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Clinical Diagnosis of Diseases Rectal Examination

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Clinical Diagnosis of Diseases Rectal Examination

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									                            ‫ثغى اهلل انشحًٍ انشحيى‬
          ______________________________________

             Clinical Diagnosis of Ruminant
                    Animals Diseases
                          Part I
               ‫الحشخيص االكلينيكي ألمراض المجحرات‬
                          ‫الجزء األول‬
                               By
              Prof. Dr. Ibrahim H.A. Abd El-Rahim
                    Professor of Infectious Diseases,
                     Animal Medicine Department,
           Faculty of Veterinary Medicine, Assiut University
                    E-mail: vetrahim@hotmail.com

_______________________________
Introduction     ‫انًمذيخ‬
Disease may be defined as ―any abnormal structural and/or functional
change in the tissues of the body.
    Diseases caused by non-infectious agents (nutritional deficiency,
     metabolic disorders and others) are non-infectious diseases
     (general medicine)                    ‫انطت انؼبو أٔ األيشاك انجبطُخ‬
    Diseases caused by infectious agents (e.g. parasites, viruses,
     bacteria, fungi, prion and others) are infectious diseases (specific
     medicine)                               ّ‫انطت انخبؿ أٔ األيشاك انًؼذي‬
_________________________________


 Pathogenic agent + susceptible animal + growth and multiplication of
  the pathogen, and production of toxins + absorption + clinical signs =
  infectious disease   ٖ‫انًشك انًؼذ‬
 Infectious disease + transmission from one individual to another
  by direct and/or indirect contact = contagious disease (Latin,
  contagium = contact). ‫انًشك انٕثبئي‬
 All contagious diseases are infectious diseases, but not all infectious
  diseases are contagious diseases. ‫كم االيشاك انٕثبئيّ أيشاك يؼذيخ ٔنيظ انؼكظ‬
 Infectious disease + transmission between animals and man =
  zoonotic disease  ‫انًشك انًؾزشن‬
________________________________________
Clinical examination of ruminant animals
                                                ِ‫انفحـ االكهيُيكي نهحيٕاَبد انًجزش‬
Firstly: The veterinarians must take the utmost care during clinical
examination of animals, by attention to precautions and by giving clear
instructions, that neither the patient nor the helpers are placed at risk.
Secondly: On the other hand, obligation lies on the owner of the animal
to inform the veterinarian of any vices (such as kicking, sideways
pressing, biting) of the animal.
___________________________________
Instruments and requirements of clinical examinations
                                                ‫أدٔاد ٔيغزهضيبد انفحـ االكهيُيكي‬
In addition to protective clothing (veterinary smock or clinical coat,
washable apron, long gloves of rubber or plastic) the following
instruments are required:

   -   Stethoscope
   -   Clinical thermometer,
   -   Heavy and light percussion hammers,
   -   Plexer and plexemeter,
   -   Torch,
   -   Urethral catheter,
   -   Vaginal speculum,
   -   Milk stripping cup,
   -   Restraining equipment (metal wedge gag, wooden mouth gag).
   -   Stomach tube and probing.
   -   Containers for collecting samples (tubes, bottles, or plastic bags).
______________________________________________

I. Identification of cattle                       ٌ‫رؼشيف انحيٕا‬
The following are the principal criteria for the description of cattle:
breed, sex, colouration, muzzle print, blood group formula, brand mark
(or tattooing), age, body weight, ear mark, neck band number.

 Breed     ّ‫انغالن‬
Some breeds are predisposed to certain diseases. All foreign breeds are
highly susceptible for tropical infectious diseases.

__________________________________

 Utilization          ‫االعزؼًبل‬
   Fattening animal tend to develop disorders associated with
    intensive feeding (digestive disorders, laminitis).
   Dairy cows tend to develop metabolic disorders.

 Sex and age         ‫انجُظ ٔانؼًش‬
    Young animals are more likely to become ill as a result of
     parasitic invasion than the immune adults.
    Tuberculosis and paratuberculosis are chronic diseases of adults,
     and so on.
_________________________________

 Body weight         ٌ‫انٕص‬
  - Assessing the state of development and nutrition.
  - It enables precise drug dosage to be calculated.
  - Change in body weight is of some prognostic importance.

 Colour pattern        ٌٕ‫انه‬
  - In the case of black-and-white or red-and-white breeds, the photo-
    sensitization only affects the un-pigmented areas of skin.

                ________________________________

 Ear tags and neck bands ‫سلى األرٌ أٔ سثبه انشلجخ‬
  - Ear tags are used to identify cattle breeds of one colour.
  - On free-running cattle, broad plastic neck bands with a number
    printed on both sides are preferable.
 Branding and tattooing               ‫انٕؽى‬
 Muzzle impression       ‫ثقًخ انؾفّ انؼهيب‬
 Blood group determination       ‫فقيهخ انذو‬
____________________________________________



II. Case history           ٗ‫انزبسيخ انًشم‬

It is usually easy to obtain information on the location of the disease,
such as:

   Absence of rumination, alternate bloat, colic or diarrhoea
    (probable location of the disease in the digestive system);
   Nasal discharge, coughing or difficulty in breathing (probable
    location in the respiratory system);
   Repeated posturing for urination, or passage of blood-tinged
    urine (probable location in the urinary tract);
   Lameness or paralysis (location in locomotory or nervous
    systems); etc.

