinated or weaker than the other.
• Pushing down on the shoulders and hips and observing the resistance to this pressure
canalso evaluate strength.

2. Wheelbarrow thoracic limbs

• Support the animal while making it stand and walk, first on the thoracic limbs and then
onthe pelvic limbs.
• The wheelbarrow test can detect subtle deficits in coordination, strength in the thoracic
andpelvic limbs, and whether one side is less coordinated or weaker than the other.

3. Wheelbarrow pelvic limbs

• Support the animal while making it stand and walk, first on the thoracic limbs and then

61
 on the pelvic limbs.
• The wheelbarrow test can detect subtle deficits in coordination, strength in the thoracic
andpelvic limbs, and whether one side is less coordinated or weaker than the other.

4. Hopping
• With support, have the animal stand and hop (hopping test) on each limb individually to
detect subtle deficits in limb coordination, strength, and whether one limb is more
uncoordinated or weaker than the others.

5. Conscious proprioception
• Individually knuckle the paw of each limb onto its dorsum.
• It should immediately return to the correct position if conscious proprioception is normal.

Spinal Reflexes
• The anatomical components of each spinal reflex are specific peripheral sensory nerves,
spinal cord segments, motor peripheral nerves, and muscles (indicated in parentheses
below).
• All components must be functional for the spinal reflex to be present.
• A depressed or absent spinal reflex indicates a lesion in the specific region of the spinal
reflex tested.
• An exaggerated spinal reflex often means a lesion is present somewhere between the
brainand the spinal reflex tested.

Thoracic Limb Reflexes

1. Biceps reflex
• Place a finger on the biceps tendon and percuss the finger.
• A brief elbow flexion indicates a normal biceps reflex (C6–C8).
• The response can be subtle in healthy dogs and cats.

2. Triceps reflex
• Place a finger on the triceps tendon and percuss the finger.
• A brief elbow extension indicates a normal triceps reflex (C7–T2)
• The response can be subtle in healthy dogs and cats.

3. Extensor carpi radialis muscle reflex

• Directly percuss the muscle.
• A brief extension of the carpus indicates a normal extensor carpi radialis muscle
reflex(C7–T2).

4. Withdrawal reflex
• Pinch the toe with fingers or forceps.
• Flexion of all thoracic limb joints indicates a normal withdrawal reflex (C7–T2).
• Pain is present if the animal turns to look, cries, or growls.

5. Crossed extensor reflex

• When the withdrawal reflex is elicited, there should be no obvious extension of the

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 opposite limb; such extension is a crossed extensor reflex, indicating a lesion between the
brain andC5.

Pelvic Limb Reflexes

1. Patellar reflex
• Percussing the patellar tendon and observing a brief extension of the stifle joint indicates
anormal patellar reflex (L4–L5).
2. Gastrocnemius muscle reflex
• Grasp the gastrocnemius muscle between the thumb and forefinger and percuss the thumb.
• A brief hock extension indicates a normal gastrocnemius muscle reflex (L6–S2).
3. Cranial tibial muscle reflex
• Percussing the cranial tibial muscle directly and observing a brief flexion of the
hockindicates a normal cranial tibial muscle reflex (L6–S2).
4. Sciatic nerve reflex
• Place a finger over the sciatic nerve in the sciatic notch and percuss the finger.
• Brief extension of the hip, stifle joint, and hock indicates a normal sciatic nerve reflex
(L6–S2).
5. Withdrawal reflex
• Pinching the toe with fingers or forceps and observing flexion of the joints of the
pelviclimb indicates a normal withdrawal reflex (L7–S2).
• Pain is present if the animal turns to look, cries, or growls.
6. Crossed extensor reflex
• Extension of the opposite limb when the withdrawal reflex is elicited is a
crossedextensor reflex, which is seen with a lesion between the brain and L5.
7. Anal reflex
• Pinching the perineal area with a finger or forceps and observing contraction of the
anal sphincter indicates that the anal reflex (S1–3) is present.
• If the tail simultaneously pulls down, this indicates the anal/caudal reflex (S1–Cd5)
is present.
• The anal reflex can also be elicited by rectal palpation.

Other Examinations
1. Babinski’s sign
• Scraping the tip of the percussion hammer proximally on the metacarpal and
metatarsalbones elicits slight flexion of the digits.
• Extension of the digits is a positive Babinski’s sign and indicates a lesion
somewherebetween the brain and C5 (thoracic limb) or the brain and L5 (pelvic limb).
2. Limb muscle atrophy
• Atrophy of the limb muscles is detected by palpation and observation. Muscle
atrophyoften indicates a lesion of the specific nerves to that muscle
3. Cervical muscle palpation
• Deeply palpate cervical muscles to detect evidence of neck pain (will induce
musclespasms, crying, or growling).
4. Neck range of motion
• A limited range of motion could indicate that the neck is painful and may induce
musclespasms, crying, or growling.

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5. Back pain
• Back pain may be elicited by palpating the paravertebral muscles; pain may result
inmuscle spasms, crying, or growling
6. Cutaneous trunci muscle response (panniculus)
• Pinching the skin with hemostatic forceps and observing contraction of the
cutaneoustrunci muscles indicates a normal cutaneous trunci muscle response (T2–L5).
• Superficial sensation is observed if the animal turns to look, cries, or growls.

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 Practical 13: Examination of sensory organs

Eye
➢ In the dog, as in other domestic animals, the orbital floor is incomplete and the medial
wall of the orbit relatively thin. Orbital contents – globe, extraocular muscles, blood
vessels, nerves and intraorbital fat.

External structure of the eye: Muscles of the orbit include five straight and two oblique
musclesfor the eyeball which are
➢ Superior rectus
➢ Inferior rectus
➢ External rectus
➢ Internal rectus
➢ Posterior rectus (Retractor oculi)
➢ Superior oblique and inferior oblique muscles.
➢ All the straight muscles originate around the optic foramen and are inserted to the
sclera,immediately behind: the attachment of the bulbar conjunctiva.

Blood supply- The major arterial supply of the eye is from the external ophthalmic artery, a
branchof the internal maxillary artery, which arises from the external carotid artery.

Globe: there are three tunics or coats of the eye which are
• Tunica fibrosa or fibrous tunic- comprising the cornea and sclera.
• Vascular tunic or Uvea-consisting of the choroid, ciliary body and iris which
providesnourishment to the eyeball
• Tunica interna or inner nervous tunic- retina

General ophthalmic examinations

Protocol for Examination of the Eye and Adnexa
History
➢ Once the age, breed, sex and vaccination status has been recorded, information about the
present problem and any previous health problems should be obtained, as well as details
ofany current or past treatment.
➢ Other relevant enquiries include the management and lifestyle and any others with which
it may come into contact.

Examination:
➢ Examination is usually best undertaken in a quiet room which can be darkened
completelyand ophthalmic examination follows general and neurological examination.
➢ Initially the dog is observed from a distance in order to assess the nature and severity
ofthe ocular problem.
➢ Ophthalmic examination is performed in two parts;
o In daylight or artificial light
o In the dark
➢ Examine general appearance of the eyes and adnexa and each side compared to ensure
that they are symmetrical.

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 ➢ The external eye should be assessed, starting with the margins, outer and inner surfaces
ofthe upper and lower eyelids.
➢ This is an important aspect of examination in a species in which developmental defects
ofthe eyelids and symblepharon are common.
➢ The lacrimal apparatus - presence and position of the upper and lower lacrimal puncta
should be confirmed and the possibility of abnormalities of production, distribution and
drainage may be suspected according to the clinical presentation.
➢ The frequency and adequacy of blinking should be noted as an empirical means of
assessing distribution of the tear film.
➢ A light source can be used to ensure that the corneal reflex is normal (in this situation the
corneal ‘reflex’ is the light from the light source reflected in miniature on the corneal
surface without disruption).
➢ Any disruption of the corneal reflex indicates a tear film deficit, a superficial corneal
abnormality, or both.

Special diagnostic testing:

➢ There are three diagnostic tests should be performed on every ophthalmic case. These are
Schirmer tear test, fluorescein staining, and tonometry.

Schirmer Tear Test (STT)

➢ This is a measurement of the animals tear production.
➢ To perform the test, the notched end of a STT strip is placed into the ventral
conjunctivalcul-de-sac of each eye.
➢ Keeping the eyelid gently closed can help retain the strip in the cul-de sac.
➢ After 1 minute, the strip is removed and the amount of wetting is measured in
millimeters.Normal tear production should be greater than 15 mm in 1 minute.

Fluorescein Staining
➢ Fluorescein is a water soluble dye that is repelled by the lipid-rich epithelial layer of
thecornea.
➢ If there is a break in the epithelium, fluorescein will stain the corneal stroma.
➢ It can be seen in normal light but is enhanced by using a Cobalt blue filter.
➢ Its high visibility and its poor ability to penetrate intact corneal epithelium make it a
usefulstain to look for corneal ulcers.
➢ Fluorescein will also stain mucous, so eye should be rinsed thoroughly with eye wash.

Patency of the nasolacrimal duct:

➢ The lacrimal system is examined for excessive tearing or for hypofunction of tear
secretionand for any swelling, redness or pain in the area of the medial canthus.
➢ When excessive tearing occurs, it has to be determined if the tearing is induced by partial
or complete obstruction of the nasolacrimal system, by increased lacrimal secretion due
to chronic ocular irritation as in distichiasis or trichiasis, or by a physiological increase in
tearproduction as may occur with uveitis.
➢ The first diagnostic step is the test of patency of the nasolacrimal system.
➢ If dye is present, it can be concluded that the lacrimal excretory system epiphora is due to tear
hyper secretion.
➢ A drop of fluorescein solution is placed into the conjunctival sac.
➢ After two to five minutes, the nostrils are examined for presence or
absencedye.

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 ➢ If no stain is present in the nostrils, an obstruction of the excretory system can be
assumedand irrigation of the nasolacrimal system in indicated.

Tonometry
➢ It is the measurement of the intraocular pressure. There are two types of tonometry
commonly used in veterinary medicine
➢ Indentation Tonometry-measures the force required to indent the cornea which gives an
indirect reading of intraocular pressure. This is performed with a Schiotz tonometer.
➢ Applanation Tonometry-measures the force required to flatten an area of the cornea
which gives an indirect reading of intraocular pressure. This is performed with the
Tonopen. When using the Tonopen, it is important to remember to use very light pressure
and not to put any pressure on the globe.
➢ The number is the intraocular pressure in mmHg. Normal intraocular pressure with a
Tonopen is typically 10-20 mmHg.

Gonioscopy
➢ Gonioscopy enables direct observation of the iridocorneal angle (pectinate ligament and
drainage angle between iris and cornea) in the anterior chamber, by use of gonioscopic
lenses.
➢ Besides detection of foreign bodies, tumors or exudate in the iridocorneal angle, this
examination is crucial for reliable diagnose in patients with suspected glaucoma.
➢ Routine examinations are conducted in dog breeds with frequent incidences of glaucoma
due to goniodysgenesis.
➢ The examination is conducted under topical anesthesia and firm restraint.
➢ Sedation is required in some animals.
➢ The gonio lens is carefully positioned on the cornea, and the lens-cornea interspaceis
filledwith 1% methylcellulose.
➢ The iridocorneal angle is examined with respect to width, status of the pectinate
ligament,inner and outer pigment zones, and the outer trabecular meshwork.
➢ The clinical classification of glaucomas (open angle, closed angle) and the decision to
usemedical or surgical treatment are based on gonioscopic findings.

