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Weight Loss/anorexia of Occult Cause
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Attention to detail is the most important aspect of approaching of approaching this problem. Referral cases generally fall into three major categories: the smallest category consists of a few cases that are so obscure that you will never find out what is going on, despite all the tests (including necropsy) that you perform. The middle group consists of cases in which a particular tool or bit of technology allows one to make the diagnosis that could not be had otherwise. The largest group consists of animals that can be diagnosed with the tools that almost every veterinarian has, if there is sufficient attention to detail.
Repeat the history and physical examination because this is the best place to find the clues which will lead you to the correct body system or test(s). Be sure that pathologic weight loss has occurred. One of the most important questions is whether the animal lost weigh despite a good or adequate appetite. If the animal lost weigh despite an apparently adequate appetite, then the alimentary tract (and hyperthyroidism in cats) is your major concern. And, don’t forget that hepatic disease can perfectly mimic intestinal disease.
If history and physical examination do not give you any major insight as to what the problem is, then do not hesitate to repeat tests that were previously performed (results may have changed as the disease progresses). If you don't know the laboratory, do not hesitate to repeat the tests. Even if you do know the lab, it may be good to see how things have changed. You need to be willing to repeat biopsies or at least have previous ones re-read by someone you trust. Be sure to have the pathologist tell you whether the sample appears adequate. Remember that it is much more likely for an animal to have an uncommon manifestation of a common disease than to have a common manifestation of an uncommon disease. Most mistakes in the work up of a difficult case occur because 1) we incorrectly assume something on the history, 2) we miss something on the physical examination, or 3) we trust prior laboratory results or get in a hurry and overlook something obvious during the work up. […]
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