  ___________________________________
  Questions of particular importance are:        ‫أعئهخ راد أًْيخ‬

 Duration of illness:                ‫يذح انًشك‬
   Peracute (lasting for between a few hours and two days), ‫فٕق انحبد‬
   Acute (3 to 14 days),                     ‫حبد‬
   Subacute (2 to 4 weeks) or          ‫رحذ انحبد‬
   Chronic (over 4 weeks).                 ٍ‫يضي‬

 Nature, development and circumstances surrounding the symptoms:
   Wound + muscular spasm = tetanus;
   Dog bite + excitement = rabies;
   Recent calving + inability to stand = hypocalcaemic paresis.
 Probable cause of the condition:   ‫انغجت انًحزًم‬
   Feeding, husbandry and utilization of the animal.
   Contact with other animals, has been purchased recently, and
    from where.

 Treatment that has been instituted so far. ‫انؼالج انغبثك‬

Common errors in attempted treatment are:          ‫أخطبء ؽبئؼخ ػُذ انؼالج‬

    Forceful administration may resulting in inhalation pneumonia,
    Peritonitis after faulty trocarization of the rumen,
    Aggravation of lameness by incorrect claw trimming,
    Damage to the birth canal by forceful extraction of calf.
    Improvement or no improvement after previous treatment will
     provide a guide to diagnosis and prognosis.
_________________________________

III. General examination                ‫انفحـ انؼبو‬

Features included in a general examination are:

       Posture,            ‫ٔمغ انٕلٕف ٔانجهٕط‬
       Behaviour,                       ‫انغهٕن‬
       Nutritional state,               ‫انزغزيخ‬
       Physical condition,          ‫حبنخ انجغى‬
       Body temperature.     ‫دسجخ حشاسح انجغى‬
       Breathing rate,             ‫يؼذل انزُفظ‬
       Pulse rate and                   ‫انُجل‬

_______________________________________

 Posture               ‫ٔمغ انٕلٕف ٔانجهٕط‬

    Arched back and tense abdomen important signs of peritonitis,
     particularly that resulting from traumatic reticulitis.
    Holding the fore legs wide apart postural anomaly characteristic
     of diseases of pericardium and lungs.
    Animals with head and neck stretched out and held low perhaps
     with the tongue extruded (oesophagus obstruction, dyspnea).
    A lying animal curled up with the head turned towards the chest
     is symptomatic of comatose states, particularly parturient paresis.
    While an animal lying flat on its side with extended limbs and
     head stretched backwards may have hypomagnesaemic tetany.
___________________________________________________

Fig 87
_________________________
Fig 88
_________________
Fig 89
____________________________
 Behaviour                         ‫انغهٕن‬

    Increased sensomotor stimulation (excitability): Restlessness and
      pressing the head against objects.
    Episodes of bellowing, throwing the bedding around with the
      horns and swaying of the hindquarters are signs of rabies
    Decreased sensomotor stimulation (depression, paresis, paralysis):
      In parturient paresis, the cow is lying down (unable to rise).
    Coma (unconsciousness) due to general intoxication.
    In acute lead poisoning. - Blindness, salivation, teeth grinding,
      pressing forwards.
    Behaviour in botulism. – Recumbency with paralysis of all
      muscles and tongue hanging out.
    In pseudorabies, restlessness and severe itching.
    With chronic illness, cattle become dull, apathetic and depressed.
_______________________________________
Fig 90
_____________________________
Fig 91
____________________________
Fig 92
_________________________
Fig 340
____________________________
Some Photos of BSE lecture
______________________________________

 Nutritional state           ‫انزغزيخ‬

When a patient is in a poor state of nutrition, it is necessary to find out
if this is due to primary or secondary under-nutrition.

    Emaciation (secondary inanition) results from illness which
     affects the appetite of the animal (as in febrile systemic infections),
     or its inability to ingest feed (actinobacillosis of the tongue).
    Wasting diseases such as gastrointestinal helminths, tuberculosis
     and paratuberculosis) and they are usually chronic.
    Diseases with continuous diarrhoea can lead to rapid emaciation.
___________________________________________

 Physical condition              ‫حبنخ انجغى‬

This comprises the general external appearance of the patient from the
clinical aspect.

    By abnormalities in bodily condition an animal may be judged to
      be mildly, moderately or severely ill.
    It is also possible to distinguish acutely or chronically ill cattle.
    The bodily condition of an animal with severe, chronic illness is
      characterized by severe emaciation, stiffness and apathetic
      appearance.
__________________________________
Fig 93
________________________
Fig 94
___________________________

Fig 95
______________________
 Body temperature ‫دسجخ حشاسح انجغى‬
The procedure for taking an animal’s temperature is:

  (a) Shake the mercury column into the bulb end of the thermometer;
  (b) Moisten or lubricate the tube by the application of water, soap or
     mucus;
  (c) Insert the bulb end through the anus into the rectum. Insert the
     full length of the tube into the rectum where it can be held in
     position by means of a clothes peg attached to one of the caudal
     folds; and
  (d) Leave the thermometer in the rectum for about 2-3 minutes.
  _________________________________
   Fig 97
________________________________

Table . Normal body temperature in different animal species

ANIMAL SPECIES                  NORMAL BODY TEMPERATURE
Calves                                 38.5 to 39.5°C
Young cattle                           38.0 to 39.5 °C
Adult cattle                           38.0 to 39.0 °C
Sheep and goats                        38.5 to 39.5°C
Camels                                    36 to 37
Horse                                   37.5 to 38.5
Dogs and cats                             38 to 39

In general, animal temperatures will vary, depending on the following
factors: Age, time of day, environmental conditions, physical activity
(work), and reproductive function.

_______________________________________

Fever       ًٗ‫انح‬
Fever is a pathological state of increased heat production (increase in
the intensity of metabolism) and decreased heat loss. It is an important
curative and defensive process.

