DAMNIT-V COMBINED EVIDENCE SNAPSHOT v12
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PATIENT
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Name: Eddy
Owner: Bright
Species: Canine
Breed: Border Collie
Sex: Male
Desexed Status: 
Life Stage: 
Activity Level: 
Current Weight kg: 23.00
Ideal Weight kg: 
BCS: 7.00

CASE
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Case Title: Vomiting
Primary Complaint: Vomiting for 2 days 
Status: Open
Date Opened: 30/05/2026

CLINICAL NARRATIVE
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Vomiting for 2 days , blood - was eating a bone

INITIAL DIFFERENTIAL NOTES
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Suspect FB vs Garbage vs Bacterial infection 

CLINICAL INTAKE DOCUMENTS
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DOCUMENT: History
Type: Clinical History
Source: Manual
Uploaded: 30/05/2026 05:44

O called early today - dog is Vomiting

NUTRITION ASSESSMENTS
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Total nutrition assessments for this case: 71

LATEST NUTRITION ASSESSMENT
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Assessment ID: 70
Title: Nutrition Assessment
Date: 05/06/2026
Feeding Goal: Maintenance
Current Diet Type: Commercial complete
Body Weight kg: 23.00
Ideal Weight kg: 
BCS: 7.00
Muscle Condition: Normal
Appetite: Normal
Owner Goals: 
Diet Concerns: 
Skin / Coat Notes: 
Digestive Notes: 
Stool Quality: 
Owner-Reactive Foods: O: Chicken, beef, lamb, roo, pork, cheese, eggs, yoghurt, kibble, wheat, peanut butter,
Owner-Tolerated Foods: : Goat, venison, wild boar, [meat must have no fillers added - that's why Canine Country is best as raw food without fillers] blueberries, strawberries, raspberries, apples, bananas, mango, cucumber/gukes, broccoli/broccolini, cauliflower, pumpkin, peas, zucchini, beans, watermelon (all vegetables are cooked), he doesn’t like carrot or celery

NUTRITION EVIDENCE SNAPSHOT
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Latest Assessment ID: 70
Assessment Date: 05/06/2026
Energy Intake: 420.7 kcal/day
Estimated Requirement: 997.74 kcal/day
Energy Percent: 42.2%
Energy Status: Low / below estimated requirement
Protein: 45.71 g/day
Fat: 18.24 g/day
Carbohydrate: 30.6 g/day
Matched Diet Items: 7 / 19
Unmatched Diet Items: 12
Micronutrient Confidence: Partial / incomplete
Nutrition Confidence: Moderate / partial evidence

Owner-Reactive / Avoid Foods:
O: Chicken, beef, lamb, roo, pork, cheese, eggs, yoghurt, kibble, wheat, peanut butter,

Owner-Tolerated Foods:
: Goat, venison, wild boar, [meat must have no fillers added - that's why Canine Country is best as raw food without fillers] blueberries, strawberries, raspberries, apples, bananas, mango, cucumber/gukes, broccoli/broccolini, cauliflower, pumpkin, peas, zucchini, beans, watermelon (all vegetables are cooked), he doesn’t like carrot or celery

Ingredient-Derived Reactive Groups:
cruciferous, fibre, fodmap, iodine_source, lectin, oxalate_possible, purine, salicylate_possible, sulphur

RAC-Reactive Foods:
Not yet connected. Future build will compare RAC-reactive foods against current diet, owner-reactive foods and tolerated foods.

EVIDENCE INCLUDED
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Clinical intake documents: 1
Nutrition assessments: 71
RAC / Audiomixer documents: 0
Pathology / laboratory reports: 0
Imaging reports: 0
HTMA reports: 0
Microbiome reports: 0
Supplement reviews: 0

EVIDENCE PENDING / NOT YET ADDED
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- Food entries, treat entries, supplement entries
- RAC / Audiomixer DOCX reports
- Pathology / laboratory reports
- Imaging reports
- HTMA report if requested
- Microbiome report if requested
- Supplement review

EVIDENCE PRIORITISATION
-----------------------

High Priority Evidence:
- Vomiting reported in clinical intake.
- Blood reported with vomiting or gastrointestinal signs.
- History of bone ingestion or bone exposure.

Moderate Priority Evidence:
- Nutrition assessment evidence is present.
- Owner-reported food reactivity / avoid foods are present.

Low Priority / Missing Evidence:
- Owner-tolerated food list is present and may assist future diet planning.
- RAC / Audiomixer evidence is not yet included in this snapshot.
- HTMA evidence is not yet included in this snapshot.
- Microbiome evidence is not yet included in this snapshot.

EVIDENCE STATUS
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Evidence Used In This Snapshot:
- Clinical Intake: Used
- Nutrition: Used

Additional Evidence Available If Clinically Indicated:
- RAC / Audiomixer screening: may help prioritise which physical tests or evidence domains should be pursued next.
- Pathology / laboratory testing: available if clinical signs, risk assessment, or response to treatment justify testing.
- Imaging: available if obstruction, foreign body, mass, trauma or structural disease remains a concern.
- HTMA: available if mineral/toxic element patterning is clinically relevant.
- Microbiome: available if chronic gastrointestinal, immune, dermatological or inflammatory patterns require deeper investigation.

