Diagnosing a Case 2

My PE’s always start from the rear of the pet. First, I feel pulses inside the rear legs to evaluate their strength and rhythm, and to see if they’re equal on both sides. Next, I feel lymph nodes behind the knees, which are present and palpable in their normal state in both dogs and cats.

I run my hands up and down both rear legs to see how well muscled the pet is, and to feel for things like thickened joints that might indicate arthritis or some other sort of joint malady. During this part I also feel the knee caps on both sides to make sure they’re in the correct position. Displaced kneecaps are a very common finding in many small dog breeds. It’s a very rare finding in cats.

Next I go up to the abdomen and do a thorough palpation there. In most pets I can feel the liver, spleen, intestines, kidneys and bladder. In intact females I can also sometimes feel the uterus if she is either pregnant or has a uterine infection, called a pyometra.

In male animals I’ll also palpate the scrotum to make sure both testicles have descended correctly, and to make sure there are no abnormal lumps in either testicle. On both sexes I’ll also check for hernias – either umbilical (at the belly button) or inguinal (in the groin). And in females I’ll palpate both mammary gland chains for abnormal lumps and bumps. And in all pets there are lymph nodes in the groin that cannot be felt in their normal state, but which are often palpable if enlarged. So that is also checked at this time.

Next I move up to the chest and listen to the heart and lungs. The normal heartbeat that can be heard through a stethoscope is produced from the heart valves slamming shut. There are four heart valves, and as the heart beats their opening and closing produces the typical lub-dup, lub-dup of the normal heart beat.

The four different valves can be ausculted (listened to) separately. We listen to three of the heart valves on the left side of the chest, in three different locations. The fourth valve is heard on the right side. I listen to these heart sounds to try to hear either murmurs or arrhythmias.

After evaluating the heart I listen to the lungs. Essentially the lungs are broken down into four quadrants on each side. If the pet has abnormal sounds in the lungs we definitely want to know whether it’s generalized throughout the chest, or whether it’s localized to one or more quadrants. If there are abnormal heart sounds I always try to characterize them as to whether they’re moist or dry, whether they’re constant or changing, and whether they occur on inspiration, expiration, or both.

Moving forward I feel lymph nodes in front of the shoulder blades, underneath the front legs, and under the jaw. I then evaluate the eyes, ears, and nose, and – in nice animals – the throat. The ears are examined with an otoscope, and the eyes are checked with an ophthalmoscope if there are any indications of ocular problems. When I look in the mouth I’m looking at the condition of the teeth, as well as the color of the gums. All healthy animals should have nice, pink gums that turn white when pressed, but refill to pink in less than two seconds.

Lastly, I examine the skin and coat and make sure that there are no signs of skin issues or excessive chewing or scratching. And throughout the entire PE I’m constantly running my hands along the animal’s body to feel for any lumps and bumps that need to be identified and checked. There are many more specifics to the PE than I’m able to outline fully here. However, this gives you an idea of the things I’m looking for in the PE and how I approach the case.

Finally, once the history is taken and a thorough physical exam performed, I can start to get a picture of the overall case. In many cases this is all I need to make a diagnosis in the case and lay out a proper course of action. In those cases in which a diagnosis is not immediately obvious, the thorough history and PE allow me to more accurately tailor my recommendations for testing to help save time and money from doing tests that weren’t ultimately necessary.