Slit-Lamp Examination
➢ Performs 2 major functions.
➢ Firstly, it provides magnification to get a more detailed examination of the eye.
➢ The second function makes use of the slit beam.
➢ By decreasing the beam of light to a slit, a cross-section of the eye is obtained.
➢ This allows location of the depth of lesions and allows visualization of mild changes
thatcould not be seen with the full illumination.
➢ This takes a significant amount of practice. Examine the eyelids and ocular
adnexa,conjunctiva, cornea, anterior chamber, iris, lens, and anterior vitreous.
Ophthalmoscopy:
➢ The most expeditious screening examination of the fundus can be
achievedlenses (10-40 D) and head light (indirect ophthalmoscopy).
➢ For adequate visualization of the fundus, the pupil has to be adequately dilated.
Theexamination needs to be done in a dark room.
➢ The lens is positioned 2.5 to5 cm in front of the patient’s eye and the inspection is done
at an arm’s length, moving the lens toward or away from the eye, until the entire lens is
filledwith the fundus image.

67
 ➢ The examiner sees an inverted picture. An advantage of this approach is a large field of
view. It mainly used for examination of the ocular fundus (optic disc or papilla, the
retinalvessels, tapetum lucidum and nigrum).
➢ Optic nerve is evaluated for size, shape, colour and elevation /depression. Retinal blood
vessels are observed for size, congestion and hemorrhage, and also for the hypo/ hyper
reflectivity of tapetum.

Ultrasonography
➢ Ultrasonography is performed in cases where posterior segment cannot be visualized
dueto opacity of the anterior segment.
➢ There are two main areas of interest in conducting an ophthalmic ultrasound: anterior
andposterior sections of the eye.
➢ Ideal: 25 – 50 MHz for anterior chamber and 7.5 – 10 MHz for vitreous body
andretrobulbar area.
➢ Sterile ultrasound coupling gel is placed on the transducer tip and on the corneal surface.
➢ The transducer is then placed directly on the cornea.
➢ If corneal ulcer or perforation is present, then the scan is performed through closed eyelids.

Common Ophthalmic
affectionsExophthalmos or
proptosis:
➢ Prominence of a normal sized globe and associated with a retro bulbar space
occupyinglesion.
➢ Usually unilateral and accompanied by prominence of the nictitating membrane.
➢ Occurs more readily in the brachycephalic breeds with their prominent eyes and
shalloworbits.
Management:
➢ Lubricate immediately and reduce the globe into the socket as soon as possible to
reducetrauma to optic nerve.
➢ Enucleation if optic nerve is severed. Systemic and topical antibiotics should be
administered.
rd
Eversion or scrolling of the 3 eyelid
➢ Rolling out of the margin of the membrane due to abnormal curvature of the vertical
portionof the T-shaped cartilage.
➢ The deformed or buckled section of excessive cartilage is removed via a surgical
approachfrom the bulbar surface.
➢ The defective, scrolled portion of cartilage is usually found in the vertical arm of the
cartilage, near its junction with the horizontal arm of the T.
Cherry Eye
➢ Protrusion of the gland of the third eyelid (or “cherry eye”) occurs most commonly in
dogsand occasionally in cats.
➢ The appearance is characteristic, with the gland of the third eyelid protruding as a
reddishfollicular mass from behind a usually “floppy” margin of the third eyelid.
➢ The gland should be surgically replaced to retain essential lacrimal function and to
prevent the exposed gland and overlying conjunctiva from becoming dry, inflamed,
secondarily infected, and cosmetically unappealing.
➢ Corrective surgical procedures may be broadly categorized as “anchoring” or “pocket”
techniques.

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Chemosis or conjunctival edema
➢ Occurs to some degree with all cases of conjunctivitis, but the most dramatic examples
areseen with trauma, hypoproteinemia, allergic reactions, and insect bites.
➢ The latter are treated with topical corticosteroids and usually resolve rapidly.
Specifictherapy for the etiologic agent is indicated.

Eyelid tumor
➢ Common occurring tumors are Meibomian (tarsal) adenoma, Squamous papilloma,
Histiocytoma, Melanoma etc.
➢ Tumors depending on the size and position may cause irritation, blepharospasm,
lacrimation and corneal ulceration.

Abnormalities of the cilia

➢ It include extra (distichia) or misdirected eyelashes on the lid margin. Epiphora,
cornealvascularization, and corneal ulceration and scarring may result.
➢ If the corneal or conjunctival damage is caused by the extra cilia, excision or
cryothermyof the cilia follicles is indicated.
➢ Electroepilation or cantholysis of the misdirected hair is indicated.

Corneal melanosis/pigmentary keratitis

➢ Superficial corneal pigment due to migration of limbal melanocytes along blood vessels.
Chronic irritation of the cornea (trichiasis, nasal folds, entropion, distichiasis,
keratoconjunctivitis sicca, pannus), or some injuries.
➢ Brachycephalic breeds with prominent eyes especially are prone because of corneal
exposure (from lagophthalmos) to the environment.
➢ Management includes correction of mechanical causes like medial entropionesp in
brachycephalics.
➢ Electro epilation of the misdirected hairs and topical application of 0.02% tacrolimus
solution/ointment and 1% pimecolimus.3% Cyclosporin compounded in corn oil and eye
lubricants.
Keratoconjunctivitis sicca
➢ It is due to an aqueous tear deficiency and usually results in persistent,
mucopurulentconjunctivitis and corneal ulceration and scarring. KCS occurs in dogs,
cats, and horses.
➢ Lack of the aqueous layer of the tears, the oil and mucus layers are increased.
➢ Tear deficiency decreases nutritional factors, growth factors, and antibacterial
enzymes(lactoferrin, lysozyme, peroxidase), which encourage the growth of bacteria.
➢ Treatment includes topical cyclosporine as lacrimogenic.
➢ Eye lubricants containing-Hydroxypropyl methylcellulose Eg: Genteal eye drops and
geland Carboxymethylcellulose artificial tears Eg: Refresh eyedrops

Corneal ulcers or ulcerative keratitis

➢ It may be superficial, deep, deep with descemetocele, or perforating. Pain, corneal
irregularity, edema, and eventually vascularization are signs of ulceration.
➢ A dense, white infiltrate at the ulcer margin indicates strong leukotaxis and bacterial
involvement.
➢ Treatment protocol includes instillation of topical atropine (1%)-iridocyclopegic - 3 or 4
times a day for 2 - 3 days, then once or twice a day.
➢ Topical broad-spectrum antibiotic- Treat 4 times a day. Topical NSAIDs like flurbiprofen,

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 ketorolac to be instilled 4 times a day. Autologous serum which blocks proteases released
from leukocytes and bacteria (helps prevent continued collagen loss).
➢ Sodium EDTA 0.05% administered every 1-2 hours-blocks the melting effects of
collagenases and proteinases.
➢ 5% natamycin eye drops in case of fungal keratitis-instill twice daily.Surgery includes
eyelid flap, conjunctival flap.

Stromal Malacia (or “Melting”)

➢ Stromal malacia or “melting” occurs as a result of collagenolysis due to collagenase
liberation from invading white blood cells, especially neutrophils within the corneal
stroma, microorganisms, or corneal epithelial cells or keratocytes.
➢ The result is loss of rigidity and structure of the corneal collagen with subsequent
“sagging” or “oozing” of the stroma over the ventral cornea or eyelid, followed by
stromal loss withdevelopment of a deep ulcer or descemetocele.

Descemetocele
➢ In case of very deep ulcers the intraocular pressure may cause Descement's membrane
toprotrude through the wound.
➢ A small, transparent vesicle will be seen.
➢ Treatment includes cornea dried with ear bud and a drop of Iso Amyl 2-Cyanoacrylate
smeared over the clear corneal perforation
➢ Bandage lens applied in the eye or Tissue adhesives-N-butyl cyanoacrylate: 1-ml syringe
with a 30-gauge hypodermic needle allows for precise application of a thin layer of glue
to the ulcer bed.
Corneal opacity

➢ Treatment includes use of corticosteriods both topically and parenterally.

Corneal edema
➢ Gray-blue opacification of the cornea often referred to as 'cobblestone' in appearance.
➢ Topical hyperosmotic- Hypersol ointment (every alternate day) and anti-
inflammatorymedications to manage the secondary keratitis.

Hyphema
➢ Hyphema is the presence of blood in the anterior chamber.
➢ It most commonly results from haemorrhage from the iris and ciliary body.
➢ Less commonly blood originates from the posterior uveal tract or retina (e.g., systemic
hypertension).
➢ Treatment includes prevention of further trauma by immediate and enforced cage or stall
rest. Administer corticosteroid drops (dexamethasone 0.1%, prednisolone 1%) three
times daily and administer 1%tropicamide drops twice daily and attempt to dilate the
pupil or combination with phenylephrine to prevent synechia formation.

Pannus or Uberreiter’s disease

➢ It is a specific, bilateral, progressive, proliferative, chronic, superficial keratitis that
begins laterally at the limbus and eventually extends from all quadrants to cover the
corneachronicsuperficial keratitis.
➢ Treatment: Topical cyclosporin eye drops, Topical corticosteriods
➢ Use strong steroids such as 0.1% dexamethasone, or 1% prednisolone acetate. Antibiotic

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 is contraindicated except if there is concurrent infection and then only until infection is
resolved.

Glaucoma
➢ Increased intraocular pressure above the normal range of 12-22 mmHg which can
ultimately lead to blindness.
➢ Optic disc cupping noticed in which most retinal vessels disappear at the disc edge. High
IOP that causes characteristic degenerative changes in the optic nerve and retina with
subsequent loss of vision.
➢ Medical management includes administration of topical b-adrenergic antagonist—(0.5%
timolol maleate); reduce aqueous humor production.
➢ Oral carbonic anhydrase inhibitor diuretic — Acetazolamide (Diamox) @ 10-25mg/kg
bwt (reduce production of aqueous humor.). Hyperosmotic agent —mannitol 25% (1–2
mg/kgIV over 20 min) or oral glycerin (1-2 mg/kg po); dehydrate the vitreous humor.

Cataract
➢ It comprises a common group of ocular disorders manifested as loss of transparency
ofthe lens or its capsule.
➢ The opacities may be of varying sizes, shapes, location within the lens, etiology, age of
onset, and rate of progression.
➢ Etiology maybe genetic, traumatic origin, diabetic changes and secondary to other
diseases like retinal diseases such as progressive retinal atrophy, inflammatory eye
diseases, such as anterior uveitis.
➢ Treatment is by surgical extraction of the cataractous lens by IntraCapsular Cataract
Extraction (ICCE), Extra Capsular Cataract Extraction (ECCE),
PhacoemulsificationTechnique with or without IOl implantation

Ear examination

A thorough physical examination of the ear should include 3 independent parts:

1. Pinnal and preauricular skin examination
2. Otoscopic examination
3. Tympanic membrane assessment

1. Pinnal & Preauricular Skin Examination

• Examination of the pinnae to assess for primary and secondary lesions can help
formulatea list of differential diagnoses and diagnostic tests.
• Lesions found on the pinnae may also suggest conditions such as
allergy,inflammatory/autoimmune conditions, infections, and infestations.

