Review on Practical Guidance of Veterinary Clinical Diagnostic Approach

Animal disease problems have been investigated by veterinarians through undertaking a careful and clinical examination with the objective of recognizing the nature of the affection. So, that effective treatment and control measure is adopted. Clinical examination is one of the fundamental for diagnosing animals which are presented to clinic. Veterinary clinical examination relies on knowledge of Anatomy, Physiology, Pathology and Animal behavior, skills in the methods and techniques of clinical examination, clinical sign and pathogenesis of the diseases which are the basic requirements for clinician in his/ her good diagnostic approach. The diseased animals which are presented to veterinary clinic can be analyzed by veterinarian or clinician, the clinician approach through asking the owners complaint, which request for professional assistance by giving animal history. The accurate and complete history of patient may get from focusing on collection of patient data, present, past and environmental history in appropriate to patient animals. The veterinarian can approach to animals by the method of restraining in order to handle in safe condition. Physical examination is the examinations that apply to animals by general inspection, palpation, percussion and auscultation methods used to detect clinical signs of abnormalities. Clinical examination can be undergone by taking vital sign, general clinical examination and systemic examination of animals. Animals which have been diagnosed by veterinarian may have medication, through the injection or oral route with an appropriate dose of drug related to body weight, age and condition of animals. In conclusion, the veterinary clinical diagnostic approach is the core and the most important to generate accurate clinical examination, investigation of animal’s disease problem and guide how to handle the animals and the methods of restraining of animals. The objective of this review paper is helps to understand and know how the procedure of veterinary clinical diagnostic undergoes and treatment of animals takes place, to guide and give knowledge on systemic and general examination of domestic animals. Review Article Review on Practical Guidance of Veterinary Clinical Diagnostic Approach Tagesu Abdisa* Jimma University, College of Agriculture and Veterinary Medicine, School of Veterinary Medicine P.O Box 307, Jimma, Oromia Ethiopia Dates: Received: 08 May, 2017; Accepted: 10 June, 2017; Published: 12 June, 2017 *Corresponding author: Tagesu Abdisa, Jimma University, College of Agriculture and Veterinary Medicine, School of Veterinary Medicine P.O Box 307, Jimma, Oromia Ethiopia, Tel: +251933681407, E-mail:


Introduction
Clinical examination is a fundamental part of the process of veterinary diagnosis. It provides the veterinarian with the information required to determine the disease or diseases producing the clinical abnormalities. In addition, the information derived from the clinical examination should assist the veterinarian in determining the severity of the pathophysiological processes present. Without a profi cient clinical examination and an accurate diagnosis, it is unlikely that the treatment, control, prognosis and welfare of animals will be optimized [1][2][3][4][5].
The organs or systems involved, the location, type of lesion present, the pathophysiological processes occurring and the severity of the disease can be deduced from the information gained during the clinical examination. The success of clinical examination relies heavily on the knowledge of the clinician and usually assumes a single condition is responsible for the abnormalities. Many clinicians begin their examination by performing a general examination which includes a broad search for abnormalities [6,7]. The system or region involved is identifi ed and is then examined in greater detail using either a complete or a problem oriented examination. For  [9]. The following points are going to be taken before diagnosing presented animals:

Taking of patient history
History taking or anamnesis is the process of obtaining information on the animal patient about its illness, onset of illness and feeding practice through careful questioning of the owner. In Veterinary practice, the disease is presented indirectly in the form of a complaint by the owner or the attendant. Thus, it is very necessary to have all the information from the owner.
Most of the time, the owner or attendant fails to provide pertinent and adequate history and inaccurate history may lead to misdiagnosis. The clinician must substantiate these with rational question utilizing professional knowledge [1,5].
The disease problem of patient animals is diffi cult to diagnose without knowing the history of animals, the history should be taken from the owners of the patient and recording the owner's complaint. Disease information should include the group(s) affected, the numbers of animal affected (morbidity) and the identities of the animals affected; the number of animals that have died (mortality) should be established. In order to get the accurate and complete history of patience the following things should be focused; patient data, present history, past history and environmental history.
Patient data is essential to identify the patient and it includes: Owner's name, Owner's address: postal address, telephone, kebele, peasant association, Species, breed, sex, age, name, ID No., body weight, Description including color, marking, polledness, and other identifi cation marks of patient [8,9].