Clinical Context:
A veterinary assessment is commonly made using the evidence that is clinically justified and practically available. This section records what was used and what could be added later, without implying that every possible test is required for every patient.

EVIDENCE WEIGHTING ENGINE v1
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Domain weights used in this snapshot:
- Imaging: 5
- Pathology / Laboratory: 5
- Clinical Examination: 4
- Clinical History / Intake: 4
- Nutrition: 3
- HTMA: 2
- Microbiome: 2
- RAC / Audiomixer: 1
- Supplement Review: 1

Current snapshot contains Clinical Intake and Nutrition evidence only. Imaging, pathology, HTMA, microbiome and RAC are pending.

DIFFERENTIAL PRIORITIES v2 - WEIGHTED
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1. Gastrointestinal foreign body / obstructive bone fragment
Weighted Evidence Score: 12
Weighted Confidence: High
Evidence:
- [Clinical History +4] Vomiting reported.
- [Clinical History +4] Bone ingestion/exposure reported.
- [Clinical History +4] Blood reported with vomiting or gastrointestinal signs.

2. Acute gastritis / gastroenteritis
Weighted Evidence Score: 8
Weighted Confidence: Moderate
Evidence:
- [Clinical History +4] Vomiting reported.
- [Clinical History +4] Blood may indicate mucosal irritation, ulceration or injury.

3. Dietary indiscretion / garbage gut
Weighted Evidence Score: 8
Weighted Confidence: Moderate
Evidence:
- [Clinical History +4] Vomiting reported.
- [Clinical History +4] Dietary exposure history should be reviewed.

4. Food reactivity / intolerance contribution
Weighted Evidence Score: 6
Weighted Confidence: Low-Moderate
Evidence:
- [Nutrition +3] Owner-reported reactive foods present.
- [Nutrition +3] Nutrition snapshot shows ingredient-derived reactive burden evidence.

AI DAMNIT-V POSSIBILITY EXPANSION v1

D = Degenerative / structural  
1. Possibilities: Gastric mucosal injury or erosion, early pyloric stenosis or obstruction secondary to foreign body or inflammation  
2. RAC screening targets: None directly relevant without imaging or endoscopy data  
3. Physical confirmation: Abdominal palpation for mass or discomfort, abdominal radiography or ultrasound to identify structural lesions or foreign body  
4. Priority: Moderate (confirm/exclude obstruction or injury causing vomiting and bleeding)

A = Allergic / autoimmune / reactive  
1. Possibilities: Food intolerance or dietary hypersensitivity causing gastritis, immune-mediated gastritis or inflammatory bowel disease (IBD) manifesting as vomiting and blood  
2. RAC screening targets: Food/reactive antigen screening for suspected dietary antigens (e.g., chicken, beef, wheat) or autoimmune markers if available  
3. Physical confirmation: Response to dietary elimination trial, gastroscopy with biopsy to evaluate for immune-mediated inflammation  
4. Priority: Low to moderate (supportive, but less urgent than obstruction or infection)

M = Metabolic / nutritional / endocrine  
1. Possibilities: Uremia or hepatic insufficiency causing secondary vomiting and gastritis, electrolyte disturbances, hypoadrenocorticism (Addison’s)  
2. RAC screening targets: Blood chemistry panel including BUN, creatinine, liver enzymes, electrolytes, cortisol testing if indicated  
3. Physical confirmation: Blood tests as above, supportive imaging if organomegaly suspected  
4. Priority: Moderate (important to check if vomiting persists or deteriorates, but no prior systemic signs noted)

N = Neoplastic  
1. Possibilities: Gastric mucosal neoplasia causing bleeding and vomiting, lymphoma or gastric carcinoma, less likely in short time frame but possible  
2. RAC screening targets: Imaging screening (abdominal ultrasound), cytology or biopsy if mass detected  
3. Physical confirmation: Diagnostic imaging, endoscopy with biopsy and histopathology  
4. Priority: Low (less likely given acute onset, but rule out with imaging if clinical progression or persistent signs)

I = Infectious / inflammatory  
1. Possibilities: Acute gastritis or gastroenteritis secondary to bacterial infection (e.g., Helicobacter, Salmonella), parasitic infection, or secondary to foreign body irritation  
2. RAC screening targets: Fecal parasite screen, bacterial culture if diarrhoea present, CBC for inflammatory leukogram  
3. Physical confirmation: Fecal exam, bloodwork, response to antimicrobial or supportive therapy, gastroscopy if indicated  
4. Priority: Moderate to high (common and treatable cause; urgent if systemic signs develop)

T = Toxic / traumatic  
1. Possibilities: Gastric mucosal trauma from bone ingestion causing mucosal ulceration and bleeding, foreign body trauma, ingestion of toxins causing vomiting (e.g., NSAIDs, rodenticide)  
2. RAC screening targets: Owner history review for toxin exposure, toxicology screening if suspected  
3. Physical confirmation: Oral/gastric examination, abdominal imaging to check for bone fragments, monitoring for systemic signs of toxicity  
4. Priority: High (bone ingestion with blood vomiting strongly suggests mucosal trauma or obstruction; urgent to confirm and treat)

