DAMNIT-V COMBINED EVIDENCE SNAPSHOT v20
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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
-------------------------

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
--------------------------------
- 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 EXPANSION v4

D - Degenerative / Structural  
Processes  
- Foreign bodies causing obstruction, mucosal injury or perforation  
- Structural or anatomical abnormalities of the gastrointestinal tract (e.g., strictures, intussusception)  
- Developmental anomalies potentially causing gastrointestinal dysfunction  
- Mechanical irritation or trauma from ingested bone fragments  

Organs / Systems  
- Stomach  
- Small and large intestines  
- Esophagus  
- Gastrointestinal mucosa  

RAC Screening Targets  
- History of ingestion of non-food items or bones  
- Signs of partial or complete gastrointestinal obstruction  
- Evidence of anatomical abnormalities via imaging if performed  

Physical Confirmation Methods  
- Abdominal palpation for masses or pain  
- Gastrointestinal imaging (radiographs, ultrasound) for foreign bodies or obstruction  
- Endoscopic examination to visualize mucosal lesions or obstructions  
- Surgical exploration if indicated by imaging or clinical deterioration  

A - Allergic / Reactive  
Processes  
- Food hypersensitivity reactions potentially causing gastrointestinal inflammation  
- Environmental allergen reactions with secondary gastrointestinal signs  
- Mast cell or histamine-mediated gastrointestinal irritation  
- Hypersensitivity-induced mucosal damage leading to vomiting  

Organs / Systems  
- Gastrointestinal mucosa  
- Immune cells within gastrointestinal tract (mast cells, eosinophils)  

RAC Screening Targets  
- Owner-reported food or environmental reactivity or intolerance  
- History of episodic gastrointestinal signs in relation to dietary or environmental exposures  

Physical Confirmation Methods  
- Elimination diet trials to identify reactive foods  
- Histopathology of gastrointestinal biopsies to detect inflammation associated with allergic processes  
- Measurement of serum or tissue markers of allergy or hypersensitivity if available  

M - Metabolic / Nutritional  
Processes  
- Nutritional deficiencies or imbalance affecting gastrointestinal function  
- Metabolic derangements causing vomiting (e.g., electrolyte abnormalities, hepatic insufficiency)  
- Vitamin or mineral imbalances contributing to mucosal health or motility disorders  
- Nutritional causes of poor mucosal integrity or delayed gastric emptying  

Organs / Systems  
- Liver  
- Kidneys  
- Gastrointestinal mucosa  
- Endocrine system (pancreas, adrenal glands, thyroid)  

RAC Screening Targets  
- Nutritional assessment indicating reduced energy or nutrient intake  
- Laboratory tests evaluating metabolic function (electrolytes, liver enzymes, renal parameters, glucose)  

Physical Confirmation Methods  
- Blood chemistry and hematology panels  
- Nutritional intake analysis and dietary history  
- Specific assays for vitamin and mineral status  
- Imaging to evaluate liver and other abdominal organs as needed  

N - Neoplastic  
Processes  
- Benign or malignant tumors of the gastrointestinal tract causing obstruction or irritation  
- Pre-neoplastic lesions contributing to mucosal ulceration and vomiting  
- Paraneoplastic syndromes associated with gastrointestinal signs  

Organs / Systems  
- Stomach  
- Small and large intestines  
- Pancreas (if physically involved or causing secondary vomiting)  

RAC Screening Targets  
- Imaging evidence of masses or abnormal thickening of gastrointestinal walls  
- Persistent vomiting not responding to initial medical management  

Physical Confirmation Methods  
- Imaging studies (radiographs, ultrasound, CT) to detect masses  
- Endoscopic biopsy of suspected lesions  
- Cytology or histopathology for definitive diagnosis  

I - Infectious / Inflammatory / Immune  
Processes  
- Infectious gastroenteritis (bacterial, viral, fungal, parasitic, protozoal)  
- Immune-mediated or autoimmune inflammatory gastrointestinal diseases  
- Secondary mucosal injury associated with infectious agents  
- Systemic inflammatory conditions involving the gastrointestinal tract  

Organs / Systems  
- Gastrointestinal mucosa  
- Associated lymphoid tissues  
- Systemic organs if involved (e.g., liver, pancreas)  

RAC Screening Targets  
- Clinical signs compatible with infectious or inflammatory etiology (e.g., fever, leukocytosis)  
- Exposure history to infectious agents or parasites  
- Fecal analysis for pathogens or parasites  

Physical Confirmation Methods  
- Fecal parasitology and bacterial culture  
- Bloodwork including inflammatory markers and immune panels  
- Endoscopic biopsy with histopathology and culture/PCR of gastrointestinal tissues  
- Response to antimicrobial or immunomodulatory therapy  

T - Toxic / Traumatic  
Processes  
- Mucosal injury from ingestion of toxins, drugs, chemicals, or bones causing physical trauma  
- Envenomation affecting gastrointestinal function or causing systemic illness  
- Radiation or chemical-induced gastrointestinal damage  
- Physical trauma to abdominal organs resulting in vomiting  

Organs / Systems  
- Gastrointestinal tract mucosa and wall  
- Systemic organs affected by toxin absorption (e.g., liver, kidney)  

RAC Screening Targets  
- History of toxin or foreign body exposure, including bone ingestion  
- Signs of systemic toxicity or trauma  

Physical Confirmation Methods  
- Toxicology screening as indicated  
- Radiographic evaluation for bone fragments or traumatic injury  
- Clinical examination for systemic effects of toxins or trauma  
- Laboratory evaluations for organ function related to toxic exposure  

V - Vascular / Neurological  
Processes  
- Vascular compromise to the gastrointestinal tract causing ischemia or infarction  
- Neurological disorders affecting the gastrointestinal motility or emetic centers  
- Autonomic dysfunction influencing vomiting reflex  
- Cerebrovascular events presenting with vomiting  

Organs / Systems  
- Gastrointestinal vasculature  
- Central nervous system (brainstem, medulla)  
- Autonomic nervous system  

RAC Screening Targets  
- Neurological examination findings relevant to emesis centers or autonomic function  
- Signs of circulatory compromise or pain suggesting ischemic gastrointestinal disease  

Physical Confirmation Methods  
- Neurological examination and imaging (MRI, CT) if indicated  
- Abdominal imaging evaluating for vascular abnormalities or infarction  
- Laboratory tests evaluating perfusion and coagulation status  

CLINICAL USE NOTE  
-----------------  
- DAMNIT-V keeps all domains visible.  
- RAC screening may help guide efficient physical confirmation testing.  
- Diagnosis remains with the clinician.

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
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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.