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Contents
PART ONE  CARDIOVASCULAR SYSTEM
DISORDERS, 1

PART THREE  DIGESTIVE SYSTEM
DISORDERS, 367

Wendy A. Ware













1 Clinical Manifestations of Cardiac Disease, 1
2 Diagnostic Tests for the Cardiovascular
System, 13
3 Management of Heart Failure, 53
4 Cardiac Arrhythmias and Antiarrhythmic
Therapy, 74
5 Congenital Cardiac Disease, 96
6 Acquired Valvular and Endocardial Disease, 115
7 Myocardial Diseases of the Dog, 130
8 Myocardial Diseases of the Cat, 145
9 Pericardial Disease and Cardiac Tumors, 159
10 Heartworm Disease, 173
11 Systemic Arterial Hypertension, 190
12 Thromboembolic Disease, 199

PART TWO  RESPIRATORY SYSTEM
DISORDERS, 217
Eleanor C. Hawkins
13 Clinical Manifestations of Nasal Disease, 217
14 Diagnostic Tests for the Nasal Cavity and
Paranasal Sinuses, 224
15 Disorders of the Nasal Cavity, 234
16 Clinical Manifestations of Laryngeal and
Pharyngeal Disease, 247
17 Diagnostic Tests for the Larynx and
Pharynx, 249
18 Disorders of the Larynx and Pharynx, 253
19 Clinical Manifestations of Lower Respiratory Tract
Disorders, 258
20 Diagnostic Tests for the Lower Respiratory
Tract, 263
21 Disorders of the Trachea and Bronchi, 297
22 Disorders of the Pulmonary Parenchyma and
Vasculature, 316
23 Clinical Manifestations of the Pleural Cavity and
Mediastinal Disease, 337
24 Diagnostic Tests for the Pleural Cavity and
Mediastinum, 343
25 Disorders of the Pleural Cavity, 349
26 Emergency Management of Respiratory
Distress, 356
27 Ancillary Therapy: Oxygen Supplementation and
Ventilation, 361

Michael D. Willard
28 Clinical Manifestations of Gastrointestinal
Disorders, 367
29 Diagnostic Tests for the Alimentary Tract, 390
30 General Therapeutic Principles, 410
31 Disorders of the Oral Cavity, Pharynx, and
Esophagus, 428
32 Disorders of the Stomach, 442
33 Disorders of the Intestinal Tract, 455
34 Disorders of the Peritoneum, 492

PART FOUR  HEPATOBILIARY AND EXOCRINE
PANCREATIC DISORDERS, 501
Penny J. Watson
35 Clinical Manifestations of Hepatobiliary
Disease, 501
36 Diagnostic Tests for the Hepatobiliary System, 512
37 Hepatobiliary Diseases in the Cat, 536
38 Hepatobiliary Diseases in the Dog, 559
39 Treatment of Complications of Hepatic Disease
and Failure, 588
40 The Exocrine Pancreas, 598

PART FIVE  URINARY TRACT DISORDERS, 629
Stephen P. DiBartola and
Jodi L. Westropp








41
42
43
44
45
46
47

Clinical Manifestations of Urinary Disorders, 629
Diagnostic Tests for the Urinary System, 638
Glomerular Disease, 653
Acute and Chronic Renal Failure, 663
Canine and Feline Urinary Tract Infections, 680
Canine and Feline Urolithiasis, 687
Obstructive and Nonobstructive Feline Idiopathic
Cystitis, 698
48 Disorders of Micturition, 704

PART SIX  ENDOCRINE DISORDERS, 713
Richard W. Nelson
49 Disorders of the Hypothalamus and Pituitary
Gland, 713






50
51
52
53

Disorders of the Parathyroid Gland, 731
Disorders of the Thyroid Gland, 740
Disorders of the Endocrine Pancreas, 777
Disorders of the Adrenal Gland, 824

PART SEVEN  METABOLIC AND ELECTROLYTE
DISORDERS, 863
Richard W. Nelson and
Sean J. Delaney
54 Disorders of Metabolism, 863
55 Electrolyte Imbalances, 877

PART ELEVEN  ONCOLOGY, 1126
C. Guillermo Couto









72
73
74
75
76
77
78
79

Cytology, 1126
Principles of Cancer Treatment, 1134
Practical Chemotherapy, 1138
Complications of Cancer Chemotherapy, 1144
Approach to the Patient with a Mass, 1154
Lymphoma, 1160
Leukemias, 1175
Selected Neoplasms in Dogs and Cats, 1186

