Head and Neck

General symmetry of the head should be evaluated. The lips, nostrils, muzzle, cheeks, eyes, and ears all should be symmetric, and the animal should carry the head square on the neck, with no evidence of lateral, dorsal, or ventral deviation. Asymmetry in the head and neck may indicate cranial nerve deficits secondary to listeriosis or possible infection in one or both ears. Retained cud or masses in the oral cavity may manifest as a swelling of the cheeks. This can be further evaluated with an oral examination. The muzzle should be examined, to include a good look at the lips, nares, and oral mucosa. Presence of vesicles or crusty lesions at the mucocutaneous junctions of the face commonly is associated with contagious ecthyma. Lesions associated with contagious ecthyma may also be found at the coronary bands, prepuce, udder, and the site of recent shearing wounds or tail docks. An atypical form of contagious ecthyma also has been described in which the typical crusty proliferative lesions are found on the head and hind legs and in other nonmucocutaneous locations. Swelling under the chin is consistent with submandibular edema (often caused by hypoproteinemia secondary to endoparasitism) or may be an enlarged submandibular lymph node. Swelling at the level of the larynx may be indicative of goiter with an enlarged thyroid gland.

The ears and eyes should get at least a cursory examination in every animal. Ears should be evaluated for evidence of trauma and exudative lesions. Ear mites, bacterial otitis, and debris within the ear canal may be the cause of head shaking or abnormal carriage of the head. The eyes should be clear and free of discharge and conjunctival inflammation. The presence of discharge may be indicative of viral or bacterial respiratory infection, traumatic lesion, foreign body, or entropion, whereas a bluish hue to the cornea is indicative of edema. Corneal edema most often is secondary to trauma or keratoconjunctivitis. This finding warrants a more detailed examination of the deeper structures of the eye. Pupils should be symmetric. Direct and consensual pupillary light responses should be present in both eyes. Evaluations of pupil diameter and function should take into account the ambient lighting, because pupils may be near maximally contracted on a sunny day.

Evaluation of the oral and conjunctival membranes is not complete without inspection for color change and estimate of perfusion. This aspect of the examination is important for parasite control with use of the FAMACHA method (see Chapter 6). Some breeds may have pigmented oral mucous membranes, making these assessments difficult. In such animals, preputial or vulvar membranes may be used instead. Pale membranes may indicate anemia, most likely caused by Haemonchus contortus infestation. Jaundice may be present in animals with liver disease or, alternatively, those that have undergone a hemolytic event, such as that related to copper toxicity. Reddish congested membranes may be indicative of fever, septicemia, or toxemia.

A crude assessment of hydration status may be made by pinching the skin over the upper eyelid. In a normally hydrated animal, the skin should snap back into place quickly. Normal structures of the head such as horns and wattles also can be examined. Naturally polled goats will have a central whorl of hair, whereas horned goats may have palpable horn buds with overlying whorls of hair. Wattles may be present in both males and females.

The oral cavity should be evaluated for structural abnormalities and smell. The teeth can be used to estimate the age of the animal (Chapter 4). Prognathism and brachygnathism are readily apparent on inspection of the head. Subtler lesions, however, will be more evident when the mouth is open and the maxilla and mandible can be better evaluated for alignment. Cleft palate can be seen as a gap in the dorsal mouth where the hard palate failed to fuse. In animals in which the mouth cannot be opened wide enough for visualization of the hard palate, sweeping a finger over the palatal surface should reveal any defect. A normal hard palate in a ruminant animal has a rough feel similar to that of corrugated cardboard.

Odor of the breath may indicate disease of the oral cavity, rumen, or respiratory tract. Abscessed teeth or infections within the mouth or laryngeal area may result in a foul odor with or without an accompanying exudate. Neonates with cleft palate may have a rancid milk odor to the breath related to the presence of milk regurgitated through the mouth and nose. Animals with pharyngeal or esophageal obstructions and possible forestomach motility disorders may regurgitate and have a rumen odor to the breath. Ketoacidotic does or ewes with pregnancy toxemia may have a sweet smell to the breath.

