Special Semiology

Semiology of the digestive tract

Introduction
Any examination of an animal has two stages: functional exam Physical or morphological exam. It is important to respect these stages, since functional symptoms are noticeable before physical ones, therefore they offer extremely important data on the diagnosis establishment.

Examination and Semiology of the Digestive System

The Digestive System consists of the digestive tract and the annex glands. By anatomic criteria, the organs of the digestive system are: prediafragmatic organs (oral cavity, pharynx, esophagus) and postdiafragmatic organs (stomach, small and large intestine). By functionality criteria, the digestive tract has three segments: a ingestive segment (oral cavity, pharynx, esophagus), digestive segment (stomach, small intestine and the first two segments of the large intestine: cecum and colon) and the ejective segment (rectum and anus).

Examination and semiology of the prediafragmatic digestive organs

Examination and semiology of the prediafragmatic digestive organs takes place through a functional ingestion exam and through a physical (morphological) exam of each digestive organ

The functional exam of ingestion

The Appetite

The Appetite represents the animals wish to eat certain foods or drink water. Hunger is the immediate need to consume food, without any differentiation in type or quality of said food. Appetite and Hunger are NOT the same thing! Satiety represents the diminishment or disappearance of hunger and appetite due to food and/or water ingestion. Hunger and satiety control belongs to the hunger and satiety center in the hypothalamic nuclei, correlated to different visual, olfactory, audible stimuli, a series of conditioned reflexes and certain humoral modifications that influence the hypothalamic centers directly.

The hypothalamic control centers are linked to other metabolic control centers. The hunger center is located in the ventro-lateral hypothalamic nucleus and its destruction determines the diminishment of food ingestion, whereas the destruction of the satiety center, located in the ventral medial nucleus of the hypothalamus, will lead to overfeeding and obesity. Appetite examination is being performed through inspection. Inspection as a clinical examination method is being performed both from the distance and also locally. Depending on the number of animals being examined, inspection can be individual or in a group. Before the animals inspection, extremely important data on appetite can be obtained during the history taking.

Appetite inspection takes place through the functional appetite test, in which small quantities of good quality food of all types that belong to the animals normal diet, are being administered to the animal. During the inspection from the distance, the examiner will appreciate the animals behavior towards the expression of hunger and thirst sensation, manifested through restlessness, limb movement and vocalizations. In the local inspection, the examiner will appreciate the way the animal performs prehension, mastication and deglutition, if the animal can reach the fodder, if it can move its head and neck. If the animal does not eat the fodder, the examiner will look for prehension and mastication problems, but also the fodders quality.

When it comes to group examination, the appetite test consists in watching the animals as they are being fed regularly, by observing the way these are or arent interested in thee food offer, the presence or absence of the appetite or if it is normal or modified, both in quantity and quality.

Appetite semiology

Appetite can be normal (normorexia), characteristic to the species and especially to the individual, or it can be modified. Appetite changes are defined as dysorexias. Dysorexias can be both of quantitative and of qualitative nature. Quantitative dysorexias can translate themselves as either of diminishment or enhancement of appetite.

Quantitative modifications of appetite (diminishment and increase of appetite)

Anorexia or inappetence represent the lack of appetite. Anorexia can manifest itself in two ways: absolute anorexia and relative anorexia. Absolute anorexia (absolute inappetence) manifests itself through total refusal of water and fodder. Relative anorexia (relative inappetence) manifests itself through a partial diminishment of appetite, expressible through: Hyporexia- when there is a quantitative reduction of appetite towards a certain fodder or the global ratio. Hypodipsia or adipsia- consists in the diminishment of thirst or complete lack of it, and is being met in feeding with succulent fodder or in certain hypothalamic conditions.

Alternative appetite consists in an unequal interest in food or with an alternation of normal appetite with hypo- or anorexia.
Selective appetite consists in the selective choice of food.

Appetite increase

Hyperorexia represents an exacerbation of appetite. This can have the following forms: Polyphagia or hyperphagia the animal eats impressive amounts of food. Polydipsia excessive thirst and consumption of water. Bulimia consists of an exaggerated and uncontrolled appetite, determined by pathological causes, such as: frontal lobe conditions, parasite infections, hypothalamic tumors, chronic enteritis, acute pancreas insufficiency. Even though food consumption is exaggerated, the animal has a low BCS and the hunger sensation persists.

Tachyphagia or greediness manifests itself through a rapid food consumption combined with insufficient mastication of food.

Qualitative appetite disturbances

Parorexia or pica represents the tendency of consuming food that does not enter the normal diet of the animal, such as earth, sand, wood etc. Paradipsia can appear together with parorexia. Parorexia has specific names depending on the substance that is consumed. Fecal consumption is called coprophagia, earth consumption is called geophagia, wood consumption is called xylophagia whereas air consumption is called aerophagia.