Presented history of patient
It comprises of recording the sequential events from the start of the patient chronic. Questions about physiological functions such as appetite, urination, defecation, rumination, respiration, sweating, milk production, gait, posture and also of the fi rst symptoms shown by the animal should be asked. All these information deal with the current problem of the animal and the events associated with it. The point which going to be asked is that as follows [1,5,8]: Locations of the problems: Following up and attention at the complaint that a farmer has to say and from there you can tentatively say the likely system involved in that condition, for instance:  Digestive system involvement will be shown as absence of rumination, appetite, bloat or diarrhea.
 Respiratory system involvement will be indicated presence of nasal discharge, coughing, dyspnea.
 Urinary system involvement will be manifested as frequent urination, passing red coloured or cloudy urine.
 Musculo-skeletal and nervous system involvement will be manifested as lameness, inco-ordination, and paralysis.

Nature of illness:
The clinician should be able to assess and fi nd out the time of onset of disease, any change management practices and signs noticed by the farmers.
 To assess to know the duration of disease whether it is peracute, acute, subacute or chronic  To know number of animal diseased and morbidity rate and mortality rate of animals  Determine whether any drug has been given for animals, before patience come to clinic for assurance  And the following question should be pointed:

Past history
Inquiring into the past history may help in arriving at a diagnosis. History of drenching a day or two earlier may cause aspiration pneumonia. History of past disease may be corelated to the present illness. Past history will also give idea if such condition prevailed previously in the area.  Is the disease restricted to certain age group / sex? (BQ is seen in animals between 1 -3 years of age in both sexes [2,4].

Management and environmental history
The environment in which the animals were kept at the time of the onset or just before the onset of the illness should be carefully examined. The animals may be housed or outside. Risk factors outdoors may include the presence of toxic material, grazing management, biosecurity and regional mineral defi ciencies. Risk factors indoors may include ventilation, humidity, dust, stocking density, temperature, lighting, bedding, water availability, feeding facilities and fi tments.
Environment or surrounding of the animals may help in the diagnosis of disease. E.g.-Animal grazing on pasture irrigated with sewerage water may suffer from nitrate poisoning.
Parasitic diseases are more in animals, which are kept in marshy lands. Recent spraying of weedicide or insecticides may poison the animals. Environmental history can be divided into outdoor environment and indoor environment [9].
Outdoor environment history: It regard to the topography of land where animals are reared, vegetation, type of agriculture practiced in the locality, use of chemicals in agriculture (pesticide, weedicide) and system garbage disposal in the area. Animals that are grazed are likely to be infested by parasites and prone to vector borne diseases like babesiosis, trypanosomiasis, or animals that are grazed in the marshy area including paddy fi led are likely to be infested by liver fl uke etc. √ If the animals are housed separately see √ If the height of the roof is at a required level, √ If it is too low, in hot places animals may be subjected to heat stress in summer months, √ If it is too high animals will be exposed to rain.

The methods how to approach to animals
Restraint is the term used to imply control of an animal and may be necessary for medical reasons and nonmedical procedures. Animals are often resist to the clinical examination procedures. The animal must be restrained so that it can be examined carefully, safely and with confi dence. The methods of restraint should be done, in order to able to carry out the examination safetly and without danger to the clinician and assistants, the methods available may be classifi ed as the following [6,9].  Physical restraint.

Physical restraint
It is important to perform all the physical manipulations in a quiet and gentle manner in order to carry out the examination safely without causing danger to the clinician or his assistants and to avoid disturbing the patient. Restraining methods for equine, cattle, Pet animal, sheep and goats Restraints of the equine: Equipment used for restraint and handling should be effective without causing stress to the horse and should be designed for maximum safety of the handler and horse. A horse should be approached from the front and slightly to the left (near) side because they are accustomed to being handled on that side. They become nervous when handled from the right side [10]. Any restraint method used to assist normal management or treatment of the horse should be the most mild and effective method available, and should be applied for the minimum amount of time necessary to carry out the task. A halter and lead rope is the most common form of restraint. Generally, the safest knots are those that can be quickly untied even if the horse has pulled on it. When used by knowledgeable Aggressive bulls for instance, will paw the ground with front feet, lower and shake the head. They may also make mowing sounds. Nervous cows will keep head and tail up and may have an anxious expression in their eyes [8,13]. The followings are the methods for restraint of cattle:  The nasal septum is gripped between the thumb and one fi nger or with 'bull-holder  Leg twitches are also employed  One rope locking two horns on a post or tree  Procedure of nose lead: It is shaped like a pair of tongs with a large ball at the end of each arm, which fi ts against the nasal septum. Usually, it has a chain or rope at the end. Hold the lead out for the animal to sniff. As the animal raises its head to sniff, slip the nose lid into the nostrils and close quickly. Then tie the rope to the post for continuous restraint but remember it loses effect when the nasal septum becomes numb. Manually holding the nasal septum with index fi nger and thumb nose grip and slip in the nose lead. It is advisable to avoid using nose lead too frequently on the animal as it may become "head shy".  Restraint using a crush: A crush can be used to restrain many animals at a go. It can be constructed of posts or planks or steel tubing. However, the internal surface should be free of sharp edges or projections that can injure the animal. So, it should comprise of an assembly area with a funnel ending in a closed pen with the fi nal run being just wide enough for one animal and suffi ciently high enough to prevent it from jumping. Backward movement is prevented by a transverse bar inserted just behind the animal [13] (Figure 2).