Teeth should be evaluated for wear and the presence of disease. Animals with abnormal wear patterns or poor dentition (no teeth, lost teeth) may have difficulty eating and maintaining body condition, particularly in situations involving competition for food. Both sheep and goats also can be aged on the basis of eruption of the dentition. Age typically is estimated using the time of eruption and wear patterns present on the incisors. After the permanent incisors have erupted, aging by dentition becomes less accurate owing to the effects of certain feedstuffs and behavior on tooth wear. Eruption times for sheep and for goats are similar, although some individual and breed variability has been documented.

Deciduous incisors erupt as follows:

Permanent incisors erupt as follows:

Cardiovascular System

A good-quality stethoscope is critical to effective auscultation. In sheep and fiber-breed goats, thick wool or hair may impede sound transmission, making the quality of the stethoscope of greater importance than in animals without such impediment.

Auscultation of the heart is performed by slowly moving the stethoscope over the valves and locating the point of maximal intensity. On the left side of the thorax, the clinician can auscultate the pulmonic valve (at the low third intercostal space, below the elbow), the aortic valve (at the high fourth intercostal space, above the elbow), and the left atrioventricular (AV) valve also known as the mitral or bicuspid valve (at the low fifth intercostal space, at the level of the elbow). On the right side of the thorax, the clinician can auscultate the right AV valve or tricuspid valve (at the high fourth intercostal space, above the elbow).

Rate, rhythm, character, and intensity of the heart sounds should be assessed. The normal heart rate ranges between 70 and 90 beats/minute in an adult goat and 70 and 80 beats/minute in an adult sheep (Table 1- 2). Heart rate in kids and lambs is more variable at 90 to 150 beats/minute and 80 to 130 beats/minute, respectively (Table 1-3). Synchrony of the heart beat and peripheral pulse can be assessed by simultaneous auscultation of the heart and palpation of the femoral artery on the medial aspect of the pelvic limb in the proximal third of the distance between the hip and stifle.

TABLE 1-2 Temperature, Pulse, and Respiratory Rates in Adult Sheep and Goats

TABLE 1-3 Temperature, Pulse, and Respiratory Rates in Lambs and Kids

Tachycardia is not an uncommon finding on physical examination of both sheep and goats and may be a normal variation in an excited animal or may indicate some pathologic process. Tachycardia may be considered normal in young, ruminating, lactating, late-pregnancy, or excited sheep and goats. Pathologic conditions that may cause tachycardia include anemia, heart failure, pain, and inflammation. Bradycardia may result from a conduction block (AV node block) or vagal syndromes. A sinus arrhythmia often is detectable during late inspiration and is considered to be a normal finding. Atrial fibrillation is the most common rhythm abnormality in ruminant species, but other arrhythmias occasionally can be heard. Generally, animals with abnormal cardiac rhythms will have an irregular pulse.

Estimates of peripheral perfusion may be made by evaluating the relative warmth of distal appendages such as ears and feet, mucous membrane color, capillary refill time, and jugular filling time. Poor peripheral perfusion may be noted in animals with heart failure, hypocalcemia, hypovolemia, or profound hypothermia. Distention of the jugular veins and the presence of pulsations may indicate heart failure. Peripheral edema also is consistent with heart failure, but other causes of edema such as hypoproteinemia, vasculitis, and lymphatic obstruction should be ruled out. Bilateral abdominal distention with ascitic fluid also may be present in animals with heart failure.

Respiratory System

The clinician can determine the respiratory rate by observing the movements of the costal arch or nostrils at a distance. The average respiratory rate for an adult goat is 15 to 30 breaths/minute, and for an adult sheep, 12 to 20 breaths/minute (see Table 1-2); kids and lambs have a respiratory rate of 20 to 40 breaths/minute (see Table 1-3). An increased respiratory rate may be a sign of excitement, high environmental temperature or humidity, pain, fever, respiratory or cardiovascular disease, or respiratory compensation for metabolic acidosis. A decreased respiratory rate may result from respiratory compensation for metabolic alkalosis. The clinician should carefully look for and note signs of dyspnea or respiratory distress, including tachypnea, extended head and neck, open-mouth breathing, flaring nostrils, abducted elbows, exaggerated abdominal movements, and anal pumping.

