Kathryn F. Murphy - Notes on Canine Internal Medicine

1 Cover

2 Title Page NOTES ON CANINE INTERNAL MEDICINE Fourth Edition Victoria L. Black, MA, VetMB, FHEA, DipECVIM‐CA, MRCVS Senior Clinician in Small Animal Medicine EBVS ® European Specialist in Small Animal Internal Medicine RCVS Specialist in Small Animal Medicine Langford Vets, Bristol Veterinary School Bristol, UK Kathryn F. Murphy, BVSc, DSAM, PGCertHE, DipECVIM‐CA, FRCVS EBVS ® European Specialist in Small Animal Internal Medicine, RCVS Specialist in Small Animal Medicine Rowe Referrals, Bristol VetCT UK Jessie Rose Payne, BVetMed, MVetMed, PhD, DipACVIM (Cardiology), MRCVS Senior Clinician in Cardiology ACVIM Specialist in Veterinary Cardiology RCVS Specialist in Veterinary Cardiology Langford Vets, Bristol Veterinary School Bristol, UK Edward J. Hall, MA, VetMB, PhD, DipECVIM‐CA, FRCVS Emeritus Professor of Small Animal Internal Medicine EBVS ® European Specialist in Small Animal Internal Medicine RCVS Specialist in Small Animal Medicine (Gastroenterology) University of Bristol Bristol, UK

3 Copyright Page

4 Dedication

5 PREFACE

6 ACKNOWLEDGEMENTS

7 USING THIS BOOK

8 COMMONLY USED ABBREVIATIONS

9 SECTION 1: PRESENTING COMPLAINTS 1.1 ABORTION 1.2 ALOPECIA 1.3 ALTERED BEHAVIOUR 1.4 ALTERED CONSCIOUSNESS 1.5 ANOREXIA/HYPOREXIA/INAPPETENCE 1.6 ANOSMIA 1.7 ANURIA/OLIGURIA 1.8 ATAXIA 1.9 BLEEDING 1.10 BLINDNESS 1.11 CONSTIPATION 1.12 CORNEAL OPACITY 1.13 COUGHING 1.14 DEAFNESS 1.15 DIARRHOEA 1.16 DROOLING 1.17 DYSPHAGIA 1.18 DYSPNOEA/TACHYPNOEA 1.19 DYSURIA 1.20 DYSTOCIA 1.21 EPISTAXIS 1.22 EXERCISE INTOLERANCE 1.23 FAECAL INCONTINENCE 1.24 FLATULENCE/BORBORYGMI 1.25 HAEMATEMESIS 1.26 HAEMATOCHEZIA 1.27 HAEMATURIA AND DISCOLOURED URINE 1.28 HAEMOPTYSIS 1.29 HALITOSIS 1.30 HEAD TILT 1.31 MELAENA 1.32 NASAL DISCHARGE 1.33 NYSTAGMUS 1.34 PARESIS/PARALYSIS 1.35 PERINATAL DEATH 1.36 POLYPHAGIA 1.37 POLYURIA/POLYDIPSIA (PU/PD) 1.38 PREPUTIAL DISCHARGE 1.39 PRURITUS 1.40 RED EYE (AND PINK EYE) 1.41 REGURGITATION 1.42 SEIZURES 1.43 SNEEZING 1.44 STIFFNESS, JOINT SWELLING AND GENERALISED LAMENESS 1.45 STUNTING 1.46 TENESMUS AND DYSCHEZIA 1.47 TREMORS 1.48 URINARY INCONTINENCE 1.49 VOMITING 1.50 VULVAL DISCHARGE 1.51 WEAKNESS, COLLAPSE AND SYNCOPE 1.52 WEIGHT GAIN/OBESITY 1.53 WEIGHT LOSS

