C09972311 / invoice 10000

Reason: RecheckIntern: SNHistory: Chronic management of granulomatous (presumed immune mediated +/- bacterial) cholangiohepatitis and diabetes mellitus.He was previously hospitalised from 7/10/25 to 12/10/25 for acute vomiting, diarrhoea & collapse. Initially stabilized with IVFT and received plasma transfusion due to marked hypoalbuminaemia (14mg/L). Diagnosed coccidiosis on faecal float and treated with toltrazuril and 2 FMTs in hospital. Responded well with supportive care. He was subsequently presented for acute vomiting on 28/10/25, noting a worsening biochemical hepatopathy (ALT 2063, ALKP 1472, AST 718, TBIL 11). Discharged and managed as outpatient due to otherwise unremarkable physical exam. Transitioned from amoxicillin back to amoxyclav due to GI adverse effects and deterioration in liver parameters suggesting that it is not tolerated well and less effective. At his last recheck and BGC (7/1/26), stable glycaemic control noted. Marginal increase in liver enzymes noted, but improvement in albumin levels observed. No changes made to treatments. Today, #########Current medications: Amoxyclav 125mg PO BID Maropitant 16mg PO SID PRN Caninsulin 16IU SC BID Prednisolone 5mg PO SID UDCA 70mg (1.4ml) PO SIDExamination Findings: T: ##    MM: pink, tacky P: ##   CRT: 1-2sR: ##  Demeanour: BARHydration: Mildly dehydrated Weight: #### 7.6kgBody Condition Score: 5/9 Muscle Condition Score: 1/3 Cardiovascular: WNL Respiratory: WNL Abdomen: static abdominal rounding Peripheral LNs: static plump SMLN Ocular: Increased corneal opacity OU related to diabetic cataract, ######## resolving left corneal ulcer (approx. 3mm diameter lesion appreciated visually but no uptake of fluorescein stain)Ears: WNL Integument: Multiple subcutaneous masses Oral exam: marked halitosis, periodontal disease 4/4 Musculoskeletal: static lumbosacral hyperpathia Gait: WNL Neurological: normal mentation, full exam deferred Rectal: NP Laboratory: ###########Problem List:Acute: Left corneal ulcer - resolving on topical antibiotics, treated at RVBiochemical hepatopathy (elevated ALT, ALKP, GGT) Coccidiosis (resolved)Chronic: Diabetes mellitus Immune-mediated hepatopathy Cystoliths Dystrophic mineralisation spleen Submandibular lymphadenopathy (static - likely dental disease related) Assessment:#######Treatment: #####Plan:#####    Vital Signs    Weight: 7.5;