General Session

Dr. Robert Darlington, Presiding

THE CLINICAL EXAMINATION OF CATTLE Part 1: The Examination of the Individual Animal

O. M. Radostits, D.V.M. Department of Veterinary Clinical Studies, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

The most common reason for the clinical examination of abnormalities which are not readily obvious are ma3or the individual animal is to make a clinical diagnosis so that causes of misdiagnosis. effective treatment can be given and control procedures 3. Incorrect interpretation of the clinical findings. A instituted. knowledge of the pathophysiology of systemic medicine is necessary to accurately interpret abnormalities. The clinical examination of the individual animal must be 0 "'O rapid, complete, economical and highly accurate. However, 4. Failure to consider all of the diagnostic possibilities. (D a thorough examination may take considerable time and re­ This is becoming a major problem because of the ever ~ ~ examination of an individual animal may be necessary in increasing number of possibilities generated by the (") (D order to make a diagnosis. "More mistakes are made for not recognition and description of diseases. 00 looking than for not knowing". When diagnosis is not obvious, a systematic clinical 00 0...... 00 The individual cow is relatively easy to examine because examination is necessary in order to achieve a high degree of ,-+- '"i the body systems which are most commonly affected are accuracy. ~ easily accessible. The digestive tract, the reproductive A complete clinical examination consists of four parts: ~...... organs, the urinary tract, the musculoskeletal system, the 1. Taking the History. On the initial visit the history 0p respiratory tract and the skin can be easily examined in the taken should be as complete as possible. Incomplete field. In recumbent cattle, a complete reliable neurological histories commonly lead to misinterpretation of clinical examination may be difficult, but a sufficient examination is findings. possible in most cases. 2. Examination of the Environment (including the This paper outlines a systematic method of clinical remainder of the herd). The immediate environment of the examination which will yield the most useful information animal may provide clues about the diagnosis. necessary to make an etiologically specific diagnosis. The 3. The Actual Clinical Examination. The clinical challenge is to examine a sick cow and detect and interpret examination consists of a general body inspection and a the clinically significant abnormalities and to make a detailed examination of each body system. diagnosis. Some details are provided on the examination of 4. The Use of the Laboratory. The laboratory should be some selected body systems. used as much as necessary to support or exclude the tentative The problems associated with the clinical examination clinical diagnoses. The laboratory will often provide and making a diagnosis include: important information which will direct the veterinarian to 1. Preconceived ideas about the diagnosis. Experienced re-examine certain body systems in order to detect veterinarians tend to make a diagnosis based on the significant abnormalities which were not obvious on initial recognition of a few reliable epidemiological and clinical examination of the animal. An example is the presence of a findings. leucopenia, neutropenia and a degenerative left shift in a 2. Incomplete history and incomplete clinical cow with sudden anorexia due to peritonitis which is not examination. An incomplete history and failure to detect the readily obvious,

2 THE BOVINE PROCEEDINGS-No. 14 A Complete Clinical Examination Figure l. Clinical Examination and Making a Diaonosis

GENERAL PHYSICAL EXAMINATION determines Step l for detection of clinically !--'} ABNORMALITY OF significant abnonnalities FUNCTION PRESENT I I 1. I History Examination of Physical Laboratory Environment Examination SPECIAL EXAMINATION OF determines Step 2 SUSPECT SYSTEMS OR ORGANS SYSTEM OR ORGAN physical and laboratory 1----.:i INVOLVED or body as a whole Detection of Significant Abnormalities

SPECIAL EXAMINATION OF determines In terp.ltation IDENTIFIED SYSTEM LOCATION OF LESION Step 3 e.g., exp loratory I~ laparotomy, endoscopy, in system or organ I radiography Diagnosis

ProJosis SPECIAL EXAMINATION OF LESION, e.g . , biopsy, determines Step 4 response to treatment, ~ TYPE OF LESION examination of fluids