10 SECTION 2: PHYSICAL ABNORMALITIES 2.1 ABDOMINAL ENLARGEMENT 2.2 ABDOMINAL MASSES 2.3 ABNORMAL LUNG SOUNDS 2.4 ARRHYTHMIAS 2.5 ASCITES 2.6 CYANOSIS 2.7 EYE LESIONS 2.8 HEPATOMEGALY 2.9 HORNER’S SYNDROME 2.10 HYPERTENSION 2.11 HYPOTENSION 2.12 HYPOTHERMIA 2.13 ICTERUS/JAUNDICE 2.14 LYMPHADENOPATHY 2.15 MURMUR 2.16 ORAL MASSES 2.17 PAIN 2.18 PALLOR 2.19 PERINEAL LESIONS 2.20 PERIPHERAL OEDEMA 2.21 PLEURAL EFFUSION 2.22 PNEUMOTHORAX 2.23 PROSTATOMEGALY 2.24 PULSE ABNORMALITIES 2.25 PYREXIA AND HYPERTHERMIA 2.26 SKIN LESIONS 2.27 SKIN PIGMENTATION CHANGES 2.28 SPLENOMEGALY 2.29 STOMATITIS 2.30 STRIDOR AND STERTOR

11 SECTION 3: LABORATORY ABNORMALITIES 3A BIOCHEMICAL TESTS 3.1 ACID–BASE 3.2 AMMONIA 3.3 AMYLASE AND LIPASE 3.4 AZOTAEMIA 3.5 BILE ACIDS 3.6 BILIRUBIN 3.7 CALCIUM 3.8 CARDIAC BIOMARKERS 3.9 CHLORIDE 3.10 COBALAMIN 3.11 CORTISOL (BASAL) 3.12 CREATINE KINASE 3.13 CREATININE 3.14 C‐REACTIVE PROTEIN (CRP) 3.15 FOLATE 3.16 FRUCTOSAMINE 3.17 GLUCOSE 3.18 IRON PROFILE 3.19 LIPIDS 3.20 LIVER ENZYMES 3.21 PANCREATIC LIPASE (cPL) 3.22 PHOSPHATE 3.23 POTASSIUM 3.24 SODIUM 3.25 SYMMETRIC DIMETHYLARGININE (SDMA) 3.26 THYROID HORMONE 3.27 TOTAL PROTEIN (ALBUMIN AND GLOBULIN) 3.28 TRYPSIN‐LIKE IMMUNOREACTIVITY (TLI) 3.29 UREA 3B HAEMATOLOGY 3.30 RED BLOOD CELLS (RBCs) 3.31 PLATELETS 3.32 WHITE BLOOD CELLS (WBCs) 3.33 PANCYTOPENIA 3C URINALYSIS 3.34 BIOCHEMICAL ANALYSIS 3.35 SEDIMENT 3.36 URINE PROTEIN: CREATININE (UPC) RATIO 3.37 URINE SPECIFIC GRAVITY (USG)