Restraint of sheep and goat:
Sheep have an intense instinct to remain with the fl ock and as such, it is best to handle them as a fl ock initially before isolating the animal you want to perform certain procedures on. When disturbed, they will stamp their front feet and will use the head to attack. Hence, always work gently, calmly and with assurance around them. Sheep have very fragile bones that can easily be broken and heavily woolled sheep may become hyperthermined if chased around [13]. The following are the methods how to restraint and holding sheep [13]: B.

Figure 1:
Pictures of how to restraint horse [12]; A: Halter If a horse or donkey's head is restrained, it can be led or held for procedures such as injections. A halter can be made from a piece of sisal or cotton rope. Avoid using nylon rope against the skin. B: The Lip twitch  the twitch is useful to restrain a horse before a painful procedure, to examine it or give it treatment. It is known that a twitch placed correctly on the nose causes the release of natural pain-killing substances in the horse's body. C: Two Rope Casting used to prevent kicking and it can be done safely without danger of being kicked. It is done to avoid being kicked when helping a mare that is having a diffi cult birth and make it lie on its side. D: Mild restraint without a twitch. Capturing a sheep: The sheep can be captured by driving the fl ock into a small pen or enclosure and then approach an individual animal slowly. Swing your arm around the neck and front quarters and quickly wrap your other hand around the hindquarters or grasp the tail if present.
Shepherds crook: Hook a rear leg at the hock, quickly immobilizes sheep as above.
Halters: Can be used but remember sheep have a short nose and should be careful not to block the nostrils.

Restraint of goat:
Goats do not tolerate rough treatment and will struggle violently if not properly handled. Therefore, restraint time should be as short as it is necessarily possible [14][15][16][17][18].
Walls and fences: Push the goat against the fence or wall wit h your legs and hip and leave your hands free for other procedures. You can also push the hindquarters against a wall and then put your hand around the neck to keep it still for temperature taking or injection.

Restraint on lateral recumbency:
The goat is placed parallel to your legs; the jaws are grasped with one hand while the inside rear leg is grasped with the other hand. Bring the leg forwards. The goat will be thrown off balance and fall on the ground.

Restraint of the Head:
This is best when the goat is pushed in a corner and the body held against a wall. Procedure: Grasp the beard (if bearded) with one hand and encircle the neck with the other arm to stabilize the head.
Use of horns: This should only be for a short time as goats react violently when horns are held. Moreover, horns should not be used in very old goats as they break easily.
Cheek hold: Place one hand on either side of the cheeks and wrap fi ngers around the mandibles to hold fi rmly. You can examine the eyes or take blood from the jugular.
Collars: Leather collar or neck chain can be used in dairy goats to lead or restrain them. They may be temporary or permanent (collars). Neck chains should be made of small, fl at links, which don't catch easily as the goat rubs against a fence ( Figure 3).

Restraint of Pet animals:
Cats have always relied on speed, agility, caution, needle sharp teeth and dagger-like claws for survival. Therefore, they should be approached in a feeble manner. Restraint techniques of cat are as following [10,13]: √ Leg restraint: Always place an index fi nger or middle fi nger between two legs. This provides a better grip to prevent escape.