Causes of Pinnal Disease

• Trauma
• Hematoma
• Ectoparasites
• Immune-mediated disease
• Keratinization defects
• Malassezia spp and dermatophytes

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 • Neoplasia
• Atopic and contact dermatitis
• Endocrine disorders

• Pustules on the pinnae can suggest either infectious (eg, pyoderma) or sterile disease
(eg,pemphigus foliaceus).
• Cytologic examination of the pustules may show acantholytic cells and neutrophils
indicative of pemphigus.
• Neutrophils and bacteria can be seen in some infectious causes of pustules.
• Papular eruptions may also be seen with parasitic diseases.
• Thick scale and erythema of the pinnal margins, particularly the apices, may indicate
sarcoptic mange, especially when a pinnal-pedal scratch reflex occurs in response to
rubbing of the pinnae. In addition, erythema, crusts, and scale may be present with
demodicosis or dermatophytosis.
• Low-power examination of skin scrapings placed in mineral oil on a microscope slide
mayhelp identify the presence of parasites.
• Fungal culture may be indicated.
• If vasculitis is suspected as a result of ulceration, necrosis, notching, and/or scarring of
thepinnal margin, a biopsy may be necessary to examine for capillary thrombosis.
• A pinna that is no longer erect may indicate ear pain.
• Palpation of the pinnal cartilage, especially at the ear base, may indicate bony
changessuggestive of chronicity.
• Aural hematoma typically indicates pain or pruritus in the ear and can result from
violenthead shaking, trauma, or autoimmune diseases.
• An aural hematoma on one side may result from otitis externa in the opposite ear.
• Excoriation of the pinnal surface indicates self-trauma from pruritus that is often
causedby otitis externa.
• Pinnal dermatitis and crusting with accumulation of purulent material on the base of
theconcave pinna may result from severe suppuration with otitis externa.
• Hemorrhagic crusting of the ear tips of erect-eared breeds and of the pinnal folding
inpendulous-eared dogs may indicate fly strike or mosquito bite hypersensitivity in cats.
• Traumatic injury to the pinna may mimic other conditions.
• Lichenification, erythema, hyperpigmentation, and glandular hyperplasia of the
concavepinnae may indicate chronic allergic dermatitis, often with concurrent otitis
externa.
• When found in cocker spaniels, this may be a manifestation of primary idiopathic
seborrheaassociated with ceruminous otitis.
• Topical drug reactionsparticularly to neomycin-containing otic medicationsmay also
resultin pinnal erythema and/or erosions or ulcerations.
• Many pinnal tumors exist, including ceruminous gland adenomas in dogs and
squamouscell carcinomas in white-eared cats.

2. Otoscopic Examination
• In nonanesthetized patients, an otoscope cone of the proper diameter is gently inserted
intothe vertical ear canal.
• Once the ear canal lumen is centered in the eyepiece, the otoscope cone is advanced

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 deeperinto the ear canal.
• This technique avoids painful scraping of the sides of the ear canal
• As the canal narrows and bends, the pinna is grasped gently and moved outward
anddownward to straighten out the ear canal.
• After making the bend into the horizontal ear canal and advancing the speculum,
theeardrum should be visualized
• In nonclinical dogs without any apparent signs of otitis externa, only a quick
otoscopic examination is necessary. After a veterinarian becomes familiar with the
normal canineand feline ear, pathologic changes should be easy to identify.
• Some patientshealthy or otherwisewill require sedation or anesthesia.
• Sedation is also recommended for any patient that is markedly painful and/or fails
torespond to empiric therapy.
• This is especially important for patients with unilateral ear disease as a source
ofdiscomfort (eg, foreign body lodged in the ear canal).
The Ear Canal
• The ear canal is lined by a modified epidermis.
• The wide vertical ear canal contains hairs surrounded by sebaceous glands, as well as
aprocrine glands unassociated with hair follicles. The normal vertical ear canal glistens
because of the cerumen coating.
• On examination of the ear canal with the otoscope, the skin of the vertical and horizontal
ear canals should be nonerythematous.
• The epithelium of the ear canal is smooth. A network of blood vessels in the dermis is
present

Examine following thing in ear

canal Cerumen
• Cerumen is composed of apocrine (watery) and sebaceous (lipid) secretions as well
asdesquamated keratinocytes.
• Normal cerumen coats the epithelium, protects against pathogens, and aids in
preventionof water loss from the ear canal epithelium.
• Its stickiness helps trap particles and other debris.
• Removal of mild cerumen accumulations in normal ears using ear cleaners is not
recommended.
• The normal process of epithelial migration removes accumulated ceruminous secretions
asthe surface epithelial cells move toward the outside of the ear canal to maintain ear
health.
• In many ear diseases, this physiologic cleaning mechanism is disrupted and
copiouscerumen accumulates in the ear canal.

Hair Loss
• Clinical signs of otitis with exudate in the ear canals may result in a depilatory effect
fromcaustic enzymes dissolving the keratin that comprises the hairssimilar to the hair loss
seenon the body in the form of an acute, moist dermatitis or hot spot.
• Clinically, this is identified as an absence of hair found in the ear canal during the acute
phase of otitis externa.
• With resolution of ear disease, hairs will regrow as the epithelium returns to normal, and

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 new hair growth can be seen on otoscopic examination at recheck.

Parasites
• Live ear mites may be seen via otoscope crawling along the epithelial surface when
apatients head is held as still as possible.
• Cats tend to have larger numbers of mites; the white-colored mites in the ear canal are
seencrawling along the dark brown otic secretions.
• Other parasites (eg, ticks, flies) or foreign material (eg, grass awns, seeds) may be seen
in the canal.
Stenosis & Swelling
• Any change in the epidermis, such as with ceruminous gland hyperplasia or ulceration,
issignificant and should be noted.
• In a patient with inflammatory ear disease, thickening of the epithelium may
obscurevisualization of blood vessels.
• The clinician should assess for presence of stenosis.
• Some dog breeds (eg, shar-peis, pugs) have small-diameter ear canals as part of
theirstandard conformation.
• Differentiation between swelling and stenosis is necessary.
• Stenosis results from permanent pathologic changes within the epidermis of the ear canal

Ulceration
• Ulceration of the ear canal epithelium is most often associated with a severe,
chronicbacterial otitis externa (often Pseudomonas spp).
• The bacteria releases cytopathic enzymes resulting in ulceration.
• Tumors within the ear canal may be present and should be noted

Exudates
• Note the character and volume of exudates.
• In general, a presumptive diagnosis of the infection type can be made based on texture
andcolor.
• Dark brown waxy or dry exudates suggest yeast otitis in dogs or ear mite infestation
incats.
• In dogs, creamy, tan-colored moist exudates tend to suggest gram-positive (eg,
Staphylococcus spp) bacterial infections.
• Purulent liquid or mucoid exudates with a white, yellow, greenish, or black color
mayindicate a gram-negative (eg, Pseudomonas spp) bacterial infection.
• Hemorrhagic exudates can indicate ulceration of the ear canal or ulceration of a
tumormass.
• Mucus should never be found in the external ear canal; there are no goblet cells in
theepithelium.
• Goblet cells abound in the lining of the middle ear, which is a mucous membrane.
• Excessive amounts of mucus can be found in the middle ear when it is inflamed and
maymove from the middle ear to the external ear canal through a hole in the eardrum.

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3. Tympanic Membrane Assessment
• Examination of the tympanic membrane (ie, eardrum) is crucial and can be performed
in almost all healthy patients without sedation.
• The eardrum has 2 parts:
o Pars flaccida: an upper, fleshy, vascular portion
o Pars tensa: a thin, translucent portion
• The eardrum must be examined to determine if it is normal or
damagedceruminous, or keratinaceous exudates are present in the bulla
behind it.
• Because the normal pars tensa is translucent, the bulla cavity can be
seenlight (using a video otoscope) transilluminates the bulla.
• In otitis media, fluid, if present, can be seen behind the eardrum in the form of
bubbles,blood, serum, or pus.
• Increasing pressure from exudate accumulation can cause the pars tensa to bulge outward.
• Both of these conditions result in marked pain; pressure must be relieved by myringotomy.
• Any tissue mass in the middle ear will obscure the ability to view the middle ear
• The eardrum may be opaque from chronic inflammation and thickening and/or
hyperkeratosis.
• If the eardrum is opaque, the middle ear cannot be evaluated visually from the ear canal.

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 Practical 14- Electrocardiography

ECG is a recording of the electrical activity of the heart from electrodes placed on the surface of
skin. Electrocardiograph (ECG machine) is a voltmeter (or galvanometer) that records the
changing electrical activity of the heart between a positive and negative electrode.

1st rule of ECG:

• A current of depolarization traveling towards the + electrode is recorded as a
positivedeflection
• A current of depolarization traveling away from the + electrode is seen as a
negativedeflection
• A current of repolarization traveling away from the + electrode is seen as a
positivedeflection
2nd rule of ECG:
• Rapid depolarization/ repolarization = Narrow width of wave or complexes
• Slower depolarization / repolarization = Wider width of wave or complexes
rd
3 rule of ECG:
• More tissue depolarization results increase the amplitude (height) of complexes
Position & Restraint
• Right lateral recumbency - the standard position for canine and feline electrocardiography
• No chemical restraint
• Lead placement
• Hair and stern surrounding the electrode should be moistened with conductive gel
oralcohol
Types of ECG machine
Single channel recorder
• Has one stylus – records one lead at a time
Multiple channel recorder
• Has more than one stylus Provide simultaneous tracings of 3 leads
LEAD SYSTEM
BIPOLAR STANDARD LEADS

AUGMENTED UNIPOLAR LIMB LEADS

o aVR :Augmented Vector Right
o aVL : Augmented Vector Left
o aVF : Augmented Vector Front

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SPECIAL LEADS
o Lead CV5 RL (V2)
o Lead CV6 LL (V2)
o Lead CV6 LU (V4)
o Lead V10
Indications:
Evaluating Cardiac Diseases
• Evaluation of anatomic cardiac changes (cardiac enlargement)
• Evaluation of arrhythmias
• Evaluation of therapy – Drug therapy e.g. Digitalis
• Electrolyte disturbance e.g. potassium
• During pericardiocentesis
• Evaluation of prognosis of the disease.
Differentiating of non-specific disease that causes weakness, fatigue, fever, lethargy, collapse or
seizures.
• Metabolic diseases with electrolyte alterations e.g. Adrenal insufficiency,
Diabeticketoacidosis severe renal insufficiency, Eclampsia, hypo kalaemia.
• Cardiac syncope
• Bradycardia and tachycardia
• Epilepsy
• Endocarditis, myocarditis and cardiac neoplasia
• Systemic diseases with toxaemias
• Monitoring before, during and after the surgery
• Evaluation of critically ill patients e.g. trauma cases
The systemic electrocardiographic interpretation can be done by noting the
1. Heart rate
2. Heart rhythm
3. Measurement of complexes and intervals and
4. Mean electrical axis of the heart.
Calculation of heart rate
• The heart rate is number of beats per minute.
• In some cardiac arrhythmias the atria and ventricles do not beat at the same rate,
necessitating that atrial and ventricular each be calculated.
• Count the number of beats in 6 seconds (paper speed 25 mm/sec or 50 mm/sec), and
multiply by 10 or count the number of beats in 3 seconds, multiplied by 20 to get the
heartrate/min.
Evaluation of heart rhythm
• In normal sinus rhythm each beat consists of normal P wave and QRS complexes and the
P-R intervals of each beats will be equal.
• Vagal arrhythmias such as arrythmia (regularly irregular beats), wandering pacemaker
(The P wave vary in height and may even become negative), sinus arrest (sinoatrial
block)are normal in canine ECG.
• In case of sinus arrhythmia, the pauses between two beats are shorter than the normal R-
R interval, while in case of sinus arrest, the pauses are longer, and is twice or greater than
twice the normal P-R interval.
• However, there will be a P wave in every QRS complex and QRS complex for every P
wave, the P-R intervals will be constant.
Measurement of complexes and intervals
• Usually the measurement of complexes and intervals is done on lead if rhythm strip.
• The amplitude of the deflections are recorded in millivolts and the duration and intervals

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 should be measured in seconds.
• The measurement of upward and downward deflections are measured from the base line
tothe peak of the wave and to the lowest point of the wave respectively.

