Abstract
This book could have been called an ‘Encyclopedia of differential diagnosis for clinical signs and data’, or better yet, and more succinct, ‘The book of signs’! If you're looking for a list of disorders or diseases associated with tachycardia, red eye, polyuria, Horner's syndrome, abnormal liver palpation cyanosis, fecal incontinence, ileus, chronic vomiting, epistaxis, mediastinal shift, altered vertebral shape, regenerative anemia, abnormalities in urine sediment, and just about any other clinical, radiographic or laboratory anomaly that you can think of, then you'll love this book. It's quite an undertaking and all by one clinician!
In general, this is a reference book, aimed at anyone who is seeing clinical cases. The author states in the introduction that this book was written to fill a gap in the market. That gap was a single ready reference to help practicing veterinarians formulate a differential diagnoses list from clinical, laboratory, and radiographic/ultrasound findings. For example, if you found ‘bowed legs’ on your radiographic examination, this book would tell you that the possible reasons for a ‘bowed leg’ are: rickets, congenital hypothyroidism, chondrodystrophy, chondrodysplasia, asymmetric growth plate bridging from plating or metaphyseal osteopathy, and tension from quadriceps contracture or shortening of the ulna.
The book is divided into seven parts. Part 1 covers ‘Historical signs’, ie, those signs that the owner presents the patient with or those uncovered during history taking. This section lists most of the common complaints: weight loss, diarrhea, fecal incontinence, dystocia, lameness, and hematuria. I said ‘most’ because if the problem wasn't listed in this area, you'll likely find it in the ‘Physical signs’. Example: Alopecia is listed under physical signs, not historical signs. It probably doesn't matter as if you use the excellent index, you'll find whatever you're looking for anyway.
Part 2 covers the ‘Physical signs’ and as such it includes more well-defined signs such as alopecia, pallor, abdominal pain, jaundice, corneal ulceration, otitis externa, etc.
Part 3 is the ‘Radiographic and ultrasonographic signs’ section and the author lists each individual organ/structure and the possible abnormalities followed by a list of what could cause those abnormalities. For example, listed under ‘abnormalities of the trachea’ is the clinical sign of ‘dorsal displacement’ and under that is a list of things that could result in dorsal displacement of the trachea. There are some radiographs and black and white ultrasound images in this section of the book to illustrate some of the signs.
Part 4 covers ‘Laboratory findings’. This area focuses upon the rule outs for abnormal results of hematological, biochemical, electrolyte, blood gas, urinalysis, cytological, hormonal and endocrinological, and fecal testing. For example, the listed potential causes of elevated alanine transferase are: artifact (hemolysis or lipemia), liver disease (a variety are listed), extrahepatic disease (anorexia, pancreatitis, hyperthyroidism in the cat, and hyperadrenocorticism), and drugs (a huge list of drugs are given).
Part 5 is the ‘Electrodiagnostic section’ that includes electrocardiogram (ECG) findings, as well as electromyographic findings, nerve conduction findings, and electroencephalography findings. A few representative ECG recordings illustrate some of the abnormal ECG findings. While the ECG section is fairly straight forward and of use to most practitioners, the neuro-electrodiagnostic testing should have been deleted as the findings probably won't mean much to most non-neurologist veterinarians.
Part 6 covers ‘Diagnostic procedures’ such as indications for many common procedures, equipment needed, and technique. Examples include central spinal fluid analysis, bronchoalveolar lavage findings, fine needle aspiration findings, water deprivation testing, contrast radiography, skin scraping, adrenocorticotrophic hormone (ACTH) testing, buccal mucosal bleeding time, and many others.
Part 7 is a short section entitled ‘Diagnostic algorithms’. Only 11 algorithms are presented. But the book is already 429 pages to this point, so this section could have been eliminated without adversely affecting the book.
The ‘Appendix’ has a few examples of records that a practitioner might need, including a neurological examination form and one for cardiology too. Again this is a section that seems to be added as an afterthought and could be deleted. The middle of the book contains 15 color plates demonstrating a few of the diseases in the book. None of the images are essential to the book.
While using the lists, you'll have to familiarize yourself with a few special notations as there are certain abbreviations described in the introduction. An asterisk follows the more common conditions. A ‘C’ for cat or a ‘D’ for dog also follows those diseases that are predominately or exclusively in that species. ‘Q.V’ indicates that the disease/abnormality can be found elsewhere in the book and the best way to find out where is to look it up in the index.
The beauty of this book is that it is a book of lists. As such it will not answer questions as to why you might hear a physiologic murmur with anemia, fever, hypertension, hyperthyroidism, or pregnancy. All the other veterinary books on the market today answer those questions in some form or another; I daresay that most of us have those books in our libraries and we can refer to them for pathophysiology, treatment, or more detail about particular diseases. There is no other book on the market, though, that provides a comprehensive list of differential diagnosis for an extensive list of signs or data abnormalities. The author is to be congratulated because he took historical, clinical, laboratory, and radiographic data findings from all systems in the dog and cat and developed differential diagnoses lists that cover just about everything.