DAMNIT-V COMBINED EVIDENCE SNAPSHOT v21
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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
--------------------------------
- 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 v4.1.1

CATEGORY: D - Degenerative / Structural  
Processes  
- Mucosal erosion or ulceration secondary to physical trauma (e.g., bone ingestion)  
- Tissue fibrosis or scarring in gastrointestinal tract causing motility impairment  
- Structural obstruction due to bone splinters causing partial or complete luminal blockage  
- Chronic inflammation leading to segmental wall thickening or anatomical distortion

Organs / Systems  
- Stomach (gastric mucosa, muscularis)  
- Small intestine (duodenum, jejunum)  
- Esophagus (less commonly)  
- Abdominal wall (secondary trauma sites)  

RAC Screening Targets  
- Structural integrity markers for mucosal damage  
- Motility-associated biomolecular patterns  
- Physical obstruction signaling molecules  
- Markers of fibrosis or abnormal tissue remodeling  

Physical Confirmation Methods  
- Abdominal palpation for masses or distension  
- Radiography or ultrasound to identify foreign bodies or obstruction  
- Endoscopy to directly assess mucosal integrity and retrieve foreign material  
- Exploratory laparotomy if obstruction or perforation is suspected  

CATEGORY: A - Allergic / Reactive  
Processes  
- Immune-mediated mucosal irritation or hypersensitivity reactions triggered by diet or environmental allergens  
- Mast cell degranulation causing local inflammation and mucosal edema  
- Food intolerance-related increased gut permeability contributing to inflammation  
- Delayed hypersensitivity reactions affecting gastrointestinal lining  

Organs / Systems  
- Gastrointestinal mucosa (stomach, small and large intestine)  
- Lymphoid tissues within gut-associated lymphoid tissue (GALT)  
- Skin (potential systemic manifestations)  

RAC Screening Targets  
- Immune activation profiles related to food antigens reported as reactive (e.g., chicken, beef)  
- Markers for mast cell and eosinophil activity  
- Gut barrier function indicators  
- Allergen-specific IgE or IgG screening  

Physical Confirmation Methods  
- Dietary elimination and challenge trials to identify reactive components  
- Cytology or histopathology of mucosal biopsies assessing cellular infiltration  
- Complete blood count with eosinophil count  
- Serum allergy panels if available  

CATEGORY: M - Metabolic / Nutritional  
Processes  
- Mucosal damage secondary to nutritional deficiencies impacting repair (e.g., protein, zinc, vitamin A)  
- Imbalanced dietary intake leading to gastrointestinal dysmotility or mucosal vulnerability  
- Alteration in gastric acid production influenced by metabolic status  
- Electrolyte or acid-base disturbances exacerbating vomiting  

Organs / Systems  
- Gastrointestinal mucosa and secretory cells  
- Pancreas (exocrine function contributing to digestion)  
- Liver (metabolic regulation)  
- Kidneys (electrolyte balance affecting systemic status)  

RAC Screening Targets  
- Nutrition-related biochemical markers reflecting protein, mineral, and micronutrient status  
- Metabolic byproducts influencing gastrointestinal function  
- Indicators of energy deficit impacting tissue repair capacity  

Physical Confirmation Methods  
- Dietary analysis and intake history cross-checking with nutrient requirements  
- Serum biochemistry panels assessing electrolytes, liver enzymes, and proteins  
- Urinalysis to evaluate systemic effects of metabolic imbalances  
- Weight and body condition scoring trends  

CATEGORY: N - Neoplastic  
Processes  
- Neoplastic infiltration causing mucosal ulceration or obstruction  
- Mass effect compromising normal motility or vascular supply  
- Paraneoplastic syndromes altering gastrointestinal function  
- Local tissue necrosis or hemorrhage due to tumor erosion  

Organs / Systems  
- Stomach and small intestine primary or metastatic tumor sites  
- Regional lymph nodes  
- Peritoneal surfaces (if carcinomatosis present)  

RAC Screening Targets  
- Tumor-associated antigens detectable in blood or tissue samples  
- Inflammatory markers secondary to tumor presence  
- Cellular proliferation indicators within gastrointestinal samples  

Physical Confirmation Methods  
- Palpation for abdominal masses or thickened segments  
- Imaging (radiographs, ultrasound, CT) to identify masses  
- Biopsy and histopathological examination of suspicious lesions  
- Cytology of peritoneal fluid if fluid accumulation occurs  

CATEGORY: I - Infectious / Inflammatory / Immune  
Processes  
- Infectious gastroenteritis caused by bacteria, viruses, or parasites leading to mucosal inflammation and bleeding  
- Immune-mediated gastritis or enteritis  
- Secondary bacterial invasion after mucosal injury from bone trauma  
- Inflammatory response inducing vomiting and hematemesis  

Organs / Systems  
- Gastric and intestinal mucosa  
- Mesenteric lymph nodes  
- Immune system cells within GALT  

RAC Screening Targets  
- Pathogen-specific antigen or antibody profiles  
- Inflammatory cytokine and mediator levels  
- Markers of systemic immune activation (acute phase proteins)  

Physical Confirmation Methods  
- Fecal testing for parasites, bacteria, or viral particles  
- Blood work including CBC and serum biochemistry with inflammatory markers  
- Endoscopic biopsy for histopathology and culture  
- Abdominal ultrasound evaluating mucosal thickening and lymphadenopathy  

CATEGORY: T - Toxic / Traumatic  
Processes  
- Mechanical trauma from bone ingestion causing mucosal lacerations or perforation  
- Localized hemorrhage secondary to mucosal injury  
- Toxicity from ingested substances causing gastric irritation or vomiting  
- Potential secondary bacterial translocation after mucosal breach  

Organs / Systems  
- Stomach and proximal intestine (primary sites of trauma)  
- Oral cavity and esophagus (entry route)  
- Systemic organs if toxins absorbed (kidneys, liver)  

RAC Screening Targets  
- Trauma-associated molecular markers indicating tissue injury  
- Toxicology screening for common gastrointestinal irritants  
- Hemorrhage markers  

Physical Confirmation Methods  
- Oral and abdominal examination for signs of trauma  
- Imaging (radiography, ultrasound) to detect bone fragments or perforation  
- Blood tests to evaluate systemic effects of toxin exposure  
- Endoscopy to visualize injury and remove foreign material  

CATEGORY: V - Vascular / Neurological  
Processes  
- Vascular compromise causing mucosal ischemia and bleeding  
- Neurological dysfunction affecting gastric emptying and vomiting reflex  
- Autonomic nervous system imbalance influencing gastrointestinal motility  
- Vagal nerve irritation secondary to inflammation or trauma  

Organs / Systems  
- Gastrointestinal vasculature (arterial and venous supply)  
- Central and peripheral nervous system components regulating vomiting  
- Enteric nervous system within gut wall  

RAC Screening Targets  
- Markers of hypoxia or ischemic injury  
- Neurotransmitter or autonomic function biomarkers  
- Vascular inflammatory mediators  

Physical Confirmation Methods  
- Neurological examination focusing on cranial nerves and autonomic reflexes  
- Doppler ultrasonography to assess vascular flow in gastrointestinal vessels  
- Gastric motility studies if available  
- Blood pressure monitoring and cardiovascular assessment  

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
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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
------------------------------------
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
--------------------
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.