100 Top Consultations in Small Animal General Practice E-Book

Peter Hill

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 874

Veröffentlichungsjahr: 2011

Beschreibung

Focusing on 'day one competencies', this book offers essential guidance to the most common problems encountered in small animal general practice. Addressing 100 core scenarios, it is ideal for the undergraduate or newly qualified vet, and for those seeking an up-to-date refresher. Organized by presenting sign (diarrhoea, itching) or disease (diabetes mellitus, pancreatitis), and with colour illustration throughout, each chapter explains: * how to make a diagnosis * which interventions are most appropriate in general practice * what the vet should say to the client before and after examination The authors also offer invaluable advice on other key topics such as annual health checks, neutering and euthanasia, and they tackle the tough questions: What if it doesn't get better? What is the low cost option? When should I refer? Never before has so much practical information been brought together in a single volume. Like having an experienced or specialist clinician standing by your side in the consulting room, 100 Top Consultations will become a trusted companion for students and practitioners alike.

Leseprobe

Table of Contents

Cover

Table of Contents

Half title page

Title page

Copyright page

List of contributors

Acknowledgements

About this book

Introduction: Diagnostic and therapeutic approaches in small animal general practice

Section 1: Health checks and vaccinations

1 The new puppy or kitten

Pre-purchase advice

The first consultation

The clinical examination

General findings

Vaccination

Antiparasitic treatment

Further advice

Additional recommendations

2 The annual health check

Problems that might be raised by owners

The clinical examination

Recommending treatments and procedures

Vaccination

Other forms of preventative medicine

3 Advising on spaying and castration

Reasons for neutering

Disadvantages or complications associated with surgical neutering

Recommended age for neutering

Chemical control of breeding

Overall recommendations

Section 2: General signs and illnesses

4 Inappetence and anorexia

Common differential diagnoses

5 Weight loss

Common differential diagnoses

6 Polydipsia and polyuria

Common differential diagnoses

7 Pyrexia

Common differential diagnoses

8 Anaemia

Common differential diagnoses

9 Jaundice

Common differential diagnoses

10 Collapse

Common differential diagnoses

11 Abdominal distension

Common differential diagnoses

12 The FeLV-positive cat

Aetiology and pathogenesis

History and clinical signs

13 The FIV-positive cat

Aetiology and pathogenesis

History and clinical signs

14 The cat with FIP

Aetiology and pathogenesis

History and clinical signs

Section 3: Skin problems

15 The itchy dog

Common differential diagnoses

16 The itchy cat

Common differential diagnoses

17 Diagnosing and treating skin diseases caused by ectoparasites

Aetiology and pathogenesis

History and clinical signs

18 The dog with demodicosis

Aetiology and pathogenesis

History and clinical signs

19 The dog with pyoderma or Malassezia dermatitis

Aetiology and pathogenesis

History and clinical signs

20 The atopic dog

Aetiology and pathogenesis

History and clinical signs

21 The dog with a hot spot

Aetiology and pathogenesis

History and clinical signs

22 The dog with acral lick dermatitis (lick granuloma)

Aetiology and pathogenesis

History and clinical signs

23 Anal sac problems

Aetiology and pathogenesis

History and clinical signs

24 Ear infections

Aetiology and pathogenesis

History and clinical signs

25 Pododermatitis

Common differential diagnoses

26 The dog or cat with a cutaneous lump or swelling

Common differential diagnoses

27 The dog with urticaria or angioedema

Aetiology and pathogenesis

History and clinical signs

Differential diagnoses

28 The cat-bite abscess

Aetiology and pathogenesis