12 SECTION 4: IMAGING PATTERNS 4.1 ABDOMEN 4.2 BONE 4.3 THORAX

13 SECTION 5: ORGAN SYSTEMS 5.1 ALIMENTARY SYSTEM 5.1.1 OROPHARYNX 5.1.1A CRANIOMANDIBULAR OSTEOPATHY 5.1.1B CRICOPHARYNEAL ACHALASIA 5.1.1C MASTICATORY MYOSITIS 5.1.1D ORAL NEOPLASIA 5.1.1E STOMATITIS 5.1.2 SALIVARY GLANDS 5.1.2A HYPERSIALOSIS/SALIVARY GLAND INFARCTION/SIALOADENITIS 5.1.3 OESOPHAGUS 5.1.3A FOREIGN BODY 5.1.3B MEGAOESOPHAGUS (MO) 5.1.3C OESOPHAGITIS 5.1.3D SLIDING HIATAL HERNIA 5.1.3E STRICTURE 5.1.4 STOMACH 5.1.4A ACUTE GASTRITIS 5.1.4B CHRONIC GASTRITIS 5.1.4C GASTRIC CARCINOMA 5.1.4D GASTRIC DILATATION‐VOLVULUS (GDV) 5.1.4E DELAYED GASTRIC EMPTYING 5.1.4F GASTRIC ULCER 5.1.5 SMALL INTESTINE 5.1.6 LARGE INTESTINE 5.1.6A ACUTE COLITIS 5.1.6B CHRONIC COLITIS 5.1.6C CONSTIPATION 5.1.6D GRANULOMATOUS (HISTIOCYTIC ULCERATIVE) COLITIS 5.1.6E LARGE INTESTINAL NEOPLASIA 5.1.7 PANCREAS 5.1.7A ACUTE PANCREATITIS 5.1.7B CHRONIC PANCREATITIS 5.1.7C EXOCRINE PANCREATIC INSUFFICIENCY (EPI) 5.2 CARDIOVASCULAR SYSTEM 5.2.1 ACQUIRED CARDIAC DISEASES 5.2.1A ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY (ARVC) 5.2.1B DILATED CARDIOMYOPATHY (DCM) 5.2.1C HEARTWORM DISEASE/DIROFILARIASIS 5.2.1D MYXOMATOUS MITRAL VALVE DISEASE 5.2.2 CONGENITAL CARDIAC DISEASES 5.2.2A AORTIC STENOSIS 5.2.2B MITRAL VALVE DYSPLASIA 5.2.2C PATENT DUCTUS ARTERIOSUS 5.2.2D PULMONIC STENOSIS 5.2.2E TETRALOGY OF FALLOT 5.2.2 FTRICUSPID DYSPLASIA 5.2.2G VENTRICULAR SEPTAL DEFECT 5.2.3 CONGESTIVE HEART FAILURE (CHF) 5.2.3A LEFT‐SIDED CONGESTIVE HEART FAILURE 5.2.3B RIGHT‐SIDED CONGESTIVE HEART FAILURE 5.2.4 ARRHYTHMIAS 5.2.5 PERICARDIAL DISEASES5.2.5A PERICARDIAL EFFUSION 5.2.5B PERITONEAL PERICARDIAL DIAPHRAGMATIC HERNIA (PPDH) 5.3 ENDOCRINE SYSTEM 5.3.1 DIABETES INSIPIDUS (DI) 5.3.2 DIABETES MELLITUS (DM) 5.3.3 GROWTH HORMONE DISORDERS 5.3.3A ACROMEGALY (HYPERSOMATOTROPISM) 5.3.3B PITUITARY DWARFISM 5.3.4 ADRENAL GLAND DISORDERS 5.3.4A HYPERADRENOCORTICISM (HAC) 5.3.4B HYPOADRENOCORTICISM (ADDISON’S DISEASE) 5.3.5 HYPOTHYROIDISM 5.3.6 INSULINOMA 5.3.7 PARATHYROID DISEASES 5.3.7A PRIMARY HYPERPARATHYROIDISM (PHPT) 5.3.7B HYPOPARATHYROIDISM 5.4 HAEMOPOIETIC SYSTEM 5.4.1 ANAEMIA OF CHRONIC KIDNEY DISEASE (CKD) 5.4.2 IMMUNE‐MEDIATED HAEMOLYTIC ANAEMIA (IMHA) 5.4.3 IRON‐DEFICIENCY