Chemical restraint
Chemical restraint may be defi ned as the use of drugs to bring about sedation or neurolepsis, neuroleptanalgesia, neuroleptanaesthesia or short duration general anaesthesia.
This is a reversible process whose purpose is to produce convenient, safe, effective and inexpensive means of restraint so that clinical procedures may be carried out with minimum of stress, pain, discomfort, and toxic effects to the patient, the anaesthetist or the clinician [13]. Drugs that is useful for this purpose includes: Acepromazine, Acetylpromazine, Chlorpromazine, Promazine and Trimeprazine; members of this group can be used in most species of animals, Butorphanol, hloral hydrat [8,13].
A. Dog

Verbal/moral restraining
It is more practiced by owner e.g., feed provision, massaging, calling name of animal etc. When the horse is alert, the ears are fl icked forwards and the horse is usually curious of one's approach. A nervous horse will continuously fl ick the ears back and forth especially when there is activity behind it while an angry or fearful horse will pull its ears backwards.
This should however not be confused with laid-back ears where a horse is concentrating on a diffi cult task such as calf roping or barrel racing. The tail always indicates the horse's attitude.

Physical examination
The main aims of physical examination is to apply general inspection, palpation, percussion and auscultation methods used to detect clinical signs of abnormalities.  Resilient, when a structure quickly resumes its normal shape after the application of pressure has ceased (e.g.,

Normal rumen)
 Doughy, when pressure causes pit ting as in edema  Firm, when the resistance to pressure is similar to that of the normal liver (e.g., neoplasia/tumor)  Hard, when the structure possesses bone-like consistency (e.g., Actinomycotic lesion)  Fluctuating, when a wave-like movement is produced in a structure by the application of alternate pressure (e.g., hernia, hemorrhage/hematoma)  Emphysematous, when the structure is swollen and yields on pressure with the production of a crepitating or crackling sound (Table 1).

Ballottement percussion:
Tactile percussion or ballottement: is method in which palpation and percussion are combined together to feel structures that cannot be felt by either of these methods applied singly. This is normally used for pregnancy diagnosis in cows when the foetus cannot be palpated through per rectum. Here a fi rm-pushing stroke is applied on to the uterus and the hand after pushing is kept in contact with uterus so that the foetus will bound and strike on it. While fi rm pushing is done, this sets fl uid in uterus into motion and foetus is made to bounce [1]. This modifi ed percussion is used to detect late pregnancy in small ruminants, dogs and cats. And also, used for detection rebound of fl oated material shows pregnancy.
Procedure: Apply a fi rm and interrupted push on the uterine region of the abdomen of small ruminants.

Auscultation
Word auscultation comes from 'auscutona' meaning 'to listen'. This is a technique of listening to the sounds produced from organs in the abdominal and thoracic cavities. In olden days listening to these sounds were done with naked ears.
This had certain limitations like the skin on animal being dirty and infested by parasites it was not healthy for the clinicians and was diffi cult to keep ears in contact on animal body due to constant movement. Therefore, an instrument was later developed for this purpose and this is called stethoscope [3,9] ( Figure 6).
The main objective of auscultation is that to listen the sounds produced by the functional activity of an organ located within a part of the body. This method used to examine the lung, trachea, heart and certain parts of the alimentary tract.
Types of auscultation:

Direct auscultation
Procedure: Spread a piece of cloth on the part to be examined using two hands to fi x the cloth and keep your ears close to the body, then listen directly.
Indirect auscultation: Use stethoscope. Areas for listening to heart and lungs sounds are shown below, for rumen left fl ank region can be used [9] (Figure 7).

Succusion (shaking)
It is the method used to determine the presence of fl uid in the body cavities like thoracic and abdominal cavity. Here the animal is shaken from side to side to set fl uid into motion so that audible fl uid sound is produced. This is diffi cult in large animals and can be applied only in small animals like dogs and cats [9]. Reptiles and fi shes). Heat is generated in the body via the intracellular oxidation of food and the muscular activities.

General physical examination
It is lost via the physical process of conduction, convection, and radiation and through the evaporation, respiration and excretion [1].  The body temperature is taken using a mercury or digital electronic thermometer placed carefully into the rectum.
The thermometer should be lubricated before insertion and checked (in the case of a mercury thermometer) to ensure that the mercury column has been shaken down before use. It should be held whilst it is in the rectum. Sudden antiperistalsis movements in the rectum may pull the thermometer out of reach towards the colon. The thermometer is left in position for at least 30 seconds; the clinician should ensure the instrument is in contact with the rectal mucosa, especially if a lower than expected reading is obtained. The thermometer must be cleaned after removal from the patient. It must not be wiped clean on the patient's coat. If the animal's temperature is higher or lower than anticipated it should be checked again [1,9] (Figure 8).
Procedure: how to take temperature and how to recording temperature [12,16].
The places, which can be used to take temperature, are ➢ Read the value to defi ne and explain a state of fever, hypothermia, and febrile or non-febrile animals.

