DAMNIT-V COMBINED EVIDENCE SNAPSHOT v16
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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
----
Case Title: Vomiting
Primary Complaint: Vomiting for 2 days 
Status: Open
Date Opened: 30/05/2026

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

INITIAL DIFFERENTIAL NOTES
--------------------------
Suspect FB vs Garbage vs Bacterial infection 

CLINICAL INTAKE DOCUMENTS
-------------------------

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

O called early today - dog is Vomiting

NUTRITION ASSESSMENTS
---------------------
Total nutrition assessments for this case: 71

LATEST NUTRITION ASSESSMENT
---------------------------
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
---------------------------
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
-----------------
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
--------------------------------
- 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
---------------

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
----------------------------
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
-------------------------------------

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 v2

CATEGORY: D - Degenerative / Structural  
Relative Priority: Moderate  
Why this category is relevant:  
- Vomiting with blood and history of bone ingestion raises concern for physical obstruction, mucosal injury, or perforation.  
- Structural damage such as foreign body impaction, mucosal ulceration, or localized inflammation from trauma could cause vomiting.  
- Less likely but possible: structural motility disorder or chronic gastritis/stricture development.  

Possible Diseases / Processes:  
- Gastrointestinal foreign body (bone fragment causing partial obstruction or trauma)  
- Mucosal injury/ulceration secondary to bone trauma  
- Gastric inflammation, erosion, or ulceration  
- Gastric or intestinal stricture (less likely in acute)  

Possible Organs / Systems:  
- Stomach  
- Proximal small intestine (duodenum)  
- Esophagus (if reflux or irritation present)  

Suggested RAC Screening Targets:  
- Symptom clusters related to obstruction or trauma  
- Owner-reported reactive foods that may exacerbate gastric irritation  

Physical Confirmation Options if RAC and clinical evidence support:  
- Abdominal palpation for pain/distension  
- Abdominal radiographs to identify radiopaque foreign body or signs of obstruction  
- Abdominal ultrasound to identify foreign material, wall thickening or perforation  
- Oral/pharyngeal exam to exclude oral trauma or foreign body  
- Endoscopy for direct visualization if available  

Cost-aware staged approach:  
- Low-cost / immediate: physical exam, abdominal palpation, plain abdominal radiographs  
- Moderate-cost: abdominal ultrasound, limited lab work (CBC, biochemistry to assess systemic effects)  
- Higher-cost / referral: endoscopy, CT imaging, exploratory surgery  

Notes for longitudinal validation:  
- What RAC prediction could be recorded? Vomiting pattern severity/frequency, reactive food associations that worsen gastric irritation.  
- What physical confirmation or outcome would validate/refute it? Visualization or retrieval of foreign body; resolution of vomiting after removal or healing of injury; absence of obstruction on imaging.  

---

CATEGORY: A - Allergic / Autoimmune / Reactive  
Relative Priority: Low to Moderate  
Why this category is relevant:  
- Owner reports several reactive foods indicating possible food intolerance or hypersensitivity.  
- Food-induced gastritis or enteritis may contribute to vomiting and minor GI bleeding.  
- Immune-mediated gastritis less common but possible as chronic process.  

Possible Diseases / Processes:  
- Food intolerance / hypersensitivity-induced gastritis  
- Eosinophilic gastroenteritis (immune-mediated inflammation)  
- Immune-mediated vasculitis affecting GI tract (rare)  

Possible Organs / Systems:  
- Gastric mucosa  
- Small intestinal mucosa  

Suggested RAC Screening Targets:  
- Specific food ingredient sensitivity or intolerance patterns  
- Clinical patterns of vomiting or GI signs relating to diet changes or reactive foods  

Physical Confirmation Options if RAC and clinical evidence support:  
- Therapeutic elimination diet trial targeting owner-identified reactive foods  
- Endoscopic gastric/intestinal biopsy (for eosinophilic infiltration or immune pathology)  
- Hematology to evaluate peripheral eosinophilia or inflammatory markers  

Cost-aware staged approach:  
- Low-cost / immediate: dietary history review, empirical diet adjustment (novel or hydrolyzed diet)  
- Moderate-cost: CBC with differential, fecal screening for parasites, endoscopy consultation  
- Higher-cost / referral: gastric/intestinal biopsies with histopathology  

Notes for longitudinal validation:  
- What RAC prediction could be recorded? Correlation of vomiting episodes with suspected dietary triggers.  
- What physical confirmation or outcome would validate/refute it? Improvement following diet change; biopsy confirmation of immune-mediated gastritis.  