ANAEMIA 5.4.4 LYMPHOID LEUKAEMIA 5.4.5 OTHER HAEMOPOIETIC NEOPLASMS 5.4.6 LEUKOPENIA 5.4.7 THROMBOSIS 5.5 HAEMOSTATIC SYSTEM 5.5.1 ANTICOAGULANT RODENTICIDE POISONING 5.5.2 DISSEMINATED INTRAVASCULAR COAGULATION (DIC) 5.5.3 FACTOR VIII DEFICIENCY (HAEMOPHILIA A) 5.5.4 HYPERFIBRINOLYSIS 5.5.5 IMMUNE‐MEDIATED THROMBOCYTOPENIA (IMTP) 5.5.6 VON WILLEBRAND DISEASE 5.5.7 VASCULITIS 5.6 HEPATOBILIARY SYSTEM 5.6.1 CHRONIC HEPATITIS (CH)/CIRRHOSIS 5.6.2 CHOLANGITIS/CHOLANGIOHEPATITIS 5.6.3 CHOLECYSTITIS 5.6.4 CONGENITAL PORTO‐SYSTEMIC SHUNT (PSS) 5.6.5 COPPER‐ASSOCIATED CHRONIC HEPATITIS 5.6.6 EXTRA‐HEPATIC BILE DUCT OBSTRUCTION (EHBDO) 5.6.7 GALL BLADDER MUCOCOELE 5.6.8 HEPATIC NEOPLASIA 5.6.9 INFECTIOUS CANINE HEPATITIS 5.6.10 NODULAR HYPERPLASIA 5.6.11 PORTAL VEIN HYPOPLASIA (PVH) 5.6.11A MICROVASCULAR DYSPLASIA (MVD) 5.6.11B NON‐CIRRHOTIC PORTAL HYPERTENSION/JUVENILE HEPATIC FIBROSIS 5.6.12 STEROID HEPATOPATHY 5.6.13 VACUOLAR/REACTIVE HEPATOPATHY 5.7 IMMUNE SYSTEM 5.7.1 (AUTO)IMMUNE‐MEDIATED DISORDERS 5.7.2 NEOPLASIA OF IMMUNE CELLS 5.8 NEUROLOGICAL SYSTEM 5.8.1 CEREBROVASCULAR DISEASE 5.8.2 CORTICOSTEROID‐RESPONSIVE TREMOR SYNDROME 5.8.3 HYDROCEPHALUS 5.8.4 IDIOPATHIC EPILEPSY 5.8.5 IDIOPATHIC HEAD TREMOR 5.8.6 IDIOPATHIC VESTIBULAR DISEASE 5.8.7 INFECTIOUS DISEASES AFFECTING THE NERVOUS SYSTEM 5.8.8 MOVEMENT DISORDERS 5.8.9 MENINGOENCEPHALITIS OF UNKNOWN ORIGIN (MUO) 5.8.10 MYASTHENIA GRAVIS (MG) 5.8.11 NEOPLASIA OF THE NEUROLOGICAL SYSTEM 5.8.12 POLYRADICULONEURITIS 5.8.13 STEROID‐RESPONSIVE MENINGITIS‐ARTERITIS (SRMA) 5.9 REPRODUCTIVE SYSTEM 5.9.1 MAMMARY GLAND DISEASE 5.9.1A MASTITIS 5.9.1B MAMMARY NEOPLASIA 5.9.2 OVARIAN REMNANT SYNDROME 5.9.3 PROSTATIC DISEASE 5.9.4 PSEUDOCYESIS (FALSE PREGNANCY) 5.9.5 PYOMETRA 5.9.6 TESTICULAR NEOPLASIA 5.9.7 VAGINITIS 5.10 RESPIRATORY SYSTEM 5.10.1 NASAL DISORDERS 5.10.1A CHRONIC IDIOPATHIC RHINITIS 5.10.1B SINONASAL ASPERGILLOSIS (FUNGAL RHINITIS) 5.10.2 UPPER‐AIRWAY DISORDERS 5.10.2A BRACHYCEPHALIC OBSTRUCTIVE AIRWAY SYNDROME (BOAS) 5.10.2B INFECTIOUS TRACHEOBRONCHITIS 5.10.2C LARYNGEAL PARALYSIS 5.10.2D TRACHEAL COLLAPSE 5.10.2E TRACHEOBRONCHIAL FOREIGN BODY 5.10.3 LOWER‐AIRWAY DISORDERS 5.10.3A CHRONIC BRONCHITIS 5.10.3B EOSINOPHILIC BRONCHOPNEUMOPATHY 5.10.3C LUNGWORM (