JIMMA UNIVERSITY

COLLEGE OF AGRICULTURE AND VETERINARY MEDICINE

SCHOOL OF VETERINARY MEDICINE

COURSE: SMALL ANIMAL MEDICINE

Semester: I

Course Code: Vetm4142

Course Credit: 3CHr

Topics to be covered: Diseases of the reproductive tract, diseases of the urinary system,
diseases of the hemolymphatic and musculoskeletal system, dermatological diseases,
diseases of the eye and ear, and Small animal toxicology.

Instructor: Bashahun G.M (BSc, MVPM-Field Epi)

Course objectives:

 At the end of the course students should:

 Possess the essential information on diseases of small animals on which to approach a
 Diagnosis
 Be able to devise appropriate strategies for treatment, prevention and control

1/By Dr.Fayera Gemeda and Mr. Bashahun G.

CHAPTER 5: DISEASES OF REPRODUCTIVE SYSTEM

1. Pyometra /cystic endometrial hyperplasia

 Is a hormonally mediated diestrual disorder characterized by cystic endometrial
hyperplasia with secondary bacterial infection.
 Is reported primarily in older bitches (>5 yr old), 4-6 wks after estrus.
 Open and closed pyometra (cervix)
o (Which one is severe and why?)
Etiology
 Excessive and prolonged stimulation of the uterine glands progesterone from persistent
corpus luteum
Pathogensis: Persistent progestrone stimulation
 thickening of endometrium due to hyperplastic growth of uterine glands
 those glands empty their content in the uterine lumen = hydrometra
 hydrometra + bacteria
 inflammation of endometrium characterized by migration of inflammatory WBC =pyometra
 E.coli and streptococcus species are the most common isolated from pyometra samples.
Clinical sign

Vaginal discharge (may or may not be seen)

 Lethargy
 Anorexia
 Fever (pyrexia)
 Vomiting
 Drinking excessive amount of water (Polydipsia) and urinating excessively (polyuria)
 Because of streptococcus infection that causes immune mediated kidney damage
increased thirsty and subsequently increases the water intake
 Enlargement of abdomen
Diagnosis
History
 the presence of recent heat
2/By Dr.Fayera Gemeda and Mr. Bashahun G.
Physical examination
 Enlargement of abdomen = palpation to the figure out the presence of enlargement of
uterus
 Pus like vaginal discharge (open)
Lab. Examination
 Abdominal X-ray = enlargement of uterus
 Abdominal ultrasonography
 Blood progesterone level = high
 High WBC count = increase
Treatment
If the bitch isn’t used for reproduction
 Ovarohysteroectomy ( = removal of uterus and ovary)
 Broad spectrum antibiotic
 Fluid therapy
For breeding dogs
 Surgical uterine drainage
 Antibiotic and fluid and electrolyte therapy
If not possible to surgical drainage administration of PGF2x (for open pyometra) is possible.
2. Metritis
 is inflammation of endometrial due to bacterial infection following: abortion, obstetrical
manipulation, parturition, dystocia and retention of fetal membrane
 Mostly occurs during post partum periods.
Clinical signs
 Depression, anorexia, vaginal discharge (foul and purulent), loss of interest in their
puppies/kittens
Diagnosis
 History (the presence of the predisposing factors)
 Physical examination
 Complete blood count (elevation of the neutrophils level)
 X-ray to check for retained placentas

3/By Dr.Fayera Gemeda and Mr. Bashahun G.

  Ultrasound (for checking retained placentas or fetuses)
 Cytological examination of the discharge and
 Bacterial culture
Treatment
 IV fluids for dehydration
 If necessary, evacuate the uterus (administration of oxytocin or erygometrine)
 Antibiotics
 Ovariohysterectomy for non-breeding animals
3. Pseudo pregnancy (False /phantom Pregnancy)
 Refers to a display of maternal behavior combined with the physical signs of pregnancy
following estrus in female dog/cat that is not actually pregnant.
 develops in the cat when they bred by an infertile cat while it may occur regardless of
whether or not dog was mated and is far more frequently in dogs than in cats.
 Usually it begins 4 – 9 weeks after the previous heat period.
 Canine false pregnancy may cause health complications like bacterial infections.
Possible cause
 Sharp declining of progesterone from day 45 of after estrus results in secretion of
prolactin
 Prolactin causes behavioral change and lactation
Clinical signs vary from dog /cat to dog/cat
But in general,
 enlargement of mammary gland with/without the production of milk
 Lethargy
 periodic vomits
 has a larger appetite than usual and may gain weight
 Behavioral change
 May select a special area of the home as a nest for these "puppies."
 Gathering up small, puppy-sized objects like dog toys and guard them as if they were
puppies.
Treatment
4/By Dr.Fayera Gemeda and Mr. Bashahun G.
 Mild symptoms may spontaneously recover within 2- 3 weeks.
 If the dog is physical ill or behavioral change is sever supportive therapy like:-
 Ovoban (megestrol acetate) - to help ease their symptoms.
 bromocriptine - prolactin inhibitors help to dry up the milk.
 The dog may need to wear an Elizabethan collar or cone in order to not lick her own
breasts and prolong symptoms.
4. Genital emergencies
Dystocia
 is prolonged (difficulty) in parturition
Possible causes are uterine inertia, fetopelvic disproportion, fetal monster, fetal malposition, or
fetal death
Uterine inertia
 is the most common cause of dystocia
 is divided into the two main categories
 Primary and secondary uterine inertia
Primary uterine inertia
 is complete/partial failure of starting uterine contraction
i. Single puppy/kitten syndrome
 is more common in dogs compare to cats
 The single fetus fails to produce sufficient ACTH and cortisol to initiate the birth process.
ii. Calcium deficiency
iii. Lack of exercise
Secondary uterine inertia
 is a consequence of another causes of dystocia, such as obstructive dystocia
 These unproductive straining results in cessation of uterine contraction due to muscle
fatigue
Fetopelvic disproportion
 is chiefly seen in the small breeds where litter size is numerically small and individual
fetal size is large.
Fetal monsters

5/By Dr.Fayera Gemeda and Mr. Bashahun G.

 is common causing dystocia in small animals
 Include hydrocephalus, schistosomus reflexus, anasarca, and conjoined twins.
 In most cases the abnormal fetus is too large to enter the maternal pelvis.
 Vaginal delivery is impossible and delivery by cesarean section is necessary
Uterine Prolapse
 is protrusion of the uterus through the vulva after parturition
 is characterized by tenasmus
Treatment
 manual replacement of prolapsed uterus starting from the base
 antibiotic therapy to prevent infection
 ovariohysterectomy (if it stay for long time )
Puerperal tetany
 occurs in bitches and queens 3 weeks of prepartum
Cause: Ca2+ deficiency
Clinical signs
 nervousness (anxiety), excessive planting, barking at nothing, ataxia (stiff gaited movement),
spastic lateral recumbence – stays for 2 – 5 min, fever due to rigorous muscular contraction
and death following relapsing after 3 days (respiratory problem & hyperthermia cerebral
edema)
Treatment
 Ca – solution or Ca-boroguluconate
Genital Emergencies in Male
Paraphimosis
 is a condition when the enlarged/edematous penis  unable to retract into the prepitual
cavity by itself
Causes: injuries during coitus and masturbation
Treatment
 reduction of edema by immersing in cold hypertonic solution or massaging  reinsert the
penis into the perpetual cavity
 if the above failed, make ventral incision over perpetual ring and stitch after inserting

6/By Dr.Fayera Gemeda and Mr. Bashahun G.

  use local antibiotic
Orchitis
 is inflammation of testis
 may be result of infection or of trauma
Clinical signs
 Swollen testicle and pain on palpation
Treatment
 long cause of antibiotic therapy (2- 3 weeks)
 castration
Prostatic Engorgement
 is common in older dogs
 possible causes of swelling of prostate glands
 tumor  hardy, irregular mass
 Hyperplasia  increased exposure to male hormone, semisolid swelling
 abscesses  fluctuating swelling
Clinical signs
 difficulty in mictuation and defecation
Diagnosis
 clinical signs
 digital palpation through rectum
Treatment
 Castration
 Radiation
 Surgical removal
 Estrogen application  reduce prostate growth for 3-4 weeks (esp. in human)

7/By Dr.Fayera Gemeda and Mr. Bashahun G.

