H

H



Halitosis




Causes


Adapted from Veterinary clinical guide to odor and disease: the oral cavity and dermatology, Yardley, Penna., 1997, Veterinary Learning Systems.



Oral Diseases



Periodontal disease (gingivitis, periodontitis, abscessation)

Neoplasia (melanoma, fibrosarcoma, SCC)

Foreign body or trauma (fractures, electrical cord injury)

Pharyngitis

Stomatitis, lymphocytic-plasmacytic feline stomatitis


Respiratory Diseases



Rhinitis and/or sinusitis

Neoplasia

Pneumonia or pulmonary abscess


Dermatologic Diseases



Lip fold pyoderma

Ulcerative mucocutaneous pyoderma

Feline or canine eosinophilic granulomas

Pemphigus complex, bullous pemphigoid, systemic lupus erythematosus

Drug eruptions

Cutaneous lymphoma

Exposure to DMSO


Metabolic Diseases



Renal failure/uremia

Diabetic ketoacidosis


Gastrointestinal Diseases



Megaesophagus

Inflammatory bowel disease

Exocrine pancreatic insufficiency

Neoplasia

Constipation


Dietary



Aromatic foods (onions, garlic)

Fetid foodstuffs (e.g., ingestion of carrion)

Coprophagy


Grooming Behavior



Anal sacculitis

Vaginitis/balanoposthitis

Lower UTI

DMSO, Dimethyl sulfoxide; SCC, squamous cell carcinoma; UTI, urinary tract infection.



Heart Murmurs




Characteristics and Clinical Signs Associated With “Innocent” Murmurs Versus Murmurs Associated With CHD


Modified from Bonagura J: Kirk’s current veterinary therapy XIII, St Louis, 2000, Saunders.



Innocent Murmur



Grade usually <III/VI

Systolic

PMI: usually left base

Murmur characteristics may change with animal position

Murmur intensity may increase or decrease with increasing heart rate

Decreased intensity with age

Generally inaudible after ∼16 weeks of age

Animal clinically normal


Congenital Heart Disease



Any grade

Any timing possible

PMI: any possible

Similar murmur characteristics in all body positions

Murmur intensity increases with increase in heart rate

Same or increasing intensity up to and beyond 16 weeks of age

Persists after ∼16 weeks of age

Stunting, unthriftiness, cyanosis, or signs of heart failure may be present.

CHD, Congenital heart disease; PMI, point of maximal murmur intensity.



Heart Murmurs: Congenital Heart Defect-Associated




Auscultatory Abnormalities in Dogs With Congenital Cardiac Disease



Heartworm: Clinical Severity




Classification of Heartworm Disease Severity Based on Signs, Physical Examination, and Radiographic Findings



Heartworm Dirofilaria Versus Acanthocheilonema




Differentiating Characteristics of Acanthocheilonema (formerly Dipetalonema) reconditum and Dirofilaria immitis



Heartworm Disease: Complications




Complications



Untreated



Eosinophilic granulomatosis

Eosinophilic pneumonitis

Right-sided congestive heart failure*

Hemoglobinuria, “pigment nephropathy”*

Hemolytic anemia*

Pulmonary thromboembolism


During or Shortly After Treatment Period



Acute (Surgical Removal)



Anaphylaxis

Hypotension

Cardiac arrest


Subacute (Medical Treatment)



Eosinophilic pneumonitis

Pain at injection site (melarsomine)

Pulmonary thromboembolism (possibly massive, especially if inadequate exercise restriction)

Sudden death (especially if inadequate exercise restriction)


* Together, comprise the “caval syndrome” of heartworm disease



Hematemesis




Causes


Modified with permission from Kirk RW, Bonagura JD, editors: Kirk’s current veterinary therapy XI: small animal practice, St Louis, 1992, Saunders, p 133.



Bleeding Disorders



Disseminated intravascular coagulation

Anticoagulant rodenticide toxicity

Thrombocytopenia

Congenital or acquired coagulation factor deficiencies/defects


Heavy Metal Toxicity



Arsenic

Lead

Zinc


Infectious Disorders



GI parasitism

Viral gastroenteritis

Bacterial gastroenteritis


Perioperative Hemorrhage



Gastric dilatation/volvulus

Gastrectomy

Gastrostomy


Gastric/Duodenal Erosions/Ulcerations



Infiltrative Disease



Neoplasia

Inflammatory bowel disease

Phycomycosis


Metabolic Disorders



Renal disease

Liver disease

Hypoadrenocorticism


Stress Erosions/Ulcerations



Burns (Curling’s ulcer)

Neurologic disorders
Head trauma (Cushing’s ulcer)

Spinal cord disorders

Sepsis/septic shock

Hypovolemic shock

Multiple trauma


Drug Administration



Glucocorticoids




NSAIDs



Aspirin

Indomethacin

Phenylbutazone

Naproxen

Sulindac

Deracoxib

Ibuprofen

Flunixin meglumine

Meclofenamic acid

Piroxicam


Gastric/Duodenal Foreign Bodies




Neoplasia



Mast cell tumor

Gastrinoma (Zollinger-Ellison syndrome)

Pancreatic polypeptide–secreting tumor

Basophilic leukemia


Hemorrhagic Gastroenteritis




Esophageal Disorders



Esophagitis

Esophageal neoplasia

Esophageal foreign bodies

Gl, Gastrointestinal: NSAIDs, nonsteroidal antiinflammatory drugs.