Fever is usually accompanied by:
  - Water retention,
   - Digestive disorders,
   - Increased breathing rate and heart rate
   - The skin surface temperature is mostly increased,
   - Dryness of mucous membranes,
   - In cattle, the muzzle is dry,
   - The eyes shine ―feverishly‖ and
   - Sometimes, the animal shivers.
______________________________

Degree of fever:
Table . Degree of fever in cattle


     DEGREE OF FEVER                CATTLE

     Mild fever               39 .5 to 40°C
     Moderate fever           40 to 41°C
     High fever               41 to 42°C

Hypothermia
Pathological lowering of the body temperature in cattle to below 37.5 °C
is called hypothermia.
________________________________

The course of fever:
    Biphasic fever: Viral infections are sometimes accompanied by a
     biphasic temperature curve, in which the first peak is due to
     viraemia, and the second to bacterial secondary infection.
    Saw-shaped fever curve: Temperature wit striking daily
     variations (Peritonitis).
    Persistent fever: (in severe, acute bronchopneumonia, malignant
     catarrhal fever, and certain forms of mastitis (E. coli infection).
    Continuous
    Remittent
    Intermittent
    Recurrent
    Atypical
________________________________

 Breathing (respiratory) rate       ‫يؼذل انزُفظ‬

Breathing rate is the number of the respiratory movements per minute,
by watching movements of the costal arch and flank.

Table . Normal respiratory rates in different animal species

ANIMAL SPECIES                           NORMAL BREATHING
                                         (RESPIRATORY) RATE
Adult cattle                                     15-35
Young calves                                     20-50
Sheep and Goats                                 12 to 20

___________________________
In examining respiration in an animal, give attention to the following
factors:

   Rate –number of inspirations per minute.
   Depth – the intensity or indication of straining.
   Character – normal breathing involves an observable expansion
    and relaxation of the ribs (costa) and abdominal wall.
   Rhythm – change in duration of inspiration and expiration.
   Sound – normal breathing is noiseless except when the animal is
    exercising or at work. Snuffling, sneezing, wheezing, rattling, or
    groaning may indicate something abnormal.

______________________
Pathological conditions
  - Polypnea means a pathological increase in breathing rate.
  - Oligopnea means a decrease in breathing rate.
  - Dyspnea – labored or difficult breathing.

________________________________________


 Pulse rate          ‫انُجل‬
Pulse rate is the number of pulse beats per minute. This is detected by
palpation of a suitable peripheral artery, such as:

   - In cattle: External maxillary artery, directly after its passage
      around the mandible, laterally at the anterior edge of the
      masseter muscle. Coccygeal artery, I or 2 handbreadths from the
      base of the tail can be also easily palpated.
   - In sheep and goats, the saphenous artery, which runs down the
      inside of the hind leg, is the most accessible location.
   - In horses, pulse may also be taken on the inside of the forearm
      (radial bone) where the radial artery travels down the bone.
____________________________________
Fig 96
____________________________________

The important factors to note in taking the pulse are:
   (1) Frequency: Counting the number of heartbeats occurring in 1
       min. Tachycardia is an increase in pulse rate while bradycardia
       is a decrease.

   (2) Rhythm: Pulse rhythm is normally regular, which means that the
       intervals between individual pulse waves are of equal duration.
       Irregularity is accompanied by unevenness of the pulse beat.

   (3) Quality: Quality is best described as the tension on the arterial
       wall; it is an indication of the volume of blood flow.
_________________________________

Table . Normal pulse rates in different animal species

ANIMAL SPECIES                       NORMAL PULSE RATE
Unweaned calves                              90 to 110
Young cattle                                  70 to 90
Barren &newly-calved cows                     65 to 80
Heavily pregnant cows                         70 to 90
Large bulls & oxen                            60 to 70
Sheep and goats                               60 to 90
   _______________________________________________
_________________________________

 Summary of findings           ‫يهخـ انفحـ انؼبو‬
When the general examination has been completed, a short summary of
the findings should be made, together with facts derived from the
history, in the following form:
   1. The general health of the animal is not, slightly, moderately, or
      severely disturbed.
   2. The location of disease is probably in skin and sc tissue,
      lymphatic system, circulatory system, respiratory system,
      digestive system, urogenital system, locomotor apparatus, CNS.

          The special examination.
_____________________________________________

VI. Special examination                ‫انفحـ انخبؿ‬
Special examination is to examine individual body systems more
thoroughly for diagnosis and differential diagnosis:

       Hair, skin, SC tissue and visible mucous membranes ‫انجهذ‬
       Lymphatic system            ٖٔ‫انجٓبص انهيًفب‬
       Circulation                   ٖ‫انجٓبص انذٔس‬
       Respiratory system            ٗ‫انجٓبص انزُفغ‬
       Digestive system             ًٗ‫انجٓبص انٓن‬
       Urinary system                 ٗ‫انجٓبص انجٕن‬
       Genital system and udder ٖ‫انجٓبص انزُبعب‬
       Locomotor system              ٗ‫انجٓبص انحشك‬
       Central nervous system        ٗ‫انجٓبص انؼقج‬

______________________________________________
Hair, skin, SC tissue, and visible mucous membranes

                           ‫فحص الشعر والجلد والنسيج جحث الجلد واالغشيه المخاطية‬

When compiling the case history, questions will have been asked about:
    - Previous occurrences of skin disease on the farm,
    - The density of cattle within the buildings,
    - Care of the hair coat (whether regular grooming, shearing,
      washing or dipping is carried out),
    - Type of bedding,
    - Possibility of injury,
    - Whether any dressing has been applied to the skin (disinfectant,
      antifungal agent, anti-parasitic agent, etc.).

