C09975344 / invoice 10000

DATE/TIME of CONSULTATION: 18:27hrs, Mon 22/12/25

CLINICIAN: Dr Marlen Waterworth 

PRESENTING COMPLAINT: head tilt 

HISTORY:
The past hour owner has noticed head tilt to left and nyastagmus. No inciting cause. Has had vestibular episode 18 months ago -resolved after a few days. O concerned because last time she did not have nyastagmus.
No overt vomiting. 
No overt wet cough but retching since 1 year. 
 
CLINICAL FINDINGS: Mentation: BAR-a bit distressed/restless; ambulatory-no ataxia; defecating in consult fine; HL CP deficits (L>R) HR: 132 bpm RSHM 1/6 -query increased BV sounds ventrally RR: 32 bpm MM: pink moist 3/4 dental dx CRT:  <2sec Temp 38.8
vertical nyastagmus; left head tilt 
 
PROBLEM LIST:
head tilt 
heart murmur
occasional retch 

DIFFERENTIALS:
geriatric vestibular dx (ddx peripheral; neoplastic; infectious; traumatic) 

OPTIONS PROVIDED:
Given eating and ambulatory suggested to monitor for now as she has had episode like that before and improved -> O agreeable 

DIAGNOSTIC TESTS: NIL 

DIAGNOSIS: likely geriatric vestibular dx 

TREATMENT: Zofran 4 mg BID 

CLIENT COMMUNICATION/PLAN: handout on vestibular dx 

DATE/TIME of CONSULTATION:17:00 26/9/13 (SG) 
PRESENTING COMPLAINT:Overnight care post foreign body enterotomy at Kensington Vet clinic 
HISTORY:Unwell since Monday, see prev history. Barium study done here last night showing filling defects in stomach and SI, returned to Kensington today for exploratory surgery. Surgery confirmed peach pip foreign body in the proximal duodenum. Regurgitation occurred while under GA - Astrid's mouth was suctioned and the stomach was emptied via stomach tube. Transferred here for overnight care, owner aware that if Astrid should deteriorate further charged will be incurred. 
CLINICAL FINDINGS:QAR, HR 100=femoral pulses, Mucous membranes pink, CRT <2, RR panting, chest sounds harsh bilaterally but there is also moderate URT referred noise. Temp 38.8.  
DIAGNOSTIC TESTS:nil 
DIAGNOSIS:post exploratory laparotomy today, concern about aspiration 
TREATMENT:continue with IVF at 1-2* maintenance, start omeprazole 10mg PO q 24hours, sucralfate slurry 1g PO TID, cephazolin 10% 350mg IV TID & buprenorphine 0.12mg IV PRN
PLAN: Return to Kensington VC Friday for food trial, antiemetics PRN. 
CLIENT COMMUNICATION:Called pre-midnight to ensure stable
PROGNOSIS:Good

******************NIGHT SHIFT UPDATE***************
CLINICIAN:07:20am 27/9/13 (KCR)
SUBJECTIVE:Bright & responsive, urinating on walks & on bedding, no faeces passed overnight, ad lib water tipped over, occasional lip licking or regurgitation in mouth pre-midnight - latter improved after metoclopromide 0.5mg/kg IV at 23:00, ranitidine 2mg/kg IV single dose 23:00 & buprenorphine 0.12mg IV at same time. No food offered overnight
OBJECTIVE:Temp = 37.4-38.8 overnight, MM pink, moist, CRT1s, HR = FP (mid-strength & regular) = 100-120/min with no murmur/arrhythmia & RR = 24-30/min with normal effort, slightly harsh lung sounds RHS, no coughing heard. Abdo palp'n - minimal discomfort, nausea improved overnight 
DIAGNOSTIC TESTS:Nil, weight = 11.6kg
ASSESSMENT:Stable post enterotomy for proximal jejunal peach pip
PLAN:Return to Kensington VC today for further resp monitoring, regurgitation management & food trial today. Given 3.5ml cephazolin 10% at 22:00 & 5:45am, buprenorphine 0.12mg IV at 23:00 & 7am PRN, metoclopromide 0.5mg/kg IV at 23:00, ranitidine 2mg/kg IV at 23:00 & omeprazole 10mg PO 20:00 & sucralfate 1g slurry at 20:00 & 4am. Hartmanns commenced at 20ml/hr on arrival, increased to 58ml/hr overnight & reduced to 29ml/hr after 5:15am when urinated on bedding.  
CLIENT COMMUNICATION:Called pre-midnight to ensure stable