 CHAPTER 6: DISEASES OF URINARY SYSTEM

Clinical Examination of urinary system

Palpation
 Kidney area pain reaction by the presence of contraction of muscle of loin, snapping
 Bladder area (relatively easy in all animals)  the presence of distension & thickness
Radiography/ultrasonography
 helps to identify the presence or absence of:
 thickness & distension of the bladder,
 tumor & inflammation of kidney,
 hydronephrosis,
 obstruction & diverticulum of urethral
 Urinary calici
Laboratory tests
Urinalysis
• Sample – urine
• Urine collection– micturation, catheter, or cystocenthesis
• Examine the presence of micro-organisms and blood
Serum chemistry
• Sample – uncoagulated blood
• Site of blood taking – cephalic or jaguar veins
Chronic renal failure
 is prolonged & progressive loss of functional nephrons  result in loss of functional capacity
of the kidney
 Prevalence is increasing as the age increases
 Causes: the problem usually occurs following :
 pyelonephiritis
 glomerulonephritis
 renal amyloidosis
 congenital diseases
 Clinical signs
8/By Dr.Fayera Gemeda and Mr. Bashahun G.
 the animals can live for long time without showing the clinical signs.
 classified into 3 arbitrary signs
i. Early  polyuria, polydipsia, vomiting, anorexia
ii. Late  dehydration, non-regenerative anemia, renal and oesteo –dystrophy, weight loss
iii. Terminal  stiff gait & arched back (renal pain), oral ulceration (uremia); diarrhea &
constipation in cycle; severe dehydration; and finally seizure & comma (high K+);
Diagnosis:
 Clinical signs
- Rickets & rubber jaw (reabsorption of Ca2+ due to high PO42+ blood level )
- Severe anemia
 Laboratory test
i) Urinalysis
- Low level of urine specific gravity
- High PO42+ level
- Presence hyaline casts
ii) Serum tests
 Uremia
 High PO42+ level
 Prognosis depends on causes, metabolic defect, the number of survived nephrons &
concurrent infection.
Treatment
 Terminate vomiting by antiemetic drugs
 Massive fluid therapy
 Prohibition from protein diets
 Broad spectrum antibiotic administration
 Rest
Acute Renal Failure
 Synonym = acute tubular necrosis
 Is caused by major damage of renal parenchyma.
 has two major causes

9/By Dr.Fayera Gemeda and Mr. Bashahun G.

i) Vascular collapse/hypotension
- Acute heart failure
- Acute haemorrhage
- Acute infection esp. acute interstitial nephritis
- Hypersensitiveshock
ii) Nephrotoxic substance
- CCl4 arsenic, gentamycin, sulphamides
Clinical signs:
 Vomiting
 Dehydration anorexia, oral ulceration
 Anuria
 Hypothermia
 Haematuria (if there is infection)
 Treatment :
 Fluid therapy
 Compatible blood transfusion
 Diuretic drug administration  anuria/oligouria
Glomerulonephritis
• is an inflammation of nephron and associated tissue esp. glomeruli capillaries
• is an immuno-mediated situation which is activited by some bacteria such as streptococcus
Clinical signs:
• proteinuria
• Anemia  pale mucous membrane
• nephrotic syndrome (edema- ascites-emaciation)
Diagnosis
• Clinical signs
• Urinalysis  massive proteinuria
Treatment:
• Very difficult to treat since the situation is immuno-mediated
• Therefore, the treatment depends on symptomatic

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Renal Amyloidosis
• is an idiopathic renal disease
• is characterized by intercellular amyloid deposition particularly in basement membrane of
glomerulus
• occurs in all species of animals but quite common in dogs
Clinical signs:
• Proteinuria
• Polyuria & polydipsia at early stage
• Anemia & nephrotic syndroms at late stage

Treatment:
• Symptomatic treatment
Urinary incontinence
• is involuntary passage of urine
• The disorder involve problems associated with storage of urine or voiding of urine or both
• There are two factors that cause the problem
i) Non-neurological causes
• Congenital defects of urine system (young animals) such as ectopic ureters, urethral
diverticulum
• Submissiveness – frightening/fear
• Chronic cystitis
• Iatrogenic inconsistence – post surgery
• Sever urethral inflammation – near to sphincter
• Urethral calculi with partial obstruction
• Hormonal
• Polyuria  fatigue of muscle
ii) Neurologic causes
- is associated with spinal injuries (tumor, trauma, herniated vertebral disc)
- depends on the site of injury
- Sites:

11 / B y D r . F a y e r a G e m e d a a n d M r . B a s h a h u n G .
L5-L7 = upper motor neuron
Sacral region = lower motor neural
Treatment
Determined by underline cause
 Surgical treatment – to correct congenital defects such as urethra diverticulum, ectopic ureter
 Training – for submissive animals
 Rational drug therapy
- cystic fibrosis- anti-cholinergic drug
- increased urethral tone- sympathetic alpha blocking drugs
- hormone responsive – estrogen or testosterone
- antibiotics
Bladder infection
• result in intense discomfort and pain
• can occur at any age but spay animals tend to develop more infection
• is more common in female animals than males
Causes
• Bacterial infection (E. coli, streptococcus, entero cocci)
• Urolithiasis
• Crystals in the bladder
Clinical signs
• Having difficulty or crying while urinating
• Bloody urine
• Urine has foul smelling
• Caring lower abdomen
• Enlargement of bladder on palpation
• Frequent licking of genitalia
• Urinating in the house or any odd places
• Animal wants to urine more often without passing urine
Diagnosis
• Clinical signs

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• Urinalysis
• Bacteria isolation from urine
Treatment
• Antibiotics
• Anti-inflammatory drugs
Canine urolithiasis
• is a disease caused by the presence and effect of uroliths, caliculi or excessive amounts of
crystal in the urinary tract
• These substances result in inflammation of the lining the tract, pain, or complete or partial
obstruction.
Risk factors
Age
- Less than 2 months or 2 – 10 years old animals
Sex
- Male > female because of male urethra is long and narrow
Breed
Confinement and lack of exercise
- Low water intake  infrequent urination  favors the formation of crystals
Diet
- High level of minerals such as Mg, P and Ca and protein
Clinical signs
 Frequent urination
 Bloody urine (hematuria)
 Dribbling of urine
 Straining
 Pain
 Anuria (due to blockage)
Diagnosis
 Abdominal palpation
 Urinalysis

13 / B y D r . F a y e r a G e m e d a a n d M r . B a s h a h u n G .
 Urine culture
 radiography
Treatment
 Emptying the urinary bladder if there is blockage
 Surgical removal
 Antibiotic for secondary infection
Bladder tumors
 are the most common tumor of urinary tract
 are more common in dogs than cats
 are usually malignant with only 30% of tumors being benign
Risk factors
 Chemicals (nitrosamides, insecticide dips, cyclophosphamide, sentinil)
 obesity or
 living in an industrial location
 Age
 Sex
 Breed
Clinical signs
The signs mimic signs seen with bladder infection
 Bloody urine
 Incontinence
 Frequent urination straining
 Anuria
If the tumor spreads to backbone
 Cry out in pain
 Relectance to jump on elevation surface
 lameness or dysfunction of hind limb
If the tumor spreads to other part of the body
 Emaciation, anorexia, malaise, lethargy, breathing difficulty

14 / B y D r . F a y e r a G e m e d a a n d M r . B a s h a h u n G .
Diagnosis
 Abdominal/digital palpation
 Urinalysis, cytology, urine culture
 Radiography
 Cystoscopy
- identify the extent and nature of the tumor
- Benign = located in the front bottom while malignant at the neck of the bladder
Treatment
 Surgical removal for benign tumors
 Radiation therapy
 Antibiotic + chemotherapy + non-steroidal anti-inflammatory drugs

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CHAPTER 7: DISEASES OF THE HEMOLYMPHATICS AND MUSCULOSKELETAL
SYSTEM

A. DISEASES OF HEMOLYMPHATICS

1. ANEMIA
Anemia is a condition characterized by the presence of too few red blood cells and reduction of
hemoglobin or both.
Clinical signs
 Pale visible mucous membranes
 Lethargy depressed, sleep more than normal
 Loss of appetite
 Increased respiratory and heart rate
 Systolic murmur during auscultation due to low viscosity of blood
Anemia development rate or severity depend on
 Rapidity of blood loss
 The presence of concurrent cardiopulmonary systemic failure
 Age – exhaustion of hemopoetic system with age
 Activity of the patient- subject to heavy exercise worsen the problem
 Cause of the disease – aplasia of bone marrow leasing to non response
Classifications of anemia
i) Regenerative anemia
The body loses blood faster than it can be regenerated but the animal is still able to produce new red
blood cells (RBCs) in its bone marrow. A mark of regenerative anemia is that the body is in a rush and
releases some RBCs a bit too early. These young RBCs are called reticulocytes.
Causes
 Internal parasite infestation such as hookworms
 Ecto-parasite infestation such as flea, lice
Note: Hemoglobin, the red pigment of blood, contains iron. In both instances so much iron is lost
from the body that the red blood cells subsequently produced are smaller than normal (microcytic
anemia).
 Trauma – large wound

