Internal Medicine

"We are detectives; we revel in the process of figuring it all out."

What is internal medicine?

The internal medicine service specialises in the diagnosis and treatment of complex medical conditions. The service will accept a variety of patients ranging from those with a confirmed diagnosis (kidney failure, liver disease, anaemia) to others with more vague clinical signs (loss of appetite, lethargy, weigh loss, pyrexia).  The service accepts both routine and emergency cases.

Our patients can’t explain what is wrong with them. The internal medicine clinicians therefore use a combination of a detailed patient history, physical examination and comprehensive diagnostic procedures (including blood work and advanced diagnostic imaging) to obtain a diagnosis. From there the Internal Medicine team will work with owners to develop a treatment plan that suits both you and your pet. We have access to state-of-the-art equipment that allows advanced diagnostic and therapeutic procedures to be carried out in order to help our patients.

Patients coming to the internal medicine service may already have a confirmed diagnosis (e.g. kidney failure, liver disease, anaemia) while others may have only vague clinical signs (e.g. loss of appetite, lethargy, weight-loss, fever). 

Common internal medicine conditions

Respiratory disease

Respiratory medicine is the study of the upper respiratory tract (nose, nasopharynx, larynx, and trachea) and the lower respiratory tract (bronchus). Patients usually present with increased respiratory rate/effort, excess panting, coughing or exercise intolerance.

Respiratory anatomy is complex, and a CT scan can provide exquisite detail to help identify a possible cause. Patients with sneezing, nasal discharge, nasal swellings or epistaxis (nose bleeds) may required advanced imaging with a CT scan and to undergo a rhinoscopy (rigid scope evaluation of the nasal chamber). Rhinoscopy can be both diagnostic (e.g. aiding in the diagnosis of nasal tumours or nasal inflammation (rhinitis) and therapeutic (e.g. removal of a foreign body or treatment of a fungal infection such as Aspergillosis).

Bronchoscopy allows direct evaluation of the area and for a guided biopsy / wash to be obtained for a more definitive diagnosis. We also commonly see patients suffering from tracheal or nasopharyngeal collapse through the Interventional Radiology service that will benefit from stent placement using fluoroscopic assistance.

For nasal diseases especially, the advances in CT imaging have greatly improved our success of an accurate diagnosis and appropriate treatment.

Endoscopic images of several nasal conditions, including nasal aspergillosis, a nasal cyst and a  blade of grass.

Gastrointestinal health can affect many aspects of an animal’s well-being. Persistent vomiting, diarrhoea, inappetance and other vague signs of ill-health may be due to ‘difficult-to-diagnose’ conditions of the bowel or related organs.

Gastroenterology

Gastroenterology refers to patients with vomiting, diarrhoea, anorexia or weight loss. Often the patients will undergoing an endoscopy to visualise and biopsy the stomach and a large part of the intestines. This often means an exploratory surgery is not required. Endoscopy also allows retrieval of foreign bodies. Patients with oesophageal strictures can undergo balloon dilation using fluoroscopic guidance.

Urinary tract disease

Urinary tract disease includes renal failure (acute / chronic) and disorders of the lower urinary tract (ureteral / bladder stones, incontinence, recurrent infections, ectopic ureters). In many cases, cystoscopy can be used to perform an internal examination of the lower urinary tract and obtain biopsies.

We have a diode laser which allows cystoscopic laser ablation (CLA) of ectopic ureters as well as debulking of urinary tract tumours. The Interventional Radiology service can place subcutaneous ureteral bypass (SUB) devices in cats with ureteral stones, stents in dogs with stones / tumours of the lower urinary tract and perform prostatic embolisation in dogs with prostate cancer to help them to urinate more easily.

Urinary stones form due to concretion of excessive minerals in the urine. They may cause obstruction at any level of the urinary tract.

Fever of unknown origin

Patients presented with pyrexia (fever) are often very frustrating to treat. Up to 10-15% of cases may never achieve a definitive diagnosis. At times often multiple investigations including blood work, advanced imaging, urine cultures, joint taps and lung washes can be required in order to determine the cause of the illness (infectious vs autoimmune vs inflammatory vs neoplastic).

Anaemia and other cytopaenias

Anaemia refers to a reduction in circulating red blood cells. These patients are often weak, collapsed and pale. Causes can include internal bleeding, immune-mediated destruction of the red blood cells, infectious causes and bone marrow production failure. Blood transfusions are often administered as part of the stabilisation to allow a  diagnosis and more definitive treatment to be performed.

Hepatic (liver) disease

Conditions affecting the liver can include inflammation (hepatitis), cirrhosis, congenital disorders (portosystemic  shunts) and non-resectable liver tumours. Advanced imaging (CT scan or ultrasound) in combination with a biopsy (ultrasound guided or laparoscopic) will be required to provide the histological diagnosis required to ensure the most targeted and effective treatment is administered.

Congenital portosystemic shunts will be either treated surgically (extrahepatic shunts) or by the Interventional Radiology service (intrahepatic shunts) who perform a minimally invasive percutaneous transjugular coil embolisation (PTCE)

Diseases of the liver and gall-bladder can cause sudden and life-threatening illness. Accurate diagnosis can result in successful treatment of many complex disorders.

Video showing management of an intrahepatic portosystemic shunt by percutaneous transjugular coil embolisation (PTCE)

AURA Stories

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Brontë
6 Years –
Sealyham Terrier

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Piper
1 Year Old –
British Shorthair

For a couple of weeks Piper had not been feeling herself. She was referred to AURA to investigate why she had lost her appetite, had become lethargic and had a persistently high temperature.

Her local vet referred her to investigate her condition after initial medical management wasn’t appearing to make a difference.

Piper had her first consultation with Dr Jonathan Bray, who recommended an abdominal ultrasound and some blood tests. The ultrasound revealed pleural and abdominal effusion, which is abnormal fluid in the chest cavity and abdominal cavity. Samples of the fluid were taken and sent to an external lab for overnight testing, and Piper was kept in the hospital for IV rehydration and supportive care.

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Internal medicine staff

Gerard Mclachlan
Dr Gerard McLauchlan
Interventional Oncology / Interventional Medicine / Internal Medicine
Dr Laura Letwin
Internal Medicine
Oriane Vigaroux
Dr Oriane Vigouroux
ECVIM Medicine resident
Jen O'Keeffe
Jen O’Keeffe
Senior Nurse (Interventional Radiology)
Ele Pardoe
Eleanor Pardoe
Senior Nurse (Internal Medicine)