Hematochezia




Causes


Modified from Tams TR: Gastrointestinal symptoms. In: Handbook of small animal gastroenterology, Philadelphia, 1996, Saunders.



Anal Disease



Perianal fistulas

Anal sacculitis or abscess

Stricture

Neoplasia (e.g., anal sac tumor)

Trauma (e.g., bite wound)

Perianal hernia

Foreign body


Rectum and Colon



Proctitis (inflammation of the rectal mucosa)

Colitis
Idiopathic

Inflammatory bowel disease

Stress

Infectious
Campylobacter spp.

Clostridium perfringens

Parvovirus

Parasitism
Hookworms

Whipworms

Coccidia

Roundworms

Neoplasia
Rectal polyp

Adenocarcinoma

Lymphoma

Rectal prolapse

Mucosal trauma
Movement of foreign material (e.g., hairballs)

Iatrogenic (e.g., thermometers, enemas, fecal loops)

Automobile trauma

Ileocecocolic area: intussusception

Bleeding disorder

Constipation often can cause excessive straining which can result in formed stools with blood on the surface.



Hematuria




Causes


Modified from Ettinger S, Feldman E: Textbook of veterinary internal medicine, ed 6, St Louis, 2005, Saunders.



Urinary Tract Origin (Kidneys, Ureters, Bladder, Urethra)



Trauma
Traumatic collection (e.g., catheter, cystocentesis)

Renal biopsy

Blunt trauma (e.g., automobile accident)

Urolithiasis

Neoplasia

Inflammatory disease

Urinary tract infection

Feline lower urinary tract signs/disease/interstitial cystitis

Chemically-induced inflammation (e.g., cyclophosphamide-induced cystitis)

Parasites
Dioctophyma renale

Capillaria plica

Bleeding disorder
Warfarin intoxication

Disseminated intravascular coagulation

Hemophilia

Thrombocytopenia

Renal infarction

Renal pelvic hematoma

Vascular malformation
Renal telangiectasia (Welsh corgi)

Idiopathic renal hematuria


Genital Tract Contamination (Prostate, Prepuce, Vagina)



Estrus

Inflammatory, neoplastic, and traumatic lesions of the genital tract


Hemoptysis




Causes


From Ettinger S, Feldman E: Textbook of veterinary internal medicine, ed 6, St Louis, 2005, Saunders.



Pulmonary



Pulmonary thromboembolism: secondary to neoplastic, endocrine, cardiac, metabolic disease

Pulmonary hypertension: secondary to heartworm disease; congenital or acquired cardiac defects that result in shunting of blood

Chronic bronchitis/bronchiectasis

Bacterial pneumonia

Nocardiosis

Pulmonary abscess

Kennel cough (rarely causes hemoptysis)

Fungal pneumonia: blastomycosis, histoplasmosis, coccidioidomycosis

Parasites: Paragonimus kellicotti, Capillaria aerophila, Aelurostrongylus abstrusus

Eosinophilic bronchopneumopathy

Neoplasia, lung: primary adenocarcinoma, undifferentiated carcinoma, SCC, chondrosarcoma; metastatic; primary tracheal tumors

Lung lobe torsion


Cardiovascular



Heartworm disease

Cardiogenic pulmonary edema

Arteriovenous fistula

Bacterial endocarditis


Systemic



Bleeding disorder: primary (quantitative or qualitative platelet defects) or secondary hemostatic (factor deficiencies, anticoagulant rodenticide toxicity, DIC) abnormalities

Trauma: pulmonary contusion, tracheal rupture, FB

Iatrogenic: endotracheal intubation; complication of lung biopsy/aspirate, transtracheal wash, or bronchoscopy

DIC, Disseminated intravascular coagulopathy; FB, foreign body; SCC, squamous cell carcinoma.



Hemothorax




Causes of Hemothorax and Sanguineous Pleural Effusion


Modified with permission from King L: Textbook of respiratory disease in dogs and cats. St Louis, 2004, Saunders, p 611.



Trauma

Malignancy

Coagulopathy

Diaphragmatic hernia

Lung lobe torsion

Pulmonary infarction

Pulmonary abscessation

Recent surgery

Aortic aneurysm

Swan-Ganz catheter placement*

Tube thoracostomy*

Hemopneumothorax*

Costal exostosis*

Endometriosis*

Foreign body

Heartworm disease

Central venous catheter placement


* Reported only in human literature.



Hepatic Failure, Acute




Clinically Relevant Causes


Modified from Ettinger S, Feldman E: Textbook of veterinary internal medicine, ed 4, St Louis, 1994, Saunders.


