16 / B y D r . F a y e r a G e m e d a a n d M r . B a s h a h u n G .
  Administration of non-steroidal anti-inflammatory medications including aspirin, ibuprofen,
phenylbutazone and naproxen and pyroxicam esp. in dogs  cause bleeding ulcers of the
stomach and small intestine leading to anemia.

ii) Non-regenerative anemia

The animal has lost the ability to make new RBCs in the bone marrow.
Causes
 Nutritional deficiency such as Fe
 Hypoplasia/aplasia of bone marrow
Diagnosis
 History and clinical signs such as paleness of mucous membrane
 Auscultation: heart murmurs- because animals with anemia have fewer red blood cells, their
blood is thinner. The noise a heart murmur makes comes from the turbulent sound thinner blood
makes as it flows through the heart.
 Laboratory tests
 Packed Cell Volume (PCV)
 Thin Blood film- to determine the characteristics of the red cells and blood platelets that
are present. In this way, I can distinguish between regenerative and non-regenerative
anemia.
 Regenerative anemia = blood serum analysis and a white blood cell count on anemic
animals to help me determine the cause of the disease
 Non-regenerative anemia = it may be necessary to examine samples of the blood-forming
marrow of the bones.
Treatment
 Mild to moderate cases of anemia are treated with blood-building vitamins and minerals called
hematinics.
 Severe cases of anemia require transfusions. Luckily, transfusion reactions are less common in
pets than in human beings.

i. Blood loss anemia

Acute blood loss anemia is caused by mostly by accident and very common in dog and cat. (Why?)
The number of platelet circulate in the blood stream is significantly reduced because of huge consumption
of platelet for clotting.

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Treatment of blood loss anemia
 Attempt to stop bleeding
 Fluid

ii. Chronic blood loss anemia

It is resulted from blood loss for extremely long period of time. This continuous blood loss subsequently
leads to Fe deficiency due to exhaustion of reserve. This causes microcytic hypochromic anemia.
Hookworm infestation, intestinal neoplasia and malabsorption of Fe could be raised as main reason for
such anemia.
iii. Hemolytic anemia
This type of anemia raises from destructive parasitic infestation such babesiosis and toxic and reduction
of life span of RBC. It is characterized by hemaglobinemia, icterus and reticulocytosis.
Acute immunohemolytic anemia
The defense system goes astray and attacks the animal’s own body and red blood cells (RBC), causing
accelerated destruction or removal of red blood cells, which can lead to severe, life-threatening anemia.
Sometimes the bone marrow cannot regenerate the red blood cells.
It is characterized by PCV< 10%, marked reticulocytosis, positive coomb’s test and icterus -in chronic
cases. It is associated with systemic canine lupus erythromotosis and thrombocytopenia purpurae.
Clinical signs
The clinical disease of AIHA can vary, depending on a combination of predisposing factors, including
host immune and environmental influences. Anemia (low red blood cell count) resulting in pale mucous
membranes is the primary clinical sign seen. Other clinical signs may include collapse, weakness,
lethargy, anorexia (lack of appetite), exercise intolerance, dyspnea (difficulty breathing), tachypnea (rapid
heart rate), vomiting, diarrhea, fever may or may not be present, jaundice (yellow mucus membranes),
joint pain, petechia (bruising) and occasionally increased drinking and urinating.
Diagnosis
 Based upon the clinical history and physical examination, several laboratory tests are indicated to
confirm AIHA.
 CBC (Complete Blood Cell Count) = the red blood cell count is low, often with a PCV (packed
cell volume) of less than 20%. White blood cell count may be elevated, decreased, or normal.
Platelets are often concurrently low. Blood smears often reveal abnormal red blood cells.
 Serum Chemistry = these tests are used primarily to rule out other concurrent diseases. Elevated
liver enzymes are common with AIHA.

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  Autoimmune Profile (Coomb’s, Antinuclear Antibody, and Rheumatoid Factor) = this is the
diagnostic test of choice. Unfortunately, this test cannot be run in house and may take several
days to get results. Please keep in mind that occasionally the Coomb’s test will be negative with
AIHA.
 Tick Panel (Ehrlichia, RMSF, Lyme)—This test may need to be done to rule out these diseases
when thrombocytopenia (low platelet count) is present.
 Radiographs/Ultrasound = these may need to be performed if the presence of a tumor is
suspected.
 Bone Marrow Biopsy= this test is indicated when the anemia is nonregenerative and there is little
or poor response to treatment.
Treatment
The treatment of AIHA is geared toward two specific areas:
 Stopping of production of antibodies by provision of immunosuppressive drugs such as high
corticosteroid doses (predensilon, glucocortisteroid).
 Removing organ of RBC destruction = splenoctomy

CANINE LYMPHOSARCOMA

Canine lymphoma (lymphosarcoma) is a malignant cancer of the lymphocytes and common in dogs
greater than 5 years old. There are 4 syndromes depending on the location of the lesions
a) Multicentric (disseminative) form
 Is the most common form of lymphoma is the multicentric form, which makes up about
80% of all cases.
 In this form of lymphoma, cancer cells can be found throughout the lymphatic system, in
many different locations of the body. Since the lymphatic system has "tubes" connecting
the whole body, it is not difficult to imagine that cancer of the lymphatic system can
spread easily. Once lymphoma occurs, it is always assumed to have spread, because of
the high mobility of the cells involved.
 There is lymphatic vessels obstruction that subsequently leads to edema formation on
extremities
b) Alimentary form
 Is characterized by diarrhea, vomiting, emaciation, and involvement of GI and mesenteric
lymph nodes
c) Cutaneous form

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  Mainly involves skin and superficial nymph nodes (sometimes)
 The lesions are multiple, firm, raised and usually red-pale plaques on the skin =
ulcerative and itchy
d) Anterior mediastinal (thymic) form
 Is relatively rare
 Clinical signs are related to respiratory signs such as dyspnea
Diagnosis
o Depending on the location of the tumor, canine lymphoma is diagnosed using a combination of
tests, such as blood tests, fine needle aspirates of the tumor, biopsies, x-rays and ultrasound.
o Histological finding = infiltration of large amount of immature lymphocytes
Treatment
o Since canine lymphosarcoma is considered a systemic or whole body disease and may strike in
any location, surgery is ineffective and impractical.
o The treatment of choice is chemotherapy which usually consists of a combination of oral and
injectable drugs given on a weekly basis.

B. MUSCULOSKELETAL DISORDERS

 Signs of musculoskeletal disorders include weakness, lameness, limb swelling, and joint
dysfunction.
 Motor or sensory neurologic impairment may develop secondary to neuromuscular lesions.
 Abnormalities of the musculoskeletal system may also affect other organs of the endocrine,
urinary, digestive, hemolymphatic, and cardiopulmonary systems.
 Evaluation of musculoskeletal disease is aimed at localizing and defining the lesion(s).
 Diagnosis requires accurate review of the signalment, history, and physical status of the animal.
A lameness examination is critical in determining a diagnosis.
 Useful supplementary tests include radiography, ultrasonography, arthrocentesis, arthroscopy,
arthrography, electromyography, and tissue biopsy and histopathology. For subtle lesions,
advanced imaging such as bone scan, computed tomography (CT), or MRI may be needed.
 There are a number of muscle, bone and joint problems that affect all breeds of dog. Accidents or
infections may cause inflammation and loss of movement.
 But the dog's musculoskeletal system is hardy until it becomes subject to the degenerative
processes of old age. On rare occasions, a dog will suffer the loss of movement in a joint because
of infection, accident, inflammation, or excessive connective tissue.
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Arthritis


Inflammation of the bone at a joint is called arthritis. Older dogs suffer from arthritis much more
than younger ones, although it may afflict dogs of an age.

With arthritis, the dog feels pain on walking and jumping.

Often there is swelling around the joint, and the dog's discomfort is more severe in damp weather.
The condition must be treated by a veterinarian.

Home treatment consists of half aspirin as a pain killer (repeated as needed) and warm packs on
the sore joint. Restrict the dog's activity and keep him in a warm, dry room away from drafts.