History and clinical signs

29 Lipomas

Aetiology and pathogenesis

History and clinical signs

30 The dog with a histiocytoma

Aetiology and pathogenesis

History and clinical signs

31 Mast cell tumours

Aetiology and pathogenesis

History and clinical signs

32 Sebaceous adenomas and follicular cysts

Aetiology and pathogenesis

History and clinical signs

33 The dog that is losing hair

Common differential diagnoses

34 Dermatophytosis

Aetiology and pathogenesis

History and clinical signs

35 Skin problems in non dog/cat species

Common skin diseases and symptoms in rabbits

Common skin diseases and symptoms in hamsters

Common skin diseases and symptoms in Guinea pigs

Common skin diseases and symptoms in caged birds

Section 4: Gastrointestinal problems

36 Dental disease

Aetiology and pathogenesis

History and clinical signs

37 Retching and gagging

Common differential diagnoses

38 Vomiting

Common differential diagnoses

39 Diarrhoea

Common differential diagnoses

40 The dog with haemorrhagic gastroenteritis

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

41 Colitis

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

42 Liver disease

Aetiology and pathogenesis

Common differential diagnoses

43 The dog or cat with pancreatitis

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

44 The dog with gastric dilatation and volvulus

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

45 Obstipation and megacolon

Aetiology and pathogenesis

History and clinical signs

Section 5: Musculoskeletal problems

46 Orthopaedic problems in young and growing dogs

Aetiology and pathogenesis

History and clinical signs

47 Forelimb lameness

Common differential diagnoses

48 Hindlimb lameness

Common differential diagnoses

49 Cranial cruciate ligament insufficiency

Aetiology and pathogenesis

History and clinical signs

50 Advising on osteoarthritis

Aetiology and pathogenesis

History and clinical signs

51 Initial fracture diagnosis and management

Aetiology and pathogenesis

History and clinical signs

52 Spinal pain and intervertebral disc herniation

Common differential diagnoses

Section 6: Cardio-respiratory problems

53 Coughing

Common differential diagnoses

54 The dog with kennel cough

Aetiology and pathogenesis

History and clinical signs

55 Sneezing and nasal discharge

Common differential diagnoses

56 The puppy or kitten with a heart murmur

Aetiology and pathogenesis

Common differential diagnoses

57 The dog with heart failure

Aetiology and pathogenesis

Common differential diagnoses

History and clinical signs

58 The dyspnoeic cat

Common differential diagnoses

Section 7: Eye problems

59 Eyelid problems

Aetiology and pathogenesis

History and clinical signs

60 Conjunctivitis

Common differential diagnoses

61 Corneal ulcers

Aetiology and pathogenesis

History and clinical signs

62 Cataracts

Aetiology and pathogenesis

History and clinical signs

63 Blindness

Common differential diagnoses

Section 8: Urinary tract problems

64 The dog with signs of cystitis or haematuria

Common differential diagnoses

65 The cat with signs of cystitis or haematuria

Common differential diagnoses

66 The blocked cat

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

67 The dog with urinary incontinence

Aetiology and pathogenesis

History and clinical signs

68 Chronic renal failure

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

69 The dog with prostatic disease

Aetiology and pathogenesis

History and clinical signs

Section 9: Reproductive tract problems

70 The bitch with pyometra

Aetiology and pathogenesis

History and clinical signs

71 Pregnancy and whelping

General advice about pregnancy

Complications during pregnancy

Preparations for whelping

The normal parturition process

Dealing with the umbilical cord

Checking the puppies

Complications of parturition requiring veterinary intervention

Caesarean section

72 Oestrus control, misalliance and false pregnancies

Oestrus control

Misalliance (Mésalliance)