__________________________________________

Hair                ‫فحص الشعر‬

   Rough or shaggy coat (prolonged nutritional deficiency or chronic
    parasitic infestations).
   Photosensitization
   Flealthy hair: As a result of sweat & sebaceous glands secretions.
   Dull coat: Due to Underproduction of sebum (asteatosis).
   Hairs covered with bran: Overproduction of sebum (seborrhoea)
    or dandrof (as if bran had been scattered over it).
   Alopocia: Alopocia is loss or shedding of hair. It may be regional
     or general alopecia. Louse and mange mite infestation.

_______________________________________
Skin ―the skin is the mirror of health‖       ‫فحص الجلد‬

    Localized (itching) pruritus (ectoparasitosis, particularly mange).
    Persistent, severe, generalized pruritus (pseudorabies).
    Skin thickening (sarcoptic mange, parakeratosis (zinc deficiency).
    Dermatitis (inflammation of the skin)
    Wounds, necrosis of small or large areas of skin, skin ulcer
    The ectoparasites include: Ticks and mange mites (Sarcoptes
     bovis, Chorioptes and Psoroptes).
____________________________________________

Subcutaneous tissue (subcutis)             ‫فحص النسيج جحث الجلد‬

  1. Dehydration (skin fold test)
  2. The disappearance of fat deposits in severe emaciation
  3. Oedema (major disturbance of venous blood flow to the heart).
   4. Hypoproteinaemia (bottle jaw).
   5. An abscess
   6. A haematoma (accumulation of blood under the skin).
   7. Subcutaneous emphysema (accumulation of air or gas).
   8. Parasites: 3rd -stage larvae of the ox warble fly (Hypoderma bovis)
   ______________________________________

Fig 113
_________________________________
Visible mucous membranes        ‫فحص االغشيه المخاطية‬

   1. Yellow staining from deposition of bile pigments (Jaundice).
   2. Non-haemolytic anaemia is manifested by extreme paleness.
   3. Bluish-violet (cyanosis) occurs during circulatory disorders.
   4. Reddening is usually due to local or general inflammation.
   5. Petechtae (in the various forms of haemorrhagic diathesis).
   6. Nodules (papular stomatitis,
   7. Vesicles (vesicular stomatitis, infectious pustular vulvo-vaginitis),
   8. Aphthae (foot and mouth disease).
   9. Erosions (as in infectious rhinotracheitis).
   10.Necrosis (as in malignant catarrhal fever and BVD.
   11.Deep ulcerative defects surrounded by a raised edge (ulcers).
______________________________
Plate 2
_________________
Some Photos of FMD lecture

__________________________________

Examination of the lymphatic system                  ٖٔ‫فحـ انجٓبص انهيًفب‬

Lymph nodes             ‫انغذد انهيًفبٔيخ‬
The body lymph nodes are normally:
  - Flaccid or tautly elastic,
  - Easily displaced and
  - In one piece.
During inspection and palpation attention should be paid to:
  - Increase in size,
  - Tenderness,
  - Firm consistency,
   - Nodule formation,
   - Adhesion to surrounding tissues, and
   - The occurrence of accessory lymph nodes.

_____________________________________________

Examination of lymph nodes:        ‫فحـ انغذد انهيًفبٔيخ‬
   Lymph nodes of the head and neck

    Mandlbular lymph nodes
    Parotid lymph nodes
    Retropharyngeal (suprapharyngeal) lymph node
    The external retropharyngeal lymph nodes.
   o Prescapular (superficial cervical) lymph nodes
   o Prefemoral (subiliac) lymph nodes.
   o Mammary lymph nodes
_________________________________________
Fig 125

___________________________________________

Examination of the circulatory system ٖ‫فحـ انجٓبص انذٔس‬

Heart ‫انمهت‬
In cattle the heart occupies a ventral position in the thoracic cavity
between the 3rd and 6th pairs of ribs. The apex of the heart points
slightly backwards and to the left, so that about three-fifths of the heart
muscle is on the left of the midline, and the remainder on the right.
Consequently the main site for examining the heart is on the left side.
Examination of the heart comprises:

   Observation,                     ّ‫انشؤي‬
   Palpation,                     ‫انزحغظ‬
   Percussion,              ‫انقذو أٔ انطشق‬
   Auscultation    ّ‫انغًبع ثإعزخذاو انغًبػ‬

______________________________
Observation:                      ّ‫انشؤي‬

   Tremor in the chest wall (the heart beat is so exaggerated)
   Congestive oedema in the dewlap (severe cardiac insufficiency).

Palpation:            ‫انزحغظ‬

   Action of the heart can be felt with the finger tips by laying the left
   hand flat against the chest inside the left elbow at the fourth (if
   necessary 3rd and 5th) inter-costal space. Normally the apex beat
   cannot be felt in fat cattle, but it can be felt in lean cattle. You have
   to notice the following:
   Displacement,
   Weakening,
   Strengthening or
   Arrhythmia.
_________________________________

Percussion: ‫انقذو أٔ انطشق‬
Using a small soft-tipped hammer and a pleximeter or by using the
fingers. On the left side of healthy, adult cattle this area is the size of the
palm of a hand, while on the right side it is smaller or indistinct. You
have to notice the following:
   - Pulmonary emphysema (cardiac dullness is smaller).
   - Hydropericardium (extensive and pronounced dullness).
   - Pericarditis (dullness cover area in front of, and behind scapula).
   - Hydrothorax (Increase in intensity & extent of cardiac dullness).
   - Portion of the reticulum in the thoracic cavity (complete dullness
     behind the heart).
   - Sensitivity of the patient to percussion in the heart region.