Determination of mean electrical axis

• Here the mean wave of electrical activity (cardiac vector) that occurs when the
ventriclesdepolarize is measured.
• The mean electrical axis is determined by examining the QRS complexes in each of the
sixbasic leads of the Bailley’s hexaxial lead system.
• The normal mean electrical axis of dog is between +40o and + 100 o.
• If the direction of axis becomes less than +40 it has shifted towards let arra; this is called
leftaxis deviation.
• Left axis deviation indicates left ventricular hypertrophy.
• If the axis shifts and becomes greater than +100, it is called right axis deviation, denoting
rightventricular hypertrophy.
• For determining mean electrical axis first not the isoelectric lead among the hexaxial lead
strip taken. In isoelectric lead the CRS complex will have equal positive and negative
deflectionsof with minimum deflections.
• Then find out the lead perpendicular to the isoelectric lead from the reference chart.
• Then note whether the perpendicular lead is positive or negative in its QRS complex from
theECG recording.
• If the QRS complex is positive the mean electrical axis of the heart points towards the
positive pole of the lead perpendicular to the isoelectric lead in the reference chart and if QRS
complexis negative the axis will be in the opposite direction.
COMMON ECG ABNORMALITIES
Right atrial hypertrophy
• P wave becomes tall and peaked. This is called “p pulmonale” and indicate right
atrialhypertrophy.
• P pulmonale is present whenever the P wave is consistently taller than 0.4 mv on lead II
ofelectrocardiogram.
• Associated with chronic lung diseases.
Left atrial hypertrophy
• P wave becomes wide and notched.
• This is termed as “P mitral” and indicate left atrial hypertrophy.
• This is mostly associated with mitral valvular defects.
• However, a noted P wave is not significant unless it is also too wide.
• In biatrial hypertrophy P wave will be tall and wide.

Right ventricular hypertrophy

• Deep Q wave (deeper than 0.5 mv) in lead II, III and a VF, deep S wave in lead I, II and
IIIare suggestive of right ventricular hypertrophy.
• The means axis of heart will be greater than +100 o (Right axis deviation).

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Left ventricular hypertrophy
• QRS complex wider than 0.06 seconds.
• R wave taller than 2.5 mv in to breeds and 3.0 mv in all dogs. S-T slurring S-T depression.
• P mitral may accompany. Left axis deviation (axis less than +40 o)
Biventricular hypertrophy
• Axis usually normal.
• Tall R wave, Wide QRS complexes deep Q waves, P mitrale, P pulmonale or both.
Ectopic arrhythmias
• When an impulse originates form one site other than the sinoatrial node, it is ectopic.
• Ectopic impulses can arise from three areas: the atria (other than the sinoatrial node)
thejunctional tissues (bundle of His or lower).
• It is important to distinguish between supraventricular and ventricular arrhythmias
becausetheir treatment is different.
• Atrial ectopic beats and junctional (nodel) ectopic beats are the two types of
supraventricularectopic arrhythmias.
• Hence, the P wave is altered. In atrial premature beat, the P wave is positive but different from
the normal P wave, while in case of junctional premature beat, the P wave is negative.
• The QRS complexes retain their normal configuration. Sometimes the P wave of one beat
willmerge with T wave of the preceding beat in supraventricular premature beats.
• In arterial tachycardia, P waves during the tachycardia are positive but different from the
Pwaves when the heart rate is normal. The QRS complexes are normal.
• In atrial fibrillation irregular rhythm with no P waves or P-R intervals. The P waves
arereplaced by fine baseline undulations called “f” waves. The QRS complexes are fairly
normal.
• In ventricular premature beats and ventricular tachycardia, there are no P waves
associatedwith the premature bizarre QRS complexes.
• If the premature QRS complexes are similar in the shapes the myocardial irritable region
willbe unifocal in nature and if the shapes differ, multifocal lesions can be suspected.
• Ventricular tachycardia is diagnosed when four or more bizarre ventricular beats occur in a
row. This type of changes are very dangerous.
• In ventricular fibrillation, specific P waves and QRS complexes are absent and a series of
baseline undulations seen.
• This is followed by a cardiac standstill during the terminal stages of cardiac arrest.

Conduction disturbances
Atrio-ventriculur heart block
• Occur due to the delay in the transmission of impulse through AV node.
• Usually occurs in digitalis intoxication.
• In first degree heart block P-R intervals are prolonged beyond 0.13 second.
• The second degree heart block is characterized some P waves occurring without
QRScomplex.
• In complete or third degree heart block there are more P waves and QRS complexes.
Bundle branch block
• This refers to a disruption of impulse transmission through the right or left branches of
thebundle of His.
• The ventricle on the affected side is delayed in its depolarization.
• The affected ventricle has to wait and receive stimulation from the muscle cells of the
normalventricle.
• So the complexes become wide because transmission through the muscles will be slower.
• In left bundle branch block the QRS complex is greater than 0.07 seconds duration in all dog.

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 • The left bundle branch block must be differentiated from left ventricular enlargement.
• The absence of left ventricular enlargement on thoracic radiography will support a
diagnosisof isolated left bundle branch block.
• Right bundle branch block is characterized by a large wide S wave in lead I, II, III

Effects of electrolyte disturbances on the electro cardiogram

Hyperkalemia
• T wave become all and peaked and P wave becomes flattened.
Hypokalemia
• Bradycardia prolonged Q – T interval and small biphasic T waves.
Hypocalcaemia and Hypercalcaemia
• Prolonged Q – T interval in hypocalcaemia.
• Hypercalcaemia in dogs is associated with elevation of S – T segment.
Effect of myocardial hypoxia on the electrocardiogram
• An early sign of myocardial hypoxia is an elevation or depression or slurring of the S –
Tsegment.
• The T wave will suddenly begin to grow larger and large in myocardial hypoxia.
• This can lead to arrhythmia, ventricular fibrillation and cardiac stand sill or cardiac arrest.

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 Practical 15- Ultrasonography
Introduction to
UltrasoundIndications
• As a compliment to abdominal radiographs
• If clinical signs or history indicate abdominal ultrasound, then it should be
performedeven if radiographs are normal!!!
• To rule in/out intestinal obstruction (foreign body)
• To determine the origin of an abdominal mass
• To check condition of visceral organ like Spleen, Liver, Kidney etc.
• To facilitate fine needle aspiration/cystocentesis
• To evaluate organ parenchyma
• To assess fetal viability in pregnant animals

Limitation of Ultrasound
• Ultrasound cannot penetrate air or bone
• May be difficult to assess the GI tract in animals with aerophagia
• Size of organs is largely subjective except renal size in cats
• Unable to evaluate extra-abdominal structures
• May still need to perform abdominal radiographs followed to USG
• High cost of machine
• User dependent results

Patient Positioning and Preparation

• Dorsal recumbency
• Lateral recumbency }- Depend upon species to be examined
• Standing position
• Clip hair
– Be sure to check with owners
• Apply ultrasound gel
• Alcohol can be used – esp. in horses

Ultrasound
• Characterized by sound waves of high frequency which is higher than the range
ofhuman hearing
• Sound waves are measured in Hertz (Hz)
• Diagnostic Ultrasound = 1-20 MHz
• Sound waves are produced by a transducer

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 Transducer Probe
• Piezoelectric crystal emit sound after electric charge applied
• Echo may be reflected, transmitted or refracted from animal body
• Echo reflected from patient is converted to electric signal  grayscale image
onmonitor
• Usually probe transmit 1% and receive 99% of all the time

Transducers/Probes
• Sector scanner
o Fan-shaped beam
o Small surface required for contact
o Cardiac imaging
• Linear scanner
o Rectanglular beam
o Large contact area required
• Curvi-linear or curvo-linear scanner
o Smaller scan head
o Wider field of view

Ultrasound
PhysicsAttenuation
• Absorption = energy is captured by the tissue then converted to heat
• Reflection = occurs at interfaces between tissues of different acoustic properties
• Scattering = beam hits irregular interface – beam gets scattered

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Acoustic Impedance
• The product of the tissue’s density and the sound velocity within the tissue
• Amplitude of returning echo is proportional to the difference in acoustic
impedancebetween the two tissues
• Velocities:
o Soft tissues = 1400-1600 m/sec
o Bone = 4080 m/sec
o Air = 330 m/sec
• Thus, when an ultrasound beam encounters two regions of very different
acousticimpedances, the beam is reflected or absorbed
o Cannot penetrate
o Example: soft tissue – bone interface

Frequency and Resolution

• As frequency increases, resolution improves
• As frequency increases, depth of penetration decreases
• Use higher frequency transducers to image more superficial structures
• Ex: Equine Tendons

Modes of Display
• A mode (Amplitude)
– Spikes – where precise length and depth measurements are needed – ophtho
• B mode (Brightness) – used most often
– 2 D reconstruction of the image slice
• M mode (Motion mode)
– Moving 1D image – cardiac mainly

Ultrasound Terminology
• Never use dense, opaque, lucent
• Anechoic
– No returning echoes= black (acellular fluid)
•Echogenic
– Regarding fluid--some shade of grey d/t returning echoes

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 • Relative terms
– Comparison to normal echogenicity of the same organ or other structure
– Hypoechoic, isoechoic, hyperechoic
• Spleen should be hyperechoic to liver
• Liver is hyperechoic to kidneys

Monitor and Computer

Converts signal to an image/ archive
1. Tools for image manipulation
• Gain – amplification of returning echoes and improve overall brightness
2. Time gain compensation (curve)
o Adjust brightness at different depths
3. Freeze- to freeze any image for report
4. Depth
o Zoom in for superficial view
o Zoom out for wide view
o Depth limited by frequency
5. Focal zone
o Optimal resolution wherever focal zone is present

Image Orientation and Labeling

• Must be consistent
• Dot Symbol on screen ~ dot on transducer
• “dot” lateral for transverse and proximal for longitudinal images
• Label images carefully
– Organ
– Animal name
– Date of examination
Artifacts
• Artifacts lead to the improper display of the structures to be imaged
– Affect the quality of images
• Improper machine settings – gain
– Image too bright or too dark
– Can disguise underlying pathology
Acoustic shadowing
– Ultrasound beam does not pass through an object because of reflection
orabsorption
– Black area beyond the surface of the reflector
– Examples: cystic calculi, bones
Acoustic enhancement
• –Hyperintense (bright) regions below objects of low U/S beam attenuation
• –AKA Through transmission
• Examples: cyst or urinary bladder

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Reverberation
– Time delays due to travel of echoes when there are 2 or more reflectors in
thesound path
– Mirror image – liver, diaphragm and GB
• Return of echoes to transducer takes longer because reflected
fromdiaphragm
• A second image of the structure is placed deeper than it really is
– Comet tail – gas bubble
– Ring down – skin transducer surface
Refraction
– Occurs when the sound wave reaches two tissues of differing acoustic impedances
– U/S beam reaching the second tissue changes direction
– May cause an organ to be improperly displayed

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 Practical 16-Echocardiography

• Echocardiography which is an extension of ultrasound for heart assessment

• A complete echocardiographic study encompasses imaging from both the right and left
sides of the chest and involves more than 15 different views, using 2D echocardiography,
M-mode echocardiography, pulsed-wave Doppler, continuous-wave Doppler and color-
wave Doppler
• Initial focus should be on chamber structure and dimension, systolic function, and
presenceor absence of any effusions (pleural or pericardial) or masses
• Because ultrasonography does not penetrate bony ribs or air inside the lungs, the heart
can only be imaged where it contacts the intercostal spaces, which only occurs in small
regionscalled acoustic windows.
• Specific acoustic windows on both the left and right hemithorax have been defined in
animals, but optimal imaging locations can vary among individuals.

