C09971717 / invoice 10000

Reason: Swallowed Something - BoneConsultation time:1330Hospitalisation period:  1430- 1800History:Presenting problem:  Oliver had a  lamb bone for tea yesterday . Ate one knuckle and bit of the middle piece. He passed faeces this morning and passed a piece of the bone. He had breakfast this morning , his normal biscuit twice , given by both husband and wife without knowing that the other person has fed him. He finished both meals this morning. O also gave him an apple, which also he happily ate. . Oliver vomited twice since then, once after reaching the hospital. More dark brown digested food, with bile. Previous medical history/medications:  Had FB- surgery (Corn cob) one year ago.Examine:  Demeanour - BART:39       HR:130       RR:24     mm:pink and moist     CRT: <2sWeight: 33.3 kg       BCS:  5/9Cardiovascular - no murmurs or arrhythmias, rate and rhythm within normal ranges Respiratory - no increase in respiratory effort, lungs sounded clear bilaterally Gastrointestinal - Pain on palpation of mid abdomen. Firm on palpation of the area.Rectal examination - empty rectum.Urogenital -  NSFMusculoskeletal - NADIntegument - no lesions or alopecia on presentationNeuro - normal mentation, full neuro exam not Eyes - NSFLymph nodes -  NSF Problem list:Eaten lamb bone -knuckle. Laboratory:Haematology: Unremarkable.Biochemistry: Mild increase in BUN and mild hyper hyperalbuminaemia Interpretation:Unremarkable changes , except minimal dehydration. Imaging:Radiography-  Survey radiograph has been taken - right lateral view.Region: Radiographic findings: Dilated intestinal loop with the knuckle in the SI area . Seems like >1.7 X diameter of the small intestine loopand likely to have an obstruction. Other soft tissue structures shows normal silhouette. MSkeletal structures are unremarkable. Interpretation:  Recommend repeating the radiograph in 6-8 hrs and reassess Problem list:Intestinal FB VomitingAssessment: Survey radiograph shows the intestinal FB . Client communication:Offered 1.Admission for IVFT, diagnostics including imaging, bloods, and treatment as needed +/- surgical exploration.2.Admission for fluid therapy , anti emetic and symptomatic therapy and transfer to regular vet in the morning.Owner decided to take Oliver home after the initial investigation with one survey radiograph and symptomatic tx with anti emetic. Owner prefer to have surgery at Reg Vet. Treatment:  Prevomax (maropitant) inj @ 3.3ml SC inj Plan:Revisit should the symptoms deteriorate and admission and diagnostics at this stage. Expect surgical removal of FBOwner could offer boiled chicken with rice  for next 24- 48 hrs    Vital Signs    Weight: 33.3;       

Reason: V+Consultation time:Hospitalisation period:  History:Presenting problem:Ate his breakfast this morning. Then a bit later he vomited it all up again. This afternoon was crying a bit and seemed uncomfortable. Normally eats a bit of grass but today ate more than usual. Went for a walk today and defecated normal stool. Later went for swim in pool. Gave dinner which was 100g of chicken. Ate but then vomited this up as well. Does eat things like socks. But normally poos them out. Has also defecated out a dish cloth before. No diarrhoea. No coughing Examine:  Demeanour - BAr, sweet boyT: 37.8    HR: 100     RR: panting     mm: pink, moist   CRT: <2secWeight:  27.5kg       Cardiovascular -No murmur or arrhythmical auscultated. Strong synchronous femoral pulses. Respiratory - Normal resp rate and effort. Normal BVS bilaterally. Gastrointestinal -Comfortable on palpation. Can feel something firm mid to caudal abdomen-possible foreign body. Urogenital -  NSFMusculoskeletal - Ambulatory. No lameness or swelling noted. Integument - nsfNeuro -nsfEyes - nsfLymph nodes - nsf    Problem list:Vomiting. Assessment:GI vs extra GI. Am suspicious of possible FB obstruction. Is known to eat FB type thing (socks and dish cloths) and can possibly feel something firm in mid abdomen. Client communication:STO about causes of vomiting. Discussed my concern for possible FB but also many other gasses such as gastroenteritis. Discussed admitting for radiographs. Owner expressed cost constraints due to several family circumstances. Opted for outpatient care tonight and owner wll take to GP tomorrow for reassessment. Treatment: Buprenorphine 0.02mg/Kg SC Maropitant 1mg/Kg  SCPlan:Recheck at reg vet tomorrow.    Vital Signs