DAMNIT-V COMBINED EVIDENCE SNAPSHOT v30
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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 

LOCAL / REGIONAL CLINICAL CONTEXT
---------------------------------
These are vet-maintained local or regional clinical context entries.
They are not diagnoses, rankings or priorities.

I - Infectious / Inflammatory
- Spirocerca lupi
Region / Locality: Queensland Mount Isa / North West Queensland
  RAC Target: Spirocerca lupi / oesophageal granuloma / nematode migration pattern
  Physical Confirmation: Thoracic radiographs, endoscopy, faecal testing where appropriate, assessment for oesophageal mass or granuloma
  Notes: Locally important in Mount Isa / North West Queensland. Include in canine vomiting, regurgitation, weight loss or coughing presentations.

T - Toxic / Traumatic
- Anticoagulant rodenticide exposure
Region / Locality: Queensland Urban / rural / bait access areas
  RAC Target: Coagulopathy / anticoagulant toxin / vitamin K antagonist pattern
  Physical Confirmation: PT/aPTT, ACT, platelet count, CBC, thoracic imaging if bleeding suspected, bait exposure history
  Notes: Include where vomiting occurs with bleeding, pale gums, bruising, respiratory signs, weakness or possible bait access.
- Cane toad toxicity
Region / Locality: Queensland Cane toad regions
  RAC Target: Bufotoxin / oral toxin exposure / neuro-cardiotoxic pattern
  Physical Confirmation: Oral exam, history of toad exposure, ECG if indicated, temperature, neurological and cardiovascular monitoring
  Notes: Include in Queensland dogs with drooling, vomiting, tremors, seizures, red gums or acute collapse.
- Snake envenomation
Region / Locality: Queensland Statewide / rural / peri-urban
  RAC Target: Snake venom / coagulopathy / myotoxicity / neurotoxicity pattern
  Physical Confirmation: Coagulation testing, CK, urinalysis, venom detection kit where available, serial clinical monitoring
  Notes: Include where acute vomiting, weakness, collapse, bleeding, pain or sudden deterioration could fit exposure.
- Tick paralysis
Region / Locality: Queensland Coastal / tick regions
  RAC Target: Paralysis tick toxin / neuromuscular weakness / LMN pattern
  Physical Confirmation: Full tick search, neurological exam, respiratory assessment, oxygenation assessment, response to tick antiserum where clinically indicated
  Notes: Keep visible for vomiting, gagging, weakness, ataxia, altered voice, regurgitation or respiratory presentations in tick regions.

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
---------------------------
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 v4.8

CATEGORY: D - Degenerative / Structural  
Processes  
- Foreign body ingestion and obstruction  
- Mechanical obstruction including strangulation  
- Partial intestinal obstruction or stenosis  
- Gastric or intestinal ulceration and perforation  
- Stricture formation (esophageal, pyloric, intestinal)  
- Torsion / volvulus of stomach or intestines  
- Impaction of gastrointestinal contents or feces  
- Motility disorders affecting gastric emptying or intestinal transit  
- Congenital abnormalities (atresia, malformations)  
- Developmental disorders causing structural compromise  
- Degenerative changes such as fibrosis or scarring  
- Compression or anatomical abnormalities from external masses or displacement  

CATEGORY: A - Allergic / Reactive  
Processes  
- Food allergy leading to gastrointestinal or cutaneous signs  
- Food intolerance causing digestive upset  
- Dietary reactivity from additives, preservatives, or fillers  
- Environmental allergens causing gastrointestinal hypersensitivity  
- Hypersensitivity or delayed-type immune reactions  
- Histamine release or mast cell activation syndromes  
- Anaphylaxis or acute systemic hypersensitivity reactions  
- Reactive enteropathy due to allergens or irritants  
- Eosinophilic gastrointestinal disease (EGID)  
- Contact or chemical reactivity affecting mucosal surfaces or skin  