The steps involved in the clinical examination of an animal in order to make a diagnosis appear in Figure I. An example follows: SPECIAL EXAMINATION OF SPECIMENS, e.g., blood, determines 1. Detection ofthe clinically significant abnormalities of Step 5 urine, feed or soil SPECIFIC CAUSE OF samples, by chemical, I-----> LESION function present in the animal. Example: Dyspnea, toxemia microbiological, and fever in a recently weaned beef calf 6 months of age. parasitological means 0 2. Determination of the body system or body as a whole '"O (D which is involved. Example: Dyspnea in the weaned calf ~ Stomach tube and pump Needles and syringes for suggests involvement of the respiratory tract. ~ Wide range paracen tes is ('") 3. Determination of the location of the lesion within the (D (l-11) pH paper 00 body system. Example: The presence of abnormal lung Spinal needles 00 Lalistix (for urinalysis) Hemetest tablets 0...... sounds on of the thorax indicates the presence 00 ,-+- of lesions in the lung. '"i The Methods of Clinical Examination include the following: ~ 4. Determination of the type of lesion. Example: The Audiovisual Inspection ~...... fever, toxemia and moist rales indicate an acute bacterial 0 Palpation bronchopneumonia. p 5. Determination of the specific cause of the lesion. Ballottement Example: Isolation of Past. hemolytica by sampling the Auscultation secretions of the nasal cavities and transtracheal aspiration Combined Auscultation and Percussion reveals the specific cause of the pneumonia. Special Diagnostic Techniques (paracentesis, An etiologically specific diagnosis is the net result of the cerebrospinal fluid, examination of ruminal fluid) consideration of many diagnostic possibilities. This is illustrated in Figure 2. For example, there are many different The Clinical Examination. The actual clinical examination causes of dyspnea in cattle. A careful clinical examination is consists of a: necessary to detect other possible abnormalities which may A. General inspection of body regions indicate that the dyspnea is due to causes other than disease B. Close physical examination of each body system of the respiratory tract. A. General Inspection (this is done from a distance by audio­ The equipment needed for a complete field clinical visual inspection). examination is not expensive and includes the following: a) Behaviour and general appearance Thermometer Rectal palpation sleeve behaviour posture Strip cut voice gait Flashlight CMT and paddle eating bodily condition Pleximeter and plexor Hoof knife defecation conformation Oral speculum Ophthalmoscope urination skin and hair coat

APRIL, 1982 3 b) Inspection of body palpable thrills may on occasion be of more value than regions auscultation of murmurs. It is best carried out with the palm Head (face, eyes, ears, nostrils) of the hand and should be performed on both sides. An Neck Uugular vein, brisket) increased cardiac impulse, the movements of the heart Thorax: Respirations against the chest wall during systole, may be easily seen on Rate close inspection of the left precordium and can be felt on Rhythm (inspiratory, expiratory) both sides. It may be due to cardiac hypertrophy or dilation Depth (shallow or deep) associated with cardiac insufficiency or anemia or to Type (abdominal or thoracic) distension of the pericardia! sac with edema or inflammatory Noises (coughing, sneezing, wheezing, fluid. Care should be taken not to confuse a readily palpable , grunting) cardiac impulse due to cardiac enlargement with one due to Abdomen: Contour contraction of lung tissue and increased exposure of the Distended heart to the chest wall. Normally the heart movements can Gaunt be felt as distinct systolic and diastolic thumps. These Symmetry thumps are replaced by thrills when valvular insufficiencies External Genitalia or stenoses or congential defects are present. When the Mammary Gland defects are large the murmur heard on auscultation may not Limbs be very loud, but the thrill is readily palpable. Early pericarditis may also produce a friction thrill. The cardiac impulse should be much stronger on the left than the right Figure 2. Schematic illustration of the large number of diagnoses which are possible when presented with an animal with a side and reversal of this situation indicates displacement of ~ly siqnificant abnomality, i.e., dysenea the heart to the right side. Caudal or anterior displacement can also occur. In auscultation of the heart the points to be noted are the i rate, rhythm, intensity and quality of sounds and whether Dia(Jnostic abnormal sounds are present. Comparison of the heart and Possibilities Final Diagnosis C pulse rates will determine whether ther is a pulse deficit due J to weak heart contractions failing to cause palpable pulse B 0 "'O waves: this is most likely to occur in irregular hearts. (D Normally the rhythm is in three time and can be described as ~ ~ LUBB-DUPP-pause, the first sound being dull, deep, long ('") (D and loud and the second sound sharper and shorter. As the 00 B. The Close Physical Examination (all methods of heart rate increases the cycle becomes shortened mainly at 00 0...... 00 examination are used) the expense of diastole and the rhythm assume a two-time ,-+- Begin the examination at the rear end of the cow. A urine '"i quality. More than two sounds per cycle is classified as a ~ sample is usually easily obtained by stroking the cow's vulva "gallop"rhythm and may be due to reduplication of either ~...... before other examinations are made. Next, the cow's rectal the first or second sounds. Reduplication of the first sound is 0p temperature should be taken. During the recording of the common in normal cattle. The rhythm between successive rectal temperature the vulvar mucous membranes may be cycles should be regular except in the normal sinus examined for color and presence of discharges and/ or arrhythmia associated with respiration. With irregularity lesions. The pulse rate is counted and the quality of pulse is there is usually variation in the time intervals between cycles assessed using the middle coccygeal artery of the tail at about and in the intensity of the sounds, louder sounds coming the level of the tip of the vulva. The hair coat and skin may be directly after prolonged pauses and softer than normal assessed at this time for evidence of dehydration, loss of hair sounds after shortened intervals as in extrasystolic and skin lesions. The area over the tail head and the perinea! contractions. The intensity of the heart sounds may vary in region should be noted for any evidence of mange. The two ways, absolutely or relatively: absolutely when the two amount and nature of feces should be noted at this time and sounds are louder than normal and relatively when one any abnormalities should be further investigated by sound is increased compared to the other in the cycle. For obtaining more history. example, there is increased absolute intensity in anemia and The animal is then examined on the left side in the in cardiac hypertrophy. The intensity of the first sound following systematic manner. depends on the force of ventricular conraction and is thus I. Examination of the thorax includes palpation, increased in ventricular hypertrophy and decreased in auscultation and percussion of the cardiac area myocardial asthenia. The intensity of the second sound (precordium) and the lung area. depends upon the semilunar closure, that is on the arterial Cardiac area. Palpation of the heart action has real blood pressure and is, therefore, increased when the blood value, the size of the cardiac impulses can be assessed and pressure is high and decreased when the pressure is low.