False pregnancy

Section 10: Endocrine problems

73 The dog with hypothyroidism

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

74 The dog with hyperadrenocorticism

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

75 Diabetes mellitus

Aetiology and pathogenesis

History and clinical signs

76 The cat with hyperthyroidism

Aetiology and pathogenesis

History and clinical signs

Common differential diagnoses

Section 11: Emergencies and trauma

77 The road traffic accident

78 The pharyngeal foreign body

Aetiology and pathogenesis

Differential diagnoses

History and clinical signs

79 Problems associated with grass seeds

Aetiology and pathogenesis

History and clinical signs

80 Burns

Aetiology and pathogenesis

History and clinical signs

Section 12: Cancer

81 The dog or cat with cancer

Aetiology and pathogenesis

Common tumours of dogs and cats

82 The dog with a mammary tumour

Aetiology and pathogenesis

History and clinical signs

83 The dog with multicentric lymphoma

Aetiology and pathogenesis

History and clinical signs

Section 13: Neurological problems

84 The dog having seizures

Differential diagnoses

85 Hindlimb ataxia and weakness

Common differential diagnoses

86 Vestibular disease

Aetiology and pathogenesis

History and clinical signs

Section 14: Behavioural problems

87 The aggressive dog

Risk assessment

Common differential diagnoses

88 The frightened dog

Common differential diagnoses

89 Separation problems in the dog

Common differential diagnoses

90 House-soiling and elimination problems

Common differential diagnoses

Section 15: Poisonings

91 Dealing with suspected poisoning

92 Anticoagulant rodenticide poisoning

Aetiology and pathogenesis

History and clinical signs

Important differential diagnoses

Section 16: Problems in non dog/cat species

93 The sick rabbit

Common presentations and conditions affecting rabbits

94 The sick hamster

Common presentations and conditions affecting hamsters

95 The sick Guinea pig

Common presentations and conditions affecting Guinea pigs

96 The sick bird

Common presentations and conditions affecting birds

97 The sick tortoise

Common presentations and conditions affecting tortoises

Section 17: Miscellaneous

98 The post-surgery check-up

Dealing with common complications

Managing dressings

Monitoring progress

99 Illnesses in animals that have travelled abroad

Common differential diagnoses

100 Elective euthanasia

Reasons for euthanasia

Permission for euthanasia

Techniques for euthanasia

Owner involvement in euthanasia consultations

Euthanasia of aggressive dogs

Euthanasia of aggressive or feral cats

Euthanasia when no help is available

After the event

Section 18: Appendices

Appendix 1 – Rational use of antibiotics

Are the animal’s clinical signs likely to be caused by a bacterial infection?

Which antibiotic will be effective?

What patient factors might influence the choice of antibiotic?

How long a course should be given?

What route and frequency of administration should be used?

What cost is involved?

Appendix 2 – Rational use of glucocorticoids

Indications

Potency and formulations

Anti-pruritic and anti-inflammatory therapy

Immunosuppressive therapy

Adverse effects of glucocorticoids

Appendix 3 – General principles of non-steroidal anti-inflammatory drug (NSAID) use for the treatment of musculoskeletal pain

Indications

General treatment principles

Adverse effects

Appendix 4 – Weight loss and obesity control

Diagnosis

Management

Appendix 5 – Interpretation of haematology and biochemistry profiles

Haematology (complete blood count)

Biochemistry (clinical chemistry)

Abbreviations

Index

100 Top Consultations in Small Animal General Practice

This edition first published 2011

© 2011 Blackwell Publishing Ltd

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Library of Congress Cataloging-in-Publication Data

100 top consultations in small animal general practice / edited by Peter B. Hill, Sheena Warman, Geoff Shawcross.

p. ; cm.

 One hundred top consultations in small animal general practice

 Includes bibliographical references and index.

 ISBN 978-1-4051-6949-3 (pbk. : alk. paper) 1. Pet medicine. I. Hill, Peter B. (Peter Barrie) II. Warman, Sheena. III. Shawcross, Geoff. IV. Title: One hundred top consultations in small animal general practice.

 [DNLM: 1. Dog Diseases. 2. Cat Diseases. 3. Professional-Patient Relations. 4. Veterinary Medicine–methods. SF 991]

 SF981.A55 2011

 636.089–dc22

2010040961

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF [ISBN 9781444393347]; ePub [ISBN 9781444393354]

List of contributors

Editors

Peter HillBVSc, PhD, DVD, DipACVD, DipECVD, MRCVS, MACVSc Senior Lecturer in Veterinary Dermatology and Immunology, The University of Adelaide, School of Animal and Veterinary Sciences, Roseworthy Campus, Roseworthy, SA 5371, Australia

Sheena WarmanBSc, BVMS, DSAM, DipECVIM-CA, PGCert(HE), MRCVS Clinical Fellow in Small Animal Medicine, Division of Companion Animal Studies, Department of Clinical Veterinary Science, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK

Geoff ShawcrossBVSc, Cert SAO, MRCVS General Practitioner (retired), Shrublands, St Patrick’s Lane, Rake, Liss, Hampshire GU33 7HQ, UK

Additional authors

Jon Bowen, BVetMed, MRCVS, DipAS(CABC) Behavioural Medicine Referral Service, Queen Mother Hospital for Small Animals, Royal Veterinary College, Hawkshead Lane, Potters Bar, North Mymms, Hatfield, Herts AL9 7TA, UK

Jim Carter, BVetMed, DVOphthal, MRCVS RCVS Recognised Specialist in Veterinary Ophthalmology, South Devon Referrals, The Old Cider Works, Old Cider Works Lane, Abbotskerswell, Devon TQ12 5GH, UK

Mark Goodfellow, MA, VetMB, CertVR, DSAM, DipECVIM-CA, MRCVS European Recognised Specialist in Veterinary Internal Medicine, Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK

Andrea Harvey, BVSc, DSAM(Feline), DipECVIM-CA, MRCVS RCVS Recognised Specialist in Feline Medicine, Feline Advisory Bureau, Taeselbury, High Street, Tisbury, Wiltshire SP3 6LD, UK

Peter Holt, BVMS, PhD, DipECVS, CBiol, FSBiol, FHEA, FRCVS Emeritus Professor of Veterinary Surgery, Division of Companion Animal Studies, Department of Clinical Veterinary Science, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK

Norman Johnston, BVM&S, FAVD, DiplAVDC, DiplEVDC, MRCVS RCVS American and European Recognised Specialist in Veterinary Dentistry, DentalVets, 31 Station Hill, North Berwick, Lothian EH39 4AS, UK

Martin Owen, BVSc, BSc, PhD, DSAS (Orth), DipECVS, MRCVS ECVS Recognised Specialist in Small Animal Surgery, RCVS Recognised Specialist in Small Animal Surgery (Orthopaedics), Dick White Referrals, Six Mile Bottom Veterinary Specialist Centre, Station Farm, London Road, Six Mile Bottom, Suffolk CB8 0UH, UK

Sharon Redrobe, BSc(Hons), BVetMed, CertLAS, DZooMed, MRCVS RCVS Recognised Specialist in Zoo and Wildlife Medicine, Clinical Associate Professor in Zoo, Wild and Exotic Animal Medicine, Director of Life Sciences, Twycross Zoo, School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Leicestershire LE12 5RD, UK

Sue Shaw, BVSc (Hons), MSc, Dip ACVIM, Dip ECVIM, FACVSc, MRCVS Senior Lecturer in Dermatology and Applied Immunology, Division of Companion Animal Studies, Department of Clinical Veterinary Science, University of Bristol, Langford House, Langford, Bristol BS40 5DU, UK

Paul Smith, BVetMed, DVC, MRCVS RCVS Recognised Specialist in Veterinary Cardiology, East Anglia Cardiology Ltd, The Bakers Cottage, Church Street, Buntingford, Hertfordshire SG9 9AS, UK

Acknowledgements

Peter Hill would like to thank Sarah, his wife, for her constant support during the writing of this book.

Sheen Warman would like to thank her husband Adrian for his patience and support whilst this book has been written. She would also like to thank colleagues and students, past and present, who have provided inspiration and helpful suggestions.

Geoff Shawcross would like to take this opportunity to thank all the professional colleagues with whom he has had the pleasure to work during his career for their unstinting support and advice, without which his contribution to this book would not have been possible.

Dedication

This book is dedicated to all the animals we have treated over the course of our careers. Without them, we would have known nothing.

About this book

This multidisciplinary text begins with a comprehensive guide to the consultation process in small animal practice. Within this section, clinicians will find highly practical, invaluable tips about history taking, physical examination and diagnostic approaches.

