Veterinary Clinical Medicine-I (General and Systemic)

HISTORY 

Immediate Patient Evaluation

• The clinician should be able to quickly determine whether immediate intervention is required. At presentation, the complaint should be noted and a brief history taken while carrying out a rapid evaluation of the patient. This evaluation should include the patient's attitude, mucous membrane color, heart rate, pulse quality, respiratory effort, and response to abdominal palpation. If the patient is in shock or bleeding, supportive therapy should be initiated and a more detailed history obtained at a later opportunity.

History

• This is always the first, and often the most important aid to diagnosis. The age, breed, sex, environment, onset, course, nature and duration of signs should all be considered. It is important to note if the onset is spontaneous or follows trauma.
• The presenting complaint for an animal with an acute abdomen may include acute abdominal pain or distension, vomiting, diarrhea, anorexia, weakness or collapse. The signalment may indicate the likely cause of the problem; for example, young animals are more likely to ingest foreign bodies, develop intussusceptions or contract viral enteritis.
• Acute abdominal diseases in the adult include: decompensated chronic infections, pancreatitis, vascular occlusive disease and intestinal obstruction or abdominal organ displacement caused by a tumor. Older obese female dogs may have an increased risk of pancreatitis. Cats tend to ingest linear foreign bodies whereas deep chested dogs such as great Danes, Wolfhounds and Irish setters are more likely to develop gastric dilatation volvulus. German shepherds and Labrador and golden retrievers are commonly affected with splenic neoplasia.
• Knowledge of the previous medical history such as exposure to infectious disease, trauma or previous abdominal surgery (which may suggest a paralytic ileus or obstruction from adhesions) is often helpful. Chronic weight loss may suggest an intra-abdominal tumor. Over-eating or the ingestion of spoiled or frozen food may precipitate acute gastric dilatation or acute hemorrhagic gastroenteritis. A history of mast cell tumors or corticosteroid or non-steroidal anti-inflammatory drug therapy increases the risk for gastrointestinal ulceration. The potential for toxin exposure can be a crucial part of the history.