Preparing
AnimalRestraint:
• Echocardiography usually requires only gentle restraint of the patient; sedation is
nottypically necessary
Positioning:
• Dogs and cats are usually imaged in lateral position, with forelimbs pulled far forward
on a table equipped with a cutout that allows the transducer to be placed from the
underside of the animal
Image Site Preparation.
• Wetting the hair with alcohol, then liberally applying coupling gel usually produces
good-quality images
• However, clipping the fur may be necessary for optimal

The Echocardiogram: 4 basic views obtained from the right parasternal acoustic window
• The right parasternal acoustic window is located between the right 3rd and 6th
intercostalspaces (usually 4th or 5th) and between the sternum and costochondral
junctions.
• It is typically found near the strongest palpable right apical beat.
• Viewing 2D imaging in this acoustic window allows the most intuitive evaluation
ofcardiac anatomy, which also makes it a useful guide for M-mode examination.
• In many new ultrasound machines, this view also allows simultaneous 2D and M-mode
orDoppler studies.
From the right side, 3 probe positions are used to produce 4 basic views of the heart:
1. Four-chamber right-sided parasternal long-axis view
2. Five-chamber right-sided parasternal long-axis view
3. Right-sided short-axis view of the left ventricle at the level of the papillary muscles
4. Right-sided short-axis view at the level of the left atrium and aorta

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1. Four-chamber right-sided parasternal long-axis view

Fig 1. Right-sided parasternal long-axis view

(CH = chordae tendineae, LA = left atrium, LV = left ventricle, LVW = left ventricular free
wall, MV = mitral valve, PM = papillary muscle, RA = right atrium, RV = right ventricle, TV
= tricuspid valve)

2. Five-chamber right-sided parasternal long-axis view

• Technique: The transducer is rotated and tilted slightly cranially from the four-chamber
view.
• Image seen: The five-chamber view shows both ventricles, atria, and atrioventricular
valves, along with the left ventricular (LV) outflow tract, aortic valve, and proximal
ascending aorta
Fig 2. Right-sided parasternal long-axis view

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 3. Right-sided short-axis view of the left ventricle at the level of the papillary muscles
• Technique: In the four-chamber right-sided parasternal short-axis view, the plane of the
ultrasound beam is oriented perpendicular to the long axis of the heart, with the
transducerindex mark pointing cranioventrally (roughly toward the elbow).
• From the four-chamber position, the transducer is rotated about 90°.
• Proper orientation is confirmed with various landmarks of cardiac structures and circular
symmetry of the left-sided ventricle.
• Several short-axis images can be obtained at various levels by fanning the transducer
fromthe apex to the base.
• Image seen: The short axis view gives important subjective information about left
ventricular (LV) function.
• From this position M-mode measurements can be obtained for accurate objective
measurement of LV size and function.
• The M-mode measurements can be evaluated either via 2D imaging while scrolling
through diastolic and systolic images (with an ECG for appropriate timing) or preferably,
with M-mode imaging

Fig 3. Right-sided parasternal short-axis view at the level of the papillary muscles
(APM = anterior papillary muscle, LV = left ventricle, PPM = posterior papillary
muscle,RV = right ventricle)

4. Right-sided short-axis view at the level of the left atrium and aorta
• Technique: From the right-sided short-axis view of the left ventricle at the level of the
papillary muscles, the transducer is slowly fanned up towards the base of the heart again
to obtain accurate imaging of the left atrium and aorta.
• Image seen: In the view shown in this figure, the ratio of the left atrium (LA) to the aorta
(Ao) should be <1.5:1

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 Fig 4. Right-sided short-axis view at the level of the left atrium and aorta
(LA = left atrium, LC = left coronary cusp, NC = non-coronary cusp, PV = pulmonic valve, RC
= right coronary cusp, RV = right ventricle, TV = tricuspid valve)
M-mode
• M-mode (ie, motion mode) uses a highly focused ultrasound beam that is transmitted
through the heart along a single line. It is sometimes referred to as an icepick view.
• Although M-mode only produces a single-dimension image, the motion of cardiac
structures over the cardiac cycle may be recorded with extremely high spatial and
temporalresolution.
Technique
• Standard M-mode images are obtained from the right parasternal window at various
levelsof the heart, from apex to base (similar to the right parasternal short-axis views).
• Optimal beam positioning is usually guided by 2D imaging.
• The M-mode image is depicted with depth on the Y-axis and time on the X-axis, with
asimultaneous ECG allowing reference to the phase of the cardiac cycle.

Important measurements from M-mode

Left ventricular (LV) wall measurements
• Left ventricular (LV) internal dimension during systole and diastole (LVIDs, LVIDd)
• Interventricular septum thickness in systole and diastole (IVSs, IVSd)
• LV free wall thickness in systole and diastole (LVWs, LVWd)

Notations for measurements

• End-diastolic measurements are made at the onset of the QRS complex and end-
systolicmeasurements at the smallest internal dimension.
• LV dimensions and wall thicknesses should be made at the level of the chordae
tendineaeor the tips of the papillary muscles just below the mitral valve tips.
• Normal values for standard LV measurements are reported for dogs (based on weight
andsome breeds) and cats.
• Right ventricular (RV) measurements have not been well described because of the
nongeometric shape of the chamber and the difficulty in standardizing measurements.
• In general, the chamber dimensions and wall thicknesses of the right ventricle should be

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 about one-third to one-half that of the left ventricle.
• Right atrial size should be similar to the size of the left atrium (LA).

Fig 5. Left ventricular measurements using M-mode echocardiography. During both

systole and diastole, this image demonstrates interventricular septum thickness (IVSs,
IVSd), left ventricular (LV) internal dimension (LVIDs, LVIDd), and LV free wall thickness
(LVWs, LVWd). Increased LVIDd causes left ventricular volume overload, whereas
increasedLVIDs results in systolic dysfunction.

Systolic Function
• Systolic function can be assessed by several commonly used indexes; however, these do
not directly assess contractility, as all are affected by both preload and afterload.
• Fractional shortening (FS) is the most common index of left ventricular systolic
function; it measures the fractional change in systolic and diastolic internal dimensions.
FS, calculated from M-mode measurements, provides an estimate of the heart’s ability to
contract.
• Normal FS is 25% to 45% in dogs and 30% to 55% in cats.
• FS%= (LVIDd-LVIDs)/LVIDd X 100

Assessing Left Atrial Size

• To assess the size of the left atrium, the transverse diameters of the aorta and left atrium
are measured in the right sided short-axis view.
• Measurements are taken in early ventricular diastole using the first frame after aortic
ejection, where the Ao appears as a symmetric three-leaf clover with closed aortic valves
and a teardrop-shaped LA.
• To measure Ao, the first caliper is placed at the midpoint of the convex curvature of the
wall of the right aortic sinus. The caliper cross is positioned as close as possible to the
blood-tissue interface.
• The second caliper is positioned at the point where the aortic wall and the noncoronary
and left coronary aortic cusps merge. This measurement point is defined by a slight
increase inechogenicity where the three structures merge.

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 • The LA is measured from this point by extending the Ao line to the blood-tissue interface
of the LA wall.
• If a pulmonary vein enters the LA at the desired measurement point, the caliper is placed
either on an extrapolation of the atrial border or immediately medial or lateral to the vein

Fig 6. Assessment of left atrial size. This image demonstrates the measurement of the
aortaand left atrium
(LA = left atrium, LC = left coronary cusp of the aortic valve, NC = noncoronary cusp of the
aorticvalve, RC = right coronary cusp of the aortic valve)

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 Practical 17-Endoscopy

Endoscopy
Derived from Greek words:
• Endo: within
• Skopein: to view or observe
• Endoscopy: view within

• Endoscopy is the examination and inspection of the interior of body organs, joints
orcavities through an endoscope to allows physicians to peer through the body's
passageways.

Endoscope
• An optical instrument designed to allow visual inspection of the interior of hollow
bodieswith small entrances

Father of endoscopy
• Philipp Bozzini
• Modern endoscopy- Basil Hirschowitz

Advantages
• Minimally invasive method
• Enables to see the inside of the body in living colour
• Less post operative pain than traditional surgery
• Faster recovery than traditional surgery
• Minimal scarring--- minimal tissue disruption (lesser trauma)
• Unmatched image resolution---Enhanced visualization
• Improved cosmetic results
• Less surgical morbidity

Patient preparation
• Withheld food for mini. 12 hrs
• General anaesthesia
• Mouth gag and endotracheal tube placement in place
• Left or right lateral recumbency as per organ examine
• Confirm no evidence of perforation by radiography
• Avoid medication which alter GI motility

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Principles
Based on the science of optics
• TIR (Total Internal Reflection) in Flexible Endoscope Systems
• Relay Lens System in Rigid Endoscope Systems

Components of an endoscope
• A rigid or flexible tube
• A light delivery source or system
• An objective
• An image guide
• An eyepiece
• Additional channels

Light source
• Tungsten- Halogen light source
• Xenon light source
• Power: 25-300 W

Camera
• Attach to eyepiece
• Basic camera with focusing adjacent
• Zooming function

Monitor
Monitor should be placed such a way that physician can see it

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 Types of endoscopes
Flexible endoscopes
o Examines depth of tubular structures that turn corners
o Stomach, intestine, bronchial tree, male canine urethra etc.

Types of flexible endoscopes

o Two basic types based on the method of sensing and transmitting images:
Fiberoscope/ Fiber optic
o bundles of optical glass fibres
Videoscope / Video endoscope
o charge coupled device (CCD) chip
Advantages
▪ Flexibility
▪ Viewing of tubular internal organs
▪ Can go deep inside body
▪ Diameter- 14 mm to 1 cm
Disadvantages
▪ Inferior optics
▪ Cannot be autoclaved
▪ Less longevity
▪ Costly
▪ Smaller diameter- not available

Rigid endoscopes
o Examines non tubular structures
o Abdominal cavity, thoracic cavity, joint spaces etc.
o Telescopes
o Simpler in design
o Less expensive
o Long lasting
o Use for non tubular structures
Advantages
▪ Superior optics
▪ Autoclavable, Reusable
▪ Less fragile
▪ Cheap
▪ Simple design
▪ Nontubular organs viewed
▪ 2.7 mm onwards
Disadvantages
▪ Rigidity
▪ Cannot turn around coily organs

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Site Methods Type of Endoscope
Upper GIT Oesophagoscopy, Flexible
Gastroscopy
Lower GIT Enteroscopy (Duodenoscopy, Flexible and
Jejenunoscopy), Colonoscopy rigid
Upper and Lower Laryngoscopy, Both flexible
airways Tracheobronchoschopy and rigid
Urogenital tracts Cystoscopy Both flexible
and rigid
Abdominal cavity Laparoscopy Rigid
Thoracic cavity Thoracoscopy Rigid
Joint spaces Arthroscopy Rigid
External and middle ear Otoscopy Rigid
Nasal cavity Rhinoscopy Rigid
Endoscopy Working length Diameter

Upper GI endoscopy 100 cm (latest – 140 cm) 7.8-9.8 mm

Colonoscopy Rigid: 25 cm 9-18 mm

Flexible: 100 cm < 10 mm
Laryngoscopy Rigid: 55-60 cm 4.8-5.2 mm
Flexible: 40-60 cm 3.5-3.7 mm

Laparoscopy 15 cm long 5 mm & O0

2.7 mm & 300

Thoracoscopy 30 cm long 5 mm

Cystoscopy Rigid: 18 cm 2.7 -4mm

Flexible: 70-100 cm 2.5 mm

Rhinoscopy 10-14 cm 1.9 and 2.7 mm & 300

Otoscopy 7-8.5 cm 4.75-5 mm

Arthroscopy 12-18 cm 1.9 , 2.4 ,2.7 , 4.0 mm

Accessories of endoscope Uses

Biopsy needle For biopsy

Foreign body retrevials For grasping

Cytology brushes For sampling

Aspiration tubing For aspiration

Injection needles For fluid infusion

Polypectomy snares For removing polyps

Coagulating electrodes Electrosurgery or laser surgery

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 Practical 18-Collection and examination of peritoneal fluid

Peritoneal Fluid
• Peritoneal fluid is a liquid that is made in the abdominal cavity to lubricate the surface of
the tissue that lines the abdominal wall, pelvic cavity and covers most of the organs in
theabdomen.
• The peritoneal cavity is the space between the abdominal organs (such as the stomach,
spleen, liver and gallbladder) and the membranes which line the wall of the abdomen.
• The peritoneal fluid is a clear, sterile fluid which is mostly water along with some white
blood cells, antibodies, electrolytes and other bio-chemicals
• The main function of the peritoneal fluid is to ease friction caused by the movement of
theabdominal organs, as they move around in the abdominal cavity

Indication:
• Infectious diseases caused by viruses, bacteria, or fungi.
• Infections may originate in the peritoneum, due to a rupture of the intestine or
the abdominal wall, contamination during surgery, or may spread to the peritoneum from
otherplaces in the body.
• Inflammatory conditions – peritonitis due to certain chemicals, irradiation, rarely due to
anautoimmune disorder
• Malignancies – such as mesothelioma, tumor of the liver (hepatoma), lymphoma, or
metastatic cancer.
• Pancreatitis

Collection of peritoneal fluid

• Abdominocentesis was performed at a site 10 cm cranial and 10 cm to the right-hand
sideof the umbilicus
• The area was clipped, washed with a surgical scrub containing 5% povodine iodine
andswabbed with 70% alcohol.
• Fluid was collected by penetrating sterile syringe and needle
• And transfer into sterile containers
• The time taken to collect sufficient (0.5 mL each for bacteriology and cytology)
variedfrom five seconds to ten minutes.
• All samples were analyzed immediately following collection.