PART TWELVE  HEMATOLOGY, 1201
C. Guillermo Couto

PART EIGHT  REPRODUCTIVE SYSTEM
DISORDERS, 897
Autumn P. Davidson





56
57
58
59

The Practice of Theriogenology, 897
Clinical Conditions of the Bitch and Queen, 915
Clinical Conditions of the Dog and Tom, 944
Female and Male Infertility and Subfertility, 951

PART NINE  NEUROMUSCULAR
DISORDERS, 966
Susan M. Taylor
60 Lesion Localization and the Neurologic
Examination, 966
61 Diagnostic Tests for the Neuromuscular
System, 990
62 Intracranial Disorders, 1000
63 Loss of Vision and Pupillary Abnormalities, 1008
64 Seizures and Other Paroxysmal Events, 1016
65 Head Tilt, 1028
66 Encephalitis, Myelitis, and Meningitis, 1036
67 Disorders of the Spinal Cord, 1048
68 Disorders of Peripheral Nerves and the
Neuromuscular Junction, 1074
69 Disorders of Muscle, 1090

80 Anemia, 1201
81 Clinical Pathology in Greyhounds and Other
Sighthounds, 1220
82 Erythrocytosis, 1227
83 Leukopenia and Leukocytosis, 1230
84 Combined Cytopenias and
Leukoerythroblastosis, 1239
85 Disorders of Hemostasis, 1245
86 Lymphadenopathy and Splenomegaly, 1264
87 Hyperproteinemia, 1276
88 Fever of Undetermined Origin, 1279

PART THIRTEEN  INFECTIOUS DISEASES, 1283
Michael R. Lappin










89
90
91
92
93
94
95
96
97

Laboratory Diagnosis of Infectious Diseases, 1283
Practical Antimicrobial Chemotherapy, 1293
Prevention of Infectious Diseases, 1305
Polysystemic Bacterial Diseases, 1315
Polysystemic Rickettsial Diseases, 1326
Polysystemic Viral Diseases, 1341
Polysystemic Mycotic Infections, 1356
Polysystemic Protozoal Infections, 1367
Zoonoses, 1384

PART FOURTEEN  IMMUNE-MEDIATED
DISORDERS, 1398
J. Catharine R. Scott-Moncrieff

PART TEN  JOINT DISORDERS, 1103
Susan M. Taylor and
J. Catharine R. Scott-Moncrieff
70 Clinical Manifestations of and Diagnostic Tests for
Joint Disorders, 1103
71 Disorders of the Joints, 1111

98 Pathogenesis of Immune-Mediated
Disorders, 1398
99 Diagnostic Testing for Immune-Mediated
Disease, 1402
100â•… Treatment of Primary Immune-Mediated
Diseases, 1407
101 Common Immune-Mediated Diseases, 1417

SMALL ANIMAL
INTERNAL
MEDICINE

This page intentionally left blank

SMALL ANIMAL
INTERNAL
MEDICINE
FIFTH EDITION

Richard W. Nelson, DVM, DACVIM (Internal Medicine)
Professor and Department Chair
Department of Medicine and Epidemiology
School of Veterinary Medicine
University of California, Davis
Davis, California

C. Guillermo Couto, DVM, DACVIM
(Internal Medicine and Oncology)
Couto Veterinary Consultants
Columbus, Ohio
Vetoclock
Zaragoza, Spain

3251 Riverport Lane
St. Louis, Missouri 63043

SMALL ANIMAL INTERNAL MEDICINE, FIFTH EDITION
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Copyright © 2009, 2003, 1998, 1992 by Mosby, Inc., an affiliate of Elsevier Inc.

ISBN: 978-0-323-08682-0

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies and our arrangements with organizations such
as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration,
and contraindications. It is the responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.
Library of Congress Cataloging-in-Publication Data
Small animal internal medicine / [edited by] Richard W. Nelson, C. Guillermo Couto.—Fifth edition.
â•…â•… p. ; cm.
â•… Includes bibliographical references and index.
â•… ISBN 978-0-323-08682-0 (hardcover : alk. paper)â•… 1.╇ Dogs—Diseases.â•… 2.╇ Cats—Diseases.â•… 3.╇ Veterinary
internal medicine.╅ I.╇ Nelson, Richard W. (Richard William), 1953- editor of compilation.╅ II.╇ Couto, C.
Guillermo, editor of compilation.
â•… [DNLM:â•… 1.╇ Cat Diseases.â•… 2.╇ Dog Diseases.â•… 3.╇ Veterinary Medicine—methods.â•… SF 991]
â•… SF991.S5917 2014
â•… 636.089′6—dc23
2013031891