4 THE BOVINE PROCEEDINGS-No. 14 Abnormal sounds may replace one or both of the normal there is no exudate in the bronchi, such as occurs in sounds or may accompany them. The heart sounds are interstitial pneumonia, the area over which bronchial tones muffled when the pericardia! sac is distended with fluid. may be heard is much increased. Sounds which are related to events in the cardiac cycle are Alterations in the vesicular murmur and bronchial tones murmurs or bruits and are caused mainly by endocardial are the most common abnormalities which are audible on lesions such as valvular vegetation or adhesions, auscultation of the lung area in animals with disease of the insufficiency of closure of valves and to abnormal orifices lower respiratory tract. Other abnormal sounds over the such as a patent interventricular septum or ductus lung area include rhonchi, rales, friction rubs and loud arteriosus. Interference with normal blood flow causes the crackling sounds. They are the result of interference with the development of turbulence with resultant eddying and the free movement of air in and out of the lungs, and of the creation of murmurs. In attempting to determine the site and presence of lesions which interfere with the normal type of lesion it is necessary to identify its time of occurrence movement of the lung and thus create additional respiratory in the cardiac cycle; it may be presystolic, systolic or diastolic sounds which are an indication of disease. The narrowing of and it is usually necessary to palpate the arterial pulse and the lumen of the tracheo bronchial tree will result in sounds auscultate the heart simultaneously to determine accurately which have a musical quality (rhonchi or dry rales). The the time of occurrence. The site of maximum audibility may presence of fluid or exudate in the lumen of the indicate the probable site of the lesion, but other tracheobronchial tree will result in coarse, medium or fine observations including abnormalities of the arterial pulse rales or crepitant sounds due to movement of inspired or wave should be taken into account. In many cases of expired air through the fluid. The presence of air in the advanced debitity, anemia and toxemia soft murmurs which interstitial spaces, due to rupture of alveoli, will result in wax and wane with respiration (hemic murmurs) can be loud crackling sounds. The rubbing together of abnormal heard and are probably due to myocardial asthemia. In cases visceral and parietal pleural surfaces as in pleuritis or severe of local pressure on the heart by other organs, for example in emphysema with over-inflation of the lung will result in a diaphragmatic hernia in cattle, loud systolic murmurs may pleuritic friction rub. be heard, due probably to distortion of the valvular orifices. There is considerable variation in the decriptions of the Abnormal sounds not related to the cardiac cycle include characterisitics and the interpretations of the significance of pericardia! friction rubs which occur with each heart cycle abnormal lung sounds (Table I). but are not specifically related to either systolic or diastolicc The intensity of abnormal lung sounds may be increased 0 "'O sounds. They are more superficial, more distinctly heard and their clarity improved by measuring the rate and depth (D than murmurs and have a to-and-fro character. Local of respirations with forced mild exercise such as walking for ~ pleuritic friction rubs may be confused with pericardia! a few minutes followed by immediate auscultation. If ~ ('") (D sounds especially if respiratory and cardiac rates are equal. exercise is undersirable the occlusion of both nostrils for 30 00 Lung area. Palpation, percussion and auscultation are to 45 seconds will be followed by some deep inspirations and 00 0...... accentuation of abnormal lungs. This can also be 00 again the methods available for examination of the lung ,-+- area. Palpation may reveal the presence of a pleuritic thrill, accomplished by placing a plastic bag over the animal's head '"i ~ bulging of the intercostal spaces when fluid is present in the for up to 2-3 minutes. This will result in and ~...... thoracic cavity, or narrowed intercostal spaces and accentuation of abnormal lung sounds. 0p decreased rib movement over areas of collapsed lung. Sounds of peristalsis are normally heard over the lung The lung area available for satisfactory auscultation is area on the left side. In cattle these sounds are due to slightly larger than that available for percussion. The normal reticular movement. In cattle, too, sounds of swallowing, lung sound or vesicular murmur is heard over the bulk of belching and regurgitation may be confused with peristaltic lung tissue, particularly in the middle third anteriorly over sounds; ruminal movements and the esophagus should be the base of the lung and is a soft, sipping VEE-EFF, the observed for the passage of gas or a bqJus to identify these latter, softer sound occurring at expiration. The sounds are sounds. -·.. -: caused by the movement of air in and out of alveoli and are Percussion may be the usual direct means, or indirectly by heard with variable ease depending on the thickness of the tracheal percussion when the trachea is tapped gently and chest wall and the amplitude of the respiratory excursion. In the sound liste~ed for over the lung area. By direct fat beef cattle the sounds may not be discernible at rest. percussion within..the intercostal spaces the area of normal Increased vesicular murmurs are heard in dyspnoea and in lung resonance can be defined and abnormal dullness or early pulmonary congestion and inflammation. The resonance detected. Increased dullness may indicate the vesicular murmur may be diminished or absent when the presence of a space-occupying mass, consolidated lung, alveoli and ,small bronchi are not filling with air, as in the edematous lung or an accumulation of fluid. An overloud later stages of pneumonia, and collapse. normal percussion note is obtained over tissue containing Bronchial tones are the sounds produced by the passage of more air than usual, for example emphysematous lung. A air through the larger air passages and in normal animals are definite tympanitic note can be elicited over pneumothorax audible only at the base of the lung. If the lung is collapsed or a gas-filled viscus penetrating though_ a diaphragmatic