Rheumatism

Rheumatism is a disease that causes pain in the joints and muscles. The symptoms of rheumatism are very
often similar to those of arthritis. The dog will experience pain on walking and jumping, and extreme
discomfort in wet weather. The most prevalent types are inflammatory or acute articular rheumatism and
muscular rheumatism, which is accompanied by muscular pain. In the rare case of pulmonary
rheumatism, the dog's breathing may be affected.

Congenital Hip Dysplasia

Congenital Hip Dysplasia is a malformation of the ball and socket of the hip, existing at birth or before.
The defect may vary from a bad fit to an outright dislocation of the hip. Saint Bernards and German
Shepherds seem to suffer from this condition more than any other breeds, but are also in other medium -
and large-sized dogs (those over 30 to 40 pounds), and even smaller dogs.

The disease can be recognized when the dog is 5 to 6 months old, although the only sure way to know is
to have a veterinarian x-ray of the hip. Dogs with the disease are usually lame, unwilling to get up, and
unable to stand straight when they do. When siting, they often stretch their hind legs to the side. The
defect varies from mild to severe and may cause great pain.

Dogs with hip dysplasia should be exercised only moderately and their weight kept down to a minimum.
Also, they should not be bred because this is a genetically determined disease.

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CHAPTER 8: DERMATOLOGICAL DISEASES

1. Ringworm
Keratinophylic fungi are common inhabitants of the soil. The group of keratinophylic fungi is very large,
but only three genera, known as dermatophytes, are known to cause disease ("ringworm") in animals and
humans. The three genera involved are Microsporum, Trichophyton and Epidermophyton. Ringworm is
of importance not only because it can cause skin disease in dogs and cats, but it also can be transmitted to
other animals as well as to humans.
The most common fungus isolated from dog and cat fur is Microsporum canis, followed by M. gypseum
and Trichophyton mentagrophytes.

Dogs and cats can suffer a dermatophyte infection at any age, but ringworm infections in the young are
most frequent. In addition to age, risk factors include poor nutrition, high density of animals, poor
management and lack of an adequate quarantine period for infected pets.

It is important to note that canine and feline ringworm infections differ clinically. Canine infections
generally produce lesions, whereas clinical signs may not be evident in cats. In cats, it is possible to
culture dermatophytes from clinically healthy animals that act only as carriers of conidia, without being
infected. In dogs lesions can occur in any part of the body, but they occur mainly in the head, ears, tail
and front paws.
Diagnosis
Skin scrapings or use of plucked hair are the most common methods used worldwide. The skin sample
skin should be taken from the edge of the lesion with a surgical blade. There is no value in cutting the
hairs because the fungal parasitic structures (arthroconidia) are in the base of the hair.
 Direct Microscopic Examination:
 Culture on sabouraud’s dextrose agar together with pencillin and streptomycin and
cycloheximide - a substance that helps to slow the growth of fast growing fungi.
 Dermatophyte Test Media (DTM) is very helpful in confirming the isolation of a dermatophyte.
 Identification and Characterization of Dermatophytes - After the primary isolation of a
suspected dermatophyte, it is necessary to identify the genus and species.
Treatment
Generally, topical treatment fails because dogs and cats usually remove the drug by licking. Systemic
drugs include griseofulvin, ketoconazole, itraconazole and fluconazole. It should be noted that

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griseofulvin may cause bone marrow suppression, with anaemia and pancytopenia, thus weekly or
biweekly complete blood counts are recommended.

2. Flea allergy dermatitis

Flea allergy dermatitis (FAD), also called flea bite hypersensitivity is the most common skin allergy
encountered in small animal. Flea bite hypersensitivity manifests as pruritic dermatitis in animals that
have become sensitized to antigenic material in flea saliva. Flea saliva contains a variety of histamine-like
compounds, enzymes, polypeptides, and amino acids. In general, most flea allergic dogs have immediate
skin hypersensitivity.

Histamine is found throughout the animal kingdom and in many plants, bacteria and in insect. Histamine
is chemically classified as an amine, an organic molecule based on the structure of ammonia (NH3). It is
formed by the decarboxylation of the amino acid histidine. Histamines are neurotransmitters that are
produced during any allergic response.

Its role in the body is to cause an immediate inflammatory response and serve as a warning sign to your
immune system, notifying it of any potential attackers. Histamine is found in nearly all tissues of the
body, where it is stored primarily in the granules of tissue mast cells and basophils. Mast cells release
histamine, causing the surrounding blood vessels to dilate and increase in permeability. Allows fluid and
cells of the immune system, such as leukocytes and blood plasma proteins, to leak from the bloodstream
through the vessel walls and migrate to the site of tissue injury or infection, where they begin to fight the
infection and nourish and heal the injured tissues.

When an animal is allergic to a particular substance, such as a food or dust, the immune system
mistakenly believes that this usually harmless substance is actually harmful to the body. In an attempt to
protect the body, the immune system starts a chain reaction that prompts some of the body's cells to
release histamine and other chemicals into the bloodstream. The histamine then acts on a individual's
eyes, nose, throat, lungs, skin, or gastrointestinal tract, causing allergy symptoms.

The common flea spps. Ctenocephalides felis (the cat flea), C. canis (the dog flea), Pulex simulans (a flea
of small mammals), and Echidnophaga gallinacea (the poultry flea). However, by far the most prevalent
flea on dogs and cats is C. felis. Cat fleas cause severe irritation in animals and humans and are
responsible for flea allergy dermatitis. They also serve as the vector of typhus-like rickettsiae and
Bartonella sp, and are the intermediate host for filarid and cestode parasites. Cat fleas have been found to
infest >50 different mammalian.
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Flea Allergy Dermatitis is most common in the summer because in the northern hemisphere that is when
fleas are most prevalent. In countries with warmer climates it can persist all year round. Cooler
temperatures and low humidity tend to inhibit flea development.

Symptoms of Flea Allergy Dermatitis

The first symptom you may notice is severe itching and inflammation of the skin. The dog will scratch
and bite at affected areas often causing damage to the skin which may develop into circular, red painful
sores that can occur anywhere but are most commonly seen along the back and at the base of the tail.

As the condition progresses there may be hair loss, broken hairs, oozing or crusty sores, pimply bumps
and general redness and inflammation of the skin. The sores can be very painful. In severe cases the skin
becomes thickened and dark, predominantly in the area on the dog's back at the base of the tail. The dog,
itself, does the damage with self mutilation due to the severe itching.

Secondary bacterial and fungal infections are common in chronic cases of flea allergy dermatitis and there
may be an unpleasant odor coming from the dog because of this.

Treatment for Flea Allergy Dermatitis

It is probably quite obvious that you need to get rid of fleas from your dog. Just one single flea can cause
terrible symptoms. Fleas must not only be removed from your dog but also from your house and
environment so that the dog is not re-infested. Top spot flea treatments such as Advantage, Revolution or
Front Line can kill fleas within hours. Using flea collars and insecticide shampoos is generally a waste of
time and money as these methods are very outdated.

3. Hot Spots: Acute Moist Dermatitis in Dogs

Also known as acute moist dermatitis, hot spots are usually a disease of dogs with long hair or those with
dense undercoats. It is often caused by a local allergic reaction to a specific antigen. Insect bites,
especially from fleas, are often found to be the cause.
Other causes of hot spots include:
 Allergies: atopy (inhalant allergies) and food allergies
 Mites: Sarcoptes scabei or Cheyletiella
 Ear infections
 Poor grooming
 Hip dysplasia or other types of arthritis and degenerative joint disease and anal gland disease

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Hot spots are circular lesions, usually found on the head, over the hip and along the side of the chest.
They will be moist, raw, inflamed and hairless, and can be quite painful. Animals usually lick, bite or
scratch the area, and thus irritate the inflamed skin even more. In fact, hot spots are sometimes called 'pyo
traumatic dermatitis' because the self-trauma is a major factor in the development of hot spots.

Treatment
Treatment must be directed at stopping the growth of the hot spot and eliminating the cause. In many
dogs the initial cause is fleas, but lesions below the ear often indicate an ear infection, those near the hip
may be the result of an anal gland infection, and so on.

