Physical Examination of the Dog and Cat

Respiratory rate

(15-30rpm) Count respirations for 15-30sec Panting

3 P's of a PE:

**Patience Perseverance Practice ** Record your findings in medical and objective terminology Avoid writing your own opinions or potentially inflammatory statements

3 Techniques of a PE

*Inspection*: looking at the patient at a distance and up-close *Palpation*: Feeling or probing with the fingers and hands *Auscultation*: Listening to the cardiopulmonary system with a stethoscope

Hydration Assessment

<5% (Euhydrated) 5%-7% (Mild) 7%-9% (Moderate) >10% (Severe)

Feline Lymph nodes

Always palpate the 5 common lymph node sites Peripheral lymphadenopathy is not as common in cats (reactive, inflammatory)

Physical examination

nose to tail exam Follow a fixed routine on every patient, every time Use the least amount of restraint possible Socialize yourself with the animal prior to beginning the exam Begin at the head and move caudally, ending at the tail Use all of your senses: Tactile, visual, auditory, olfactory

Eyes

Asses eyes for size, position, discharge Abnormalities: Squinting, corneal clouding, uneven pupil size, redness, inflammation, entropion/ectropion, conjunctivitis

CRT (capillary refill time)

Assesses peripheral blood flow (tissue perfusion) When an area of the gum is pressed, blood is forces out of the capillaries; When the pressure is released, the blood should almost immediately refill the capillaries Press on the dog's gums with a finger, and then release the pressure and observe how long (in seconds) the area takes to refill with blood The normal CRT for a healthy dog is less than 2 seconds Record the CRT as either 1 or 2 seconds in the record A prolonged CRT indicates that the blood is not flowing adequately to peripheral tissues

Where does the PE start?

At the head

Auscultation Techniques

Auscultation should be performed in a QUIET environment Use an appropriate sized diaphragm of the stethoscope **Listen to as many "normal" animals as you can** Listen to overall lung sounds first, then focus on heart sounds -Check for pulse deficit Listen to the larynx and trachea

>10% (Severe)

Considerable skin turgor loss Dry oral mucous membranes Tachycardia with weak pulses Hypotension Enophthalmus

Heart Rate

Dogs (60-160) Count beats for 30 sex (x2); 15sec (x4) Palpate pulse at the same time but take pulse rate separately Record HR (not both)

Mouth and Pharynx

Elevate the upper lip and examine the teeth and gums Observe the teeth for tartar and broken or cracked teeth; Gingivitis, masses Observe the mucous membrane color and perform a "capillary refill time" (CRT) Note mucous membrane color (MMC) Evaluate the gingival surfaces and the hard and soft palate

Cardiac Auscultation

Evaluate the heart rate, rhythm and sounds Apex: point of maximal intensity of heart sounds in "most dogs" Located between 4' and 6' intercostal space

Examine palates

Examine the hard and soft palate for erosions, masses, or altered color of the mucous membranes In dogs, place your dominant index finger on the base of the tongue and pull it forward to evaluate the pharynx, larynx, and tonsils

Mass Description

Found during palpation/insection Masses palpated should be described by: -location -size -shape -Consistency -Presence of pain and mobility

Ears

Gently pull the pinna upward and examine the upward and examine the external ear canals for debris, inflammation, masses, and odors - yeast infections tend to produce a distinct odor -Purulent material or ulcers in the ear canal tend to cause a strong, foul, putrid odor If the ears are painful or if a more thorough otic examination is needed, the animals may require sedation

Opening a cat's mouth

Hold the head by the zygomatic arches and pull down the lower jaw, keeping your finger on the midline over the incisors Use the middle finger of the hand on the lower jaw to push up on the intermandibular space which will elevate the underside of the tongue

History

Includes environment, diet, medical history, reproductive history, vaccination status, current medications Description and history of presenting complaint Be sure to follow up with questions for clarification Helpful to have a checklist

Abdomen/Trunk

Inspection and palpate the trunk of the body for symmetry, masses, pain Examine skin and hair coat for ectoparasites, masses, abrasions, dry skin, matting Palpate vertebral column for pain/deviations Palpate ventral abdomen and indicate if tense, tender or painful; Begin behind the ribs and gently press hands into the belly moving caudally Inspect the ventral abdomen for abnormalities such as abdominal distention or bruising Inguinal lymph nodes should not be palpable

Lymph nodes

Mandibular Pre-scapular Axillary Inguinal Popliteal

5%-7% (Mild)

Mild dry oral mucous membranes (tacky) Minimal skin turgor loss

7%-9% (Moderate)

Mild to moderate decrease in skin turgor Dry oral mucous membranes Weak/rapid pulses

Head and Neck Anatomy of the Dog

Nasal Cavity Hard palate Soft palate Tonsil Epiglottis Larynx Esophagus Trachea tongue

General appearance/initial observations

Note any asymmetry; differences in extremities Body condition *Mentation* (level of attentiveness/reaction to environment)- BAR,QAR,depressed,stuporous/dull, moribund *Posture/gait*: limping, ataxic/unsteadiness, circling, abnormal limb placement *Hydration status*

