Veterinary internal medicine referrals
Advanced referral-level assessment and practical support for complex, chronic, recurrent and multi-system disease, working in partnership with the referring veterinary practice.
Led by Fabrizio Tucciarone, DVM MRCVS GPcert(SAM) MSc PgCert (Endo) CertAVP
A structured approach
Internal medicine problems rarely fit neatly into one test or one organ system. The service brings together the history, examination findings, laboratory results and diagnostic imaging to build a prioritised, proportionate plan for the individual patient.
Referrals are welcome when the diagnosis remains uncertain, signs recur despite treatment, results conflict, several body systems may be involved, or the referring vet would value a second clinical perspective.
Areas of support
The following examples show the types of problems that may be investigated. The exact plan is always tailored to the patient and agreed with the referring practice.
Digestive · hepatic · pancreatic
Chronic or recurrent vomiting and diarrhoea, weight loss, suspected malabsorption or protein-losing disease, and investigation of gastrointestinal, liver, biliary or pancreatic disorders. Ultrasonography and endoscopy can be integrated when clinically appropriate.
Renal · urinary · electrolytes
Acute or chronic kidney disease in stable patients, polyuria and polydipsia, proteinuria, electrolyte or acid–base abnormalities, and recurrent or complex urinary tract presentations, including imaging and sampling where indicated.
Diabetes · adrenal · thyroid
Diabetes mellitus, adrenal and pituitary disease, thyroid disorders, calcium disturbances and other suspected hormonal disease—particularly atypical, unstable or apparently treatment-resistant presentations.
Red cells · white cells · clotting
Investigation of anaemia, erythrocytosis, thrombocytopenia, leucocyte abnormalities, coagulation disorders, suspected immune-mediated disease and unexplained changes on the haemogram.
Diagnosis · staging · planning
Investigation and staging of suspected or confirmed neoplasia, including imaging, interpretation of results and planning of appropriate sampling. Findings are used to support treatment decisions or onward referral to another service when required.
Airways · lungs · pleural space
Stable patients with chronic cough, exercise intolerance, nasal disease, recurrent pneumonia or suspected airway, pulmonary or pleural disease. Investigation may include diagnostic imaging, airway sampling or respiratory endoscopy when appropriate.
Murmurs · rhythm · cardiac function
Assessment of stable patients with a heart murmur, suspected cardiac disease, syncope, exercise intolerance or rhythm concerns. The work-up may include ECG, Holter monitoring and echocardiographic assessment, with onward referral when a different cardiac procedure or service is needed.
Complex · recurrent · multi-system
Unexplained fever, weight loss, weakness, recurrent illness, abnormal laboratory results or signs affecting several organ systems can be assessed even when the most likely discipline is not yet clear.
Clinical boundaries
The service is designed to add an advanced internal medicine perspective while keeping the referring veterinary practice central to the patient’s care.
How referral works
Appointments are arranged through your usual veterinary practice. Please speak to your own vet first if you think your pet may benefit from referral.
The referring practice shares the clinical question, history, current medication, laboratory results and previous imaging or reports.
We review suitability, any preparation required and whether the case is best seen at a selected local clinic or by mobile arrangement.
The consultation and agreed investigations are completed, followed by a written report with practical recommendations for the referring vet.
Ongoing decisions are coordinated with the primary practice, with onward referral advised if a different service is required.
Common questions
If you are unsure whether a case fits the service, send the clinical question and available records so we can advise on suitability.
No. Referrals and appointments are arranged through the patient’s primary veterinary practice.
Please send the referral question, relevant history, current medication, laboratory results and any previous imaging or reports. A concise timeline is particularly helpful for chronic or recurrent cases.
No. Investigations are prioritised according to the clinical question, previous results, likely benefit, patient needs and discussion with the referring vet.
Most appointments take place at a selected local host clinic. A mobile visit to the referring practice may be considered for a suitable case, subject to facilities, service and availability.
No. Urgent or unstable patients should follow the referring practice’s emergency pathway.
Discuss a case
Share the case details and we’ll help identify the most useful next step.