4. Collie Nose (Nasal Solar Dermatitis)

Collies are beautiful dogs by any standard. 'Collie nose' is used to describe a condition in which breeds
with little or no pigment on their face develop lesions, usually on the nose, eyelids, and lips. The lesions
are caused by a hypersensitivity to sunlight. Despite the term 'Collie nose,' breeds other than Collies can
also be affected, especially Shetland Sheepdogs. Collie nose has an inherited component and is worse in
areas with sunny climates.
• Collie Nose also called Discoid Lupus Erythematosus (DLE)
• is localized and doesn't spread through the entire system
• DLE is skin specific and the sores are confined to the face and nose
• The common issue with these areas is that they are not protected by much fur,
• Thus, exposing them to the sun and UV rays aggravate the condition
• Collie's have a genetic predisposition towards developing DLE
• It is an autoimmune disease that causes the immune system to overreact and attack the body's tissues
• Exposure to the sun aggravates this condition and they must have sun protection
Clinical signs
Usually the lesions appear as pink, raw areas about the nose and occasionally on the eyelids. The
hypersensitive areas may actually ulcerate and develop a crusty scab-like covering. The condition may
vary from mild irritation to severe ulcerating lesions that hemorrhage.
Management
Exposure to sunlight should be kept to a minimum. Sunscreen lotions help, but have limited effectiveness
due to a dog's licking behavior. In some cases, the treatment of choice is tattooing. A permanent black ink
is tattooed into the affected areas. The black ink serves as a shield against sunlight. It is best if young dogs
with lightly pigmented noses, as a preventive, are tattooed before any lesions development.

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• Foods with omega-3 fatty acids which reduce inflammation, boost immunity and improve skin
condition (e.g. fish)
• Foods with vitamin E, including sunflower
• Ginger also possesses impressive anti-inflammatory properties
• Incorporating ginger root into dog's food may, reduce inflammation associated with collie nose
• Topical Aloe vera can help reduce dog's itchiness
• Zinc oxide is the most well known, but ingestion can cause zinc toxicity in dogs
• Keep your dog out of direct UV rays!!!

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CHAPTER 9: DISEASE OF EAR AND EYE

Anatomy of Canine and Feline Ear

• The canine and Feline ear are made up of three separate areas:
 The outer ear, the middle ear and the inner ear
• The only section that you can see is the outer ear

Outer Ear

• The outer ear includes the ear flap orpinna, as well as the portion of the ear you can see
with the naked eye
• The pinna, which can be either upright or floppy

Middle Ear

• The outer ear and middle ear are separated by the ear drum, which is also called the
tympanic membrane
• Three small bones make up the middle ear
• The middle ear also contains the bulla, an air-filled cavity connected to the back of the
mouth through the Eustachian tube, which is also in the middle ear
Inner Ear
• The inner ear connects to the brain.
• It is a nerve center for the dog/cat, controlling hearing and balance
• The cochlea is the final organ in the ear canal that aids in hearing
• It converts vibrations and messages from the auditory nerve to sound
Balance
• A dog's ears also deal with balance
• In the inner ear there are semicircular canals where liquid moves as the dog's head
changes position
• The movement of the liquid in the canals tells the brain which way the head is moving
and by how much

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 • The brain, in turn, sends messages to the limbs and muscles in the dog's body so they
respond appropriately to changes in orientation and to maintain his balance

Otitis Externa
Otitis externa is inflammation of the external ear canal distal to the tympanic membrane; the ear
pinna may or may not be involved. It may be acute or chronic and unilateral or bilateral. It is one
of the most common reasons for small animals to be presented to the veterinarian. Clinical signs
can include any combination of headshaking, odor, pain on manipulation of the ear, exudate, and
erythema. It can be seen in rabbits (in which it is usually due to the mite Psoroptes cuniculi) and
is uncommon in large animals.

Etiology and Classification System

Causes of otitis externa are now defined as primary or secondary, with factors that contribute to
or promote disease. It is also standard of care to determine whether the cause is curable or
lifelong management is required. Primary causes of otitis externa are those that create disease in
a normal ear. They can cause otitis without any other cause or factor and can be subtle; they
often go unrecognized by owners and veterinarians until secondary causes develop. Primary
factors alter the ear environment, which allows secondary infections to develop. The major
primary causes of otitis externa are allergy, autoimmune (eg, pemphigus), endocrine,
epithelialization disorders, foreign bodies, glandular disorders, immune-mediated (eg, drug
reactions), fungal (eg, aspergillosis), parasites, viral (eg, canine distemper), and miscellaneous
(auricular chondritis, eosinophilic diseases, juvenile cellulitis, proliferating necrotitizing otitis of
cats). Secondary causes are those that cause disease in an abnormal ear. These causes are
relatively easy to eliminate and include bacteria, fungi, medication reactions, overcleaning, and
yeast overgrowth.

Factors are elements related to the disease or pet that contributes to or promote the otitis externa
by altering the structure, function, or physiology of the ear canal. Factors are subdivided into
predisposing factors, which are present before the development of the ear disease, and
perpetuating factors, which occur as a result of the inflammation. Predisposing factors include
conformation of the ear, excessive moisture, obstruction of the ear canal (eg, polyp, feline

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apocrine cystadenomatosis), primary otitis media (eg, primary secretory otitis media, otitis media
due to neoplasia or respiratory disease), systemic diseases (eg, catabolic states), and treatment
effects (eg, alterations of normal microflora, trauma from cleaning). Perpetuating factors
include changes in the ear epithelium (eg, failure of migration), ear canal (eg, edema, stenosis,
proliferation), tympanic membrane (eg, dilated, ruptured), glandular (eg, sebaceous hyperplasia),
pericartilaginous fibrosis (eg, calcification), and middle ear (eg, filled with debris, otitis media).
This system is currently referred to as the PSPP classification system. A prognosis should be
given for otitis externa. Curable means that the component of the problem is readily resolved
with treatment (for weeks) or via surgery. Longterm management indicates that the component
of the ear problem may be resolvable, but it can take months of treatment. Lifelong treatment
indicates that the owner will need to play an active role in management for the life of the pet.

Clinical Findings and Diagnosis

There is no recognized sex distribution for otitis externa. Young animals may be more
commonly affected. There are clear breed predispositions for otitis, which directly reflect the
breed predispositions for skin disease (eg, allergies in retrievers and terriers). The most common
historical findings are headshaking and aural pruritus.

The first step in physical examination is determination of the severity of pain. This can be done
by gentle palpation or petting of the animal. If the ear is painful or the degree of discomfort is
high, the animal should be sedated before performing any further diagnostic testing. The second
step is gentle palpation and manipulation of the ear canal and pinna to determine the presence of
swelling, pruritus, fibrosis, or calcification. The presence or absence of these findings will help
determine whether advanced diagnostics are needed, specifically imaging of the ear canal. Next,
the outside of the ear should be examined, noting erythema, edema, crusts, scale, ulcers,
lichenification, hyperpigmentation, or exudate. The pinnae and periauricular regions should be
examined for evidence of self-trauma, erythema, and primary and secondary skin lesions. Pinnal
deformities, hyperplastic tissue in the canal, and headshaking suggest chronic otic discomfort. If
the otitis is unilateral, the unaffected ear should be examined first to prevent iatrogenic
contamination of the unaffected ear with organisms (eg, Pseudomonas aeruginosa or Proteus

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mirabilis) that may be present in the diseased ear. The unaffected ear may, in fact, be diseased,
meaning that the differential diagnosis list should also include causes of bilateral otitis.

Otoscopic examination is often not possible because the ear is painful, swollen, or filled with
exudate; sedation is usually required. Swelling of the ear canal often makes it impossible to see
the tympanic membrane. A handheld otoscope must have enough light and magnification to
clearly visualize the external canal to the level of the tympanic membrane. Disposable otoscopic
ear cones are recommended, because studies have demonstrated contamination of cones.
Handheld otoscopes are available with a variety of heads, including magnification options and
surgical operating heads, that allow for visualization of the ear canal while inserting another
instrument. The surgical head is used when biopsies, foreign body removal, or deep flush of the
canal is anticipated.

A video otoscope provides magnifcation of the ear canal and tympanic membrane. Most have a
working channel through which biopsy instruments, catheters for flushing debris from the canal,
and laser tips can be passed. Video otoscopes allow visualization through water and saline to
determine the integrity of the tympanic membrane and to facilitate sampling and culture of the
middle ear.

During an otoscopic examination, the ear canal should be inspected for changes in diameter,
pathologic changes in the skin, quantity and type of exudate, parasites, foreign bodies,
neoplasms, and changes in the tympanic membrane. The tympanic membrane should be
examined for evidence of disease or rupture. However, in many cases of otitis, the character of
the ear canal and tympanic membrane cannot be visualized at all until the exudate is gently
flushed from the canal. Samples for cytologic evaluation and culture should be obtained before
the ear is flushed. Examination is attempted again after the ear is dried. In chronic cases, the
canal may be too stenotic, either from hyperplasia or edema, to be examined. Systemic
glucocorticoids given daily for 1 wk may reduce swelling enough to allow examination.