Method of recording temperature
1. Keep the bulb of the thermometer immersed in the antiseptic solution for sterilization.

2.
Bring down the column of the mercury before recording the temperature by shaking.
3. Lubricate the bulb with liquid paraffi n or Glycerine or soap and water, when the thermometer is to be used in pup or kitten.

4.
Insert the bulb of the thermometer into the rectum and tilt to one side so that the bulb of the thermometer touches the mucous membrane of the rectum.

5.
Keep the thermometer in this position for one minute.
6. Take it out, wipe the faeces with cotton and read the temperature directly (Figure 9).  A. B.

Interpretation of thermometer
C. Figure 9: Picture procedure how to take and read temperature of animals [12]. A: procedure how to insert thermometer to animal's anus; B: If the reading is not below 36°C, shake the mercury down to the bulb. Use fl icking motions, taking care not to hit the thermometer on anything. C: Take the thermometer out of its case and hold it between the thumb and forefi nger. Roll it until you can see a broad silver band of mercury.
Preparations like paracetamol, Phenylbutazone is normally given to control fever (refer drug index for these preparations) in addition keeping animals in cool place [3].
Subnormal temperature / hypothermia: The temperature of animal drops below normal and this occurs when animals get exposed to extreme cold for example when a calf is exposed to heavy rain, when animal is in shock and a clinical condition like milk fever. Here the animal body is unable to regulate body temperature or the heat regulatory mechanism fails to generate heat to compensate the heat loss from the body. In such cases the pulse should be checked again after a period of rest lasting 5 to 10 minutes [3,9].

Procedure how to examine and take pulse
• Place the digits on the artery to be examined  [12]. Count the number of beats per minute (counting should be done at least for 30 seconds and multiplied by 2); notice the quality and rhythm of pulse (Table 3).

Method to record pulse
1. Hold the tail / limb.
2. Locate the artery for recording pulse accordingly.
3. Place the tip of the index / middle fi nger on the artery. 8-Posture: pulse rate reduced about 10% when animal is recumbent than when standing [17,18] (Table 4).  Respiration taking: Respiratory movements can be observed at the right fl ank. Any change in the rate indicates respiratory involvement. Thoracic respiration is seen in animals suffering from acute peritonitis and abdominal respiration in pleurisy. Double expiratory movements are seen in emphysema in horses [3,14].

Types of respiration:
1. Costal respiration: In this type of respiration thoracic muscles are mainly involved and the movement of the rib cage is more prominent. It is seen in dogs and cats.

Abdominal respiration:
This type of respiration is seen in ruminants viz cattle, goat, sheep and yak. Here the abdominal muscles are involved and movement of the abdominal wall is noticed.

Costo-abdominal respiration:
In this type of respiration muscles of both thorax and abdomen are involved so the movement of the ribs and the abdominal wall are noticed 4. The respiration rate is measured through counting of either contraction or expansion of the thorax and abdomen which can be observed during clinical examination. A method for respiration rate taking includes [4,9]: • Inspection: Stand behind and to one side of the animal, and observe the movement of the thoracic and abdominal areas of the body.
• Palpation: Put one hand in front of the nostril, feel the exchange of the gas; or put one hand on the lung area or the thorax and feel the respiratory movements.
• Auscultation: Use stethoscope, listen to the respiration sound in the trachea or lung area.
Inspiratory or expiratory movements of the chest wall or fl ank can be counted. In cold weather, exhaled breaths can be counted. If the animal is restless the clinician should count the rate of breathing for a shorter period and use simple multiplication to calculate the respiratory rate in breaths/ minute. Mouth breathing is abnormal in cattle and is usually an indication of very poor lung function or a failing circulation (Table 5).

