SECTION 1
PRESENTING COMPLAINTS

In this section, the common presenting complaints are listed alphabetically according to a stylised format.

• Each problem is defined, and the expected clinical signs listed, although not every case will show every sign.
• Causes for the problem are divided into 'common' and 'uncommon' to guide the reader, but are only the opinion of the authors, and may vary in different geographical locations.
• For each problem a logical diagnostic approach is suggested; any numbering indicates a suggested order for the investigations:
  • Clinical clues in the history.
  • Potential findings in the clinical examination.
  • Laboratory findings that aid the diagnosis.
  • Key results from imaging.
  • Special tests that may confirm the diagnosis

• 1.1 Abortion
• 1.2 Alopecia
• 1.3 Altered behaviour
• 1.4 Altered consciousness
• 1.5 Anorexia/hyporexia/inappetence
• 1.6 Anosmia
• 1.7 Anuria/oliguria
• 1.8 Ataxia
• 1.9 Bleeding
• 1.10 Blindness
• 1.11 Constipation
• 1.12 Corneal opacity
• 1.13 Coughing
• 1.14 Deafness
• 1.15 Diarrhoea
  • 1.15.1 Acute diarrhoea
  • 1.15.2 Chronic diarrhoea
• 1.16 Drooling
• 1.17 Dysphagia
• 1.18 Dyspnoea/tachypnoea
• 1.19 Dysuria
• 1.20 Dystocia
• 1.21 Epistaxis
• 1.22 Exercise intolerance
• 1.23 Faecal incontinence
• 1.24 Flatulence/borborygmi
• 1.25 Haematemesis
• 1.26 Haematochezia
• 1.27 Haematuria and discoloured urine
• 1.28 Haemoptysis
• 1.29 Halitosis
• 1.30 Head tilt
• 1.31 Melaena
• 1.32 Nasal discharge
• 1.33 Nystagmus
• 1.34 Paresis/paralysis
• 1.35 Perinatal death
• 1.36 Polyphagia
• 1.37 Polyuria/polydipsia (PU/PD)
• 1.38 Preputial discharge
• 1.39 Pruritus
• 1.40 Red eye (and pink eye)
• 1.41 Regurgitation
• 1.42 Seizures
• 1.43 Sneezing
• 1.44 Stiffness, joint swelling and generalised lameness
• 1.45 Stunting
• 1.46 Tenesmus and dyschezia
• 1.47 Tremors
• 1.48 Urinary incontinence
• 1.49 Vomiting
• 1.50 Vulval discharge
• 1.51 Weakness, collapse and syncope
• 1.52 Weight gain/obesity
• 1.53 Weight loss

1.1 ABORTION

DEFINITION

The spontaneous expulsion of one or more fetuses before the end of full-term pregnancy, i.e. when the fetus is incapable of independent life.

RELATED CLINICAL SIGNS

• Abdominal pain
• Abnormal vulval discharge
• Fever
• Lethargy/depression
• Premature whelping is reported with live or dead pups or no live pups at term

COMMON CAUSES

Infectious

• Bacterial
  • Brucella canis in endemic countries; not endemic in UK
  • Streptococcus infection
• Viral: Canine herpesvirus-1 (CHV-1)

Non-infectious

• Congenital defects: various lethal defects
• Genetic causes: various lethal defects
• Maternal factors:
  • Illness
    • Diabetes mellitus (DM)
    • Eclampsia
    • Pregnancy toxaemia
  • Drugs
    • Corticosteroids
    • Griseofulvin
    • Itraconazole
    • Phenylephrine
    • Prolactin inhibitors
    • Prostaglandins
    • Progesterone-receptor blockers
  • Toxins: insecticides, plant toxins
    • Trauma
    • Hypoluteinization (low progesterone)
    • Advanced age
• Traumatic: dystocia

UNCOMMON CAUSES

Infectious

• Bacterial
  • Escherichia coli
  • Campylobacter
  • Leptospira
  • Salmonella
• Fungal
• Protozoal
  • Leishmania
  • Neospora
  • Toxoplasma
• Viral
  • Bluetongue virus
  • Canine adenovirus 1
  • Canine distemper virus
  • Canine parvovirus 1 (minute virus)