If sedation is not needed, samples for ear diagnostic tests should be collected: skin cytology from
the external and inner pinnae, cytology of any exudates present, hair trichograms and skin
scrapings for Demodex, and ear swab cytology with mineral oil in young and adult animals
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(especially cats, because feline demodicosis can present as pruritic otitis). Wood's lamp
examinations need to be done with care, keeping in mind that the key color is apple-green
fluorescense and that sebum can glow yellow. Dermatophytosis affects the hair of the pinnae and
hairs in the concave surface of the ear canal.

Cytologic evaluation of exudate or cerumen taken from the horizontal ear canal may provide
immediate diagnostic information. The external ear canals of most dogs and cats harbor small
numbers of commensal gram-positive cocci. These organisms may become pathogenic if the
microenvironment is changed and encourages their overgrowth. Exudate obtained with a cotton-
tipped applicator can be rolled onto a glass slide, stained with a 3-step quick stain or modified
Wright's stain, and examined under a microscope. (A study has shown that heat fixing is not
necessary for ear swab cytology.) Smears should be examined microscopically under 4X, 10X,
and oil immersion to look for numbers and morphology of keratinocytes, bacteria, yeasts, and
WBCs; evidence of phagocytosis of microorganisms; fungal hyphae; and acantholytic or
neoplastic cells.

A stained smear can quickly determine whether microbial overgrowth is present. Coccal
organisms are usually staphylococci or streptococci. Rod-shaped organisms are usually
Pseudomonas aeruginosa, Escherichia coli, or Proteus mirabilis; their appearance in large
numbers indicates that a bacterial culture with antibiotic sensitivity should be performed because
of their known resistance to many antimicrobial agents. The presence of many neutrophils
phagocytizing bacteria confirms the pathogenic nature of the organisms.

The yeast Malassezia pachydermatis is found in low numbers in the ear canals of many healthy
dogs and cats. Because yeasts colonize the surface of the ear canal, they are most easily found
adhered to clumps of exfoliated squamous epithelial cells. M pachydermatis is identified readily
on microscopic examination and its numbers easily assessed. There is no specific number that
indicates yeast overgrowth. The key determining factor is whether the ears are pruritic. In
addition, if previous treatment did not include antifungal therapy and if otitis externa is recurrent,
antifungal therapy is warranted.

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A dark exudate in the canal usually signals the presence of either Malassezia spp or a parasite
but may also be seen with a bacterial or mixed infection. In addition to stained cytology, otic
exudate should be examined for eggs, larvae, or adults of the ear mite Otodectes cynotis and for
Demodex mites in dogs and cats, and Psoroptes cuniculi in rabbits and goats. Smears are made
by combining cerumen and otic discharge with a small quantity of mineral oil on a glass slide. A
coverglass should be used, with the smear examined under low-power magnification. Rarely,
refractory ceruminous otitis externa may be associated with localized proliferation of Demodex
sp in the external ear canals of dogs and cats and may be the only area on the body affected.

Microbial cultures are taken before otoscopy is completed and before any cleaning is done.
Samples for culture should be taken with a sterile culturette from the horizontal canal (the region
where most infections arise) or from the middle ear in cases of tympanic rupture. A bacterial
culture and antibiotic sensitivity and an antibiotic mean inhibitory concentration should be done.

Histopathologic changes associated with chronic otitis externa are often nonspecific.
Histopathologic evidence of a hypersensitivity response may support a recommendation for
intradermal allergy testing or for a hypoallergenic diet trial. In addition, biopsies from animals
with chronic, obstructive, unilateral otitis externa may reveal whether neoplastic changes are
present.

Radiography of the osseous bullae is indicated when proliferative tissues prevent adequate
visualization of the tympanic membrane, when otitis media is suspected as a cause of relapsing
bacterial otitis externa, and when neurologic signs accompany otitis externa. Fluid densities and
proliferative or lytic osseous changes provide evidence of middle ear involvement.
Unfortunately, radiographs are normal in many otitis media cases. CT or MRI, if available,
should be performed for cases of severe, chronic otitis.

Treatment
Key to treatment is a discussion with the owner regarding the suspected or known cause of the
otitis externa, whether the otitis is curable, and whether treatment must be longterm for
resolution or lifelong management will be required. All primary and secondary causes and
predisposing factors need to be identified, managed, and treated. Management of pain or pruritus
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must be included in the initial treatment protocol. Tramadol for the first 5–7 days at 5 mg/kg,
PO, tid, may be especially beneficial. In addition, otitis externa is one of the few dermatologic
conditions in which glucocorticoids are beneficial in the face of concurrent antimicrobial use or
sepsis. Glucocorticoids decrease swelling of the ear canal and may be key to successful
treatment. Prednisone or triamcinolone is used most commonly. Duration depends on the
severity. Ear hygiene is important; in particular, the hair from the pre- and periauricular area
should be clipped, as well as hair from the surface of the inner pinnae and ends of the ears. This
facilitates cleaning and treatment of the ears. Plucking of hair from the ear canal is controversial
but may be needed to adequately resolve the ear infection. Hair plucking is painful and should be
done under anesthesia.

The first ear cleaning should be done in the veterinary clinic, and owners should be instructed
not to clean the ears until recheck in 5–7 days. Owners are often unable to clean the ears and/or
are too aggressive, causing further damage. Owners should initally focus on administration of
topical and/or systemic drugs and can begin to clean the ears after the first recheck and if the
otitis is resolving. It is important to remember that topical medications are inactivated by
exudates, and excessive cerumen may prevent medications from reaching the epithelium. The
ears should be gently cleaned with an ear cleaner that will remove the debris in the canal. Thick,
dry, or waxy material requires a ceruminolytic solution such as carbamide peroxide or dioctyl
sodium sulfosuccinate (DSS). If rods are seen, the ear cleaner should contain squalene, because
one possible cause is Pseudomonas, which can produce a biofilm that protects bacteria from
antibiotics. The ears should be thoroughly rinsed with warm water to remove residual ear
cleaner. If the tympanic membrane is ruptured, detergents and DSS are contraindicated; milder
cleansers (eg, saline, saline plus povidone iodine, Tris EDTA) should be used to flush the ear.

Effective treatment may require both topical and systemic antimicrobial therapy, along with pain
medications and glucocorticoids.The duration of treatment may vary from 7–10 days to >30
days, depending on the diagnosis. In treatment of acute bacterial otitis externa, antibacterial
agents in combination with corticosteroids reduce exudation, pain, swelling, and glandular
secretions. The least potent corticosteroid that will reduce the inflammation should be used.

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Most commercial topical products contain a combination of antibiotic/antifungal and
glucocorticoids. The volume of the ear canal in most dogs is 1 mL, and adequate treatment
requires instillation of at least this volume twice daily. Products with an aqueous base or those
that have a thin film should be used; ointments are to be avoided.

Irritating medications (eg, home remedies and vinegar dilutions) should be avoided. They cause
swelling of the lining of the ear canal and an increase in glandular secretions, which predispose
to opportunistic infections. Substances that are usually not irritating in normal ear canals may
cause irritation in an ear that is already inflamed. This is particularly true of propylene glycol.
Powders, such as those used after plucking hair from the canal, can form irritating concretions
within the ear canal and should not be used.

Systemic therapy should be incorporated into the treatment regimen in most cases of chronic
otitis and in any case in which otitis media is suspected. The most common cause of recurrent
otitis externa is undiagnosed oitits media. Failure to use systemic antimicrobial therapy is an
important cause of chronic ear disease in dogs. Systemic antibiotics should be used when
neutrophils or rod-type bacteria are found on cytology, in cases of therapeutic failure with topical
antimicrobial agents, in chronic recurring ear infections, and in all cases of otitis media. Yeast
infections in dogs can be treated with oral ketoconazole 5 mg/kg/day, PO, for 15–30 days.
Ketoconazole should not be used in cats; itraconazole 2–3 mg/kg/day for 15–30 days or one
week on/one week off are recommended.

Duration of treatment will vary depending on the individual case but should continue until the
infection is resolved based on reexamination and repeat cytology and culture. Animals with
bacterial and yeast infections should be physically examined, with cytologies evaluated weekly
to every other week until there is no evidence of infection. For most acute cases, this takes 2–4
wk. chronic cases may take months to resolve, and in some instances, a therapeutic regimen must
be continued indefinitely.

