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Berg, Gregor (2009): Diagnosefindung in der Tiermedizin: Einführung von "Rule-Outs" in der Inneren Medizin und Labordiagnostik. Dissertation, LMU München: Tierärztliche Fakultät

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In this work, the potential causes of clinically relevant problems in internal medicine and clinical pathology are divided into groups and subgroups, using the problem-oriented approach. The division into subgroups is performed until finally a list of examples for differential diagnoses is presented. In this approach “problems” are defined as symptomes and changes of normal findings in animal history, physical examination and clinical pathology parameters. For this reason all groups, subgroups and differential diagnoses are defined as “rule outs”. The criterias for classification are chosen in a way that they are well-distinguishable and didactically plausible in their pathophysiological background. The intention of these subdivisions is to get a good structure for problems with several causes. In this work it is shown that this approach leads to a comprehensible classification. In the end, just a few rule outs with a small amount of diseases is left, which can be directly verified or falsified. The rule-outs, at first defined by the author, were discussed and modified in several discussion groups, till in the end the final result was supported by all participants. Senior lecturers of the Clinic for Small Animal Medicine, Munich, took part in these discussion groups. Therefore the rule outs were found consensus-based, to contribute to a standardization of the diagnosis process in internal medicine in theory and application. With this method both, veterinarians and students with lack of experience, can solve complicated cases completely. Additionally the procedure of finding a diagnosis becomes comprehensive and understandable. Finally, the rule outs can also be regarded as a general tool to understand problems in the field of pathophysiology.