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Internal Medicine

The medical speciality dealing with the prevention, diagnosis, and treatment of internal diseases

Our Internal Medicine Team

Dr Nora Romero-Fernandez

Dr Nora Romero-Fernandez

Dr Nora Romero-Fernandez DipACVIM DipECVIM-CA MRCVS, RCVS Recognised and European Specialist in Internal Medicine
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Katherine Limebear - Internal Medicine Nurse Team Leader

Katherine Limebear

Katherine Limebear RVN CertVNECC VTS (SAIM) Internal Medicine Nurse Team Leader
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Internal Medicine is the medical speciality dealing with the prevention, diagnosis, and treatment of acute and chronic internal diseases. This involves profound knowledge of the whole body and the management of patients who have often multi-systemic morbidities. Internists are basically detectives for all body systems and play a central role within a clinical setting.

Internal Medicine patients present with a wide variety of clinical signs including:

  • vomiting
  • diarrhoea
  • excessive drinking
  • abnormal urination
  • weight loss
  • cough
  • bleeding
  • fever etc.

It is the task of the clinician to collect all the information and evidence to solve the predominant problem.

These patients rarely need surgery. The most important tools for an internist include a deep willingness to listen, an obsession for details and the understanding and usage of further methods of investigations like radiographs, ultrasound, CT/MRI and non-invasive endoscopic procedures of the lung, nose, throat and gastrointestinal tract.

We understand that not every client will want to go ahead with referral and we are more than happy to discuss cases by email or over the telephone with our referring vet colleagues.

Advice Request

Referring vets can use the form below to submit cases for advice requests to our medicine team.

Internal Medicine Advice Request Form

Internal Medicine Overview

Internal Medicine in general has two most important components - a detailed medical history and thorough physical examination. These tools are readily available for all practitioners and shortcuts are not advised to understand which organ system is most likely involved.

Internal Medicine Specialists have been trained additionally in non-invasive procedures like performing endoscopies, cytology of internal organs, bone marrow sampling, diagnostic imaging, and other minimally invasive therapies and diagnostics.

Specialists use their knowledge of up-to-date medical literature and evidence-based medicine to find the right diagnosis and optimal treatment recommendation tailored for each individual case. Medical cases have commonly more than one problem and a multidisciplinary approach is often necessary.

Examples of common problems Internal Medicine Specialists deal with include:

  • Diarrhoea
  • Sneezing
  • Weight Loss
  • Anaemia
  • Coughing


Diarrhoea: is the excess of faecal water due to almost unlimited pathologies. To understand if there are diseases within or outside of the gastrointestinal tract laboratory tests and diagnostic imaging is recommended.

If the gastrointestinal tract is considered the primary problem the work up includes step wise therapeutic trials to rule out food responsive or antibiotic responsive pathologies.

If these are not successful endoscopy for taking histological biopsies is highly advised.


Sneezing: this protective and clearing reflex of the upper respiratory tract sounds relatively harmless but can have serious underlying pathologies.

Differentials include infections, inflammation, tumour or all sorts of foreign bodies.

Corner stones in understanding sneezing patients most commonly include a CT scan of the head and endoscopy of the nose and throat.

Weight Loss

Weight loss: can be intentional or unintentional.

The latter can reflect a serious underlying condition and further investigations are highly advised after exclusion of a dietary problem.


Anaemia: there is hardly any disease which cannot be linked to any form of anaemia, meaning reduced red blood cell count.

It is important to understand whether it is a regenerative anaemia or a nonregenerative anaemia, presence and reason of possible bleeding or blood loss, duration, and evidence of haemolysis, meaning red blood cell destruction within or outside a vessel.

Due to the multi-faceted nature, further investigations can be very intensive and sometimes frustrating.


Coughing: this protective reflex of the lower respiratory tract has a very important defensive function in the body.

However, if persistent can have detrimental effects on the wellbeing of a patient, not only due to an underlying pathology.

Work up includes steps like radiographs and endoscopy to understand intra and extra thoracic reasons for the origin in a coughing patient

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