APRIL, 1982 5 Table 1. Identification and Cllnlcal Significance of

Lung Sound Identifying Characteristics Significance

Increased vesicular Increased amplitude of vesicular Occurs in fever, after sounds sounds, audible with ease, heard exercise, high on expiration and inspiration environmental temperature, early pneumonia

Decreased vesicular Decreased amplitude of vesicular Any disease resulting sounds sounds, audible on early in decreased volume of inspiration not on expiration, alveolar space difficult to hear (pneumonia, pulmonary edema, and/or fluid accumulation in pleural cavity)

Increased bronchial Increased amplitude of Any disease resulting tones bronchial breath sounds, begin in collapse or filling and end abruptly, on of alveolar spaces and inspiration and expiration leaving bronchial lumen open. Suggests consolidation. Heard commonly in cattle with severe pneumonia and

calves with enzootic 0 "'O pneumonia (D ~ ~ ('") Rhonchus Continuous musical type humming, Originate in the lumen (D 00 (dry rales) whistling, squeaking and of the tracheobronchial 00 0...... wheezing, which occur primarily tree, resulting from 00 ,-+- on expiration although they narrowing, mucosal '"i frequently are heard during irregularities or thick ~ ~...... both inspiration and expiration tenacious exudate all 0 of which produce p turbulence and eddy formation . Sonorous rhonchi originate in the large bronchi and are low-pitched. Sibilant rhonchi originate in the smaller bronchi and are high­ pitched. Sonorous rhonchi suggests chronic , sibilant ronchi are common jin chronic exudative pneumonia with small amounts of tenacious exudate in the bronchioles