_______________________________________
Auscultation ّ‫انغًبع ثإعزخذاو انغًبػ‬
Using tubed phonendoscope (stethoscope). The chest piece should be
pressed firmly against the chest on the left side in 3rd & 4th intercostal
space beneath and above the tip of the elbow. Normal heart sounds:
   1. First (systolic) heart sound: longer, deeper and louder than 2nd.
   2. Second (diastolic) heart sound is shorter, higher and more gentle.
- Heart sounds is (bub – dup), equivalent to lub - dupp in man.
- Listening to cardiac function is (F-I-R-D-A= frequency, intensity,
  rhythm, demarcation & any adventitious sounds).
_____________________________________

Plate 5 b
____________________________

Fig 129

____________________________

Heart frequency         ‫يؼذل مشثبد انمهت‬

Normal heart rate
Heart frequency (heart rate) usually coincides with that of the pulse.
Tachycardia
Increase of the heart rate. A rate of over 90 in resting, adult cattle, over
100 in young cattle or over 120 a minute in calves denotes tachycardia, a
symptom of circulatory disorder.
Bradycardia
Slowing of the heart rate in cattle to less than 65/minute (bradycardia).
____________________________


Intensity of the heart sound               ‫ؽذح مشثبد انمهت‬
   Intensity of the heart sound is normally strong and even; upon
      auscultation the sounds are clear and of a uniform strength.

   A more or less pronounced increase in the first heart sound occurs
     during increased heart work of physiological or pathological
     origin (bodily exertion, psychic excitement, anaemia, cardiac
     insufficiency).

__________________________________

Heart rhythm          ‫إَزظبو مشثبد انمهت‬
Normal heart rhythm
Heart rhythm is normally regular with no change in the duration of the
first and second heart tones nor in systole and diastole at the same heart
rate. Abnormal heart rhythm:

   Duplication of the second heart sound
   Pronounced cardiac arrhythmia
________________________________

Demarcation or distinctness of the heart sounds         ‫حذٔد مشثبد انمهت‬

   - Demarcation or distinctness of the heart sounds refers to the
     clarity of onset and termination.
   - Indistinctly terminated (blurred, rolling) heart sounds may be the
     first sign of incipient valvular endocarditis. Occurring with
     tachycardia, such sounds are an indication of deteriorating heart
     function.
_______________________________________

Adventitious heart sounds (murmurs)            ‫ػبسك مشثبد انمهت‬

   - Adventitious heart sounds (murmurs) comprise any that are
     additional to the first and second sounds, regardless of the nature
     of the sound.
   - They are almost invariably pathological features, and are divisible
     into endocardial and exocardial (or pericardial) murmurs.
   - Adventitious sounds are also caused by malformations in the
     heart, such as persistent foramen ovale (organic murmur).
_______________________________________


                           ٍ‫انحًذ هلل سة انؼبنًي‬
             _______________________________________
ANOTHER POWERPOINT FILE (Clinical examination II)
      __________________________________________

                   ‫ثغى اهلل انشحًٍ انشحيى‬
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           Clinical Diagnosis of Ruminant
                  Animals Diseases
                        Part II
             ‫الحشخيص االكلينيكي ألمراض المجحرات‬
                       ‫الجزء الثانى‬
                             By
            Prof. Dr. Ibrahim H.A. Abd El-Rahim
                  Professor of Infectious Diseases,
                   Animal Medicine Department,
         Faculty of Veterinary Medicine, Assiut University
                  E-mail: vetrahim@hotmail.com

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Examination of the respiratory system             ٗ‫فحـ انجٓبص انزُفغ‬

   First observe the breathing from a distance, while listening for
    abnormal sounds associated with breathing.
    Next examine each segment of the respiratory tract separately in
     the following order: breath, muzzle, nose and nasal sinuses,
     pharynx and larynx, trachea and lungs.

    At the same time inspect the chest wall for pathological changes.

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Respiratory movements           ‫حشكخ انزُفظ‬
   - Breathing is best observed from behind and to one side of the
     animal, without disturbing the animal, by watching movements of
     the costal arch and flank.

   - Rate, intensity, type and rhythm should be considered. Intensity
     is normally moderately pronounced in cattle, so respiratory
     movements of chest and abdominal wall are clearly visible.

   - In normal breathing rhythm the ratio of duration of inspiration to
     duration of expiration is about 1.0 to 1.2; there is a short pause in
     breathing at the end of expiration.

   - Eupnoea: Breathing of normal frequency, intensity, type and
     rhythm is called eupnoea.

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Fig 144

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Fig 145

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Dyspnea         ‫ميك انزُفظ‬
Difficulty in breathing with changes in normal characteristics (normal
frequency, intensity, type and rhythm) accompanying respiratory
disease.

1. Inspiratory dyspnoea ‫ميك انزُفظ أثُبء انؾٓيك‬
   - It is characterized by more frequent breathing and by stronger
     and longer inspiration due to narrowing of the upper air passages
     and those forms of bronchopneumonia unaccompanied by
     pulmonary emphysema.
   - Signs of severe dyspnoea are extension of the head and neck,
     nostril dilation during inspiration, spreading of the scapulas, slack
     or sunken flanks and sagging belly; sometimes sounds of stenosis
     are audible at a distance from the animal.
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2. Expiratory dyspnoea         ‫ميك انزُفظ أثُبء انضفيش‬
   - If breathing out is impeded, expiratory dyspnoea occurs
     characterized by mainly abdominal breathing and stronger and
     longer breathing out than breathing in.
   - The forced breathing out distends the flank and anal region, and
     it is often accompanied by long groans. Other symptoms are
     breathing with the mouth open and the tongue protruded.

3. Mixed dyspnoea         ‫ميك انزُفظ أثُبء انؾٓيك ٔانضفيش‬

   - It occurs with chronic respiratory disease, and here there is
     difficulty in breathing in and out.
   - It occurs during primary pulmonary emphysema.