Analysis of Peritoneal
FluidPhysical examination
Opacity
• Normally peritoneal fluid is clear.
• Cloudy peritoneal fluid may indicate the presence of microorganisms and/or white
bloodcells pointing to an infection
Clotting:
• Normally peritoneal fluid won’t clot. But immediate clotting after collection
indicatehigher fibrinogen contents as well as higher inflammation

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Color:
• The normal appearance of a sample of peritoneal fluid is usually straw-colored and
clear.Abnormal appearances may give clues to conditions or diseases present and may
include:
• Yellow with liver disease, milky from obstruction of the lymphatic system, and
greenishfrom bile
• Reddish peritoneal fluid may indicate the presence of blood.

Chemical examination
• Total protein and albumin indicate liver source of effusion
• Fibrinogen-indicate degree of inflammation
• Glucose—typically about the same as blood
• Glucose levels- may be lower with infection.
• Amylase—increased with pancreatitis
• Tumor markers—to identify type of malignancy

Microscopic examination
• Total cell counts—WBCs and RBCs in the sample are enumerated. Increased WBCs
maybe seen with infections and malignant conditions.
• WBC differential—determination of percentages of different types of WBCs.
Anincreased number of neutrophils may be seen with bacterial infections.
• Cytology – a cytocentrifuged sample is treated with a special stain and examined under
a microscope for abnormal cells and for white cell differentiation. The differential can
helpdetermine whether the cells are the result of an infection or the presence of a tumor.
• Gram stain – for direct observation of bacteria or fungi under a microscope. There
shouldbe no organisms present in peritoneal fluid.
• Bacterial culture and susceptibility testing- If bacteria are present, susceptibility
testingcan be performed to guide antimicrobial therapy.
• If there are no microorganisms present, it does not rule out an infection; they may
be present in small numbers or their growth may be inhibited because of prior
antibiotictherapy

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 Practical 19- Peritoneal dialysis

What is Dialysis?
• A method of removing toxic substances (impurities or wastes) from the blood when
thekidneys are unable to do so.
• Most frequently used for animals who have kidney failure
• Usually dialysis done when BUN >100 mg/dl or creatinine > 10mg/dl
• But may also be used to quickly remove drugs or poisons in acute situations.
• Two methods of dialysis are hemodialysis and peritoneal dialysis

Principles of Dialysis
• It works on principle of diffusion and osmosis

Diffusion
• The movement of electrolytes & minerals through the peritoneum from greater to
lesserconcentration; it stops when two sides of the membrane are equally crowded
• Solutes are transported across the membrane by diffusion

Osmosis
• The movement of water into the dialysate using sugar/glucose (glucose attracts water)
• The driving force is the concentration gradient between the dialysis fluid and the blood.
• An osmotic pressure gradient is applied by the addition to the dialysis fluid of an
osmoticagent which will “suck” fluid from the blood.
• The concentration of this osmotic agent is chosen to give just the fluid removal needed
i.e.glucose
• Waste products present in the blood per fusing the peritoneum will diffuse from the
bloodvessels into the “cleaner” dialysis fluid.
• Small solutes move quickly through the membrane creating an equilibrium during
thedwell period.
• Larger solutes move slowly across the peritoneum, reaching equilibrium point takes a
longtime.

Peritoneum
• All the organs of abdominal cavity lined by a thin smooth membrane called as peritoneum.
• It is a loose connective tissue containing blood vessels and nerves.
• It is semi-permeable membrane
• Three layers between the peritoneal cavity and the blood stream.
o Capillary wall
o Interstitium
o Mesothelium
• Each of these is a barrier to the transport of fluid and solutes

Peritoneal Dialysis
• A dialysis process which requires the introduction of peritoneal dialysis solution
(dialysate)into the peritoneal cavity via gravity or a cycler.
• In peritoneal dialysis the peritoneum serves as the dialysis membrane.

98
 • The peritoneal cavity can often hold more than 3 litres, but in clinical practice only 1.5 –
2.5L of fluid are used.
• A soft, elastic tube (catheter) inside the lower abdomen is inserted through a minor
surgicaloperation.
• When a dialysate is put into the peritoneal cavity, the dialysate gently pulls the small
piecesof waste products & water from the blood into the dialysate via the semi-permeable
membrane.
• The osmotic agent normally used in peritoneal dialysis fluid is glucose.
• The dialysis fluid should be instilled for 4 to 6 hours.
• When the dialysis fluid is drained from the abdominal cavity, it contains waste
productsand excess fluid extracted from the blood.
• Peritoneal dialysis is most often applied and effective as a continuous therapy.
• In this way it is a more physiological treatment then Haemodialysis

Peritoneal Dialysis Fluid

• Components of dialysis fluid can be divided in into electrolytes, buffer and osmotic agents.

Electrolytes
• The most abundant electrolyte in dialysis fluid is sodium. It is in hyponatremic state.
• Sodium has a lower concentration than blood to ensure sufficient removal of sodium
fromblood.
• Standard dialysis fluid contains no potassium.
• Today, there is a tendency to use normocalcemic dialysis fluid as many patients
receiveextra calcium from phosphate-binding drugs.
Buffer
• The buffer normally used in dialysis is lactate. Lactate is metabolised to form
bicarbonate,the most important buffer in the blood.

Osmotic agent
• Major osmotic agent used today is glucose.
• As the rate of fluid transport is related to the osmotic strength of the dialysis solution,
theultrafiltration can be controlled by an appropriate glucose concentration.
• Normal range of glucose concentrations include 1.5%, 2.3% & 4.25%.
• Glucose is not ideal, as it is rapidly absorbed from the dialysis fluid.
• This may lead to problems with fluid removal, patient gains calories and can lose theirappetite.
• Alternative osmotic agents has resulted in new products which are still not widely used
• Amino acids are an interesting alternative as they provide nutritional supplement.
• High molecular weight glucose polymer (extraneal/icodextrin) provide sustained
ultrafiltration for long overnight dwells.

Types of Peritoneal Dialysis

A. Intermittent /fractional peritoneal dialysis (IPD)
• A dialysis treatment carried out for few minutes then time given for osmotic changes
• After few hours again dialysis fluid is administrated
B. Continuous peritoneal dialysis
✦Continuous Ambulatory Peritoneal Dialysis (CAPD)
o A dialysis treatment carried out continuously 24/7 without the use of a

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 dialysis machine
✦Automated Peritoneal Dialysis (APD)
o A dialysis treatment carried out continuously 24/7 with the use of a
dialysismachine

Procedure for peritoneal dialysis:

• Animal is kept in lateral or dorsal recumbency and hair is clipped from xiphoid to
pubisregion.
• Site is aseptically prepared and mild lignocaine is infiltrated
• Small incision given at the level of umbilicus and nick for insertion of catheter should
bemade
• The catheter is inserted into abdomen via midline approach at the level of umbilicus
• Catheter should be positioned caudally and positioned at floor of pelvis
• Catheter placement should be verified by infusing, and easily retrieving, a small volume
ofdialysate (2–5 ml) before the catheter is secured

Insufficient Outflow
• Check for kinks and placement
• Encourage high-fiber diet
• Leakage around the catheter site

Complications
1. PERITONITIS
✦The most common and also one of the major problem it may damage the peritoneum andforce the
patient to choose another treatment
✦The normal cause of inflammation is bacterial infection. Bacteria from the animal skin, equipment or
from an unclean environment can be flushed into the abdominal cavity bythe instilled dialysis fluid.
✦The exit site of the catheter is also an infection route. In rare cases bacteria may enter fromthe
intestines.
✦Signs: cloudy bag, stomach pain, fever
✦If suspected, obtain a culture of the outflow to determine the infective organism

2. Hernia
o Partly a result of the increased abdominal pressure. APD can be a suitable option
(lyingdown) as these patients are not CAPD candidates with the added abdominal
pressure.
3. Bladder or Bowel Perforation
4. Abdominal Pain
o Pain during inflow is common during the 1st few exchanges & usually disappears 1 to
2weeks of dialysis treatments
o Place heating pad on site

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 Practical 20-Lymph node biopsy and bone marrow aspirate

Lymph node
biopsyIsolation of
Node
• When isolating a lymph node:
• Place the forefingers in an anatomic location just beyond the node.
• Use the thumb to isolate and steady the node.
• For example, to isolate the prescapular/superficial cervical node:
• Place the fingers in, or just above, the thoracic inlet.
• Sweep the thumb down the front of the shoulder where the supraspinatus muscles meet
theneck muscles.
• The gesture above will guide the node between the thumb and forefinger.
• While each practitioner will develop their own feel for lymph node palpation, this
technique may help isolate the deeper and more elusive lymph nodes.
• Normal sized lymph nodes can sometimes be difficult to palpate and properly aspirate,
especially in overweight or heavily muscled (eg, Staffordshire terrier, some Labrador
retriever) dogs.
• To increase the chance of success, before isolating the node itself:
• Use a reference point as described above.
• Make a mental note of normal structures that are palpated near the node.

Fine-Needle Aspiration
• Use a needle without a syringe attached; any gauge is acceptable, but my preference is to
use a 22-gauge needle to avoid discomfort.
• Once a node is trapped between thumb and forefinger, introduce the needle.
• Redirect the needle by moving it in and out through the node several times, until—when
looking into the needle hub—a tiny bleb is apparent within the needle’s inner
circumference; this avoids unnecessary hemodilution.

Slide Preparation
The following technique provides high-quality diagnostic slides for needle aspiration cytology:
• Attach an air-filled syringe to the needle and expel only ½ drop from the needle onto
each of 2 to 3 slides, which keeps each slide’s sample the right consistency, avoiding
preparations that are too thick.
• Gently lay a clean slide crosswise on the droplet, allowing it to break the surface tension.
• While holding the slide on both ends with the free hand, gently pull the spreading slide
across the aspirate slide, which allows good smearing of the droplet. This technique
avoidsapplying too much pressure on the sample and traumatizing the cells.

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CYTOLOGIC EVALUATION
Lymphocyte Size
• Lymph nodes are predominantly comprised of small, mature lymphocytes (80%–90%).
Lymphoid cells typically have high nuclear to cytoplasmic ratios.
• Size is important when determining whether the lymphoid population is of concern. Cell
size is typically compared to a red blood cell (RBC), but neutrophils are less likely to
foldand pile up, and are slightly larger than RBCs.
• Therefore, if possible, the nucleus should be compared to a RBC, and the whole cell to a
neutrophil, if any are present.

