Читать книгу Clinical Reasoning in Veterinary Practice - Группа авторов - Страница 40

Always ask yourself, particularly when assessing clinical pathology or results of other diagnostic procedures in light of particular problems, Does this make sense – does this clinicopathological abnormality explain the problem that the animal has? Good clinicians are good detectives!

Example 1

 A dog is depressed, anorectic, vomiting and polydipsic.

 Its blood glucose is 12 mmol/L (just above the reference range).

 It has 3+ glucosuria and no ketones in the urine.

Does this mean that diabetes mellitus explains all of the dog’s clinical signs? No – usually uncomplicated diabetes does not result in depression, anorexia and vomiting. There must be another reason for these clinical signs. Diabetic ketoacidosis might have been an explanation, but it has been ruled out by your urinalysis. Hence, you must look further for an explanation for the vomiting, anorexia and depression.

Example 2

An unwell dog (anorectic, vomiting and depressed) is found to have clinicopathological changes consistent with hyperadrenocorticism. Does this explain all of the dog’s clinical signs? No – dogs with uncomplicated hyperadrenocorticism are not metabolically unwell, so there must be some other explanation for the dog’s malaise that you will need to identify and resolve before definitive testing for hyperadrenocorticism is possible (because concurrent disease has a significant impact on dynamic adrenal testing).