Methicillin-resistant Staphylococcus intermedius and Pseudomonas otitis (caused by

Pseudomonas aeruginosa) have emerged as frustrating and difficult perpetuating causes of otitis
because of the development of resistance to most common antibiotics. These infections are often
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chronic in course (>2 mo) and associated with marked suppurative exudation, severe epithelial
ulceration, pain, and edema of the canal. Successful treatment is multifaceted and should include
the following steps: 1) identify the primary cause of the otitis and manage it, 2) remove the
exudate via irrigation of the ear canal, 3) identify and treat concurrent otitis media, 4) select an
appropriate antibiotic from the results of culture and mean inhibitory concentration on the
organism and use it at an effective dosage for an appropriate duration, and 5) treat topically and
systemically until the infection resolves (weeks to months).

The best treatment of chronic otitis is prevention. In addition to identifying the cause of acute
otitis, topical and/or systemic medications should be chosen based on cytology or culture; they
should have a narrow spectrum and be specific for the current condition. Aminoglycosides and
fluoroquinolone antibiotics should not be used unless absolutely required for successful
treatment but are the most common ingredients in topical otic medications. Because many topical
products contain a combination of glucocorticoid, antibiotic, and antifungal medications, it is
imperative to educate the owner on proper use (frequency and duration). Many owners
discontinue treatment when the ear “looks better” before the infection is resolved. Polymyxin B
and fluoroquinolone antibiotics have shown the best success in controlling Pseudomonas
infections in cases in which resistance has been identified through culture. However, resistance is
developing to fluoroquinolones.

Maintenance Care
Owners should be shown how to properly clean the ears. The frequency of cleaning usually
decreases over time from daily to once or twice weekly as a preventive maintenance procedure.
The ear canals should be kept dry and well ventilated. Using topical astringents in dogs that
swim frequently and preventing water from entering the ear canals during bathing should
minimize maceration of the ear canal. Chronic maceration impairs the barrier function of the
skin, which predisposes to opportunistic infection. Preventive otic astringents may decrease the
frequency of bacterial or fungal infections in moist ear canals. Clipping hair from the inside of
the pinna and around the external auditory meatus, and plucking it from hirsute ear canals,
improves ventilation and decreases humidity in the ears. However, hair should not routinely be

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removed from the ear canal if it is not causing a problem, because doing so can induce an acute
inflammatory reaction.
Otitis media, inflammation of the middle ear structures, is seen in small and large domestic
animals, including dogs, cats, rabbits, ruminants, horses, pigs, and camelids. It can be unilateral
or bilateral and can affect animals of all ages. Although typically sporadic, outbreaks are possible
in herds. Otitis media usually results from extension of infection from the external ear canal
through the tympanic membrane or from migration of pharyngeal microorganisms through the
auditory tube. Occasionally, infection extends from the inner ear to the middle ear, or reaches the
middle ear by the hematogenous route. Primary otitis media has been reported in certain breeds
of dogs, particularly Cavalier King Charles Spaniels. Untreated otitis media can lead to otitis
interna (inflammation of the inner ear structures) or to rupture of an intact tympanic membrane
with subsequent otorrhea or otitis externa.

Clinical Findings and Diagnosis

Signs of otitis media include head shaking, rubbing or scratching the affected ear, and tilting or
rotating the head toward the affected side; self-trauma can lead to aural hematoma. The most
common cause of recurrent otitis externa is undiagnosed otitis media. When otitis externa
accompanies otitis media, the external ear canal may look inflamed and contain an abnormal
discharge. The pinna or ear canal may be painful and malodorous, and the hair surrounding the
base of the ear may be wet or matted. Because the facial (cranial nerve VII) and sympathetic
nerves course through the middle ear, animals with otitis media may exhibit signs of facial nerve
paralysis (eg, ear droop, lip droop, ptosis, collapse of the nostril) and/or Horner syndrome (eg,
miosis, ptosis, enophthalmos, protrusion of the nictitating membrane) on the same side as the
affected ear. Exposure keratitis and corneal ulceration may develop. With facial paralysis, the
nasal philtrum or lip may deviate away from the affected side. These signs help to distinguish
otitis media from simple otitis externa.

With otitis interna, inflammation impairs function of the vestibulocochlear nerve (cranial nerve
VIII), resulting in hearing loss and signs of peripheral vestibular disease such as head tilt,
circling, leaning or falling toward the affected side, general incoordination, or spontaneous
horizontal nystagmus with the fast phase away from the affected side. Extension of infection

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from the inner ear to the brain leads to meningitis, meningoencephalitis, or abscesses, with signs
referable to those conditions. In horses, severe otitis media/interna can result in fusion and
fracture of the tympanohyoid joint; extension of the fracture line to the calvarium can lead to
intracranial spread of infection or cause hematoma and death.

Whereas animals with otitis media/interna are usually alert, nonfebrile, and have a good appetite,
those with meningitis or meningoencephalitis are usually depressed, febrile, and inappetent. A
major differential diagnosis for otitis media/interna in ruminants is listeriosis. However, in
listeriosis, cranial nerves other than VII and VIII may be affected, causing signs such as
dysphagia or loss of facial sensation, and affected animals are usually depressed.

In large animals, otitis media and interna are presumptively diagnosed based on history and
clinical signs. A history of bottle feeding or feeding of contaminated milk to neonates,
concurrent or previous respiratory disease, chronic ear infection, or aural foreign body, in
conjunction with typical signs of otitis media/interna, should prompt examination of the ear
canal. Otitis media is confirmed by visualizing a bulging, discolored, or ruptured tympanic
membrane. Although the tympanic membrane may be visualized using a simple otoscope in
many cases, the anatomy of the ear canal hinders visualization in some species, such as horses
and llamas; endoscopy, or video otoscopy, is an alternative approach. Imaging methods assist in
diagnosis and assessment of lesion severity. Radiography can detect osseous changes in the
tympanic bulla and fluid in the tympanic cavity if appropriate positioning and techniques are
used. However, CT and MRI are more sensitive and are the preferred methods when feasible. In
some cases, diagnosis is made only at necropsy, using special techniques to expose the tympanic
region. Diagnosis of clinical otitis media/interna in one ear should always prompt examination of
the other ear to determine whether subclinical otitis is present.

Otitis media has been reported to be present in 16% of dogs with otitis externa and in >50% of
dogs with chronic otitis externa. The tympanic membrane has also been reported to be intact in
>70% of cases, and the disease is usually bilateral in dogs. Primary and secondary causes and
factors of otitis externa can lead to otitis media. Diagnosis can be challenging, because the
tympanic membrane can be intact. Palplation of the tympanic membrane with a blunt instrument

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is not an accurate method of determining the patency of the tympanic membrane. Advanced
imaging techniques (CT or MRI) are more sensitive than routine radiographs but are not 100%
sensitive and specific. In some cases, exploratory (and therapeutic) bulla osteotomy may be
necessary.

Treatment and Prognosis

Treatment of otitis media/interna is most successful when started early in the course of the
disease. Chronic cases are often refractory to treatment or recur after apparent remission. When
otitis externa accompanies otitis media/interna, the ear should be examined closely for mites and
foreign bodies, such as plant awns, and the discharge cultured for bacteria. Many aerobic and
anaerobic bacteria have been cultured from the ears of animals with otitis media/interna, and
mixed infections are common. Pathogens that warrant mentioning because of their frequency of
isolation include Malassezia spp and Pseudomonas spp in small animals; Streptococcus suis in
pigs; Streptococcus spp in horses; Mycoplasma spp in goats; and Mannheimia haemolytica,
Pasteurella multocida, Histophilus somni, and Mycoplasma bovis in cattle. M bovis is
particularly problematic in dairy calves fed unpasteurized waste milk from cows with
intramammary infection. However, other pathogens, such as coliform bacteria, Staphylococcus
spp, Neisseria spp, corynebacteria, and Arcanobacterium pyogenes are frequently isolated from
the ears of affected animals. Isolation of a bacterial pathogen(s) or mites from the ear helps direct
initial treatment but does not necessarily imply causation of otitis media/interna, because the
same organisms can be isolated from the external ear canals of apparently healthy animals.