6 THE BOVINE PROCEEDINGS---No. 14 Table 1 continued

Lung sound Identifying Characteristics Significance (Q) n 0 Expiratory '"a Loud groaning and grunting on Severe diffuse pulmonary '-< grunting expiration which is usually emphysema, extensive ...... '"i (JQ ~ forced and against a partially consolidation, severe ..-+- closed glottis with sudden , acute > release, audible on auscultation peritonitis (D8 ...... '"i of the thorax, over the trachea (") ~ and often audible without the ~ aid of a stethoscope 00> 00 0 (")...... a...... Coarse rales Coarse, bubbling, moist sounds Suggest the presence of 0 primarily on inspiration. movable exudate in the ~ 0 Coarse rales are easily moved large bronchi and 1-i; to by coughing trachea. Heard in 0 exudative pneumonia, <...... ~ exudative trachea- (D ~ bronchitis, aspiration '"i ~ pneumonia (") ..-+-...... -+-...... 0 ~ (D '"i Fine rales Fine crackling sizzling sounds Suggest the presence of 00 (crepitant or on inspiration exudate in the terminal 0 '"a crackling rales) bronchioles. Also occur (D ~ when collapsed bronchi ~ (") are di lated by the (") (D 00 passage of air as in 00 early pneumonia and 0...... 00 emphysema ..-+- ...... '"i cr' I= ..-+-...... 0 Loud crackling Harsh crackling sound on Suggests alveolar and p breath sounds inspiration and expiration interstitial emphysema. especially in cattle

Pleuritic friction 'Sand Papery' rather than Pleuritis, diffuse rubs crackling. Dry, grating, sound pulmonary emphysema close to the surface, on with a dry pleural inspiration-expiration, tend to surface. Diminish or be jerky and not influenced by disappear with pleural coughing effusion

Peristaltic Intermittent gurgling sounds Are normal, especially sounds after eating. Do not indicate diaphragmatic hernia unless other signs are present

APRIL, 1982 7 Table 1 continued

Lung sound Identifying Characteristics Significance

Absence of lung Loud sounds not audible with Bronchial lumen filled sounds (both carefu I auscultation with exudate, space­ vesicular and occupying mass, bronchial) diaphragmatic hernia, pleural effusion

Laryngeal Loud stenotic sounds on Suggests obstruction stertor inspiration audible with or of the larynx (due to without stethoscope over the edema, laryngitis, trachea paralysis of vocal cord). Prime example is calf diphtheria

hernia. For percussion to be a satisfactory diagnostic aid paralumbar fossa. The character and magnitude of the affected areas need to be large with maximum abnormality, bubbling sounds are noted at the level of the fossa. The and the chest wall must be t}:J.in. examiner then auscultates over the area where the ping, 2. Palpate the left neck, jugular groove and left suspected to be due to the displaced abomasum, is loudest. If prescapular lymph node. the abomasum is displaced, the bubbling sounds from the 0 tube are much reduced in intensity. If the abomasum is not "'O 3. Examine the left paralumbar fossa and abdomen. (D (a) rumen displaced, the intensity of the sounds at both sites is about ~ the same. ~ Visual inspection. Can you see the rumen pack? (") 4. Palpate the left prefemoral lymph node before leaving (D Is the fossa distended due to ruminal tympany 00 or a displaced abomasum? the left side. Then examine the right side of the cow which 00 0...... includes the following: 00 palpation. Can you palpate the rumen pack? ..-+­ I. Examination of the thorax (already described for the '"i auscultation. Listen for the ruminal movements ~ left side). for at least 3 minutes. Identify primary and ~...... 2. Palpation of the right neck, jugular groove and right 0 secondary contraction of the rumen. p prescapsular lymph node. Percussion and auscultation to detect a pmg 3. Examination of the right paralumbar fossa and associated with an atonic rumen or abdomen: pneumoperitoneum. Deep palpation and ballottement for distended (b) Left-sided displacement of the abomasum viscera, gravid uterus and enlarged liver. Auscultate for the spontaneous percolating and Auscultation and percussion for the presence of tinkling sounds associated with a displaced "pings" associated with the following: abomasum. • Cecal dilation and torsion Auscultate and percuss between the 9th and 12th • A bomasal dilatation and torsion rib for evidence of a high-pitched ping associated • Intestinal tympany due to paralytic ileus or with a displaced abomasum. acute intestinal obstruction. Auscultate over the paralumbar fossa and then • Pneumoperitoneum following a laparotomy over area where the abomasum is commonly • Presence of post-partum pings displaced to detect the presence or absence of ruminal sounds. Detection of Abdominal Pain The stomach tube test may be useful to differentiate Cattle with acute local or diffuse peritonitis may grunt between an atonic rumen and aleft-side displacement of the with almost every expiration. The grunt is exaggerated in the abomasum, in both of which there is a "ping" on percussion. recumbent position. However, grunting may also be caused The tube is passed into the rumen and an assistant blows on by severe pneumonia, pleurisy and severe pulmonary the tube while the examiner auscultates over the left emphysema. Careful auscultation and percussion of the

