Textbook of Veterinary Internal Medicine DISEASES OF THE DOG AND THE CAT EIGHTH EDITION STEPHEN J. ETTINGER, DVM DACVIM (SMALL ANIMAL INTERNAL MEDICINE AND CARDIOLOGY) FACC; FAHA; CCRP Doctor Honoris Causa (University of Veterinary Medicine Bucharest) VetCorp, Inc. Los Angeles, California EDWARD C. FELDMAN, DVM DACVIM (SMALL ANIMAL INTERNAL MEDICINE) Emeritus Professor of Small Animal Internal Medicine University of California, Davis Davis, California ETIENNE CÔTÉ, DVM DACVIM (SMALL ANIMAL INTERNAL MEDICINE AND CARDIOLOGY) Professor 3M National Teaching Fellow Department of Companion Animals Atlantic Veterinary College University of Prince Edward Island Charlottetown, PE, Canada 2 Disclaimer This title includes additional digital media when purchased in print format. For this digital book edition, media content may not be included. 3 Table of Contents Cover image Title Page Contributions from Around the World Copyright Dedication Editors Section Advisors Contributors Preface About the Cover Client Information Sheets Volume 1 Section I The Real Basics of Veterinary Medicine Chapter 1 The Medical History Overview The Approach to the Pet Owner Requirements for a Thorough History The Elements of the History Questions for the Vague Clinical Complaint References Chapter 2 The Physical Examination Observing the Pet and Meeting the Caretaker The Physical Examination Process Completing the Physical Examination 4 Chapter 3 Basic Genetics Important Genetic Terminology Dna to Protein Modes of Inheritance Dna Evaluation References Chapter 4 Clinical Genomics Important Genetic Terminology Clinical Genetics Factors That Impact Clinical Presentation of Familial Disease Genetic Counseling Types of Genetic Tests Pharmacogenetics References Chapter 5 Evidence-Based Medicine References Chapter 6 Biomedical Statistics Hypothesis Testing Statistical Methods Chapter 7 Euthanasia References Section II Differential Diagnosis for Chief Concerns General Chapter 8 “Ain't Doing Right”: The Nonspecific Chief Concern of Ill Thrift Signalment Medical History Physical Examination Diagnostic Tests Treatment Ill Thrift That is Not a Sign of Disease Resolution Suggested Readings Chapter 9 Distinguishing Behavioral Disorders from Medical Disorders Introduction 5 Behavioral Disorders Potential Medical Disorders in Dogs Summary References Chapter 10 Dermatologic Manifestations of Systemic Disease Systemic Diseases Associated with Alopecia Systemic Diseases With Diffuse Hypotrichosis, Scales and Crusts Systemic Diseases With Facial and Dorsal Erythema, Alopecia, Scaling and Crusting Systemic Diseases With Alopecia, Erythema, Scales and Crusts Affecting Face, Legs and Tail; Dermatomyositis (DM) Systemic Diseases With Alopecia and Shiny Skin of Periocular Region, Ventral Neck, Ventral Abdomen and Legs; Feline Paraneoplastic Alopecia (see ch. 352) Systemic Diseases With Cutaneous Erythema, Alopecia, Scales and Crusts of Mucocutaneous Junctions and Footpads Systemic Diseases With Cutaneous Plaques Systemic Diseases With Cutaneous Nodules Systemic Diseases With Skin Fragility Systemic Diseases With Thick Skin References Chapter 11 Ophthalmic Manifestations of Systemic Disease Introduction Ophthalmic Examination Orbital Disease Systemic Hypertension Metastatic Neoplasia References Chapter 12 Neurologic Manifestations of Systemic Disease Diseases Causing CNS Signs Diseases Causing PNS Signs References Chapter 13 Intoxication versus Acute, Nontoxicologic Illness: Differentiating the Two Case History Stabilizing the Patient Toxicologic Versus Nontoxicologic Suggested Readings Chapter 14 Orthopedic Manifestations of Systemic Disease Diagnostic Approach to Orthopedic Manifestations of Systemic Disease (Figure 14-1) Other Causes of “Orthopedic Signs” Diagnostic Testing 6 References Chapter 15 Swollen Joints and Joint Pain Overview and Definitions Physical Examination Pathophysiology Septic Arthritis Immune-Mediated Polyarthritis Erosive Polyarthritis Nonerosive Polyarthritis Other Causes of Mono- or Polyarthropathies Arthrocentesis Joint Fluid Analysis Additional Testing References Chapter 16 Weight Gain Overview History Physical Examination Diagnostic Approach References Chapter 17 Abdominal Enlargement Differential Diagnoses Diagnostic Approach Treatment References Chapter 18 Peripheral Edema Mechanisms of Edema Formation Diagnosis and Treatment of Edematous Diseases References Chapter 19 Weight Loss as a Chief Complaint Background History Physical and Laboratory Findings Diagnostic Plan Therapy References 7 Chapter 20 Failure to Grow Introduction Pathophysiology Endocrine Causes of Failure to Grow Non-Endocrine Causes of Failure to Grow Diagnostic Approach (Figure 20-1) Treatment References Chapter 21 Weakness Specific Mechanisms and Diseases Chapter 22 Restlessness History Intoxications and Drugs Pain or Discomfort Metabolic Encephalopathies Primary Intracranial Conditions Need for Behaviorist? References Suggested Readings Chapter 23 Anorexia Definitions and Consequences Causes Treatment References Chapter 24 Polyphagia Physiology and Pathophysiology History Physical Examination Diagnostic Plan Management Suggested Readings Chapter 25 Body Odors Addressing the Body Odor Issue Normal Pet Odors Normal Pet with an Obvious Non-Medical Cause Primary Medical Condition Resulting in Pet Malodor 8 References Cardiorespiratory Chapter 26 Coughing Coughing Mechanisms History Differential Diagnosis for Coughing Clinical Assessment Clinical Investigations Clinical Management References Chapter 27 Sneezing and Nasal Discharge Clinical Presentations Diagnostic Approach Diagnostic Plan Treatment/Outcome References Chapter 28 Tachypnea, Dyspnea, and Respiratory Distress Pathophysiology Immediate Assessment and Management of the Dyspneic Patient (see also ch. 131 and 139) Important Historical Information Complete Physical Examination Localization Further Diagnosis and Therapy References Chapter 29 Epistaxis and Hemoptysis Epistaxis Hemoptysis References Chapter 30 Syncope Mechanisms and Causes of Syncope History-Taking Diagnostic Approach Summary References 9 Neurologic Chapter 31 Movement Disorders Clinical Evaluation Spasticity Myotonia Tetany Tetanus Paroxysmal Dyskinesia Drug-Induced Dyskinesia Myokymia and Spinocerebellar Ataxia Myoclonus Encephalomyelitis Dancing Doberman Other Abnormal Movements References Chapter 32 Tremors Definition Pathophysiology of Tremor Classification Acute Onset Generalized Tremor Syndromes Other CNS Inflammatory Disease That May Present with Tremor Chronic Onset Generalized Tremor Syndromes References Chapter 33 Ataxia, Paresis, Paralysis Ataxia Paresis and Paralysis Suggested Readings Chapter 34 Stupor and Coma Definitions Pathophysiology Approach to the Patient with Stupor or Coma Diagnostic Plan Treatment Goals Prognosis Suggested Readings Chapter 35 Seizures 10