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Externally audible sounds associated with breathing
                          ‫أفٕاد غيش طجيؼيخ يغًٕػّ ٔيقبحجخ نؼًهيخ انزُفظ‬
These have to be differentiated according to origin & cause, as follows:

   o Snorting - a sneezing sound produced by a brief, powerful
     expiration through the nose (occurs during irritation of the nasal
     mucosa).
   o Stenosis sounds - produced by constriction, in the upper
     respiratory tract. Nasal stenosis sound (snuffling). Pharyngeal
     stenosis sound (snoring). Laryngeal stenosis produces roaring in
     the throat (calf diphtheria).
  o Coughing – Due to inflammation of the respiratory mucous
    membrane. The type of cough may provide a clue to the site of the
    lesion: it is relatively dry & powerful in diseases of the upper
    respiratory tract, and more moist & feeble during the more deep-
    seated bronchopneumonia, pulmonary emphysema or pleurisy.

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Nasal discharge     ‫االفضاد االَفيخ‬
  - The colour is normally water-clear and serous, otherwise whitish
    and cloudy; red to rust-brown if due to haemorrhage.
  - The consistency is normally watery, otherwise mucoid or
    flocculated in catarrhal or purulent inflammation; lumpy or
    crumbly in necrotic inflammation.
  - The odour is normally odourless (foul in deep-seated tissue
    damage).
  - Any sputum ejected from the mouth or nose is always
    pathological, and should be examined in the same way as nasal
    discharge.

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Lungs and pleura           ٖ‫انشئخ ٔانغؾبء انجهٕس‬
The lungs and pleura are examined by acoustic and sensitivity
percussion, together with auscultation of the lung field.

The lung field
  - Dorsal margin is the lateral edge of the trunk musculature.
  - Cranial border is formed by the posterior edge of the triceps
    muscle. Caudal border extends from its dorsal extremity at the
    11th intercostal space, across the middle of the 9th rib to about two
    fingerbreadths above the elbow joint.
  - On the right side the posterior border extends 1 or 2 finger-
    breadths further back (to about the 12th rib) compared with the
    left side.

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Acoustic percussion ٗ‫انطشق انغًؼ‬
   - The percussion hammer is held loosely between the thumb and
      index finger, and the pleximeter is pressed against the chest.
   - The first stage is horizontal percussion to establish the course of
      the caudal lung limits. This is best performed on the right side.
   - The next stage is vertical percussion from above to below,
      commencing at the cranial edge of the thoracic lung field and
      extending backwards at each intercostal space. This establishes
      any change in the normal lung resonance.
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Fig 152
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Fig 153
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Table . Summary of types of sound heard during percussion of the lung
         field

SOUND QUALITY            CHARACTERISTICS OF TYPES OF PERCUSION
                                            RESONANCE
Good       resonance Normal lung sound
without booming
A     fairly    loud, It is heard over areas of emphysema and pneumothorax.
subtympanic sound
Circumscribed         They are produced by air-free pneumonic lesions,
areas of dullness     abscesses, tumours, enlarged lymph nodes, prolapse of
                      digesta-filled portions of the digestive system through the
                      diaphragm, or pronounced thickening of the pleura.

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Auscultation ّ‫انغًبع ثإعزخذاو انغًبػ‬

Normal respiratorz sounds              ٗ‫أفٕاد انزُفظ انطجيؼ‬
    Vesicular breathing is heard only in the caudodorsal third of the
     thoracic field. it resembles the start of the syllable ―V‖, whispered.
    In the rest of the field a mixed breathing sound occurs in which
      vesicular breathing is mixed with the dominant bronchial
      breathing, it resembles a prolonged syllable ―ch‖.
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Fig 156

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Abnormal respiratory sounds           ٗ‫أفٕاد انزُفظ انغيش انطجيؼ‬
   Areas of lung tissue that contain no air (pneumonic lesions,
    pulmonary oedema, large abscesses, neoplasms, Echinococcus
    cysts) are completely silent.
   Vesicular breathing sounds are enhanced during the deeper
    inspirations of dyspnoea and over emphysematous areas.
   Bronchial breathing is louder than normal in the various forms of
    stenosis of the upper respiratory tract and during laryngitis,
    tracheitis and bronchitis.
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Pathological variations in respiratory sounds:
                                       ‫أفٕاد انزُفظ فٗ انحبالد انًشميخ‬
   Crepitating (rustling), due to small-bubbled foam, occurs during
    pulmonary emphysema (like the light rubbing of fine sandpaper).
   Moist rales are heard when the bronchi contain watery secretion
    or exudation (pulmonary oedema, catarrhal bronchopneumonia,
    or aspiration pneumonia). It resembles simmering, the whipping
    up of froth.
   Dry rales are heard when the exudates thicken up to form thick
    mucus, resulting in elongated projections into the bronchial lumen
    and vibrate in air currents, producing dry rales.
   Friction sounds - Movement of parts of the pleura, thickened by
    inflammation, against each other produces friction sounds.

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Sounds may be heard during auscultation, and it is important not to
confuse them with normal and abnormal breathing sounds:
                                         ‫أفٕاد لذ رزذاخم يغ أفٕاد انزُفظ‬
    Muscular tremor (which shakes the chest piece of the
     phonendoscope).
    Hair rustling (press the phonendoscope more firmly).
    Tooth grinding, swallowing, eructation and cud regurgitation.
    Grinding chewing (rumination), contractions of the forestomachs
     and painful moaning.
    Unilateral absence of breathing sounds may be due to pneumo-
     thorax.