The book then covers 100 of the most common scenarios that a small animal practitioner will have to deal with in the consulting room. These chapters are of three main types:

1) Presenting-sign-based chapters – These chapters, coloured blue, cover an important symptom, listing the common differential diagnoses, outlining the diagnostic approach for its investigation and indicating how the case should be treated. These chapters inform clinicians about what to tell clients before a diagnosis has been made.

2) Diagnosis-based chapters – These chapters, coloured purple, cover important diseases and describe how clinicians should diagnose and treat them. These chapters inform clinicians about what to tell clients after a diagnosis has been made.

3) Miscellaneous chapters – These chapters, coloured red, cover various topics that are rarely found in veterinary texts, such as annual health checks, neutering, oestrus control and euthanasia.

Within the first two types of chapter, there are three unique ‘boxed’ sections covering ‘What if it doesn’t get better?’, ‘The low-cost option’ and ‘When should I refer?’, which can be quickly identified by their colour (red, orange and purple, respectively). This type of information is rarely taught at veterinary school and practitioners usually have to learn it the hard way, by trial and error.

There are then five appendices covering the use of antibiotics, glucocorticoids and non-steroidal anti-inflammatory drugs, as well as information on obesity control and the interpretation of laboratory tests.

Never before has such practical information been put together in a single text. When grouped together, these chapters provide a comprehensive guide to the vast majority of consultations undertaken in small animal general practice. It’s like having an experienced or specialist clinician standing by your side in the consulting room.

This book will be invaluable to:

Undergraduate veterinary studentsNewly graduated veterinariansExperienced veterinarians who are looking for an up-to-date refresher on small animal practiceVeterinarians who are returning to the profession after a leave of absenceVeterinarians who are converting from large animal to small animal practice, or for whom small animal consulting constitutes only a small part of their duties.

Section 1: Health checks and vaccinations

1

The new puppy or kitten

Geoff Shawcross

A new puppy or kitten will be presented either by an existing client who has acquired another pet, or by a new client who has never been to the practice before. The purpose of this consultation is to evaluate the clinical well-being of the pet, advise on diet and discuss preventative medicine. However, during this time, the client will also be forming their opinion of the expertise, compassion and efficiency of the whole practice team.

Pre-Purchase Advice

Clients may occasionally ask veterinarians for advice about choosing particular breeds. However, what appears to be a simple question can have a very complicated answer. Choosing a breed of dog or cat is a very personal matter, so the final decision can rest only with the purchaser. Potential owners should be advised to do some research into the breeds they are considering, and ensure that they have the time, facilities and financial resources to own the breed that they choose. Factors that need to be considered are the size of the animal, the amount of exercise it will need and its likely temperament. In particular, veterinarians need to be aware of the many breed predispositions to disease so that they can answer specific questions when asked. For example, potential owners may want to know if the breed they would like to buy is prone to joint disease, skin problems or cancer.

If there is the opportunity to advise the client before they actually purchase their new pet, it should be suggested that finalising the purchase should be dependent on a satisfactory report from a veterinary surgeon. If the clinician subsequently finds a problem that could be detrimental, or have long-term financial implications, the animal then can be returned. The clinician should appreciate, however, that the majority of clients ‘bond’ very quickly with their new pet and cancelling the purchase, even after an unsatisfactory veterinary surgeon’s report, is rarely an option. Indeed, many owners will feel that they have ‘rescued’ their new pet if they felt that the breeder/supplier would not look after it properly were it to be returned, and are often prepared to invest the necessary care and finances to resolve the problems. If the animal is to be returned, treatment (especially surgical procedures) should not be instigated unless there are significant welfare issues.

The First Consultation

The pet may be presented as soon as it has been acquired, but it is often better to see the animal after it has had the chance to settle in its new home for a few days and the owner has had the opportunity to observe its behaviour and demeanour. The owners can then describe any issues of concern and may describe signs that warrant further evaluation during the clinical examination. In most cases, puppies and kittens will be presented when they are 8–10 weeks of age, at which time they require their first vaccinations.

It is always helpful if reception or nursing staff can obtain the signalment (breed, age and sex) before the clinician sees the animal. It is permissible for them not to know that the dog is a Nova Scotia Duck-Tolling Retriever and not a mongrel but, unfortunately, not the veterinary surgeon!