8 THE BOVINE PROCEEDINGS-No. 14 Give new feeders superior' ■ protection> ■ against■ ·. Baemoglailus som11us.

7215-21 HAEMOPHILUS SOMNUS­ PASTEURELLA liAEMOLYTICA· MULTOCIDA BACTERIN

0 animals~ Both the H. somnus portion Somubac [;)TM and the combined portions of Somubac-P provided greater immunity against H. contains three different somn us than another commercial H. H. somnus strains for somnus bacterin. When your new feeders arrive, give broader immunity. them Somubac-P for superior protec­ tion against H. somnus. Your veterinarian You know how H. somnus could cripple superior protection, consider the com­ has it in stock or can get it for you. your feeder operation. You also need plexity of Haemophilus somnus. Scien­ *Data on file at Beecham Laboratories and the U.S.D.A. The to know what bacterin offers superior tists have identified three different correlation between standardized mouse potency tests and protection against it. Somubac-P is a com­ strains, any one of which can cause the clinical results in cattle has not been clearly established. bination product which gives greater disease in varying forms. immunity against three types of H. som­ Somubac-P contains all three of these Beecham nus, plus Pasteurella haemolytica, Type 1 killed H. somnus strains. Its superior Biologicals and Pasteurella multocida, Type A. protection has been demonstrated in l\/laking the world a safer place. To understand how Somubac-P provides carefully controlled tests in laboratory BEECHAM LABORATORIES. DIV. OF BEECHAM INC . BRISTOL. TN 376 20

,1,;'·\JC.~ ~QUALITY, The Mark Of A Licensed Vaccine

©1981, Beecham Lab., Div. of Beecham Inc. lungs is therefore necessary to exclude the presence of • Fibrinous adhesions of the caudal abdomen pulmonary disease. • Abnormalities of the reproductive tract, bony Not all grunts occur spontaneously. Deep palpatation of skeleton, lymph nodes and bladder the abdomen using the closed hand or knee is often necessary For purposes of recording, the presence of abnormalities to elicit a grunt. Auscultation over the trachea is often palpable on rectal examination of the abdomen can be necessary to hear the grunt. The grunt is best produced if divided, as viewed from the rear of the cow, into 4 quadrants: pressure is applied to the abdomen at the end of inspiration upper and lower left and upper and lower right quadrants. and the beginning of expiration. The inspiratory and The examination of the genito-urinary system includes expiratory sounds are ausculated for 6 to 8 respirations and visual inspection of the vulvar mucous membranes and then without any particular warning the pressure is applied palpation of the vagina, cervix, uterus, bladder, ureters and to the abdomen. The presence of a grunt means the presence kideneys through the vagina and by rectal of a peritoneal lesion (stretching, inflammation, edema). palpation. Examination of the oral cavity includes visual The absence of a grunt does not exclude the presence of a inspection of the mucous membranes for the presence of peritoneal lesion. In acute traumatic reticuloperitonitis the lesions. It is important to be able to distinguish between grunt may be absent in 3 to 5 days after the initial erosions, vesicles, ulcers and proliferative lesions. By using a penetration of the reticulum. simple mol;lth gag or by exteriorizing the tongue and with a A rigid bar or wooden pole may .be necessary to apply strong flashlight it is possible to examine all aspects of the pressure in large cattle (large cows and bulls). The bar is held oral cavity which includes the state of the tongue, the by two people in a horizontal position just behind the pharynx and the larynx. The larynx may be examined in xiphoid sternum while a third person auscultates over the detail by the use of a long, cylindrical plastic vaginal trachea when the bar is lifted quickly up into the abdomen. speculum and a strong flashlight. Several attempts should be made to elicit a grunt before Examination of the eyes and eyesight include the concluding the absence of a grunt. The ventral and both following: sides of the abdomen should be examined beginning at the 1. The menace reflex or blink reflex is done by thrusting level of the xiphoid sternum and moving caudally to a point the partially flexed hand in front of the animal's eye and caudal to the umbilicus. In this way the anterior and caudal observing the closure of the eyelids. This is an excellent test aspects of the abdomen will be examined for evidence of for the presence of blindness in cattle. painful points. 2. The pupillary light reflex is conducted with a strong 0 "'O Pinching of the withers is also used to elicit a grunt. In the flashlight. (D ~ average sized cow, pinching of the withers causes the animal 3. The state of the cornea, sclera, pupil and anterior ~ to depress its back. In an animal with an inflammatory lesion ('") chamber of the eye can be examined with a direct light (D 00 of the peritoneum, depression of its back will commonly source. 00 result in a grunt which may be audible without auscultation 4. The fundus of the eyes should be examined with an 0...... 00 ,-+- over the trachea, but auscultation will usually be necessary. ophthalmoscope. The common lesions of the fundus of the '"i Rectal Examination eyes of cattle include: optic disc edema in vitamin A ~ A rectal examination is indicated when abnormalities of deficiency, Polioencephalomalacia and lead poisoning and ~...... 0 the abdomen are detected by physical examination of the other diseases which cause increased intracranial pressure, p abdomen or when the diagnosis is not obvious. The and the hemorrhagic retinal lesions associated with following observations should be made: H emophilus meningoencephalitis. 1. The amount and nature offeces and the presence of Examination of the musculoskeletal system includes the blood in the rectum following: 2. The condition of the rectal wall. Is the animal able to walk and stand normally? Is the animal 3. The structures which are palpable in their normal recumbent and unable to stand? The muscles, bones, joints, state include the following: the caudal sacs of the rumen, the ligaments and tendons and feet are examined by visual left kidney, the deep inguinal lymph nodes, the uterus and inspection and palpation. Arthrocentesis of joints to obtain the bladder. Under normal conditions the small and large joint fluid for laboratory examination is indicated when the intestines, the abomasum and omasum, and the liver cannot joints are enlarged. be palpated. · Examination of the nervous system is a major subject The fallowing are commonly palpable when abnormal: which will not be presented here, but a detailed neurological • A dilated and distended cecum examination, when necessary, includes examination of the • Intestinal tympany - primary or secondary (distended following: loops of small or large intestine) • Distended abomasum and/ or omasum 1. The gait • Intussusception 2. The cranial nerves • An enlarged liver 3. The spinal reflexes • An enlarged kidney and ureters 4. Examination of the cerebrospinal fluid