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Examination of the digestive system                          ًٗ‫فحـ انجٓبص انٓن‬
The general examination will have provided information on:

   - Appetite and feed intake,        ‫انؾٓيّ ٔرُبٔل انغزاء‬
   - Thirst and fluid intake,         ‫انؼطؼ ٔؽشة انًبء‬
   - Rumination,                                 ‫االجزشاس‬
   - Eructation (or development of bloat),        ‫انزكشيغ‬
   - Any regurgitation of feed or vomiting of stomach contents; ‫انزشجيغ‬
   - Also the type and nature of defecation.       ‫انزجشص‬
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Intake of feed and water              ‫رُبٔل انغزاء ٔؽشة انًبء‬

Appetite            ّ‫انؾٓي‬

Classification of inappetence according to the cause:

   o True or primary inappetence: It means absent or diminished
     appetite (due to poor feed quality or a disease of the GIT).
   o Secondary or symptomatic inappetence: It means poor appetite
     (due to diseases of organs unrelated to the digestive system, or a
     wide range of systemic diseases.
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The return of appetite is always a favourable sign for prognosis. The
following types of appetite disorders are distinguished:

   - Diminished appetite, when the animal eats hesitantly or more
     slowly than its neighbours, or consumes only part of its ration, as
     during mild illnesses.
   - Complete inappetence (anorexia) occurs during persistent, severe
     diseases.
   - Abnormal appetite. - An appetite confined to certain feeds and
     abnormal appetite (licking disease, allotriophagia, pica) for
     substances other than feeds point to a metabolic or deficiency
     disorder.

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Rumination              ‫االجزشاس‬

   o Commencement of rumination, usually 1/2 to 1 1/2 hours after
     feeding.
   o Number and duration of rumination cycles, in a day there may be 4
     to 24 periods of rumination each lasting 10 to 60 minutes, so that
     up to 7 hours may be spent ruminating every day.
   o Number of ruminated boluses: 360 to 790 a day.
   o Size of each ruminated bolus: about 80 to 120 g. A bolus can be
     recovered from the oral cavity by a quick thrust of the hand
     immediately after its return.
   o Number of jaw movements and chewing time per bolus: 40-70
     chews within 45-60 seconds, depending on composition of the feed.

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Disorders of rumination occur either as a result of: ‫اعجبة إمطشاثبد االجزشاس‬

    Pathological changes in the mouth, oesophagus or forestomachs
     (foreign body trauma, functional gastric stenosis), or
    May accompany severe diseases affecting general health and
     located elsewhere in the body; consequently primary and
     secondary (symptomatic) disorders can be distinguished.
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Features to be watched for are:
   -   Delayed onset of rumination after feeding;
   -   Too few or too brief periods of rumination;
   -   Too few chews per bolus;
   -   Too short or too long duration of chewing per bolus;
   -   Superficial, intermittent or absent rumination;
   -   More rarely, faulty chewing or loss of the cud;
   -   Abnormally frequent or prolonged rumination, accompanied by
       salivation, smacking the lips or grinding the teeth (in brain
       diseases, lead poisoning or the nervous form of acetonaemia).

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Rumen          ‫فحـ انكشػ‬
The rumen is examined by:
   o  Observation of the left flank,
   o  Palpation (through the abdominal wall and through the rectum),
   o  Auscultation,
   o  Percussion, and
   o  By collecting and testing a sample of rumen fluid.
   o  Particular cases may require laparoscopy, rumenography,
      telemetric recording or (in calves) radiography.
   o Sometimes a diagnosis can be established only after exploratory
      rumenotomy.
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Fig 178______________________

Fig 175
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Fig 176
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Observation      ‫انشؤيخ‬
Observation of the hollow of the left flank provides information on:
   - The degree of fullness of the rumen (hollow flank - not full; tensed
     - normal; bulging - overfull), and
   - The intensity of contractions, which are clearly visible only in
     cattle having a thin abdominal wall.

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Fig 179
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Palpation         ‫انزحغظ‬
   - Abnormal filling with gas or foamy feed mass (bloat) produces
     taut, elastic tension with a more or less pronounced bulge in the
     dorsal part of the left flank.
   - Overloading of the rumen with solid food produces a firmer,
     barely yielding consistency.
   - In functional stenosis of the stomach the rumen is dilated, tone is
     abolished and it is usually overloaded with fluid or foamy food
     masses responding to punching with fluctuation and splashing.
   - During advanced rumen acidosis (lactic acid) the contents of the
     forestomachs are very fluid.

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Auscultation       ّ‫إعزخذاو انغًبػ‬
Attention is paid to the nature, strength and frequency of rumen
sounds, which in health cattle take the form of a periodic rustling sound,
increasing, to a crescendo then falling away.

    The normal rate of rumen sounds is 2 or 3 strong contractions/
     2 minutes.
    Hypermottllty — increase in the rate of rumen movements —
     occurs during vagus stimulation.
    Hypomotility — decrease in the rate of rumen movements —
     occurs when a ration poor in fibrous structure is fed, during
     forestomach disorders (indigestion).
    Atony — stop of rumen movements — occurs during severe
      forestomach disorders (traumatic reticuloperitonitis, rumen
      acidosis, etc.).
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Fig 180
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Acoustic percussion of the rumen         ‫انطشق انغًؼٗ نهكشػ‬
    Subtympanic sound: It is the normal rumen sound in the dorsal
      part of the left abdominal wall.
    Damped sound: Ventral to this there is a relative damping of the
      percussion sound. This zone becomes completely damped when
      the rumen is overloaded.
    Drum-like boom: In bloat (tympany).
    Tympanic sound: In left-sided abomasal displacement.
    Box sound: In fresh cases of traumatic reticuloperitonitis.
    Pain percussion: in rumenitis and large abscesses of the rumen.
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Fig 181
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Fig 206

