C09970118 / invoice 10000

Reason: UTI?History: Stranguria with bloody clots in urine. Episodes of straining to urinate with no urine production alternating with episodes producing yellow urine containing blood clots. Pollakiuria. History began this morning. No similar issues in the one year of ownership.- Preexisting heart murmur, not on cardiac medications- Previous cruciate ligament tear- Up to date with vaccinationsPossible exposure to rodents around the house.Otherwise BAR, no lethargy, PU/PD, vomting, diarrhoea, coughing or sneezing Physical Exam: - Demeanor: BAR, fas 2/4- Temperature: 38.4 degrees- Heart rate: 112 beats per minute, strong and synchronous pulses- Pulses: strong and synchronous- Respiratory rate: 20 breaths per minute, normal- Respiratory effort: WNL- Mucous membranes: pink with capillary refill time less than 2 seconds- Ambulatory: WNL- Heart murmur: present (preexisting)Body weight: 5 kilograms- Urine sample collected showing blood clots- urinated on consult floor No other evidence of clinical bleeding including petechaie Assessment: Problem list:1. STranguria2. Pollakiuria 3. Blood clots in urine, rest of urine no haematuria Ddx: UTI, crystalluria, sterile cystitis, coagulopathy Client Communication: Option recommended: urine dip stick, sedivue, USG, wet prep, dry prep, chem 10 + SDMA, CBC, pt and aPTT- estimate $1300Also recommended POCUS: O declined for today Concerned re clots- if cost an issue can do urinalysis as above and blood smear O aware next step specialist US VS GP POCUS to look at bladder and kidneys, r/o neoplasia ect Diagnostics: CBC: mild leukogram, likely inflammatory, mild reticulocytosis, no anemia PT:Aptt: WNLChem 10 + SDMA: mild elevated urea, SDMA, crea WNL Dip stick:   - pH 7  - Leuk 25/uLPro 30/dlGlucose 50/dlKetone negUbg normBld 250 ery/uLBacteria: none, confirmed on stained prepCrystals: none, confirmed on wet prep Inflammatory cells:   - WBCs > 50 per HPF  - RBCs > 50 per HPF RBCs: 1 - 3 squamous epithelial cells USG: 1.035Assessment:Sterile inflammation Ddx: neoplasia, UTI Plan: 1. Gabapentin 100mg PO BID q14d 2. Onsior 5mg PO SID TWO hours after a full meal for 6 days. If V+, D+ or anorexia stop immediatly and contact clinic 3. Recheck if no improvement in 48 hours O aware next step abdo US (specialist VS POCUS) and urine collected via cysto sent for CandS    Vital Signs