The cranial border of the lung field is deep to the triceps, the dorsal border extends from the point of the shoulder to the last rib, and the caudoventral border arches from the point of the elbow to the last rib. The clinician can place a stethoscope well forward under the triceps to auscultate the cranial lung fields. Because of the goat’s relatively thin chest wall, normal breath and bronchial sounds are readily detectable and may have a harsh quality (louder on inspiration than on expiration). Bronchial sounds usually are loudest over the craniodorsal lung field at the level of the tracheal bifurcation. Increased breath sounds suggest the conditions causing tachypnea be considered. Decreased breath sounds may be appreciated with pneumothorax.

Abnormal lung sounds include crackles (air moving through inflammatory fluid in the alveoli) and wheezes (air moving through inflamed, narrowed airways). Respiratory conditions causing abnormal lung sounds include pulmonary edema and pneumonia. Because significant lung disease can be present without causing an audible abnormality, other signs of respiratory disease (e.g., signs of dyspnea along with fever, cough, and nasal discharge) must be assessed. An awareness of the interrelationship of the respiratory and cardiovascular systems is essential; detection of disease in one system warrants careful examination of the other.

Symmetry of airflow from the nostrils can be assessed using the back of the hand or a feather. Uneven airflow may be caused by blockage of a nasal passage by a foreign body or, rarely, nasal adenocarcinoma. The character of any nasal discharge should be noted (i.e., consistency, volume, unilateral or bilateral, continuous versus intermittent). Food and water containers should be examined for nasal exudate. A “scalded skin” appearance or hair loss below the nostrils suggests an intermittent discharge. Small-volume bilateral serous discharge may be normal in animals, particularly sheep, maintained in poorly ventilated conditions. However, serous discharge also may be a sign of nasal inflammation or early viral infection. A mucoid discharge may be a manifestation of early pneumonia, lungworm infestation, Oestrus ovis larval infection (a disease of sheep that occasionally is seen in goats), traumatic injury, or abscessation. A mucopurulent nasal discharge may be seen in advanced pneumonia with bacterial infection. A hemorrhagic discharge usually indicates more severe nasal trauma. Unilateral hemorrhagic discharge indicates disease rostral to the nasal septum, while bilateral discharge accompanies disease caudal to the septum.

A foul, rotten-smelling breath suggests pharyngitis, laryngitis, or fungal pneumonia. A dull sound produced on percussion of the sinus area indicates fluid accumulation caused by an inflammatory disease (e.g., tooth root abscess [in the maxillary sinuses], infected dehorning site, ascending respiratory infection [in the frontal sinuses]). Rarely, tissue masses (e.g., polyp, tumor) cause abnormalities on sinus percussion.

The clinician should auscultate the trachea for wheezing (as heard with tracheal collapse or an obstructive lesion) and crackling sounds (characteristic of tracheitis). A cough sometimes can be elicited by palpating the larynx and squeezing the trachea. A normal animal may cough once or twice, whereas a diseased animal will cough repeatedly after tracheal compression. Upper airway disease (e.g., rhinitis, tracheitis, foreign body, compressive lesion) usually is characterized by a loud, harsh, dry, nonproductive cough of acute onset. Affected animals do not swallow after coughing. Lower airway disease usually is characterized by a chronic, soft, productive cough. Animals with lower airway disease typically cough infrequently and will swallow after coughing. Examples of lower airway disease are chronic pneumonia, lung abscess, and lungworm infection. Coughing up blood suggests aspiration pneumonia or pharyngeal abscess (Chapter 7).

Gastrointestinal System

The gastrointestinal system is one of the largest, most expansive in the body, extending from the mouth to the rectum. It should be evaluated in segments as the practitioner performs the physical examination. The mouth should be observed for any erosions, ulcerations, swellings, ptyalism, or signs of periodontal disease. Teeth should be evaluated for presence and soundness. Animals with excessive wear, malocclusion, or damaged or missing teeth should be evaluated closely. Poor dentition is a major impedance to eating and may lead to the demise of the animal. Teeth should be checked in all kids before they are retained in the herd. Dentition in adults should be checked annually. Wear patterns will vary dramatically depending on feed and soil type. In harsh environments, animals may have premature dental abnormalities that require removal from the herd. Evaluation of the molars is difficult, because most sheep and goats will resist this examination. Use of a mouth gag and a bright light source will help. It is important that animals have good molars because these teeth are critical to grinding forages in both primary and rumination phases of eating.