10 THE BOVINE PROCEEDINGS-No. 14 Examination of the mammary gland includes physical both inflammatory and space-occupying, abscesses in the palpation of the udder for presence of enlargement of the spinal cord or lung are typical examples. In these quarters, increased or decreased temperature and firmness. circumstances it is necessary to modify the diagnosis and say The skin of the teats, the teat cistern and the streak canal and that such and such a lesion is space-occupying and may or teat end must also be examined. Milk samples are examined may not be inflammatory. using a strip cut with a strip plate for any gross evidence of The differentiation between functional disturbances and water milk, clots, purulent material or clumps of cells which physical lesions is often extremely difficult because the are barely visible to the naked eye as may be seen in coliform abnormalities produced may be identical. For example, in a mastitis. The California Mastitis Test is used for indirect case of hypomagnesemia in a cow there is no physical lesion, examination of the total number of cells in the milk from but differentiation from the encephalitis of furious rabies each quarter. Suitable milk samples may be taken for culture may be impossible. As a rule, functional disturbances are of mastitis pathogens. transient, often recurring or fluctuating and are readily Simple Diagnostic Tests reversible by treatment, whereas structural lesions cause Several simple diagnostic tests can be done in the field to changes which are relatively static or at least change only supplement the physical examination of certain body gradually and are affected only gradually by treatment. This systems: is by no means a regular rule; the acute abdominal pain of I. Paracentesis (abdomen, thorax, pericardium and intestinal obstruction usually fluctuates, but the lesion is a other swellings). This is very useful for the diagnosis of physical one whereas the paralysis of parturient paresis of peritonitis, pleuritis, pericarditis and cellulitis. cattle is static, but the disturbance is functional only. 2. Rumen juice. Examine the rumen juice for pH and Differentiation between inflammatory, degenerative and protozoan activity. space-occupying lesions is usually simple. Space-occupying 3. Urine. Gross examination for the presence of red lesions produce signs characteristic of pressure on blood cells, turbid and cloudy material, or hemoglobin. surrounding organs and can often be detected by physical Wide range pH paper or Labstix can be used for the means. Inflammatory lesions are characterized by heat, determination of ketone, glucose, protein, and the presence pain, swelling and a local or generalized leucocytosis and, in of blood in urine. Cattle affected with right-sided distention severe cases, a systemic toxemia. A total white blood cell of the abomasum may be in a state of paradoxic aciduria and count and a differential count is a sensitive, non-specific, but very useful test for the presence of an infection causing a the urine pH will be below 6. 0 "'O 4. Cerebrospinal fluid. Cerebrospinal fluid can be systemic illness. A leucopenia and neutropenia with a (D obtained with relative ease by puncture of the cysterno­ degenerative left shift suggests a severe infection such as ~ ~ medullary cavity. However, the cerebrospinal fluid must be coliform mastitis, acute diffuse peritonitis, septic metritis, (") (D examined within minutes after its collection. The fluid may pleuritis, severe bacterial pneumonia and a bacteremia 00 (Hemophilus speticemia). A neutrophilia and a regenerative 00 be placed and dryed on a glass slide and examined later for 0...... 00 the presence of cells. shift suggest an active chronic infection such as pericarditis, ,-+- peritoneal and pulmonary abscesses and other deep body '"i 5. California Mastitis Test on milk. ~ 6. Hemetest for occult blood in feces. system infections which may not be readily detectable. ~...... Degenerative lesions produce the same loss or abnormality 0p Interpr,etation of the Clinical Abnormalities and Making a of function as lesions of the other types, but are not usually Diagnosis accompanied by evidence of inflammation unless they are The clinical abnormalities found on clinical examination extensive. If the lesion is accessible, a biopsy or paracentesis will suggest the body systems which are affected. These body should be considered as a means of determining its nature. systems must then be examined in detail to determine the The specific cause of the lesion. If the system involved, the location of the lesion in the system, the type oflesion and the nature of the abnormality and the type of lesion can be specific cause of the lesion. satisfactorily determined, it then remains to decide on the The location of the lesion is determined by clinical specific cause of the abnormality. If, for example, it could be examination of the body system combined with special said that a particular case of paralysis in a calf was caused by diagnostic procedures such as endoscopy, paracentesis, a degenerative lesion of the musculature, only a few specific radiography and laparatomy. A detailed neurological etiological agents would have to be considered to make a examination is necessary to localize the lesion in a cow with final diagnosis. In many, if not most, cases it is impossible to paralysis of the hindlegs. go beyond this stage without additional techniques of The abnormality observed may be produced by lesions of examination, particularly laboratory examination, and it is different types. In general, lesions can be divided into a general practice to make a diagnosis without this anatomical or physical lesions andfunctional disturbances. confirmatory evidence because of limitations of time or Physical lesions can be further subdivided into facilities. inflammatory, degenerative or space-occupying. These It is at this stage that a careful history-taking and classifications are not mutually exclusive, a lesion may be examination of the environment show their real value. It is

