DAMNIT-V COMBINED EVIDENCE SNAPSHOT v23
==================================================

PATIENT
-------
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 

LOCAL / REGIONAL CLINICAL CONTEXT
---------------------------------
No matching active local/regional clinical context entries found for the recorded species and presenting signs.

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 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  
- Structural damage or obstruction of gastrointestinal tract (e.g., foreign body, bone fragment causing mucosal injury or obstruction)  
- Degenerative changes in gastrointestinal motility  
Organs / Systems  
- Stomach, intestines, esophagus  
- Abdominal wall and associated structures (e.g., pylorus, duodenum)  
RAC Screening Targets  
- Signs of mechanical obstruction or mucosal damage associated with ingested bone or objects  
- Motility abnormalities indicated by altered gut function patterns  
Physical Confirmation Methods  
- Abdominal palpation for pain, masses, or distension  
- Abdominal radiography or ultrasound to detect foreign bodies or structural abnormalities  
- Endoscopy for direct visualization of mucosal injury or obstruction  

CATEGORY: A - Allergic / Reactive  
Processes  
- Hypersensitivity or intolerance reactions causing gastrointestinal inflammation or irritation  
- Immune-mediated mucosal reactivity leading to vomiting  
Organs / Systems  
- Gastrointestinal mucosa (stomach, intestines)  
- Associated lymphoid tissue  
RAC Screening Targets  
- Identification of dietary or environmental allergens contributing to mucosal irritation  
- Correlation with owner-reported reactive foods and ingredient-derived reactive groups  
Physical Confirmation Methods  
- Dietary elimination trials  
- Serologic or intradermal allergy testing (where applicable)  
- Histopathology of gastrointestinal biopsy if inflammation suspected  

CATEGORY: M - Metabolic / Nutritional  
Processes  
- Nutritional imbalances contributing to gastrointestinal upset  
- Electrolyte disturbances secondary to vomiting  
- Metabolic disturbances causing secondary gastrointestinal signs (e.g., uremia, hepatic dysfunction)  
Organs / Systems  
- Gastrointestinal tract functional integrity  
- Liver, kidneys, pancreas (organ systems influencing metabolic and nutritional status)  
RAC Screening Targets  
- Assessment of nutrient intake adequacy and reactive dietary components affecting gut function  
- Screening for metabolic derangements that may present as vomiting  
Physical Confirmation Methods  
- Blood chemistry and electrolyte panels  
- Nutritional evaluation and feeding history review  
- Imaging or lab tests assessing liver and kidney function  

CATEGORY: N - Neoplastic  
Processes  
- Neoplastic infiltration or mass effect causing vomiting or gastrointestinal bleeding  
- Paraneoplastic syndromes affecting gastrointestinal motility or function  
Organs / Systems  
- Gastrointestinal tract walls (stomach, intestines)  
- Mesenteric lymph nodes and associated structures  
RAC Screening Targets  
- Screening for masses or neoplastic signals within imaging or biochemical parameters  
- Evaluation of non-specific signs such as weight loss, anorexia in addition to vomiting  
Physical Confirmation Methods  
- Abdominal imaging (ultrasound, radiographs) for masses or lymphadenopathy  
- Fine needle aspirates or biopsy for histopathology  
- Complete blood count and biochemical profiles for systemic effects  

CATEGORY: I - Infectious / Inflammatory / Immune  
Processes  
- Infectious gastroenteritis from bacterial, viral, parasitic agents  
- Inflammatory enteritis or gastritis including immune-mediated forms  
- Mucosal injury leading to bleeding and vomiting  
Organs / Systems  
- Stomach, intestines, lymphoid-associated tissues  
- Mucosal immune system components  
RAC Screening Targets  
- Identification of infectious agents via fecal testing or serology  
- Inflammatory markers in blood or tissue samples  
- Immune reaction profiles  
Physical Confirmation Methods  
- Fecal parasitology, culture, or PCR assays  
- Blood work including CBC and inflammatory marker panels  
- Endoscopic biopsies for histologic evaluation  

CATEGORY: T - Toxic / Traumatic  
Processes  
- Mucosal trauma from ingested bone causing mucosal injury, bleeding, inflammation  
- Toxin ingestion causing vomiting and gastrointestinal irritation  
- Physical trauma to abdomen causing secondary vomiting  
Organs / Systems  
- Oral cavity, esophagus, stomach, intestine mucosa  
- Abdominal wall and visceral organs  
RAC Screening Targets  
- Exposure history to toxins or ingested bony material  
- Signs of trauma-related inflammation or hemorrhage  
Physical Confirmation Methods  
- Physical examination for abdominal tenderness or bruising  
- Radiographs or ultrasound detecting foreign bodies or trauma sequelae  
- Laboratory toxin screening if suspected  

CATEGORY: V - Vascular / Neurological  
Processes  
- Vascular compromise causing gastrointestinal mucosal ischemia or hemorrhage  
- Neurological causes of vomiting such as vestibular disease or central vomiting center stimulation  
Organs / Systems  
- Gastrointestinal vasculature  
- Central and peripheral nervous systems related to emetic control  
RAC Screening Targets  
- Evidence of vascular compromise or neurological origin in clinical signs  
- Screening for autonomic nervous system involvement in vomiting  
Physical Confirmation Methods  
- Neurological examination including cranial nerves and vestibular function  
- Blood pressure and perfusion assessment  
- Advanced imaging (CT/MRI) if neurological cause suspected  

CLINICAL USE NOTE  
-----------------  
- DAMNIT-V keeps all domains visible for comprehensive consideration.  
- RAC screening may help guide efficient physical confirmation testing by highlighting relevant processes or systems.  
- Diagnosis remains with the clinician integrating all clinical, diagnostic, and history data.

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