CATEGORY: M - Metabolic / Nutritional  
Processes  
- Hypoadrenocorticism (Addison’s disease) impacting electrolyte balance  
- Renal insufficiency or uraemia affecting multiple systems  
- Hepatic or biliary disease including cholestasis  
- Electrolyte imbalances (hyponatremia, hyperkalemia etc.)  
- Acid-base disturbances impacting cellular function  
- Dehydration or fluid distribution abnormalities  
- Pancreatic exocrine insufficiency or dysfunction  
- Diabetes mellitus or glucose regulation disorders  
- Hyperthyroidism or hypothyroidism effects  
- Primary or secondary nutritional deficiencies (vitamins, minerals)  
- Nutritional excesses causing metabolic derangements  
- Mineral or vitamin imbalances (calcium, phosphorus, copper etc.)  
- Mitochondrial or cellular energy metabolism disorders  

CATEGORY: N - Neoplastic  
Processes  
- Benign masses or polyps within GI tract or organs  
- Malignant masses including carcinomas and sarcomas  
- Gastric neoplasia of various histologic types  
- Intestinal neoplasia including adenocarcinoma or lymphoma  
- Lymphoma affecting GI or lymphoid tissues  
- Mast cell tumors with systemic or local effects  
- Carcinomas arising from epithelial tissues  
- Sarcoma including fibrosarcoma and leiomyosarcoma  
- Melanoma arising on mucosa or skin with metastasis potential  
- Gastrointestinal stromal tumors (GIST)  
- Haemangiosarcoma affecting vascular tissues  
- Paraneoplastic syndromes causing secondary clinical signs  
- Mass effect compressing adjacent structures  
- Infiltrative neoplastic diseases or diffuse involvement  
- Pre-neoplastic dysplasia or metaplasia changes  

CATEGORY: I - Infectious / Inflammatory / Immune  
Processes  
- Bacterial gastrointestinal infections (e.g. Clostridium)  
- Viral infections affecting GI or systemic health  
- Fungal infections impacting mucosa or systemically  
- Protozoal infections (Giardia, coccidiosis)  
- Parasitic infestations (helminths, nematodes, cestodes)  
- Rickettsial or tick-borne infectious diseases  
- Regionally important pathogens (Spirocerca lupi in QLD)  
- Infectious gastroenteritis and colitis  
- Pancreatitis with inflammatory component  
- Hepatitis or inflammatory liver disease  
- Nephritis or renal inflammatory conditions  
- Enteritis with acute or chronic inflammation  
- Granulomatous inflammatory disease  
- Immune-mediated diseases affecting GI or other organs  
- Autoimmune diseases causing systemic or local involvement  
- Sepsis or localized abscess formation  

CATEGORY: T - Toxic / Traumatic  
Processes  
- Anticoagulant rodenticide exposure causing coagulopathy  
- Drug adverse reactions or toxicities  
- Chemical or household toxin exposures  
- Heavy metal poisoning (lead, mercury etc.)  
- Plant ingestion or mycotoxin exposure  
- Envenomation from snakes, spiders, insects  
- Snake envenomation causing neuro- or myotoxicity  
- Tick paralysis causing neuromuscular weakness  
- Cane toad toxicity (bufotoxin) exposure  
- Physical trauma including blunt or sharp injury  
- Foreign body trauma causing mucosal damage  
- Bite or sting injuries with secondary effects  
- Burns or thermal injuries  
- Iatrogenic toxicities from treatments or interventions  

CATEGORY: V - Vascular / Neurological  
Processes  
- Vascular compromise or obstruction  
- Hypoperfusion or shock states  
- Systemic hypertension effects  
- Thromboembolic events causing ischemia  
- Infarction or localized ischemic injury  
- Haemorrhage or hemorrhagic events  
- Coagulopathy-related bleeding disorders  
- Vestibular system disease  
- Seizure disorders or central nervous system disease  
- Peripheral neuropathy or radiculopathy  
- Autonomic nervous system dysfunction  
- Neurological dysmotility affecting GI tract  
- Cerebrovascular disease including stroke or hemorrhage  

CLINICAL USE NOTE  
-----------------  
- DAMNIT-V keeps all domains visible.  
- RAC screening and physical testing remain clinician-directed.

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