APRIL, 1982 11 only by a detailed knowledge of specific disease entities, the Infectious bovine rhinotracheitis conditions under which they occur, the epidemiology and Atypical interstitial pneumonia the clinical characteristics of each disease than an informal Pleuritis judgement can be made with any degree of accuracy. If the Verminous pneumonia diagnostic possibilities can be reduced to a small number, For the differential diagnosis, make a list of the possible confirmation of the diagnosis by laboratory methods diagnoses, followed by a shorter list of the probable becomes so much easier because there are fewer diagnoses, then the tentative diagnosis and finally the final examinations to be made and confirmation by response to diagnosis. treatment is easier to assess. If it is necessary to treat with a What do you do if y ou cannot find significant great many drugs serially, or in combination, to achieve a abnormalities and cannot make a diagnosis? cure the expense is greater and the satisfaction of both the • Make a list of all the body systems and exclude those client and the veterinarian is diluted in proportion to the which are normal · range of treatments. Accuracy in diagnosis means increased • Re-examine the body systems which may be abnormal efficiency and this is the final criterion of veterinary practice. • Do a hemogram to determine the presence or absence An example of correlating the history and the of a "hidden" infection epidemiological and clinical findings of a group of sick • Review the history carefully weaned beef calves 6 to 8 months of age, with the accepted • Come back and re-examine the animal several hours knowledge of the diagnostic possibilities is presented here: later if possible History and Epidemiological Findings • Consult with another veterinarian Recently weaned beef calves 6 to 8 months of age. Clinical Findings Diagnosis is the challenge and the opportunity. Dyspnea, mucopurulent nasal discharge, anorexia, toxemia, fever, abnormal lung sounds, low protective . Differential Diagnosis (in order of References probability) Pneumonic pasteurellosis Fifth Edition (1979) Veterninary Medicine: - Blood, D.C. - Henderson, Viral interstitial pneumonia J.A. & 0 . M. Radostits: Lea & Febiger, Philadelphia.

0 "'O (D ~ ~ (") (D 00 00 0...... 00 ,-+. '"i ~ ~...... 0p

Dr. D. C. Blood, left & Dr. Otto Radostits

12 THE BOVINE PROCEEDINGS- o.. 4