The neck should be palpated along its course to feel for any swellings that may impede passage of feed or ingesta through the esophagus. Animals with esophageal disease or an inability to swallow may present with excessive salivation or focal pain at the affected area of the esophagus.

Because the gastrointestinal system occupies the major portion of the abdominal cavity, abdominal contour is an important part of the examination of this body system. Animals should be observed from behind to compare both sides. The presence of the rumen on the left causes a natural mild asymmetry in abdominal contour in both sheep and goats. The presence of a heavy wool or hair coat can mask abnormalities in contour, so these animals should be palpated for normal contour. The clinician should evaluate all areas of the abdomen, alternating percussion and ballottement. Rumen contractions can be auscultated and palpated in the left paralumbar fossa. In healthy sheep and goats, occurrence of one to two primary rumenal contractions (ingesta mixing) and one secondary contraction (eructation) per minute is characteristic (Table 1-4). In healthy animals, a gas cap will be present dorsally on clinical examination, with the fiber mat sitting directly below. Normal fiber mat should be firm but indentable. The normal fluid layer will lie below the fiber mat. Decreased rumen contraction rate and abnormal striation of contents may be due primarily to indigestion or disease of the rumen. However, rumen contraction rate often is abnormal in animals as a result of other, nongastrointestinal illnesses. The presence of a “ping” indicates a fluid-gas interface, typically in a distended viscus. Secussable fluid may be trapped within a viscus or free in the abdomen. Large abdominal masses or fetuses may be detectable by ballottement, depending on size.

TABLE 1-4 Some Physiologic Parameters in Sheep and Goats

A clear understanding of normal ruminant gastrointestinal anatomy is necessary for accurate evaluation for abdominal distention. Distention high on the left side with a ping would suggest rumen tympany. Severe rumen tympany may cause distention present on the lower right side of the abdomen as the ventral sac of the rumen moves toward the right. Rumen impaction may cause distention beginning on the left and progressing ventrally to the right. In such cases, the lower left and ventral right swelling will be firm.

Distention of the upper right quadrant of the abdomen typically is associated with cecum, spiral colon, or small intestinal distention. Depending on the amount of fluid and gas accumulated, a ping and fluid may be present. Distention of the lower right quadrant typically is due to abomasal impaction or, in late gestation, the presence of fetuses. Rarely, severe rumen impaction will manifest with distention of both the lower right quadrant and the left side.

Bilateral ventral abdominal distention is often caused by abdominal disease outside the gastrointestinal tract, although chronic indigestion or ileus may manifest in this fashion. Fluid distention of the abdomen may occur as a consequence of liver failure, endoparasitism, or severe congestive heart failure.

The normal rectal temperature in sheep and goats ranges between 102° and 103.5° F and 100.5° and 104.0° F, respectively (see Tables 1-2 and 1-3). Hyperthermia may result from elevated environmental temperature and humidity, stress and excitement, or inflammatory disease. Hypothermia may occur in malnourished or older animals. Diseases of the rectum are uncommon in mature sheep and goats. Sheep with excessively short tail docks or certain feeding regimens are prone to rectal prolapse. Fecal consistency should be evaluated. Of note, increased fecal water is attributable to many physiologic processes and is not always a sign of infectious disease. Fecal soiling of the perineum and the back of the hindlegs is a consistent finding in animals with persistent diarrhea.

The abdomen of young kids should be palpated for pain and swelling. Particular attention should be paid to both the internal and external umbilical structures. The remnants of the umbilical vein can be palpated in the abdomen moving cranially toward the liver, whereas the remnants of the urachus and both umbilical arteries course caudally toward the urinary bladder. Pain in any remnant with or without swelling is indicative of infection. The perineum and pelvis of lambs should be evaluated for fecal staining. Diarrhea can quickly lead to life-threatening acid-base and electrolyte abnormalities in young kids and lambs. In neonates, the presence or absence (atresia ani) of the anus should be noted (Chapter 5).