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CATEGORY: M - Metabolic / Nutritional / Endocrine  
Relative Priority: Low to Moderate  
Why this category is relevant:  
- Nutrition evidence shows energy intake below estimated requirement indicating possible underlying metabolic stress or reduced intake due to illness.  
- Metabolic causes of vomiting include systemic illness (renal, liver disease), endocrine disease (Addison’s, diabetes), or nutritional deficiencies.  
- Nutritional imbalance or deficiency could complicate or predispose to GI signs.  

Possible Diseases / Processes:  
- Acute metabolic derangement (e.g. hypoadrenocorticism)  
- Hepatic insufficiency or dysfunction  
- Renal insufficiency  
- Nutritional insufficiency or imbalance contributing to GI irritability  
- Pancreatitis (metabolic/inflammatory overlap)  

Possible Organs / Systems:  
- Liver  
- Kidney  
- Adrenal glands  
- Pancreas  

Suggested RAC Screening Targets:  
- Metabolic patterns associated with vomiting clinically (e.g. electrolyte disturbances, endocrine dysfunction)  
- Associations between nutrition insufficiency and clinical signs  

Physical Confirmation Options if RAC and clinical evidence support:  
- Basic blood profile including chemistry panel and electrolytes  
- ACTH stimulation test (if Addison’s suspected)  
- Pancreatic lipase immunoreactivity (PLI) test if pancreatitis suspected  

Cost-aware staged approach:  
- Low-cost / immediate: basic blood chemistry, electrolytes  
- Moderate-cost: specific endocrine testing (ACTH stim), pancreatic enzyme assays  
- Higher-cost / referral: advanced diagnostics (imaging, biopsy)  

Notes for longitudinal validation:  
- What RAC prediction could be recorded? Metabolic risk score or biochemical pattern predictive of systemic causes for vomiting.  
- What physical confirmation or outcome would validate/refute it? Blood tests confirming/improving with treatment, normalization of metabolic parameters.  

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CATEGORY: N - Neoplastic  
Relative Priority: Low  
Why this category is relevant:  
- Vomiting with blood can rarely result from gastric neoplasia causing bleeding or obstruction.  
- Acute presentation less typical but not impossible.  
- Age, chronicity, and other signs would guide suspicion.  

Possible Diseases / Processes:  
- Gastric carcinoma or lymphoma  
- GI stromal tumors or polyps  
- Metastatic neoplasia affecting stomach or intestines  

Possible Organs / Systems:  
- Stomach  
- Small intestine  

Suggested RAC Screening Targets:  
- Risk factors related to age, breed, chronic vomiting patterns  
- Reactive patterns suggesting neoplastic inflammatory signatures  

Physical Confirmation Options if RAC and clinical evidence support:  
- Abdominal imaging to detect masses (ultrasound preferred)  
- Endoscopic inspection and biopsy of gastric mucosa or lesions  

Cost-aware staged approach:  
- Low-cost / immediate: physical exam and abdominal palpation  
- Moderate-cost: abdominal ultrasound  
- Higher-cost / referral: endoscopy with biopsy, CT scan  

Notes for longitudinal validation:  
- What RAC prediction could be recorded? Risk prediction score for GI neoplasia based on clinical and RAC data.  
- What physical confirmation or outcome would validate/refute it? Imaging/biopsy confirmation; response to treatment or surgical outcome.  

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CATEGORY: I - Infectious / Inflammatory  
Relative Priority: Moderate to High  
Why this category is relevant:  
- Vomiting with blood suggests mucosal inflammation or infectious gastroenteritis.  
- Common causes include bacterial infections, viral enteritis, parasitic infestation, or secondary inflammation from trauma.  
- Bone ingestion raises risk of bacterial invasion or secondary inflammation.  

Possible Diseases / Processes:  
- Bacterial gastroenteritis / gastritis (e.g. Helicobacter spp., Clostridium, Campylobacter)  
- Viral gastroenteritis (parvovirus, coronavirus—less likely without other signs)  
- Parasitic infestation (hookworms, whipworms causing hemorrhagic enteritis)  
- Foreign body-induced local inflammation and secondary infection  

Possible Organs / Systems:  
- Gastric mucosa  
- Intestinal mucosa  

Suggested RAC Screening Targets:  
- Common enteric pathogens or inflammatory markers  
- Patterns of inflammation reactive to bone ingestion or food triggers  

Physical Confirmation Options if RAC and clinical evidence support:  
- Fecal examination for parasites and bacteriology  
- CBC with inflammatory markers (leukocytosis, left shift)  
- Abdominal imaging if suspicion of abscess or perforation  
- Endoscopic biopsy or swab for microbial culture if chronic  

Cost-aware staged approach:  
- Low-cost / immediate: fecal parasitology, CBC  
- Moderate-cost: abdominal ultrasound, fecal bacterial culture/PCR  
- Higher-cost / referral: endoscopy with biopsies, advanced microbiology  

Notes for longitudinal validation:  
- What RAC prediction could be recorded? Inflammatory or infectious risk patterns based on clinical signs and diet history.  
- What physical confirmation or outcome would validate/refute it? Resolution with appropriate antimicrobial/antiparasitic treatment; identification of pathogens.  