Parorexia can have many causes: an unbalanced ratio, absorption problems, parasite infections, neurological problems, organ disease etc. When parorexia involves nipping and nibbling of tissue or organs from fellow animals, it is called cannibalism. It is frequently seen in swine and birds. Cannibalism can manifest itself as: Plumophagia (feather ingestion) Malophagia (wool ingestion) Trichophagia (hair ingestion) Lychomania (hair licking mania) Onicophagia (nail ingestion)

Cannibalism per se manifests itself:

Condophagia (tail consumption) Placentophagia (placenta consumption) Fetophagia (neonate consumption) Ovophagia (egg consumption) Nibbling of the head in birds

Prehension semiology and examination

Prehension is the physiological act in which the animal takes in and introduces in its oral cavity food and water. The prehension exam will be performed together with appetite exam.

Prehension semiology

Prehension can be normal, specific for each species, or modified, equivalent to oral dysphagia, when prehension of food and water is performed through other organs than the normal ones, or when prehension cannot be performed at all. In horses prehension of fodder takes place with the lips, in bovines, with the tongue, in sheep and goats with the front teeth, in pigs with the whole mouth, in carnivores with the incisors and canines, sometimes also using their front limbs, and in birds with the beak. To examine the way the animal performs prehension, the examiner will use the history and inspection as examining methods, also using the functional appetite test.

The exam needs to focus on the following: : How does the animal approach the food? How does it perform prehension? Amplitude, frequency and execution style of the prehension. Quantity of fodder in one bite The animals attitude (especially head and neck positioning)
Changes in prehension can be as follows:
It

can be impossible Prehension is possible but through other means than normal

Semiology and examination of mastication

Mastication is the physiological act through which food introduced to the oral cavity are chopped, insalivated and prepared so as to form the food bolus ready to be swallowed. Mastication is examined through inspection and the examiner appreciates: The way mastication is performed Mastication intensity Mastication frequency Mastication duration

Mastication can be normal, when all physiological qualities of the species are being fulfilled or modified (equivalent to oral dysphagia). Mastication deviations can be as follows: Abolished mastication is a temporary phenomenon that appears at the same time with anorexia. Interrupted mastication manifests itself by the sudden stop of mastication, because the food that needs to be chewed down provokes acute pain. Continuous mastication is met in certain encephalic problems. Empty mastication takes place when mastication moves and saliva secretion are present, but not food.

 Unilateral

mastication is a clue towards teeth, gum, muscle pain or unilateral muscle paralysis. Sloppy mastication is a type of seldom mastication, where long pauses are required, being frequently seen in nervous depression or relative anorexia. long teethed mastication is a superficial type of mastication, characterized by slow and shallow movements of the maxilla, being seen in stomatitis, dental deformities, pharyngitis.

Insalivation is the process in which food is chopped up and stirred in with saliva. Insalivation can be normal or modified. The quantity of saliva can be increased (hypersalivation) or decreased (hyposalivation). Sialorrhea (impossibility to swallow own saliva, even though saliva secretion is normal) can be seen in stomatitis, pharyngitis, esophageal occlusion or obstruction. Hyposalivation (hypo or asialia) represents the decrease of saliva secretion, noticeable through the diminishment of saliva production or complete lack of it, with the oral mucosa drying up (xerostomy) and insalivation and deglutition difficulties. Xerostomy can be seen in salivary lithiasis, A, C and PP hypovitaminoses, atropine intoxications, dehydration, fever syndrome.

Deglutition exam and semiology

Deglutition is the act in which food and liquids in the oral cavity is transported in the gastric compartments. Deglutition exam is performed through inspection. Through inspection one follows: If deglutition takes place easily or it is difficult. Head and neck position Peristaltic movement.

In normal circumstances, deglutition has three stages: oral

stage (I), pharyngeal stage (II) and esophageal stage (III). Deglutition deviations are called dysphagias and must be interpreted by taking the three stages of deglutition into consideration: there can be oral, pharyngeal and esophageal dysphagia.

Odynophagia defines painful deglutition. Regurgitation is a symptom of dysphagia and consists of eliminating food, water, saliva and eventually other products (blood, membranes) from the prediafragmatic part of the digestive tract. Oral dysphagia consists of deglutition delay and hesitation of the animal to swallow, noticeable by either prolonged mastication, or the maintenance of food in the mouth (as a deposit), or after chopping food up, dropping it on the floor. Pharyngeal dysphagia is characterized by early regurgitation, where food or water show up by the nostrils, or even by the mouth, immediately after they were swallowed.

