C09970257 / invoice 10000

Pepper has some diarrhea.  No Blood.  Watery Grumbly stomach.

Reason: (BEAH consult)

PRESENTING/OWNERS CHIEF COMPLAINT: (Diarrhoea overnight)

Consult Nurse: (JL vet tech)

Reason
(BEAH consult)

Presenting/Owner's Chief Complaint
Acute onset of diarrhoea, inappetence, and suspected nausea.

Consult Nurse
John

Triage Notes
Veterinary Technician: John
-   Weight: 6.51 kg
-   Temperature: 39¡C (ear), noted as upper end of normal.
-   Heart Rate: 130 bpm with a significant sinus arrhythmia.
-   Respiration Rate: 30 breaths per minute, lungs clear on auscultation.
-   General: Mucous membranes are very moist, suggestive of nausea. Abdomen palpated as firm.

History
EDDU: Eating is decreased (refused chicken), no vomiting reported, urination not commented on, defecation is diarrhoea.  
No V+ or D+: No vomiting. Diarrhoea commenced at approximately 03:00. The first bowel motion was soft and mucousy, and subsequent motions have become watery. All motions have been brown in colour. The owner reports hearing gurgling sounds from the abdomen and the patient was passing gas the previous evening.  

Diet: Usually eats chicken and vegetables. Had a milk stick treat this morning but refused chicken.  
Vaccinations: UTD
Preventatives;  
Worming: Due for treatment, but owner is delaying until gastrointestinal signs resolve.  
Heartworm: Not mentioned.  
Flea & Tick: Not mentioned.  
Current Age: 7 years  

Current Medications: None. Recently finished a course of ear drops for a right ear infection approximately 2 weeks ago.  
History: Peppa is reported to be a 'sticky beak' on walks, sniffing everything including bird poop. The owner also notes that she frequently licks her paws after walks. She lives with another dog who is currently well. The owner notes a recent increase in crusty discharge from the eyes over the last 6-8 weeks.


Physical Exam
Veterinarian: Dr. Cassie  
  
Demeanor: Quiet but responsive.  
Behaviour: A little quieter than normal.  
HR: 130 bpm; RR: 30 bpm; T: 39.0¡C; MMC: Moist; CRT:  <2
Hydration:  
BCS: /9  
EENT: Mild crusty ocular discharge noted bilaterally; no swelling or discharge to the external ear canal, ear pinnae clear; no nasal discharge;  
Cardiac: Significant sinus arrhythmia noted. No murmurs on auscultation.  
Resp: normal rate, normal clear sounds auscultated in all lung fields  
Abdo: Tense and firm on palpation.  
Urogenital: Mild perianal irritation secondary to diarrhoea.  
Integument: no external parasites noted; Owner reports frequent paw licking.  
Neuro: proprioception NAD; NSF  
Musk: ROM in all joints NAD; no abnormalities on palpation  
Ln's: Peripheral LN's WNL

Client Communication
Dr. Cassie discussed that acute gastroenteritis is common, particularly after rainfall, due to potential exposure to bacteria from the environment (e.g., puddles, bird faeces). The treatment plan involving a probiotic paste (Pro-Kolin) and a bland, digestible diet (Gastrointestinal Biome) was explained. Instructions for administering the oral paste by wiping it on the roof of the patient's mouth were provided. The owner was advised on the signs of deterioration that would warrant a recheck, including persistent diarrhoea, lethargy, inappetence, or signs of dehydration.


Assessment/Problem List
-   Acute gastroenteritis: Characterised by diarrhoea, nausea (hypersalivation), inappetence, and a tense abdomen. Suspected secondary to environmental exposure.
-   Mild pyrexia (39.0¡C).
-   Mild bilateral ocular discharge.

Treatment
Dispensed for at-home administration:
-   Pro-Kolin 30 ml: Administer 3 ml orally twice daily for 5 days.
-   Gastrointestinal Biome canned food (3 tins): Feed approximately half a tin twice per day.

Plan
1.  If diarrhoea persists beyond 3 days, a progress examination is recommended.
2.  If patient deteriorates (e.g., becomes lethargic, refuses to eat or drink, appears dehydrated) then reassess immediately.

Treatment Plan Comms
The rationale for starting with supportive care (probiotics and diet) was explained. The possibility of needing antibiotics and/or hospitalisation for intravenous fluids if the condition worsens or fails to resolve was discussed. 

Follow Up Notes
Next Visit: Recheck in 3 days if diarrhoea has not resolved, or return sooner if the patient's condition declines.  
Follow-up Call: The owner was advised to contact the clinic with any concerns or if there is no improvement within 24-48 hours.