TABLE 1. Lymphocyte Size & Appearance

Type Size Appearance

Lymphocytes: Same size or smaller • Dense chromatin in nucleus (more

Small Mature thanneutrophil or RBC deeply basophilic appearance)
• High nuclear:cytoplasmic ratio (very
little cytoplasm)

Lymphocytes: Similar to, or only • Interpret in light of total cell

Intermediate slightly larger population
than,neutrophil

Lymphoblasts: Larger than neutrophil • Looser chromatin in nucleus (lighter

Large orRBC blue appearance)
Immature • Lower nuclear:cytoplasmic ratio
(more cytoplasm)

Bone marrow aspirate

Collection of Bone Marrow Samples from Dogs and

CatsIntroduction
• Evaluation of a bone marrow aspirate and a bone marrow core biopsy may provide

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 valuable information about the status of the bone marrow, its ability to respond to correct
abnormalities in the peripheral blood and/or to determine if there is infection,
myelofibrosis, necrosis, neoplasia or other abnormalities.
• For optimal interpretation of the status of the bone marrow, a Full Blood Count and
peripheral blood film should be submitted at the same time as the bone marrow aspirate.
• A bone marrow biopsy should be collected at the same time as the bone marrow aspirate.

Patient Restraint:
• Bone marrow collections are typically performed under general anaesthesia. In
compliant animals it may be possible to obtain bone marrow samples with sedation and
local anaesthesia

Equipment:
• Jamshidi Disposable Illinois sternal-iliac bone marrow needle.
• An 18 gauge needle is usually adequate for medium to large dogs.
• A paediatric needle may be preferred for small dogs and cats.
• Petri dish.
• Microscope slides (frosted end preferred), labelled with patient name in pencil.
• Small disposable pipettes or capillary tubes.
• 2-3% EDTA/isotonic saline solution. This may be prepared as follows: A 2 ml EDTA
vacutainer tube (lavender top) is filled with isotonic (0.9%) saline and mixed well. The 2
ml of the resulting EDTA solution is added to 5-8 ml of sterile isotonic saline in a serum
tube (red top).
• 10 ml syringe
• Tissues or gauze sponge for wicking away blood during smear preparation
• At least 2 ml of 10% buffered formalin in histology submission jar

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Sample Collection
Bone marrow aspirate collection
1. Animals may be standing or positioned in sternal or lateral recumbency, depending on
thesite of collection and collector preferences.
2. Sites commonly used for collection include the iliac crest (medium to large dogs),
trochanteric fossa (small dogs and cats) or proximal humerus (dogs or cats).
3. The region is clipped and prepared as for surgery. The technique must be performed
aseptically.
4. In animals with sedation only, 1-2 ml of local anaesthetic (Lidocaine) is infiltrated into
the subcutaneous tissue and the periosteum. Special care should be taken to infiltrate the
periosteum in the area of collection.
5. A small stab incision is made in the skin over or slightly to one side of the selected site
ofcollection.
6. The stylet should be removed from the collection needle and it should be filled with the
EDTA/saline solution and 0.5-1.0 ml of EDTA/saline solution left in the syringe to be used
for collection.
7. The collection syringe is removed from the needle and the stylet is replaced.
8. The needle is then advanced into the stab incision and down to the periosteum at the
chosen collection site. The bone is stabilized with one hand and the other hand is used to
advance the needle through the periosteum by firm pressure and a back and forth twisting
motion.
9. When the needle is correctly seated in the marrow cavity it is usually very secure and
neednot be held.
10. The stylet is then removed and the collecting syringe containing the EDTA/saline
solutionis attached.
11. Marrow is aspirated by applying short bursts of negative pressure with a pumping action
of the syringe plunger. This type of action, rather than slow drawing pressure is needed
tohelp dislodge marrow particles.
12. After a small amount of marrow is collected the pressure is released. The volume
collected should not exceed the volume of anticoagulant. Do not keep aspirating once
material is visible in the hub of the collection syringe in order to prevent excessive
haemodilution. Some animals may find marrow aspiration painful if the procedure is
performed under sedation and local anaesthesia.
13. The syringe is then disconnected and the stylet replaced. The contents of the syringe are
gently expelled into the Petri dish. Marrow spicules or particles should be visible. These
are usually dull or granular, whilst fat droplets without associated marrow particles are
shiny, refractile or glistening.
14. Several marrow particles are transferred to a labelled glass slide with a small pipette or
capillary tube. If excessive blood is also transferred, this should be removed from the
surface of the slide using a pipette or wicked away using a tissue or gauze sponge.
15. Squash preparations are recommended: A second microscope slide is used to apply
gentle pressure upon the bone marrow particle prior to smearing by pulling the slides
apart. Care should be taken not to apply excessive pressure. However, sufficient pressure
should be applied to allow the marrow particle to spread between the slides prior to
gently pulling them apart. The preparations should be rapidly air-dried using a hair dryer
or heating bar. Both slides used for making the squash preparation are suitable for

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 submission.
16. At least 6 smears are recommended if sufficient bone marrow particles are available.
17. Any additional unfixed bone marrow aspirate material may be submitted to the
laboratorywith the prepared smears
Squash preparations of slide

Special considerations with bone marrow aspirate collections:

1. If no bone marrow particles are obtained at the first attempt, the stylet should be replaced
within the needle and the needle advanced slightly further into the bone marrow.
2. If no bone marrow particles are obtained in 3 attempts at a single site, then the bone
marrowneedle should be removed and collection from a different site attempted (opposite
site or different site).
3. If no bone marrow particles are obtained in attempts to aspirate from 3 different sites,
then direct and sediment smears should be made from any aspirated material and bone
marrowcore biopsies should be collected

Bone marrow core biopsy collection:

1. Following collection of the bone marrow aspirate, bone marrow core biopsies should
becollected. These sites are prepared as for the bone marrow aspirate, as described above.
2. The needle is introduced into the marrow (without the stylet) and a core is obtained
bytwisting the needle in a back and forth motion.
3. The needle is withdrawn without replacing the stylet.
4. The core biopsy should be teased out of the needle using a 25 gauge needle by pushing it
retrograde through the largest part of the collection needle (not through the small
openingat the tip of the needle). This helps prevent cellular distortion.
5. The core biopsy can be rolled onto a slide for cytologic examination.
6. The core biopsy should then be immediately placed into a minimum of 2 ml of 10%
neutralbuffered formalin and submitted for histologic evaluation.
Special considerations with bone marrow core biopsy specimens:
1. The formalin-fixed core biopsies should be packaged separately from the cytologic
specimen and cytologic smears to avoid exposure to formalin fumes that may result in
poorcytologic staining

105
 Practical 21-Methods of medication
Department of Medicine

Drugs may be administered in various ways. The route chosen depends on the part of the body
thedrug needs to affect, how quickly the drug needs to work, and the ability of the owner to give
thedrug.
Routes of administration
• Oral
• Parenteral
• IV IM IP IC SC
• Other
• Topical
• Rectal
• Intrauterine
• Intramammary
Oral
Advantages of Oral medication
• Usually least painful
• Can be administered by client
• Skin not penetrated, less risk of introducing
infectionDisadvantages
• Aspiration of medication - choking, pneumonia (eg paraffin to cats)
• Variable rate of absorption depending on patient, contents of gut, etc.
• Vomiting, irritation of gut (eg aspirin)
• Patients may not tolerate administration
• May be difficult to ensure correct dosage

Oral medications
• Tablet
• Capsule
• Granule
• Powder
• Paste
• Liquid

Tablet
• Compressed drug in a carrier such as chalk or sugar
• Often coated
• To protect drug inside from moisture
• To disguise unpleasant tastes
• To protect from gastric juices, slow down the breakdown of the drug for a slower releaseto avoid
irritation
• To give the tablet a recognizable colour
• Usually scored into halves or quarters for ease of breakage for more accurate dosing
• Most common form of medication

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Tablet administration

Capsule
• Bullet-shaped, gelatin container
• Contains powder, granules or liquid
• Easier to swallow (smooth)
• No need for 'carrier'
• Gelatin dissolves in stomach

Granules/Powder
• Solid preparations
• Dissolved in water
• Mixed with feed

Paste
• Semi solid preparation
• Usually in a water soluble base Via syringe
• Easy for owner to use
• Rabbit, guinea pig
• Horse (worming paste)
• Cat (worming paste)
Liquid
Syrup
• Drugs contained in a concentrated sugar solution.
• Good for young animals/small doses (eg Clavulox
drops).Solution
• Drug in liquid form or dissolved in water (eg glucose
solution).Suspension
• Insoluble particles float in liquid but settle when standing
• Needs to be mixed before use
(shaken)Emulsion
• Two immiscible liquids (eg water and paraffin).

Routes of enteral liquids

• Directly into the mouth
• By crop needle (birds)
• By stomach tube
• Drugs which burn the mouth
• Very young animals, to reduce the risk of aspiration
• Large volumes of fluid.

Parenteral Preparations
• These are drugs that can be given by injection.
• All drugs in this form must be sterile.
• The most common routes of injection of drugs in small animal practice are iv ,im,ip,sc,ic
• Usually taken to mean ‘by injection’

107
 • Strictly, par-enteral = ‘adjacent the gut’
Injection Route depends on
• Type of drug
• Condition and temperament of patient
• Volume of the drug
• Required speed of action

Systemic Drugs
• Some drugs cannot be applied directly where they are needed.
• Instead they need to travel through the animal’s system until they get to where they
areneeded. These drugs are said to be given SYSTEMICALLY.
• Examples include oral preparations and injections

Routes of injection
• Intradermal
• Intramuscular
• Intravenous
• Intraperitoneal
• Intracardiac
• Intrapleural
• Intra-articular
• Epidural
• Subconjunctival

Intradermal (ID)
• Into the dermis
• The living part of the surface layer
• Needs a very fine needle
• Causes a blister like appearance (bleb) if performed correctly
• Allergy testing
• Tuberculin testing

Subcutaneous(S/C)
• Under the skin
• Most common site
• Loose skin over shoulder blades a good site
• Less painful than intramuscular injections
• Only for low irritant drugs
• Slow absorption if dehydrated
• Used for most vaccines

Intramuscular
• Injected deep into the body of a muscle
• Less likely to cause an overt tissue reaction
• Insert needle at right angles to the skin
• Larger volumes may be injected in the one site than with other routes
• Faster absorption than s/c
•

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Intravenous (IV)
• Into the vein directly
• Fastest onset of action
• Can give irritant solutions into the vein which cannot be given IM or SC
• Irritant drugs should be given via an intravenous catheter, (caparsolate,
thiopentone,guifenasin)

Peri-vascular Necrosis
• When irritant solution leaks from a vein and enters
• Area may 'slough‘
• Immediately inject the area with saline (isotonic i.e. 0.9% NaCl) to dilute the drug

Intra-peritoneal (IP)
• Into peritoneal cavity
• Usually near umbilicus
• Or half way between umbilicus & pubis
• Used for Rodents, Birds
• Euthanasia of young difficult patients

Intra-cardiac (IC)
• Injection through the chest wall into the heart
• Emergency administration of drugs during cardiac resuscitation e.g. adrenaline
• Euthanasia
• Moribund animals

Intrapleural
• Injection into the pleural space through the chest wall

• Not commonly used

Intra-articular
• Injection into the joint space
• Needs full surgical preparation should also wear gloves and draw drug up in a
sterilemanner, new unused bottle, etc, to avoid introduction of infection.
• Used for Dogs (eg cortisone with greyhounds, Cartrophen)

Epidural
• Injection into the epidural space surrounding the spinal cord usually in the lumbar site
• Full sterile prep needed
• Animal positioned on sternum, with back legs drawn forwards
• Used for Before an orthopaedic procedure on spine or hindquarters
• Pain relief (eg morphine, local anaesthetic for dog)
• Stops straining and gives pain relief, (lignocaine, xylazine).

