A visit to the veterinarian’s office usually consists of two major parts: the initial taking of a history and the secondary physical examination. While the purpose and advantages of taking a history are often rather apparent, the physical examination is often more mysterious. So today this blog will go over what exactly your veterinarian is looking for in his or her physical examination.
I always begin my physical examination with the head and then work backwards, towards the tail.
Placing a hand over one eye and making a motion towards the other eye tests for the “menace reflex.” A visual dog (unless the patient is a young puppy or kitten) will blink or pull away from that threatening gesture. This is our primary indicator of vision. We also check the sclera, or “whites of the eye,” for any signs of inflammation such as prominent blood vessels or discharge. Ensuring that both pupils are the same size is important – unequal pupil size (anisocoria) can indicate a range of neurological or other disorders.
A quick look inside the ears can reveal red (erythematous) skin, which is a sign of infections or allergies. One can also easily judge if there is pus, excessive earwax (also known as ceruminous debris), or anatomic abnormalities.
Examining the nose can reveal exudate such as blood, pus, or mucous. (A recurring theme of the physical exam is checking any orifice for leaking material.) If a veterinarian suspects an issue with airflow in the nasal cavity (such as with a nasal polyp), he or she can place a glass slide or cotton ball in front of each nostril to assess air flow. A vet may also take a quick listen to the nose as the animal breathes to ascertain if there is any impairment to airflow.
The mouth (also known as the oral cavity) is perhaps the most important body cavity to examine. A quick glance and feel of the gums will let us know if there is adequate blood flow. If gums are pale, blue, or tacky (dry and sticky), there may be a problem with proper oxygenation and blood flow. Teeth can be checked for the presence of dental tartar. Foreign bodies such as sticks or string can often be found in the oral cavity and can be a source of pain or cause a patient to be unable to eat properly. Your veterinarian may also open your animal’s mouth to see if this causes pain. Once open, a vet can place a finger at the back of your animal’s tongue and see if they can get a normal gag reflex. The absence of a gag reflex can be an indicator of neurologic dysfunction.
Palpation (careful touching of an area) of the trachea (windpipe) should be performed. If this easily elicits a cough, tracheal collapse or other disorders may be considered. In cats, we often palpate the thyroid glands to see if they are enlarged.
At this point, I personally move away from the “head to tail” rule to feel all five sets of palpable lymph nodes. Lymph nodes are organs spread throughout the body that filter lymph (a fluid collected in the lymphatic vessels, filtered in the lymph nodes, and returned to the blood) and collect white blood cells to help them mature and monitor for pathogens. Enlarged lymph nodes can indicate a local infection or spread of cancer (metastasis).
Auscultation (listening via stethoscope) of the heart and lungs is one of the most important parts of the physical exam. Listening to the heart will reveal heart murmurs, which are sounds due to abnormal blood flow in the heart. Not all heart murmurs indicate a clinical problem, but they often warrant a further work-up. A muffled heart sound may indicate a build-up of fluid in the sac around the heart, which is known as pericardial effusion.
As for the lungs, quiet lung sounds can indicate air or fluid in the chest. If the lungs are quieter ventrally (towards the stomach), then there is likely fluid because fluid will settle due to gravity. Quieter lung sounds dorsally (towards the back) is more likely air due to the fact that air will rise up. Increased lung sounds and abnormal noises such as crackles or wheezes can indicate a wide variety of pulmonary (lung-based) diseases.
Palpation of the ribs, combined with looking at your animal’s overall body shape, will let give us an idea of how healthy their weight is.
Palpation of the abdomen can reveal any distention due to fluid or masses. Pain is checked for and may indicate conditions such as pancreatitis. Especially in cats, one can often palpate the kidneys and check if they are enlarged or otherwise abnormal. The bladder can often be palpated and stones (if present) can occasionally be felt.
The limbs should all be palpated (the right and left limbs should be palpated at the same time so as to check for symmetry). A veterinarian can detect muscle atrophy (wasting) or pain if certain areas are touched. The paws are often one by one onto the ground to detect if the animal can sense this. If they cannot, it is called a “proprioceptive deficit” and is indicative of a neurologic dysfunction.
The rectal examination is often saved for last. In male dogs, we can check the prostate to see if it is enlarged or has any associated masses. In both sexes, we also check to see if the anal glands are distended with fluid. Anal glands are just inside of the rectum and fill with a scented fluid which is normally expressed when a dog or cat defecates. If they fail to be expressed, they can become swollen, uncomfortable, or even infected.
That concludes a basic physical examination, which ideally should be performed 1 – 2 times a year on a healthy animal. There are also more in-depth examinations for different body systems. A good ophthalmic examination will examine both the exterior and interior eye, as well as checking multiple aspects of its function. A neurological exam checks multiple reflexes in all limbs as well as other areas of the body. An orthopedic exam will examine the mobility of all joints in various ways. So remember, when your veterinarian props your pet up on the exam table and seems to pet him, he or she is doing a lot more than listening to the heart and feeling for obvious masses. A good physical examination is an incredibly important diagnostic tool and is often the first step in figuring out what is wrong with your pet.