Ear mites, when present, should be treated with an appropriate systemic antiparasitic agent.
Topical acaricides can be instilled into the external ear canal once it is cleaned. Bacterial
infection should be treated with appropriate systemic antimicrobial agents, based on culture and
susceptibility test results. If the tympanic membrane is intact, a culture can be obtained via a
myringotomy incision with a tom cat catheter. It may be possible to aspirate fluid. If not, 0.5 mL
of sterile water can be instilled into the bulla and the fluid aspirated for culture. No antimicrobial
agents are labeled for treatment of otitis media/interna in food-producing animals in the USA, so
extra-label drug use guidelines must be followed and prohibited drugs avoided.

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In addition to antimicrobial and/or anthelmintic therapy, the external ear canal should be cleaned
and flushed if otorrhea or otitis externa is present; physiologic saline or dilute antiseptic
solutions, such as iodine, chlorhexidine, or hydrogen peroxide, are commonly used for flushing.
Steroids or NSAIDs can help reduce inflammation and pain associated with otitis media/interna.
Corneal ulceration, aural hematomas, and concurrent infections should be treated appropriately,
if present, and the animal protected from further self-injury.

If the tympanic membrane is intact and otitis media/interna does not respond sufficiently to
systemic antimicrobial and anti-inflammatory therapy, myringotomy (perforation of the
tympanic membrane) can be performed to relieve pressure and enable culture and drainage of
fluid from the tympanic cavity. In chronic, nonresponsive or recurrent cases of otitis
media/interna, it may be necessary to perform bulla osteotomy or total ear canal ablation to
establish sufficient drainage and enable effective lavage. Tympanostomy tubes can be implanted
into the tympanic membrane after myringotomy to allow continuous drainage in Cavalier King
Charles Spaniels with primary secretory otitis, but such tubes are not useful to drain more
purulent exudate.

Early diagnosis and treatment of otitis media/interna can result in complete resolution of
infection and clinical signs. However, with severe, chronic, or nonresponsive cases, owners
should be advised that neurologic deficits and hearing loss may persist even if infection is
resolved. In small animals, otitis media may be resolved only by surgery (total ear canal
abalation), particularly if multidrug-resistant bacteria are present.

COMMON EYE DISEASES

Physical Examination of the Eye

The initial examination of the eye should assess symmetry, conformation, and gross lesions; the
eye should be viewed from 2–3 ft (~1 m) away, in good light, and with minimal restraint of the
head. The anterior ocular segment and pupillary light reflexes are examined in detail with a
strong light and under magnification in a darkened room. Baseline tests like the Schirmer tear
test, fluorescein staining, and tonometry (intraocular pressure measurement), may be followed by
ancillary tests such as taking corneal and conjunctival cytology and cultures, everting the eyelids
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for examination, and flushing the nasolacrimal system to evaluate the external parts of the eye,
including the anterior segment. Diseases of the vitreous and ocular fundus are evaluated by direct
and indirect ophthalmoscopy (usually performed after inducing mydriasis) and vision testing
(menace reflex, obstacle course, dazzle reflex, etc).

Fig. 1. The eye and eyelids, median section. Illustration by Dr. Gheorghe
Constantinescu.

Schirmer tear tests and cultures should be performed before topical anesthetic is instilled.
Fluorescein staining and eversion of the eyelids do not require topical anesthesia, but tonometry,
examination of the bulbar surface of the nictitating membrane, conjunctival and corneal
cytology, gonioscopy, and lavage of the nasolacrimal system usually do. To avoid false-
positives, samples for corneal and conjunctival cytology that will be analyzed by fluorescent
antibody procedures should be collected before topical fluorescein staining.

Special examinations such as slit-lamp bio microscopy, ultrasonography, fluorescein

angiography, and electroretinography may require sedation or local, regional, or general
anesthesia, depending on the species.

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ENTROPION

• is an inward rolling of the eyelid

• The problem is most common in the Shar Pei, Chow Chow, Bulldog, Retrievers,
Rottweiler, and Setters
• Although the exact genetic pattern is usually not known
• the problem is most likely caused by many genes that are responsible for the overall head
and face conformation
• When the eyelids roll in, the hair on the outside of the lid rubs on the surface of the eye
and cause corneal irritation
• In some patients, entropion leads to corneal ulceration
• The treatment for entropion is surgery to remove excess skin and muscle along the eyelid
margin

CATARACT

• Cataracts are opacities in the lens of the eye

• Many people mistakenly think the cloudiness is on the surface but in fact, the cloudy lens
is deep inside the pet’s eyeball
• Most cataracts are inherited, and are found in many breeds
• Other causes of cataracts include: Diabetes, trauma, inflammation, and puppy milk
replacers. Many cataracts will worsen to the point of blindness
• Treatment for cataracts is surgical removal by a technique called phacoemulsification.

EYELID TUMOR

• Some are small and slow growing, while others may rapidly grow in size
• Some lid tumors are not bothersome, while others may rub against and irritate the surface
of the eye, or even obstruct vision
• On the other hand, large or fast-growing tumors that cause irritation, obstruct vision or
periodically bleed are often surgically removed

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CORNEAL ULCER

• An ulcer is an unprotected wound on the surface of the eye

• The normal cornea is covered by a layer of tissue called the epithelium, sort of like “skin”
over the deeper eye layers
• When the epithelium is damaged, infections can occur and result in complete perforation
of the eye if left untreated
• causes of corneal ulcer are injuries, abnormal eyelashes that irritate the surface, lack of
tear production, infections, and many types that we don’t understand very well
• Clinical signs of corneal ulcer include squinting, redness, cloudiness, tearing, and
lethargy
• Some corneal ulcers require simple application of medications to prevent infection
whereas very deep corneal ulcers require surgically placed grafts

GLAUCOMA

• is defined as “an increase in pressure in the eye, with a loss of vision”

• The disease is quite painful in most cases, especially when the eye pressure is very
elevated
• The signs of glaucoma include redness, cloudy eye, tearing, squinting, loss of vision, an
enlarged eyeball
• The normal physiology of the fluid in the eye calls for the fluid to be made in one
structure behind the pupil (ciliary body), travel through the pupil, and exit out the space
between the cornea and the iris
• When the fluid cannot properly drain from the eye, the pressure in the eye is increased
• if the drain is open and the water is running, there is no problem
• If a plug is placed in the drain and the water keeps coming, then the sink fills up with
water and overflows!
• Some patients have primary glaucoma where there is no concurrent disease but some
secondary causes of glaucoma include inflammation, trauma, and tumors
• All of these factors can obstruct the drainage of fluid from the eye

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 • Unfortunately, there is no “cure” for glaucoma. It is a disease that is managed with
medical therapy or surgery

HYPHEMA

• Hyphema refers to bleeding inside the eye

• The condition can be caused by a variety of factors, including trauma, tumor, clotting
disorders, multiple eye diseases, or high blood pressure
• Hyphema usually causes secondary inflammation inside the eye (uveitis)
• Sometimes as the blood clots and settles it can plug the drainage ducts inside the eye and
cause glaucoma
• Treatment for Hyphema depends on the overall health of the eye
• Often topical steroids are used to decrease secondary inflammation.

UVEITIS

• Uveitis refers to an inflammation (irritation) of the part of the eye that supplies blood to
the eye
• If the eye is to remain clear so that light rays can focus on the back of the eye, the blood
vessels must be located out of the way of the clear structures such as the cornea and lens
• When the blood vessels become irritated, blood cells and debris leak out and result in
cloudiness
• causes of uveitis include trauma or infections
• Some of the infections in dogs include: Rocky Mountain spotted fever, Ehrlichiosis,
hepatitis virus, and systemic fungal infections and possibly Lyme’s disease and
Anaplasmosis
• In cats the causes can include: feline leukemia virus, feline AIDS virus, FIP virus,
Bartonellosis and Toxoplasmosis
• Treatment for uveitis is aimed at reducing the inflammation and preventing the
complications.
• The treatment protocol will vary for each patient but often includes a steroid eye
medicine to decrease the inflammation, atropine to alleviate the pain
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REFERENCES

Aiello, S.E. (1998). The Merck Veterinary Manual. 8th ed. Merck and CO., INC., Whitehouse
Station, N.J., U.S.A.

Ettinger, S.J. (1989). Textbook of Veterinary internal Medicine –disease of dogs and cats.
Volume I, W.B. Saunders Company.

Ettinger, S.J (1989). Textbook of Veterinary Internal Medicine-disease of dogs and cats.
Volume II, W.B. Saunders Company.

Reedy, L.M., Miller,W.H. and Willemse, T. (1997). Allergic skin diseases of dogs and cats.
2nded. W.B. Saunders Company Ltd., London.

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