C09974727 / invoice 10000

Reason: Repeat Abp Us CKGAP ONLY HISTORYFirst clinical signs - re-check for elevated liver values noted on blood test 9/10/25, gall bladder sediment on ultrasound 3/11/25 Summary - hepatobiliary disease and gall bladder sediment Diagnosis - hepatobiliary disease and gall bladder sediment Treatment - continue Ursofalk for GB sediment and r/c bloods in 3mth Presented for abdominal ultrasound to assess liver and gall bladder sediment Recent bloods showed slight improvement in liver values Had been on Ursofalk 250mg PO SID Received Gaba 600mg and Traz 200mg PO on admissionSedated with Torb 0.66ml and Dom 0.1ml SC Perfect sedation, calm through the day, no further sedation required for ultrasoundUltrasound by JP- Bladder: 8.48cm size, normal echogenicity, normal wall thickness with no evidence of urolithiasis or masses- Prostate: smooth margins, heterogenous echotexture, hypoechoic-isoechoic to surrounding structures, width 4.71 x 6.59cm- Kidneys: normal size, shape, echotexture and corticomedullary definition with smooth capsular margin, length: left: 7.43cm right: 6.71cm- Adrenals: normal shape and appearance, left 0.63cm at caudal pole, right 0.51cm at caudal pole- Spleen: smooth capsular margins, homogenous parenchyma, mid body height measures 1.70cm, no focal lesions- Liver: smooth capsular margins, homogenous parenchyma, liver hypoechoic to spleen, one hypoechoic lesion measures 0.51 x 0.60- Gall bladder: normal appearance, large amount of mobile sludge/sediment- Pancreas: isoechoic to slightly hyperechoic to the liver, homogenous echotexture, no observable focal lesions- Stomach: empty with normal wall layering, thickness (0.27cm) and motility, no evidence of obstruction- Duodenum: normal wall layering, thickness (0.45cm) and motility, no evidence of obstruction- Small Intestine: normal wall layering, thickness (0.37cm) and motility, no evidence of obstruction and serosa-to-serosa < 1.5cm- Colon: normal wall layering, thickness, normal gas shadow dropout- No free peritoneal fluidUltrasound findings:1. Gall bladder: large amount of mobile sludge/sediment2. Liver: one hypoechoic lesion measures 0.51 x 0.60cmPlan:1. Ursofalk 250mg PO SID ongoing 2. Re-check bloods in 3mths for liver values and bilirubin levels3. Consider anunal ultrasounds to check gall bladder or sooner if any changes on blood test    Vital Signs    Weight: 22.2;