Vice President and Publisher: Linda Duncan
Content Strategy Director: Penny Rudolph
Content Development Specialist: Brandi Graham
Publishing Services Manager: Catherine Jackson
Project Manager: Rhoda Bontrager
Design Direction: Ashley Eberts

Printed in Canada
Last digit is the print number:â•… 9â•… 8â•… 7â•… 6â•… 5â•… 4â•… 3â•… 2â•… 1â•…

Section Editors
Richard W. Nelson, DVM, DACVIM
(Internal Medicine), Professor and
Department Chair, Department of
Medicine and Epidemiology, School of
Veterinary Medicine, University of California, Davis. Dr. Nelson’s interest lies
in clinical endocrinology, with a special emphasis on disorders of the endocrine pancreas, thyroid gland, and adrenal
gland. Dr. Nelson has authored numerous scientific publications and book chapters, has co-authored two textbooks,
Canine and Feline Endocrinology and Reproduction with Dr.
Ed Feldman and Small Animal Internal Medicine with Dr.
Guillermo Couto, and has lectured extensively nationally
and internationally. He was an associate editor for the Journal
of Veterinary Internal Medicine and serves as a reviewer for
several veterinary journals. Dr. Nelson is a co-founder and
member of the Society for Comparative Endocrinology and
a member of the European Society of Veterinary Endocrinology. Dr. Nelson has received the Norden Distinguished
Teaching Award, the BSAVA Bourgelat Award, and the
ACVIM Robert W. Kirk Award for Professional Excellence.

C. Guillermo Couto, DVM, DACVIM
(Internal Medicine and Oncology),
Couto Veterinary Consultants, Columbus, Ohio; Vetoclock, Zaragoza, Spain.
Dr. Couto earned his doctorate at
Buenos Aires University, Argentina. He
has been editor-in-chief of the Journal of Veterinary Internal
Medicine and President of the Veterinary Cancer Society. He
has received the Norden Distinguished Teaching Award; the
OSU Clinical Teaching Award; the BSAVA Bourgelat Award
for outstanding contribution to small animal practice; the
OTS Service Award; the Legend of Small Animal Internal
Medicine Award, Kansas State University, Department of
Veterinary Clinical Sciences; the Faculty Achievement Award,
American Association of Veterinary Clinicians; and the Class
of 2013 Teaching Award, The Ohio State University College
of Veterinary Medicine. Dr. Couto has published more than
350 articles and chapters in the areas of oncology, hematology, and immunology.

Autumn P. Davidson, DVM, MS,
DACVIM, Clinical Professor, Department of Medicine and Epidemiology,
School of Veterinary Medicine, University of California, Davis. Dr. Davidson
obtained her BS and MS at the University of California, Berkeley, with an
emphasis in wildlife ecology and management. Dr. Davidson
is a graduate of the School of Veterinary Medicine, University of California, Davis. She completed an internship in
small animal medicine and surgery at Texas A&M University,
and a residency in small animal internal medicine at the
University of California, Davis. She became board certified
in internal medicine in 1992. Dr. Davidson is a clinical professor at the School of Veterinary Medicine, University
of California, Davis, in the Department of Medicine and
Epidemiology. She specializes in small animal reproduction
and infectious disease. Additionally, Dr. Davidson practices
at Pet Care Veterinary Hospital in Santa Rosa, a private referral practice, where she receives both internal medicine and

reproduction cases. From 1998 to 2003, Dr. Davidson served
as the Director of the San Rafael veterinary clinic at Guide
Dogs for the Blind, Inc., overseeing the health care of 1000
puppies whelped annually, as well as a breeding colony of
350 and approximately 400 dogs in training. Dr. Davidson
served on the board of directors for the Society for Theriogenology from 1996 to 1999 and the Institute for Genetic
Disease Control from 1990 to 2002. Dr. Davidson consults
with the Smithsonian Institution National Zoological Park
in Washington, D.C., concerning theriogenology and internal medicine. She has authored numerous scientific publications and book chapters and is a well-known international
speaker on the topics of small animal theriogenology and
infectious disease. She has traveled the world working with
cheetahs, ring-tailed lemurs, and giant pandas in the field.
Dr. Davidson was the 2003 recipient of the Hill’s Animal
Welfare and Humane Ethics Award, which recognizes an
individual who has advanced animal welfare through
extraordinary service or by furthering humane principles,
education, and understanding.

v


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