Category of Injury Examples
Trauma
Automobile accident

High-rise syndrome
Toxin
Environmental agents:
Aflatoxin

Amanita pantherina, Amanita phalloides

Cycadaceae

Heavy metals

Drugs:
Thiacetarsemide

Mebendazole

Diethylcarbamazine-oxibendazole

Acetaminophen

Methoxyflurane, halothane

Diethylcarbamazine

Tetracycline

Trimethoprim-sulfadiazine

Griseofulvin

Diazepam (cats)
Infectious agents
Infectious canine hepatitis

Leptospirosis

Toxoplasmosis

Heartworm caval syndrome

Bacterial sepsis
Thermal Heatstroke
Extension of abdominal inflammation
Pancreatis

Peritonitis

Inflammatory bowel disease
Metabolic disorder Lipidosis (cats)


Hepatic Fibrosis




Causes in Dogs


From Bonagura J: Kirk’s current veterinary therapy XIII, St Louis, 2000, Saunders.



Chronic hepatitis
Hepatic copper accumulation
Primary (Bedlington terriers, West Highland white terriers)

Secondary (Doberman pinschers, Skye terriers)

Infectious

Drug-induced Primidone

Metabolic
α1-Antitrypsin deficiency

Others
Lobular dissecting hepatitis

Idiopathic chronic hepatitis

Toxins, chemicals
Pyrrolizidine alkaloids, CCI4

Postnecrotic fibrosis

Chronic congestive heart failure

Chronic cholangiohepatitis

Chronic biliary obstruction

Idiopathic hepatic fibrosis
Perivenous

Diffuse pericellular

Periportal


Hepatic Infections and Abscesses




Bacteria Isolated from Hepatobiliary Suppurative Inflammation and Abscesses


Modified with permission from Greene C: Infectious diseases of the dog and cat, ed 2, St Louis, 1999, Saunders, p 616.



Aerobic Cultures (Positive Cultures: n = 54)



n ≥ 3 each



Escherichia coli

Staphylococcus pseudintermedius

S. aureus

S. epidermidis

Streptococcus group D enterococci

Streptococcus β-hemolytic

Enterococcus

Enterobacter aerogenes

E. agglomerans

Pseudomonas aeruginosa


n = 1 each



Pseudomonas fluorescens

Klebsiella pneumoniae

Bacillus spp.

Acinetobacter calcoaceticus

Citrobacter freundii

Moraxella phenylpyruvica

Pasteurella multocida

Bordetella bronchiseptica

Nocardia

Salmonella

Campylobacter jejuni


Anaerobic Cultures (Positive Cultures: n = 26)



Propionibacterium acnes

Clostridium perfringens

Clostridium

Bacteroides melaninogenicus

Corynebacterium spp.

Actinomyces

Peptostreptococcus

Fusobacterium

Anaerobic streptococci


Additional Microbes




Reported Elsewhere



Bacillus piliformis

Corynebacterium spp.

Proteus spp.

Francisella tularensis

Listeria monocytogenes

Eugenic fermenter-4 bacilli

In order from most to least common. Data acquired from case records, Companion Animal Hospital, College of Veterinary Medicine, Cornell University, Ithaca, NY, 1985–1996.



Hepatic Neoplasia




From Ettinger S, Feldman E: Textbook of veterinary internal medicine, ed 6, St Louis, 2005, Saunders.



Dogs



*Primary Hepatic Tumors (26%)



Hepatocellular carcinoma

Hepatocellular adenoma

Hepatic hemangiosarcoma

Biliary carcinoma


Other



Leiomyosarcoma

Liposarcoma

Myxosarcoma

Fibrosarcoma

Biliary adenoma

Hepatic carcinoid


Hemolymphatic Neoplasia (28%)



Lymphoma

MCT

Plasma cell tumor


Metastatic Neoplasia (46%)




Cats



*Primary Hepatic Tumors (20%)



Biliary carcinoma

Hepatocellular carcinoma

Hepatic hemangiosarcoma


Other



Biliary cystadenoma

Myelolipoma

Hepatic carcinoid


Hemolymphatic Neoplasia (60%)



Lymphoma

MCT

Plasma cell tumor


Metastatic Neoplasia (20%)


MCT, Mast cell tumor



* Primary tumors: in order of prevalence.



Hepatopathy, Vacuolar




Differential Diagnoses for Canine Vacuolar Hepatopathy


Modified from Ettinger S, Feldman E: Textbook of veterinary internal medicine, ed 6, St Louis, 2005, Saunders.



Hyperadrenocorticism



Spontaneous disease

Pituitary or adrenal origin

Iatrogenic, Glucocorticoid Therapy:


PO, IM, SQ, topical (skin, eye, ear)


Adrenal Hyperplasia Syndrome



Abnormal sex hormone production (aberrant adrenocortical disease)


Superficial Necrolytic




Dermatitis (Hepatocutaneous Syndrome)




Chronic Stress



Illness > 4 weeks


Severe Dental Disease



Infection
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