PE of Eyes

Observe the eyes and eyelids and not any ocular discharges: -Unilateral vs. bilateral; type of discharge -clear, colored? Dry: Purulent? Size and shape of each eye Palpebral fissures should be equal Conjunctiva is normally a pale pink Sclera is normally shiny white Corneas should be clear Nictitating membrane

Inspection Techniques of a PE

Observe the patient on entrance into the examination room, on the floor or table, and BEFORE the exam begins. Some animals are better behaved with the owner out of the exam room -Assess your patients individually -Least amount of stress

Hind Limbs

Palpate each leg and joint with the dog in a standing position Palpate all of the joints starting distally for pain, swelling, and range of motion Limping?: check paws and nailes The popliteal lymph nodes are usually palpable-check for symmetry

Neck

Palpate for conformation, muscle symmetry, pain, skin lesions and masses Palpate the larynx and trachea -A very slight cough on palpation is probably ok, but a retch, loud or prolonged cough, or gag is abnormal -Note size of trachea The thyroid gland should NOT be palpable

Pelvis and Spine

Palpate the ilium, ischium, and greater trochanter for pain, swelling, and masses Palpate over each dorsal spinous process of the vertebral column Note pain, muscle mass, symmetry, and sensitivity

Palpation Techniques

Palpation is the use of the tactile sense Direct palpate uses the finger tips to the surface of the animals body -Allow tie for the animal to become accustomed to your touch

Why is it so important for my pet to have a semi-annual physical examination

Pets age faster than we do. Therefore, one year in the life of a companion animal can be anywhere from 5-7 years as compared to a human In pets, many small, yet detrimental changes can occur from one year to the next. These subtle changes often go unnoticed until the condition gets worse or becomes life-threatening

<5% (Euhydrated)

Possible history of fluid loss but normal on physical exam (no clinical signs)

Capillary Refill Time (CRT)

Press and release finger tip to mucous membrane (i.e.the gums)- the area will "blanch" white Count how many seconds it takes for blood return (white to pink) 1-2 seconds is normal

Recorded Objective Observations

Record objective data in the medical record Objective data is measurable in units Rectal temperature Body weight in lbs or kgs Heart rate (HR) & pulse rate Respiratory rate Capillary refill time (CRT)

Thorax/thoracic spine

Run your hand down the mid portion of the back to check the spine, and also palpate both sides of the thoracic wall and ribs Check for masses, pain, symmetry, conformation Evaluate skin and hair coat Check the skin elasticity

PE of the Cat

Same approach as in a dog Nose to tail Consistency Less is more in most cats during a PE Work quickly and efficiently

Physical Exam process

Signalment History General appearance/initial observations Vital signs Physical examination

Assess Hydration

Skin tent Mucous Membrane moisture Sunken eyes

Signalment

Species, breed, age, sex, reproductive status Verify information (medical record, client reported information) Canine, 7 yr. old MN Collie Feline, 11 yr. old FS DSH

PE of the Head and Neck

Start the PE at the head by observing the nares and nose for symmetry, conformation and discharges: abrasions, swelling

Subjective Observations

Subjective data is information for which you make a judgment or observation not assessed as accurately Examples include: -Heart sounds and rhythm *should listen for at least 30 seconds when assessing cardiac sounds and rhythm Mucous membrane color Hydration status (mucous membrane texture, eyes, and skin turgor) Body condition score

Shoulders and Forelimbs

The forelimbs should be palpates for symmetry, evidence of pain, skin lesions, and masses Starting distally and working proximally, all of the joints of the forelimbs should be palpated for swelling, pain and range of motion Pay attention to the musculature of each forelimb and always compare to the other side the pre-scapular lymph nodes (located cranial and dorsal to the shoulder joints) should not be palpable normally The axillary lymph nodes are not normally palpable Note the condition of the feet, paw pads, nails

Salivary Glands and Lymph Nodes

The mandibular salivary glands are normal palpable They are located at the base of each ear at the angle of the jaw The salivary glands are firm, smooth, and large as compared to the mandibular lymph nodes (grape:pea ratio)

Physical Examination

The physical examination should be done systematically so that the process is consistent between patients and important clinical variable are not over-looked Start at the head and work toward the tail, always thinking about the various body components such as integumentary, musculoskeletal, cardiovascular, respiratory, abdominal, and genitourinary systems

Tonsils in the Canine

There are two tonsils located in the back of the throat When they are normal, they are not easily seen because they reside in crypts or pouches Swollen, red tonsils that are out of their crypts are easily seen in the back of the throat= abnormal finding

Classify nasal discharge as:

Unilateral or bilateral Serous/Serosanguineous Purulent Hemorrhagic/epistaxis Mucoid Mucopurulent (containing mucus+ purulent material)

Feline objective Data

Weight Temperature: 100.5F-102.5F Heart Rate: 110-180b/m Count for 5-10 seconds Respiratory rate and quality 20-30rpm CRT

Vital signs

Weight temperature heart rate respiratory rate and quality pulses MMC CRT