DATE/TIME of CONSULTATION: 2020 25/9/13
PRESENTING COMPLAINT:vomiting
HISTORY:
23/9/ Mon am small vomit - not unusual - after vomit ate Dentostix and started  vomiting profusely. Took to RV that morning  - admitted for IVF, Xrays - Rx Temgesic, IV fluids and enrofloxacin (no anti emetic on Hx)- discharge home in evening. Re-presented in the next morning as NQR. X rays rpt concerned re swelling in stomach . Had eaten small amount of chicken in clinic without vomiting
Today seemed a bit brighter - vocal - recc discharge. Once home seemed quiet. Offered chicken - took into mouth but hasnt eaten. Owner rang RV and recc transfer to AVC. To consider further X rays and poss barium study.  
Had prosciutto on Sat, Sun dead mussels at river - playing with them, not seen to eat them 
Eructations in consult - owner reports often does this. 
CLINICAL FINDINGS:Temp 38.6, HR 150, Resp 20, MM pink/tacky, CRT <2
GIT - mild abdominal discomfort, dry per rectum, some black/dark spot of faecal material 
DIAGNOSTIC TESTS:PCV/TP 55/92, Lytes WNL  - mild hypokalemia (3.4)
Plain Xrays (unable to view RV Xrays - code/password not working) - cranial abdomen globoid swelling - DDx pyloris/liver/other. STO- as no improvement with IV fluid elect to cont with Barium study
8ml/kg Barium given PO - tolerated well, poss 10-20ml not ingested. No coughing or distress during admin. No vomiting or regurg noted. 
Xrays taken immed, 15min post Ba, 30min post 1.5hr post and 4.5hr post - summary of findings : stomach remained distended with barium throughout Xrays,  filling defect noted in fundus consistently in all VD Xrays. Duodenum distended and with filling defect also noted. Ba after 4.5hours had not reached rectum. 
Also noted in abdominal Xrays - small amount aspiration of Ba - bronchial tree single caudal lung lobe marginally highlighted, sm amount barium present in trachea also. After 15min most of Ba diffused. No vomiting or regurg noted so suspect inhalation of Barium only. Barium in airways should be cleared via mucociliary pathways. Suspect no consequences will occur from this however owners need to be aware maybe present in subsequents Xrays - especially part of LN in future XRays.     
DIAGNOSIS:
suspect gastric and duodenal FB, (versus gastric/duodenal ileus)
mild Ba inhalation(no gastric fluid), 
dehydration
TREATMENT: IV catheter placed on admission - bolus 20ml/kg LRS, cont at 3xM for 8hours - reduced to 2xM @4am. KCL added once on 3xM rates at 1.5g/L.
RX buprenorphine 0.01mg/kg IV q6-8hours. Rx maropitant 1mg/kg SC, Rx metronidazole 10mg/kg IV12hr
Since admission Astrid has not vomited and has been bright - she has not urinated however has been taken for a  walk outside  - not keen to walk outside as raining. There has been non productive regurgitation or vomiting, she will occasionally eructate. Her abdomen is mildly  uncomfortable.   SpO2 99% and no resp rate/effort changes.
PLAN: Admitted for supportive IV fluids, baseline bloods (lytes, PCV/TP), analgesia and anti emetic - if no improvement elect X rays and Ba study. 
As X rays as suspicious gastric and duodenal FB would recc exl lap. Need to discussed with RV whether they are happy to perform surgery this morning.
Consider monitoring chest X rays
Could consider NG placement and gastric suction with followup rpt X rays to investigate ileus.  - would req sedation to place and not keen to perform sedation with stomach filled Barium overnight - would prefer GA and entubation
CLIENT COMMUNICATION:Owner updated re bloods and consent for barium study. Need to discuss plan re poss Sx this morning
PROGNOSIS: Good if simple gastric FB.