C09975786 / invoice 10000

Appointment Notes: EUS anal glands +/- xrays +/- enema. Estimate given that was attached to KPB hx - CRAppointment Notes: EUS anal glands +/- xrays +/- enema. Estimate given that was attached to KPB hx - CRKPB admitstill straining and only producing small drops of soft faeceseating ok also had 2 more episodes of "wetting" himself- urine pool where he was lying Also been licking at rear end a bit PRESENTED FOR: xrays of abdomen & assess anal glands/rectumXRAY REGION: abdomen FOR PURPOSE OF: investigation of constipation PAP?: accepted- very sligh increase eosinophils- borderline decrease lymphocytes- BUN very slightly increased- everything lse WNLCURRENT MEDICATIONS?: meloxicam yesterday MICROCHIP CHECKED?PRE-ANAES EXAM: HR	100	; RR pant	   ; T=38.7		; MM 	pink & moist	;CRT <2sPlaced IV catheter. Was quite drooly in hospital & took a while to settle but was relaxed prior to sedation PREMED:- Methone 0.3mg/kg + medetomidine 0.02mg/kg IV- good sedation XRAYS VIEWS TAKEN:L & R lateral abdomen & DV abdomen FINDINGS:- faecal impaction ~13cm of distal colon- formed faces throughout rest of colon but moderate gaseous distension (2.5-3.5cm)- bladder normal shape & small in size- no obvious prostatic enlargement - lumbar spine & pelvis appear normal - spleen moderately enlarged SEND FOR RADIOLOGIST READING?: no ANAESTHETIC:Induced via propofol IV (17mls). Intubated (size _ ET tube). Maintained iso and O2.	Overall the GA was smooth Rectal- also assessed by Dr ALK & Dr CHS- soft faeces (no diarrhoea) within rectum with mild amount of fur within - thickened internal rectum (and senstive to palpation) - bloody d/c when anal glands & rectal region palpated - area smells of anal gland discharge - NO obvious exteneral fistulas (area clipped free of fur) Removed some soft faeces via manual evacuation (unable to do water enema at time of sedation due to area needed in use) - post evacuation xray shows only mild improvement in faecal impactionOTHER DRUGS:	Administered 2x vials of microlax- due to large rectum size ~50% of liquid stayed within rectum - did do few small drops of soft faeces with tiny amount of blood d/c. No liquid d+ Metoclopramie 5.4mls IV Trazodone 400mg PO once in recovery as quite stressedAssess:ddx; megacolon vs localised colitits vs diffuse neoplasia vs otherDiscussed with O complex nature of possible dx & are recommended medical referral vs attempted tx for potential megacolon (but advised this is only an assumptive dx & may not be effective)O elected referral PLAN:Referral sent to SASH medical team D/c withDr ALKongoing tx plan until referral app;- stop meloxicam (due to blood in colon)- start paracetamol 500mg x2 tablets q12hours- continue actilax as needed 0.25-0.5ml/kg q 8-12 hoursDiet: Blackhawk LB dry chicken + chicken strips treats. SASH booked next Thursday 10:20am    Vital Signs    Weight: 54;