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Tests for foreign bodies       ‫إخزجبساد ٔجٕد االجغبو انغشيجخ‬
  o Back grip: A fold of skin over the withers is pulled up so that the
    animal's back is suddenly pressed down.
  o Pole test: A pole 1-1 1/2 metres long is placed under the animal
    and held at each end by two assistants. The pole is pulled upwards
    slowly, and then allowed to fall suddenly.
  o Pain percussion: It is carried out with a fairly heavy hammer
    having a rubber head applied with short strokes.
  o Palpation for tenderness: A strong pressure is applied with the fist
    or the palm of the hand to the reticular projection field.
  o Leading the animal up and down a steep slope
Increased sensitivity is manifested by signs of tenderness (a sighing
grunt or brief holding of the breath).
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Liver           ‫انكجذ‬
Examination of the bovine liver commences with:

    Inspection of visible mucous membranes.
    Palpation and percussion of the liver region. Dorsally behind the
      right costal arch is the site for palpation of the liver by forceful
      pressure on the abdominal wall by the finger tips, just behind the
      last rib
    Examination of urine and faeces.
    Liver function test.
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Plate 8
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Fig 223
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Rectal exploration           ‫االعزكؾبف ػٍ طشيك انًغزميى‬
   o Rectal examination of the intestines includes the rectum itself,
     (e.g. thickness and tension of the wall).
   o Organs that can be felt through the rectum are:
      -   The caudal loops of intestine,
      -   Internal genital organs and parts of the peritoneum, rumen,
      -   Left kidney (sometimes the caudal pole of the right kidney),
      -   Aortic bifurcation, Bony pelvis, Sacrum,
      -   Internal ilio-femoral lymph nodes, Urinary bladder
   o Pregnancy disgnosis
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Fig 208
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 Conditions can be diagnosed through rectal examination:
                        ‫حبالد يًكٍ رؾخيقٓب ثٕاعطخ االعزكؾبف ػٍ طشيك انًغزميى‬
   1. Acute enteritis: mesenteric lymph nodes slightly enlarged;
   2. Chronic enteritis: mesenteric lymph nodes enlarged & firm
      (paratuberculosis or leukosis), or hard (tuberculous calcification);
      thickened wall (paratuberculosis.
   3. Intussusception (jejunal invagination).
   4. Volvulus and strangulation of the small intestine.
   5. Intestinal obstruction.
   6. Torsion of intestinal mesentery.
   7. Dilation and torsion of the caecum.
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   8. Intestinal rupture with generalized peritonitis.
   9. Necrosis of adipose tissue.
   10.Dilation and overloading of the rumen
   11.Displacement of the abomasum to the right, with or without
      torsion
   12.Excessive placental fluid.
   13.Simple dilation of the abomasum.
   14.Displacement of the abomasum to the left.
   15.Accumulation of purulent exudate within the cavity of the
      omental bursa.
   16.Kidney disease.

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Examination of faeces            ‫فحـ انجشاص‬
   - Faeces are inspected, felt and smelt for the characteristics such as
      amount, colour, and consistency.
   - Examination for parasites, bacteria, viruses or poisons may be
      indicated, particularly in diarrhoea, depending on concomitant
      circumstances (single animal affected or whole herd; type of
      feeding and management; environmental factors).
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Plate 10

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Abnormal contents of faecal matter ‫يحزٕيبد غيش طجيؼيّ ثبنجشاص‬
Abnormal contents are detected by inspection and feeling, as follows:
  -  In very severe enteritis, faeces may be replaced by fluid.
  -  Greyish-white mucus (sign of intestinal obstruction).
  -  Fibrin (during severe catarrhal enteritis)
  -  Blood from posterior segments of intestine appears bright red in
     the form of streaks on the surface of the faecal matter.
   - Blood from anterior portions (chocolate brown or black
     (melaena), and well-mixed with faecal matter.
   - Gas bubbles (in diarrhoeic excrement, and paratuberculosis).
   - Macroscopically visible parasites (tapeworm segments,
     roundworms) may be included here.
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Examination of the udder              ‫فحـ اننشع‬

For examination of the udder:

  - Case history (husbandry conditions, milking techniques, milking
    hygiene, treatment)
  - Inspection,
  - Palpation,
  - Inspection of the udder secretion, and
  - If necessary biochemical and microbiological examination of milk
    samples.

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Inspection          ّ‫انشؤي‬
Asymmetry of the udder is usually due to atrophy (or more rarely
hypertrophy) of one quarter.
Enlargement of the whole udder or one quarter may conceal rupture of
the rectus abdominis muscle, a flank rupture extending as far as the
udder, abscess or haematoma.
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Fig 296
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Fig 297
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Palpation          ‫انزحغظ‬
This includes: Teat canal, Teat cistern, Wall of the teat, Udder cistern,
Udder skin and Glandular tissue of each quarter.

   - Swelled, hot, painful palpation (acute mastitis)
   - Hard indurated (fibrosed) udder tissue (chronic mastitis)
   - Physiological oedema occurs shortly before calving
   - A pathological form of oedema leading to induration of the skin
     and subcutaneous tissue ―hard udder‖.
   - Each quarter is felt in the milked-out state for consistency
     (granules, nodules, diffuse hardening, acute swelling, consistency).
   - Mastitis of infectious origin leads to enlargement of the mammary
     lymph nodes.

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   Fig 302
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   Fig 303
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   Fig 308
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   Plate 15
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   Fig 309 and 310 (together)
                              THE END
                           ٍ‫انحًذ هلل سة انؼبنًي‬
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