V = Vascular / neurological  
1. Possibilities: Rarely, vascular injury or ischemic gastritis secondary to embolism or thrombosis, neurological causes of vomiting (vestibular/brainstem disease)  
2. RAC screening targets: Not prioritized without neurological signs; Doppler ultrasound if vascular compromise suspected  
3. Physical confirmation: Neurological examination, abdominal imaging for vascular patency  
4. Priority: Low (not supported by current evidence)

Summary:  
Top urgent priorities are structural (foreign body with possible obstruction or trauma) and toxic/traumatic causes related to bone ingestion. Infectious/inflammatory causes are also moderately urgent. Metabolic and allergic/immune causes are lower priority initially and should be pursued if high-priority issues are ruled out or if clinical signs persist. Neoplasia and vascular/neurological causes are low priority given acute presentation and lack of supportive clinical signs. RAC screening could assist by focusing on food antigen reactivity and prioritizing dietary adjustment if no high-risk issues are found. Imaging and bloodwork remain key physical diagnostics in the next clinical stage.

DIFFERENTIAL POSSIBILITY MAP v1
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Purpose: broaden the clinical thinking before final prioritisation. This is not a diagnosis list; it is a structured map of plausible branches that may be explored using RAC screening and, where justified, physical confirmation testing.

Gastrointestinal / Obstructive / Traumatic
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Possible branches to consider:
- Foreign body
- Bone fragment irritation or obstruction
- Gastritis
- Enteritis
- Gastrointestinal mucosal trauma
- Intestinal pain / spasm
- Pancreatic irritation
- Peritonitis risk if deterioration occurs
Suggested RAC screening targets:
- GIT obstruction signal
- Stomach trauma / irritation
- Small intestinal trauma / irritation
- Abdominal pain
- Pancreas stress
- Inflammation
- Peritoneal irritation
Possible physical confirmation if RAC/clinical evidence supports:
- Abdominal radiographs
- Abdominal ultrasound
- CBC / biochemistry
- Electrolytes / hydration assessment
- Serial abdominal palpation and pain scoring
- Surgical referral if obstruction/perforation concern increases

Dietary / Food Reactivity / Toxicity
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Possible branches to consider:
- Dietary indiscretion
- Food intolerance flare
- Reactive food exposure
- High fat exposure / pancreatitis risk
- Toxin or irritant ingestion
- Microbiome disruption
Suggested RAC screening targets:
- Reactive foods currently in diet
- Owner-reported reactive foods
- Histamine / sulphur / lectin / oxalate / purine burden
- Pancreas stress
- Liver detoxification burden
- Gut dysbiosis pattern
Possible physical confirmation if RAC/clinical evidence supports:
- Diet history review
- Elimination / bland diet trial if stable
- CBC / biochemistry if persistent or systemic signs
- cPL / pancreatitis testing if indicated
- Microbiome testing if chronic or recurrent

Systemic / Metabolic / Infectious
---------------------------------
Possible branches to consider:
- Systemic infection / inflammatory disease
- Renal or hepatic contribution
- Endocrine/metabolic stress
- Electrolyte disturbance
- Pain-driven nausea
Suggested RAC screening targets:
- Kidney stress
- Liver stress
- Systemic inflammation
- Electrolyte disturbance
- Pain focus
- Fever / infection pattern
Possible physical confirmation if RAC/clinical evidence supports:
- Temperature and physical exam
- CBC / biochemistry
- Urinalysis
- Electrolytes
- Further infectious disease testing if clinically indicated

DAMNIT-V Integrative Screening Branches
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Possible branches to consider:
- Degenerative / structural
- Allergic / autoimmune / reactive
- Metabolic / nutritional
- Neoplastic
- Infectious / inflammatory
- Toxic / traumatic
- Vascular / neurological
Suggested RAC screening targets:
- Run RAC screening across DAMNIT-V categories
- Identify strongest organ/system signals
- Identify strongest pathology-type signals
- Compare RAC positives with clinical history and nutrition evidence
Possible physical confirmation if RAC/clinical evidence supports:
- Select physical confirmation based on strongest RAC-supported branch
- Use pathology, imaging, HTMA, microbiome, or referral testing only where clinically justified

RAC-GUIDED NEXT EVIDENCE v1
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RAC is treated here as a screening and prioritisation layer. A positive RAC signal does not replace physical diagnosis, but it can increase the justification for targeted physical testing when cost, risk, or uncertainty make broad testing difficult.

Suggested workflow:
1. Generate broad differential possibility map.
2. Run RAC screening against the most plausible branches.
3. Compare RAC positives with clinical history, nutrition, examination and owner observations.
4. Increase priority for physical confirmation where RAC and clinical evidence converge.
5. Record later confirmation and outcome so RAC predictions can be validated longitudinally.

INTERPRETIVE CAUTION
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This evidence snapshot is not a final diagnosis. It represents the evidence currently available at the time of generation. Later laboratory, imaging, HTMA, microbiome, RAC, nutrition, or supplement evidence may change the interpretation.