It is always wise to establish a fixed routine of preliminary clinical examination. If this routine is rigidly adhered to in every case other than those confined to a single obvious superficial lesion it is unlikely that serious error will arise.
The following routine will usually suffice for the first clinical examination.
Rectal temperature is recorded, using a lubricated stubby-ended clinical thermometer which must be inserted beyond the internal sphincter of the anus. Normal temperature is usually regarded as being 38-6° C. (101-5° F.) but the range 38-39° C. (100-5-102° F.) will cover most afebrile patients. Rise of temperature due to excitement is not common.
This may be checked at the femoral artery during the previous procedure.
The volume of the cat pulse is small and minor variations are therefore more difficult to detect.
Regular intermittence which is so common in the dog and is regarded as normal in that species does not occur in the cat.
Pulse rate is increased in any form of nervous tension. In some cardiac conditions the pulse rate is so greatly increased as to be virtually uncountable. Quality and rate are probably less helpful in the cat than any other of the veterinary surgeon’s usual range of patients.
VISIBLE MUCOUS MEMBRANES
Palpebral conjunctiva, gums and tongue should all be examined. The normal conjunctiva of the cat is somewhat pallid compared with the dog and is seldom deeper in colour than a pale pink.
Gum colour is likewise somewhat pallid and may even appear faintly bluish in normal subjects.
The tongue is probably the best visible guide to adequacy of blood in anaemia or haemorrhage cases.
The sclerotic is a clear almost bluish-white in normal subjects.
Contusions are often present after accidental wounds. Icterus may not be easily detected in the sclera unless it is very intense; it is more easily detected in the mucous membranes of the inside of the lips. Detection is often facilitated by the pressure of a finger to cause local ischaemia and subsequent withdrawal, the colour being observed before blood returns.
The integument of the ear flap frequently shows yellow staining which is difficult to detect with certainty elsewhere in cases of mild jaundice.
During this examination of the mucous membranes of the mouth, the presence or absence of gingivitis or, more rarely, ulceration may be observed.
The presence of missing, loose or broken teeth, tartar deposits, parodontal disease, alveolitis or caries and the mouth odour is noted; uraemia in the cat gives rise to a distinctly ammoniacal smell.
PHARYNX AND TONSILS
These will be examined by opening the mouth as previously described.
Inflammation of the pharynx of the cat differs from the diffuse reddening of pharyngitis in the dog and is shown by congestion of the network of blood-vessels coursing over the pharyngeal mucosa; these are virtually invisible in the normal cat.
Tonsillitis is rare in the cat; the tonsils are usually tucked well into the crypts. In older subjects they should be examined for evidence of carcinoma, a relatively rare condition.
Ulcers are occasionally seen on the soft palate.
This should be observed as a guide to anaemia and haemorrhage and for evidence of marginal or dorsal ulceration. The ventro-lateral surfaces should be observed for signs of inflammation, ranula or neoplasia.
EYES A N D NOSTRILS
Should be observed for presence of aqueous, catarrhal or purulent discharges.
It is not uncommon to find a dark brown mucoid discharge accumulated in the conjunctival sac or exuding from the inner canthus ; this is often described by owners as ‘blood coming from the eye’.
Those at the angle of the jaws are palpated. Any enlargement should lead to palpation of all other superficial nodes.
The flap is examined for signs of wounds or haematomata. The external canal should be examined for parasitic (otodectic) or pyogenic infection.
GENERAL BODILY CONDITION
Bodily condition is assessed with particular reference to recent loss of muscle or adipose tissues. The state of hydration is also noted.
At the same time a rough estimate of coat condition can be made in respect of coat change, adequacy of grooming, abnormal scratch reflexes, parasites, scurf and obvious lesions.
The most important information to be derived from a glance at these is the sex of the cat. Reliance should not be placed on the owner’s word as to its sex although this will have to be accepted as to neutering or otherwise since no external evidence of castration or spaying should be obvious. Difficulties arise in the case of stray adults which may be spayed females and males without visible testicles which, rarely, may be cryptorchid.
In the case of entire females vaginal discharge will be looked for.
Routine abdominal palpation is a highly desirable habit to acquire; surprising and unexpected lesions are often detected.
The state of the large bowel should be ascertained and the bladder palpated to assess fulness and thickness of bladder wall.
Pregnancy may be detected from about 24 days onwards with great ease.
Enlarged liver, kidneys or spleen are also easily detected.
During this palpation lesions such as abscesses, mastitis or neoplasms in mammary glands will usually become obvious, and also abnormal breaks in the abdominal wall such as umbilical or ventral hernia.
Painful areas of any part of the trunk may likewise become evident indicating incipient sepsis which is often a cause of ill-defined malaise.
Respiratory rhythm should be initially observed during temperature and pulse recording at which time most cats remain reasonably quiet in lightly restrained sternal recumbency.
Auscultation of heart and lungs may be undertaken; it is highly desirable that both sides of the chest should be auscultated.
The bronchial area should receive careful attention.
If preliminary examination leads to suspicion of fluid, abnormal tissue or air in the thoracic cavity, percussion will be helpful. Fluid levels especially can often be accurately delineated by this means.
Fluid in the pleural cavity causes dulling and muffling of the heart sounds; breath sounds are absent below the fluid level but clearly audible above it; on percussion resonance is only present above the fluid line.
In pneumothorax the paradox of co-existence of inaudible breath sounds with extreme resonance on percussion is virtually diagnostic.
In view of the cat’s proneness to escaping, examination of the completely unrestrained cat is best kept to a minimum but it is essential in some cases of lameness and in neurological cases.
Persuading a cat to show its paces needs patience and tact. Most cats when placed on a strange floor make for a space under furniture and remain there; they do not come when called. Whenever possible they should be placed in the middle of the floor and left undisturbed and so far as possible unobserved and not molested. After some time natural curiosity overcomes most cats and they start investigating their surroundings. Those that just stay put in sternal recumbency may be gently stimulated by stroking along the back or by a very gentle push on the rump.
Abnormalities of gait and tail carriage can be detected in this way but often the examination is time and patience consuming.
As a result of the foregoing procedures, of which the last is only used when necessary, it is unlikely that gross abnormality will be overlooked.
At best a firm diagnosis can be made, at worst an indication of which systems require detailed investigation. This will be dealt with more fully under the appropriate headings.