DIAGNOSTIC APPROACH

Clinical clues

Predisposition

• Advanced age
• Previous history of abortion
  • Assess for hypoluteinization by checking progesterone concentrations

History

• Abnormal vulval discharge
• Bitch whelps early with live or dead pups or no pups at term

Clinical examination

Visual inspection

• Often unremarkable

Physical examination

• Abdominal contractions and expulsion of fetus(es) in later pregnancy
• Vulval discharge: purulent, haemorrhagic, green, black, malodorous

Laboratory findings

Haematology

• May be normal
• HCT often low in pregnancy due to decreased plasma volume, e.g. 30-35% compared to 45-55%
• Mild mature neutrophilia common in pregnancy, may sometimes be more pronounced changes or bands

Serum biochemistry

• May be normal

Urinalysis

• May show evidence of inflammation with free catch or catheter samples

Imaging

Plain radiographs

• May show evidence of dystocia

Ultrasound

• May show evidence of fetal death

Special tests

• Examination of fetus post mortem
• Virus isolation/bacterial culture/PCR of fetus/placenta/vaginal secretions/milk

Tests of dam

• Serology ± PCR of dam for CHV-1, B. canis
• Serum progesterone to assess if sufficient to maintain pregnancy: should be > 2 ng/ml (6 nmol/l); if less than these values for > 48 hours suggests hypoluteinization but can be seen due to fetal death
• Thyroid hormone analysis: total T4/thyroid-stimulating hormone (TSH)

1.2 ALOPECIA

DEFINITION

Absence of hair from areas of skin that normally carry hairs, due either to a failure of production or to an increased loss of hair. Hypotrichosis refers to thinning of hair. Hair loss may be focal or diffuse, and symmetrical or non-symmetrical.

RELATED CLINICAL SIGNS

• Endocrinopathies are likely to cause concurrent systemic signs such as changes in drinking, eating, exercise tolerance and body weight
• Loss or absence of hair
• Self-traumatic lesions if pruritic skin disease

COMMON CAUSES

Primary follicular disease

Inherited abnormalities of follicular structure, ranging from absence of follicles that normally produce hair of a particular colour to complete absence of follicles, are uncommon except in specific breeds.

Secondary follicular disease

• Bacterial folliculitis/superficial pyoderma
• Demodectic mange
• Hyperadrenocorticism (HAC)
  • Iatrogenic
  • Pituitary- or adrenal-dependent
• Hypothyroidism
• Interdigital pyoderma
• Malassezia infection
• Seasonal flank alopecia (cyclic follicular dysplasia)

Self-trauma when pruritic

• Atopy
• Fleas and flea-allergic dermatitis
• Pyotraumatic dermatitis ('hot spot')
• Sarcoptic mange
• Secondary bacterial pyoderma

UNCOMMON CAUSES

Primary follicular disease

• Alopecia areata
• Alopecia mucinosa/follicular mucinosis: Shar pei
• (Auto)immune skin disease
  • Dermatomyositis
  • Erythema multiforme
  • Exfoliative cutaneous lupus erythematosus (ECLE)
  • Systemic lupus erythematosus
  • Pemphigus foliaceous
  • Sebaceous adenitis
• Catagen arrest: Weimaraners
• Colour mutant/dilution
• Congenital hypotrichosis/alopecia
• Follicular dysplasia
  • Black hair follicular dysplasia
  • Breed-specific follicular dysplasia
    • Loss of primary but retention of secondary hairs changing coat to reddish-brown: Siberian Husky and Alaskan Malamute
    • Flank and saddle region involved initially in red or black dogs: Dobermann
    • Flank and saddle hair loss: Airedale terrier, Boxer, English bulldog, Staffordshire terrier
    • Hair loss around face and over dorsum; cyclic initially but eventually permanent: Curly-coated Retriever, Irish Water spaniel, Portuguese Water dog
  • Medullary...