Visible mucous membrane:
The mucous membrane in the eyes, mouth and vagina in the case of females can be examined to determine the health status of an animal. Examination of the mucous membrane should be done in natural light (sunlight) not in the lamplight. The abnormalities of color of mucous membrane are cause by different factor like Pallor of the mucous membranes may indicate anaemia caused by direct blood loss or by haemolysis, A blue tinge may indicate cyanosis caused by insuffi cient oxygen in the blood, A yellow colour is a sign of jaundice, the mucosae may be bright red (sometimes described as being 'injected mucous membranes') in febrile animals with septicaemia or viraemia, Bright red colouration of the conjunctiva is often seen, for example, in cases of bovine respiratory syncitial virus infection. A cherry-red colouration may be a feature of carbon monoxide poisoning. A greyish tinge in the mucosae may be seen in some cases of toxaemiasuch membranes are sometimes said to be 'dirty'. High levels of methaemoglobin, seen in cases of nitrate and/or nitrite poisoning, may cause the mucosae to be brown coloured [3,9].
The normal colour of different species of animal is listed below table ( Table 6).
The color of mucous membrane may change occurs in various diseases as follow by the following [19]:

A.
B.   ➢ Exposure to X-rays and some medications.

Congested mucous membranes.
➢ High environmental temperatures and exercise.
➢ Any disease resulting in fever.
➢ Diseases of the heart, brain and its membranes.

Capillary Refi ll Time (CRT): Capillary refi ll time (CRT) is
defi ned as "time required for return of color after application of blanching pressure to a distal capillary bed [20][21][22][23][24][25]. This is taken by compressing the mucosa of the mouth or vulva to expel capillary blood, leaving a pale area, and recording how long it takes for the normal pink colour to return. In healthy animals, the CRT should be less than 2 seconds. ACRT of more than 5 seconds is abnormal, and between 2 and 5 seconds it may indicate a developing problem. An increase in CRT may indicate a poor or failing circulation causing reduced peripheral perfusion of the tissues by the blood [8,9].
Methods how to examine mucous membrane by capillary refi ll time as follow:  This is taken by compressing the mucosa of the mouth or vulva to expel capillary blood, leaving a pale area  Recording how long it takes for the normal pink color to return.
 In healthy animals, the CRT should be less than 2 seconds.  A CRT of more than 5 seconds is abnormal, and between 2 and 5 seconds may indicate a developing problem Physical body condition: Body condition scoring is an important management practice used by producers as a tool to help optimize production, evaluate health, and assess nutritional status. Different scores can be given for individual animal and can further classifi ed as normal, fatty, lean/thin, emaciation [9].
Condition Score 1: Very thin: This animal's skeletal structure is very prominent. Notice the deep depressions next to the spine, between the pelvis and rib cage, between the hooks and pins, and around the tail head.
Condition Score 2: Thin: The animal's skeleton is still very apparent. The individual spinous processes are clearly visible, but there is a small amount of fat tissue over the spine, hooks, and pins.

Condition Score 3: Medium (Normal body condition):
The animal appears smooth over the spine, ribs, and pelvis and the skeletal structure can be easily palpated. The hooks and pins are still discernible, with a moderate, rather deep depression between the pelvis and rib cage, hooks and pins, and around the tail-head.
Condition Score 4: Fat: There are no spinous processes detectable, and no depression in the loin area, which gives the top-line of the animal a fl at, tabletop appearance. The ribs can no longer be felt, and the pelvis can only be felt with fi rm pressure. The hooks and pins have a rounded appearance due to areas of fat covering.
Condition Score 5: Very Fat: The animal appears rounded and smooth with a square-shaped appearance, because of the amount of fat fi lling in the loin. The skeletal structure is no longer visible, and can only be palpated with excessive pressure (Figure 11).
Normal demeanor: When, on being approached, an animal makes a normal response to external stimuli, such as movement and sound, the demeanor is said normal (bright).
Normal reaction under these circumstances may consist of elevating the head and ears, turning towards and directing the attention at the source of stimuli, walking away and evincing signs of attack or fl ight [8].
 Excitation or increased response: apprehension (mildly anxious); restlessness; mania; frenzy. The perspective of this examination is to identify pale and discolored mucus membranes; assess problems of oral cavity and deranged appetite. The following points are to be considered:  Visible mucous membrane  Eyelids, conjunctivae and eyes  Nasal regions and nasal mucous membrane  Prehension, mastication and deglutition  Salivation  Teeth eruption Procedure: • Visible mucous membrane examined by visual inspection to note the presence of lesions, discharge, glaucoma, nystagmus.
• Examine the nose and nasal sinuses; lesions, discharges should be noted by percussion, palpation • Examine the mouth and appetite; oral lesions, salivation, feed intake should be noted. The rigidity of tetanus, the cunning leer or maniacal expression of rabies and acute lead poisoning are cases in point.
The symmetry and confi guration of the bony structure should be examined. Doming of the forehead occurs in some cases of congenital hydrocephalus and in chondrodysplastic dwarfs, and in the latter there may be bilateral enlargement of the maxillae. Swelling of the maxillae and mandibles occurs in osteodystrophia fi brosa; in horses swelling of the facial bones is usually due to frontal sinusitis; in cattle enlargement of the maxilla or mandible is common in actinomycosis. opisthotonos is an excitation phenomenon associated with tetanus, strychnin poisoning, acute lead poisoning, hypomagnesemic tetany, polioencephalomalacia and encephalitis [3]. Visible discharge should be noted; protrusion of the eyeball, as occurs in orbital lymphomatosis, and retraction of the bulb, as occurs commonly in dehydration, are important fi ndings; spasm of the eyelids and excessive blinking usually indicate pain or peripheral nerve involvement; prolapse of the nictitating membrane usually characterizes central nervous system derangement, generally tetanus [3]. Excessive salivation or frothing at the mouth denotes painful conditions of the mouth or pharynx or is associated with tremor of the jaw muscles due to nervous involvement. Swellings below the jaw may be infl ammatory, as in actinobacillosis and strangles, or edematous, as in acute anemia, protein starvation or congestive heart failure.