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CATEGORY: T - Toxic / Traumatic  
Relative Priority: High  
Why this category is relevant:  
- Bone ingestion is a traumatic event; sharp fragments can cause mucosal lacerations, perforations or irritation leading to vomiting and GI bleeding.  
- Toxicity from ingestion of harmful substances or secondary to GI mucosal damage is plausible.  
- Trauma from foreign bodies or bone fragments is most likely direct cause here.  

Possible Diseases / Processes:  
- Mucosal lacerations or ulcerations from sharp bone fragments  
- Perforation with localized peritonitis or bleeding  
- Secondary aspiration or chemical irritation from gastric contents  
- Toxic exposure less likely unless corroborated  

Possible Organs / Systems:  
- Stomach  
- Intestines  
- Abdominal wall/peritoneum if perforation  

Suggested RAC Screening Targets:  
- Evidence of traumatic injury risk or toxin exposure from history and diet items  
- Predictive signs of GI bleeding or mucosal injury  

Physical Confirmation Options if RAC and clinical evidence support:  
- Physical exam focused on abdominal pain, signs of peritonitis  
- Diagnostic imaging (radiographs/ultrasound) to detect bone fragments or perforation  
- Hematology to assess anemia, coagulation if bleeding excessive  

Cost-aware staged approach:  
- Low-cost / immediate: physical exam, abdominal radiographs  
- Moderate-cost: abdominal ultrasound, blood panel including coagulation profile  
- Higher-cost / referral: surgical exploration, endoscopy  

Notes for longitudinal validation:  
- What RAC prediction could be recorded? Trauma risk or bleeding risk scores correlated with clinical severity.  
- What physical confirmation or outcome would validate/refute it? Confirmation of bone fragments causing injury; healing after intervention or surgery.  

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CATEGORY: V - Vascular / Neurological  
Relative Priority: Low  
Why this category is relevant:  
- Vascular causes of vomiting with blood less common but possible (e.g. gastric ulceration from ischemia).  
- Neurological causes of vomiting (e.g. vestibular disease, increased intracranial pressure) do not usually produce blood in vomitus; less likely here.  
- Vascular injury secondary to trauma is plausible; primary vascular disease uncommon.  

Possible Diseases / Processes:  
- Gastric ulceration secondary to vascular compromise or stress gastritis  
- Neurological causes of vomiting without blood (low priority)  
- Vascular injury secondary to trauma or coagulopathy  

Possible Organs / Systems:  
- Stomach vasculature  
- Central/peripheral nervous system (low priority)  

Suggested RAC Screening Targets:  
- Risk predictors for vascular or neurological causes of vomiting  
- Inflammatory/coagulation patterns influencing vascular integrity  

Physical Confirmation Options if RAC and clinical evidence support:  
- Coagulation profile and platelet counts  
- Abdominal imaging as above  
- Neurologic exam to exclude intracranial causes if indicated  

Cost-aware staged approach:  
- Low-cost / immediate: physical and neurological exam, CBC with platelets and coagulation panel  
- Moderate-cost: abdominal imaging if vascular compromise suspected  
- Higher-cost / referral: MRI/CT brain if neurologic cause suspected  

Notes for longitudinal validation:  
- What RAC prediction could be recorded? Risk of vascular injury or bleeding tendency scores.  
- What physical confirmation or outcome would validate/refute it? Laboratory confirmation of bleeding/coagulation disorder; response to treatment.  

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Summary Suggestion:  
Focus initially on the high priority categories D (structural foreign body/trauma) and T (trauma from bone ingestion), supported by I (infectious/inflammatory gastritis/gastroenteritis). Concurrent low-cost screening via physical exam, abdominal radiographs, and basic bloodwork is indicated. Simultaneous evaluation of dietary contribution and reactive foods (A) can guide food trials. Metabolic screening (M) and neoplastic (N) considerations are lower priority unless clinical signs evolve. Vascular and neurological causes are unlikely currently but should be reconsidered if relevant signs emerge.  

This cost-aware sequence helps prioritize tests justified by current evidence while preserving options to expand investigation based on evolving clinical picture and RAC screening results once available.

DIFFERENTIAL POSSIBILITY MAP v1
--------------------------------
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
------------------------------------------
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
------------------------------------
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
---------------------------------------
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
---------------------------
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.