Epidural site
Subconjunctival
• Into the conjunctiva of the eye
• Use a fine needle
• Needs good restraint

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 • Used for Ocular conditions
Safety Considerations
• Wear all proper PPE for the procedure.
Supplies Needed
• Before giving an injection, gather the following:
• The drug or substance to be injected.
• Alcohol swab or alcohol moistened cotton ball
• Correct size syringe
• Correct size needle
• Sharps Container- a hard plastic with a screw- on or tightly-secured lid

Factors to Consider
When choosing needle size, syringe size, and injection site / route of injection there
areseveral factors which need to be considered:
• The type of the solution / medication.
• The viscosity (Thin / watery? Thick / sticky?)
• The absorption rate for the solution / medication.
• The size of the patient (Beagle? Hound? Something larger?)
• The mobility status of the patient (Anesthetized? Immobile? Fully conscious?

Venipuncture
• The cephalic vein on the inside of the front limb below the elbow may be used.
• Hold off the vein by gripping and rolling laterally
• Prepare the site -Clip area -Wipe with alcohol
• Insert needle, bevel up, into the vein.
• Gently pull back. Hold off when completed.

Medial saphenous vein on the hind limb can also be used.

Factors to Consider: IM Injections

• Intramuscular injections may be performed in the thigh muscles on the front of the rear
limb, or using the hamstring muscles on the back side of the rear leg
• If blood is aspirated, the needle should be removed as this indicates needle placement in
ablood vessel. Reinsert the needle at a different site.
• Needle sizes used for IM injections range from 25 to 20 gauge.
• Muscle is dense tissue and can only accommodate small volumes of fluid

Triceps muscle
• The triceps muscle belly located caudal to the humerus is one IM injection site.
• The left thumb is placed on the humerus, isolating the muscle belly in the left hand.
• The needle is placed in the muscle belly.
• The plunger is withdrawn to create negative pressure.

Quadriceps muscle
• The quadriceps muscle is located anterior to the femur.
• The left thumb is on the femur.
• The needle is inserted at a right angle to the muscle belly.

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Semitendinosis muscle
• Administering an injection into the semimembranous/semitendinosis muscle group, the
tip of the needle (white arrow) should be directed toward the caudal aspect of the limb
soif the patient moves, the needle will not advance toward the sciatic nerve.
• Notice the left hand is being used to isolate the muscle group caudel to the femur.

Lumbar muscle
• The dorsal lumbar muscles on either side of the midline can be used for IM injections.
• The thumb of the left hand is on the transverse processes of the lumbar vertebrae.

Factors to Consider: SC Injections

• For SQ (subcutaneous) injections, in general, use:
• An 18 or 20 gauge needle, 1 to 1.5 inches long.
• SQ medications are deposited into the loose connective tissue just below the dermis.
• This tissue is not richly supplied with blood vessels so the absorption rate is slow.
• There are many pain receptors in this tissue so only non- irritating, water-
solublemedications in small doses should be given by the SQ route.
• The loose skin over the shoulders and neck is an ideal site for subcutaneous injection.
Topical medications
• External surfaces e.g. the skin, eyes, ears
• Exposed mucous membranes e.g. gums, nasal mucosa, prepuce and penis, vulva
andvagina.
• Medication may work
• Topically - on only the area to which it is applied (e.g. ringworm ointment)
• Systemically (e.g. Spotton, Ivomec Pour On, DMSO)

Cream
• CREAMS – the drug is dissolved in water and mixed with oil or fat.
• Creams spread easily and penetrate the outer layers of the skin
• A semi-solid water-soluble emulsion which penetrates the skin surface
• Tubes or plastic squeeze bottles
• Wash off with water.

Ointment
• OINTMENTS – the drugs are present in a base of wax or fat.
• They do not penetrate the skin.
• Semi-solid oil-based preparation, usually with a base of wax or jelly
• Comes in tubes, jars, etc.
• Does not usually get absorbed by the skin, (eg prednoderm).

Suspension
• Liquid preparation in which particles suspended in the liquid
• Will separate out on standing, so needs to be shaken, (eg calamine lotion, yellow lotion)

Rinse/Wash/Solution
• Liquid which often diluted and poured on an animal
• May have a residual action when dry, (asuntol, otoderm, ectodex).

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Aerosol
• SPRAYS – a way of applying liquids in fine droplet form
• Liquid under pressure
• Sprayed on as particles of liquid suspended in air, (eg chloromide, debrisol, frontline,
flyrepellent)

Powder
• Finely particulate solid preparation which dusted on
• Can be irritant to open wounds
• May help to dry weeping wounds, (eg tricin powder, pinkeye powder)

MEDICATED SHAMPOOS
• MEDICATED SHAMPOOS – drugs mixed with detergents which penetrate the coat.
• Shampoos are left in contact with the skin for the recommended amount of time and then should be
rinsed off thoroughly.
EYE & EAR MEDICATION
• EYE & EAR MEDICATIONS – these are both examples of topical medication.
• Eye medications should be sterile.
• Once they have been opened they should be stored only for the length of
timerecommended by the manufacturer.

Aural medications
• Drops or Ointments
• The ear is ideally cleaned of wax and discharge before administration of medication

Medications per rectum

• Enema
• Suppository
• Fluid replacement

Enema
• Commercial solutions
• Syringe, tube or pack (eg Microlax® )
• Soapy water
• Funnel and tubing
• Other substances
• paraffin, bloat treatment (Tympanyl®) )
Suppository
• Bullet shaped, semi solid, glycerine based
• Melts at body temperature
• Can contain antibiotics, laxatives, soothing agents May be absorbed systemically

Medications intra-uterine
• Pessaries
• Solutions

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Pessaries
• Large tablets
• Usually antibiotic
• May also have a foaming agent
• Administered by hand when the cervix is open for example, after a calving

Intra-uterine fluids
• Administered via the cervix with a pipette or balloon (Foley) catheter
• During oestrus when the cervix is relaxed
• Some will remain in the uterus, while others will be siphoned out again

Health & Safety and Administering Medicines

• It is important to ensure that the animal doesn’t get hurt or frightened.
• Health and safety should be considered in order to make sure that we don’t get hurt whilst
administering medicines
What are the risks to animals when administering medicines?
• Overdose
• Allergic reaction
• Wrong administration route selected
• Animal stressed
• Animal gets injured

How can these risks be minimised

• Follow instructions carefully
• Make sure that the animal is adequately restrained
• Use sprays in a well ventilated area
• Wear appropriate PPEs (e.g. gloves, mask etc)

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 Practical 22-Disease Estimation

Measures of disease occurrence

Prevalence
• Prevalence is the number of instances of disease or related attributes (e.g., infection or
presence of antibodies) in a known population, at a designated time, without
distinctionbetween old and new cases.
• When the time is not specified, prevalence usually refers to point prevalence; that is,
theamount of disease in a population at a particular point in time.
• Period prevalence refers to the number of cases that are known to have occurred during
aspecified period of time; for example, a year (annual prevalence).

𝒏𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒍𝒂𝒔 𝒉𝒂𝒗𝒊𝒏𝒈 𝒂 𝒅𝒊𝒔𝒆𝒂𝒔𝒆 𝒂𝒕 𝒂 𝒑𝒂𝒓𝒕𝒊𝒄𝒖𝒍𝒂𝒓 𝒑𝒐𝒊𝒏𝒕 𝒐𝒇 𝒕𝒊𝒎𝒆

P= 𝒏𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒂𝒍𝒔 𝒊𝒏 𝒕𝒉𝒆 𝒑𝒐𝒑𝒖𝒍𝒂𝒕𝒊𝒐𝒏 𝒂𝒕 𝒓𝒊𝒔𝒌 𝒂𝒕 𝒕𝒉𝒂𝒕 𝒑𝒐𝒊𝒏𝒕 𝒐𝒇 𝒕𝒊𝒎𝒆

• For example, if 20 cows in a herd of 200 cows were lame on a particular day, then
theprevalence of lameness in the herd on that day would be 20/200, that is, 0.1.

Incidence
• Incidence is the number of new cases that occur in a known population over a
specifiedperiod of time. The two essential components of an incidence value are:
1. The number of new cases;
2. The period of time over which the new cases occur.
• Incidence, like prevalence, can be defined simply in terms of the number of
affectedanimals, but again is usually expressed in relation to the population at risk

Cumulative incidence
• The cumulative incidence, el, (also termed risk) is the proportion of non-diseased
individuals at the beginning of a period of study that become diseased during the period:
number of individuals that become

𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑡ℎ𝑎𝑡 𝑏𝑒𝑐𝑜𝑚𝑒 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑑 𝑑𝑢𝑟𝑖𝑛𝑔 𝑎 𝑝𝑎𝑟𝑡𝑖𝑐𝑢𝑙𝑎𝑟 𝑝𝑒𝑟𝑖𝑜𝑑

𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 ℎ𝑒𝑙𝑎𝑡ℎ𝑦 𝑖𝑛𝑑𝑖𝑣𝑖𝑑𝑢𝑎𝑙𝑠 𝑖𝑛 𝑡ℎ𝑒 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑡 𝑡ℎ𝑒 𝑏𝑒𝑔𝑖𝑛𝑛𝑖𝑛𝑔 𝑜𝑓 𝑡ℎ𝑎𝑡 𝑝𝑒𝑟𝑖𝑜𝑑

CI=—————————————————————————————————————

• Thus, if 20 animals in a cattery develop feline viral rhino tracheitis during a week, and
there are 100 healthy cats in the cattery at the beginning of the week, then, for the
weekCI=20/100 = 0.2

Incidence rate

Incidence rate measures the rapidity with which new cases of disease develop over time

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The relationship between prevalence and incidence rate
Prevalence therefore depends on the duration and the incidence rate of a disease:
P = I x D.
This means that a change in prevalence can be due to:
• A change in incidence rate;
• A change in the average duration of the disease;
• A change in both incidence rate and duration

Mortality
• Mortality measures are analogous to incidence measures where the relevant outcome
isdeath associated with, rather than new cases of, a specific disease.

Mortality rate
• Mortality rate (mortality density) is calculated similarly to incidence rate.
• The numerator comprises the number of deaths.
• However, since an animal is at risk of dying after onset of disease, animals that
developdisease continue to be included in the denominator until they die

𝒏𝒖𝒎𝒃𝒆𝒓 𝒐𝒇 𝒅𝒆𝒂𝒕𝒉𝒔 𝒅𝒖𝒆 𝒕𝒐 𝒂 𝒅𝒊𝒔𝒆𝒂𝒔𝒆 𝒕𝒉𝒂𝒕 𝒐𝒄𝒄𝒄𝒓 𝒊𝒏 𝒂 𝒑𝒐𝒑𝒖𝒍𝒂𝒕𝒊𝒐𝒏 𝒅𝒖𝒓𝒊𝒏𝒈 𝒂 𝒑𝒂𝒓𝒕𝒊𝒄𝒖𝒍𝒂𝒓 𝒑𝒆𝒓𝒊𝒐𝒅 𝒐𝒇 𝒕𝒊𝒎𝒆
M= 𝑻𝒉𝒆 𝒔𝒖𝒎,𝒐𝒗𝒆𝒓 𝒂𝒍𝒍 𝒊𝒏𝒅𝒊𝒗𝒊𝒅𝒖𝒂𝒍𝒔 𝒐𝒇 𝒕𝒉𝒆 𝒍𝒆𝒏𝒈𝒕𝒉 𝒐𝒇 𝒕𝒊𝒎𝒆 𝒂𝒕 𝒓𝒊𝒔𝒌 𝒐𝒇 𝒅𝒚𝒊𝒎𝒈

Death rate
• The death rate is the total mortality rate for all diseases rather than one specific disease
-in a population

Case fatality
• The tendency for a condition to cause the death of affected animals in a specified time
isthe case fatality. This is the proportion of diseased animals that die
𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠

𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑑 𝑎𝑛𝑖𝑚𝑎𝑙𝑠

CF= ——————————————————-

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