Examination of skin and appendages:
The skin provides protection against minor physical injuries supports hair growth and offers some defence against microbial invasion.
The condition of the skin is a refl ection of the general health of the animal, deteriorating in cases of ill health, ill thrift and debility. In some conditions, such as jaundice, the skin may provide through discolouration direct diagnostic evidence of a specifi c disease process. In other conditions, such as parasitism or severe mineral defi ciency, a nonspecifi c general deterioration of skin health may occur causing a greater number of hairs than normal to enter the telogen or resting phase and a delay in their replacement, leaving the coat in poor condition with little hair. Sebaceous secretions may be reduced, allowing the skin to become abnormally dry and infl exible and less able to perform its normal defence role in an already debilitated animal. In other cases, sebaceous secretion increases causing the skin to have either a greasy or a dry seborrhoeic, fl aky Appearance [9]. Structures or parts associated with skin as its appendages are hoofs, hairs, horns, quills, claws, nails, sebaceous glands and sweat glands. Discrete skin lesions range in type from urticarial plaques to the circumscribed scabs of ringworm, pox and impetigo. Diffuse lesions include the obvious enlargements due to subcutaneous edema, hemorrhage and emphysema.
Enlargements of lymph nodes and lymphatics are also evident when examining an animal from a distance [3,4].

Examinations of the thoracic cavity
Examination of the thoracic cavity guide to show the regional anatomy of the lungs and the heart, and perform physical examination of the lung and the heart area. Regional anatomy of the lungs -locate the lung area. The lung is located on the external surface of the thoracic region by forming an imaginary triangle by using the points at the angle of the scapula, olicranun process and the second intercostals space from the last [8,9].

Physical examination of the thorax (lung area).
• Inspection -note respiratory movements

Palpation
Chest palpation can be useful to identify thoracic pain which may be caused by rib fractures and pleuritis. Gentle pressure should be applied to the thorax using the palm of the hand and the animal observed for a pain response. The entire thorax should be explored in a systematic manner to identify focal areas of pain. In addition to pain, subcutaneous emphysema may be detected as a spongy sensation which may be accompanied by crackling noises. This clinical sign is sometimes seen in outbreaks of respiratory syncytial virus (RSV) and is caused by rupture of emphysematous bullae in the lungs [9].

Auscultation
During auscultation, the stethoscope should be moved systematically to cover the whole of thoracic lung fi elds with the aim of identifying any abnormal sounds present, their location and their occurrence in relation to the respiratory cycle. The location of an abnormal sound is deduced from the position of maximal intensity. Particular attention should be given to the apical lobe if bacterial pneumonia is suspected or the diaphragmatic lobe if lungworm is suspected [3,9].