Esophageal dysphagia manifests itself similar to the pharyngeal one, when the deviation is set on the anterior part of the esophagus, but it manifests itself differently when the problem is in the thoracic or abdominal segment of the esophagus. Dysphagia can be relative (only for solid food) or it can be absolute/total (for both solids and liquids). The etiology of dysphagia is diverse, from general affections to some local affections.

Rumination exam and semiology

Rumination is a reflex act, that consists in rejection, reinsalivation, remastication i redeglutition of the bolus. Rumination begins in 30 90 minutes after fodder consumption, but it sets on faster if the animal has had green forage and slower if it had fibrous forage. Finely chopped forage and corn will not be ruminated. Rumination periods have nothing to do with certain times of the day, and over 24 hours, there will be 5 15 rumination periods. A ruminant will ruminate 7 10 hours/day. A rumination period will last from a couple of minutes to an hour or even more, depending on the quantity of consumed fodder.

The duration of rumination for a bolus is about a minute, the time needed for rejection and redeglutition is about 3-4 seconds. The time between redeglutition and the rejection of the next bolus is also of 3-4 seconds. The number of remastication moves necessary for a bolus is about 60 in calves and 50 90 in small ruminants, variation appears depending on the quality of fodder: for fibrous or gross forage, there will be more movements than for succulent fodder or a bolus that was already chewed. In most ruminants, rumination takes place in a lying down stance.

During rumination, the eyes are semi closed, the facies expresses satisfaction. If the animal is not allowed to lie down or stand still, rumination can take place during gait, too. In lambs, rumination sets on in 3-5 days after birth, but in vain (still suckling), at 6-15 days of age, rumination is accompanied with antiperitalsis. In 4 weeks of age, rumination takes place in complete cycles. In calves, rumination sets on in 20-27 days after birth.

Rumination examination takes place through an inspection from the distance and consists of the following aspects: When does rumination start (after fodder administration)? How many rumination periods are there /24 h? How long does a rumination period take? How many remastications /bolus are there needed? How is the facies and the animals attitude during rumination?

Rumination semiology

Rumination deviations are very variable, some of them being equivalent to mastication deviations. Sad rumination manifests itself through normal rumination but a sad facies. Sloppy rumination is a superficial rumination, where chewing movements are seldom and shallow. Prolonged rumination is similar to the superficial rumination, but the period of time dedicated to chewing a bolus is much longer. Uninterrupted rumination consists in a continuous rumination, the frequency of rumination periods is increased.

 Interrupted

rumination manifests itself through the appearance of pauses during rumination, or by suspending rumination in certain positions. Intermittent or seldom rumination consists in the reduction of the number of rumination periods/24 hours and a significant reduction of each rumination period. Abolishment of rumination assumes that rumination needs to be suspended for at least 24 hours.

Eructation semiology and examination

Eructation is a vital reflex act of ruminants and consists in elimination of fermentation gases from the prestomachs to the exterior, by oral and nasal means. Eructation examination will appreciate: frequency intensity duration Smell of the eliminated air

The following deviations can be met:

Complete

lack of eructation Diminishment of eructation Intensification of eructation

Vomit examination and semiology

Vomiting (emesis) represents the reflex elimination by the mouth and nose, of stomach content. Emesis has two stages: Nausea Vomiting per se Vomiting exam looks at: frequency intensity duration Efforts sustained by the animal Vomit content

The semiology of emesis consists in following both stages: nausea, and vomiting per se. Nausea is a sensation that is very difficult to define. It is probably the expression of minor stimulation of the center of vomit, situated in the solitaire tract nucleus (bulbar nucleus of the tenth cranial nerve), which explains the association of nausea with other symptoms characteristic to the stimulation of this nerve (hypersalivation, bradycardia, sweating). Vomiting per se consists in the elimination of gastric content in the exterior. In horses, vomiting manifests itself as nasogastric reflux and consists in the elimination of gastric content only by the nostrils and in very small quantities, in a liquid form orally.

By manifestation, emesis can be: singular repeatable unstoppable By excitation center, emesis can be: central peripheric Fake vomit

Characteristics of the vomit

Quantity of the vomited material depends on the capacity of the stomach, the diet and the frequency of vomiting. The smell of vomit can be acid, fetid, feces-like, garlic-like, ammonia-like. The color of vomit varies by the ingested food.

Vomit composition can be: Gel-like Hemorrhagic Bilious Fecaloid Hematemesis represents vomiting whole blood or digested blood, with a characteristic color of coffee leftovers. Hematemesis is always followed by melena.

Questions?