When auscultating the chest, listen to the lungs before the heart. It is my clinical impression that listening to the louder
heart sounds first decreases the ability to detect the softer lung sounds. Tachypnea may be related to stress from transport
or being in the clinic, so ask the owner about the cat's breathing rate and rhythm at home. Allow the cat to relax in the
room before taking its temperature and evaluating its respiratory and heart rates. Dyspnea should prompt a search for intrathoracic
and upper respiratory disease.
A murmur may be auscultated in patients with severe anemia, hyperthyroidism, hypertension, or primary cardiac disease. Sinus
bradycardia can occur with intestinal obstruction, hyperkalemia, or increased intracranial pressure from central nervous system
disease. Cardiac cachexia is uncommon in cats, but when it is present it is usually associated with severe, chronic, right-sided
congestive heart failure.3 Tachycardia may occur with hyperthyroidism, primary cardiac disease, fever, anemia, sepsis, hypoxia, or stress. Gently compress
the cat's chest to assess compressibility. Decreased compressibility and decreased resonance on thoracic percussion may occur
with mediastinal masses or pleural effusion.
Figure 2. V-trough pet positioners assist in keeping patients in place and comfortable during abdominal examination and selected
procedures.
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Evaluate intestinal wall thickness and intestinal contents through abdominal palpation. A slippery feel to the intestines
or abdominal distention could indicate ascites (e.g. feline infectious peritonitis, pancreatitis, neoplasia, right-sided heart failure). With practice, especially by palpating
a thin animal, you can learn to identify intestinal wall thickening. In a report of 67 cats with GI lymphoma, about half had
abnormal abdominal palpation findings.4 A palpable abdominal mass was reported in about one-third of cats with GI lymphoma; one-third had thickened intestinal loops.4 Thickened intestinal wall can also be palpated with inflammatory bowel disease.
In cats with pancreatitis, abdominal tenderness sometimes is noted. Most cats with pancreatitis probably have pain that is
unrecognized by the practitioner and owner. Bilaterally small, hard, and irregular kidneys may be palpated in cats with chronic
renal failure. Enlarged and irregular kidneys may be encountered with renal feline infectious peritonitis, neoplasia, or polycystic
disease.
Placing a cat on its back may make an intra-abdominal mass more prominent visually and on palpation. Applying pressure to
various locations on the abdomen while a cat is on its back can also help you localize a painful site. V-trough pet positioners
and towels can comfortably position cats for such examinations (Figure 2).
Figure 3. A cat with a plantigrade stance associated with diabetes. The stance resolved with treatment.
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Palpate the joints for effusion, increased warmth, and pain. A plantigrade stance in an elderly cat can be seen with chronic
diabetes mellitus (Figure 3).
Note the patient's mentation. If you suspect a neurologic disease, you may elicit a positional nystagmus or strabismus by
placing the patient on its back and extending the neck.
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