Regional anatomy of the heart -locate the heart area:
The heart is suspended by great vessels and located on the  Pericardial frictional sounds  Venous pulsation (jugular pulsation) ( Table 8)

Anatomical locations of valves
➢ Mitral valves: Examined on the left side in the 5 th intercostals space, 4 inches above the sternal extremity of 5 th rib.

➢ Tricuspid valves:
Present on the right side in the 3 rd intercostals space and 3 inches above the sternal extremity of the 4 th rib.
➢ Aortic semi-lunar valve: Present on the left side in the 4 th intercostals space level with the shoulder point [16].

Clinical examinations of the abdominal and associated digestiveorgans
Objective: to undertake clinical examination of the abdomen and identify disturbances of the digestive system. The examination of abdominal of ruminant as following [9]: Conditions occurring in ruminant [9].  Absence of movements occurs in the following [9,16]: testes and penis are noted [3,5,9].
Clinical examination of female genital organs-visual inspection and palpation of the vaginal region, use of vaginal speculum to examine the inside of vagina and intra-rectal examination of the cervix, uterus and ovaries would be performed [3,8,9]:

Procedure:
The examination of the nervous system: 3. Examine the joints long bones and different muscles: arthritis, dislocation of the joints, rickets or osteocalcin, muscular atrophy, central or peripheral origin paralysis [3,9].

Examination of skeletal muscle of an animal
The musculoskeletal system is composed of the bones of the skeleton, joints, ligaments, muscles and tendons. In addition to the nervous system, the musculoskeletal system is important considering gaits, one full cycle is referred to as a stride [21] ( Table 10).

Examination of superfi cial lymphnodes of animals:
Objectives: to compared each paired node for size and consistency with the contralateral node.
Method: Grossly enlarged lymph nodes may have been seen during observation of the patient before it is handled.
Observation andpalpation is possible when the animal is restrained.

Anatomical Location of lymphnodes (LN): Lymph nodes
are round or bean-shaped structures that are widely distributed throughout the body. Imbedded in connective tissue or fat, they are concentrated in the cervical, axillary, and inguinal regions -the neck, armpits, and groin, respectively. They are typically less than ½ inch in length, depending on the size of the animal. The lymph nodes fi lter the lymph before returning it to the veins [2,9].

Drug dosage form
The body condition of a livestock is generally assessed by visual observation. The references to an animal being too thin, in good fl esh, or obese all relate to the animal's weight. Therefore, the weight of an animal can be used as a measurement tool to determine its well-being, or the presence of problems which may threaten the health of the horse.
Several methods can be used to determine the body weight of livestock in an approximate scale. The domestic animals body weight estimation equation as following [24].

External dosage forms:
• Ointment-semisolid preparation for external application.
• Cream-a viscous semisolid, consisting of oil in water emulsion or water in oil emulsion.
• Dusting powder e.g., popular antibacterial agent applied on animal wounds.
• Lotion-an aqueous solution or suspension for local application.
Spray-a drug applied in liquid form by pressure.

Routes of drug administration
Medications are administered to cattle by injection for a variety of reasons. For example, vaccines (biological) are injected to prevent disease, and antibiotics or anthelmintic may be injected to treat bacterial or parasitic infections, respectively. Other medications may be given by injection for supportive medical care, to relieve pain or to enhance production. Injection may be the best, or the only, route of administration for a particular medication [23].
The routes of drug administration in domestic animals are summarized as following form [8,12,22,23,25].    Epidural route: Refers to deposition of drug up on or outside the dura matter. E.g., Introduction of local anesthetics between the fi rst and second coccygeal vertebra to eliminate straining.
Subconjunctival: Disposition of a pharmaceutical preparation beneath the conjunctiva.
Topical or local application: It refers to external application of drug to the body surface for localized action at accessible site, such as skin, eyes, body orifi ces, body cavity.

Drug dose calculation
If drugs are used incorrectly, disease organisms can build up resistance making drugs ineffective. This usually happens from under dosing or overdosing drugs. It is best to calculate the correct dosage based upon the weight of each animal determined by using a scale or estimated by using heart girth measurement [22,24].Dose is the quantity of the drug to be administered at one time and expressed in mg/kg or IU/kg. (Table 11) ( Figure 13).
Method and procedure how to load a syringe during taking drug [12].
 Be sure the needle is fi rmly attached.  Withdraw more medicine or squirt some back into the bottle until the right amount is in the syringe.
Body weight x Dose Rate : Dose Concentration