Many owners are worried that their newly acquired pet will be exposed to infections at the practice and this concern should be appreciated. Practice policy may include keeping kittens and puppies contained within a pet carrier, or even waiting outside the building in the car, pending their appointment. At all times, the examination room, equipment and clinician should appear to be scrupulously clean. Owners of pedigree pets should be asked about the future use of the animal, whether it is for breeding, working or simply a family pet. Owners who wish to show their animals should be advised to seek the opinion of a recognised judge of the breed, if conformation is an absolute priority. The clinician’s opinion should be confined to veterinary matters.

The clinician should check through any paperwork that the client has been given by the breeder/supplier. Often, they will have been given copies of the results of breed-related health schemes of the parents (e.g. hip scores, elbow scores, eye schemes) and this will introduce a discussion about diseases that will not be apparent at the time of the examination but may develop as that animal gets older (such as hip dysplasia, elbow dysplasia, cataracts, retinopathies, heart disease). In addition, the client is likely to have been given a diet sheet, together with advice about worming and vaccinations. This information should be checked, to make sure it is broadly consistent with practice policy. Any differences in advice should be explained to the client.

The Clinical Examination

Time taken to ensure the consultation is pleasurable for the pet will pay dividends later. Forceful restraint and painful manipulations may make the animal fearful at future visits.

The physical examination should be thorough and follow the general principles outlined in the Introduction. Particular attention should be focussed on signs of infectious and congenital disease. The limitations of the examination should be explained to the owner and the results of all parameters that have been checked (whether normal or not) must be recorded.

General Findings

Puppies and kittens should be alert, bold and inquisitive, but it should be appreciated that some individuals are naturally reserved in a strange environment. Young animals that are genuinely ill are invariably lethargic, disinterested in their surroundings and reluctant to eatCoughing (dogs) and sneezing (cats) initially should be considered as signs of an infectious diseaseDiarrhoea is common and often associated with a change in diet but if the animal has diarrhoea when purchased, this concern should be addressed as it could have an infectious cause. Diarrhoea in young cats can be frustrating to treatNeurological signs such as intention tremors, ataxia or dysmetria may or may not progress, but rarely improveBreeds that have extreme characteristics (e.g. dwarfism, hairlessness, excessive skin folds) have their own ‘in-built’ problems and these should be mentioned, so that the owner knows what to look out for/expect as the animal matures. However, it would be unwise to make disparaging remarks about the characteristics of a particular breed to the owner, because often it is the eccentricity that has attracted the owner to the breed in the first place.

The Head

The mucous membranes should be normal. Abnormalities, such as cyanosis or pallor, are serious and will be associated with other clinical signsThe mouth should be checked for cleft palates and normal primary dentition. Acceptable dental occlusion varies with the breed standards, although in most breeds maxillary prognathism (overbite) is a fault. Although malocclusions are a serious show fault, they are rarely of clinical significance for the pet animalThe eyes should be clear and bright, with no ocular discharges or epiphora. The eyelids should not show signs of entropion, which if present can lead to severe corneal damage. A degree of ectropion is a characteristic of certain breeds and would have to be deemed normal in such individuals. The nictitans should be in the correct position and there should be no deformity of its free edge. The globes and pupils should be of equal size, and there should be no signs of a strabismus or nystagmus. The identification of lens defects and retinopathies in very young animals requires considerable expertise, and it is often difficult to obtain the necessary restraint required for a thorough ophthalmoscopic examination. Rather than carry out a poor ophthalmoscopic examination, it may be preferable to outline the conditions that may exist (within the breed) and advise referral to a specialist at the appropriate ageThe ear canals should be clean and odour-free. Infestation with ear mites (Otodectes cynotis) is quite common and requires prompt treatment. The pinnae of most prick-eared dogs will not be erect until they are several months of ageThe nose should be free of discharges. The external nares are often small in brachycephalic breeds (both dogs and cats) and although this may accepted as part of the breed standard, extreme stenosis may result in respiratory problems as the animal matures.