C09977483 / invoice 10000

Reason: RecheckHistory: Recheck cholestasis with chronic cholangiohepatitis, chronic inflammatory enteropathy See previous histories for details Current Medications: 1) Mirtazapine 2mg (Mirtazapine 2mg, 1 cap) PO eod PRN 2) Prednisolone 5mg (PredMix 5mg/mL, 1mL) PO sid 3) Ursodeoxycholic acid 30mg (Ursodeoxycholic acid 30mg, 1 cap chicken flavoured) PO sid - not started yet 4) Diet: Hydrolysed protein diet Plan: (from last time)1) Stop Clindamycin, Marbofloxacin, and start Ursodeoxycholic acid and Prednisolone at a immunomodulatory dose of 1.5mg/kg sid - for chronic inflammatory enteropathy and unspecified chronic cholangiohepatitis 2) Start a hydrolysed protein diet 3) Repeat GREYP 1-month later, monitor CIE with FCEAI, cholangiohepatitis with ALT, ALP, and TBil 4) Consider repeat hepatic biopsies (for liver histopathology and more importantly liver copper) in 6-12 months Problem list: 1) Inappropriate urination (15/8/24) - UA unremarkable - resolved with blocking visual access to other passer-by cats 2) Hx Weight loss with good appetite 3) Acute lethargy and hyporexia (15/12/25) 4) Acute vomiting (15/12/25) 5) Cholestatic hepatopathy (15/12/25) - No evidence of haemolysis - CT = Duodenal foreign body obstruction; Mild steatitis of the mesoduodenum is secondary to the foreign body - given the clinical history of hyperbilirubinemia, the steatitis surrounding the duodenum could be causing mild extrahepatic bile duct obstruction; Liver histopathology = Cholestasis, with mild multifocal vacuolar change (mild steatosis), mild portal fibrosis with septa; Liver copper - 658 ug/g dry weight; Liver C&S - No growth - Ddx Cholestasis with chronic cholangiohepatitis; secondary abnormal copper accumulation 6) Jejunal moderate neutrophilic and mild lymphoplasmacytic enteritis (23/12/25) - Ddx Chronic inflammatory enteropathy Examination: (update)Neurological Mentation: BAR Gait: Ambulatory, no weakness or ataxia Cardiovascular HR: 180bpm MMs: Pink, moist CRT: 1.5s Pulses: Normal and synchronous Auscultation: No murmurs or arrhythmias Respiratory Rate: 20brpm Effort: Normal Pattern: Costoabdominal Auscultation: No crackles or wheezes Abdominal palpation: Comfortable Temperature: 38.2C Assessment: Plan: 1) GREYPTreatment: See SmartFlow for full treatment records Current Medications: 1) Mirtazapine 2mg (Mirtazapine 2mg, 1 cap) PO eod PRN 2) Prednisolone 5mg (PredMix 5mg/mL, 1mL) PO sid 3) Ursodeoxycholic acid 30mg (Ursodeoxycholic acid 30mg, 1 cap chicken flavoured) PO sid - not started yet 4) Diet: Hydrolysed protein diet Other communication:    Vital Signs    

Reason: RecheckHistory: Recheck cholestasis with chronic cholangiohepatitis, chronic inflammatory enteropathy See previous histories for details Violet has been vomiting every night now and has diarrhoea, otherwise unchangedAppetite has been goodCurrent Medications: 1) Mirtazapine 2mg (Mirtazapine 2mg, 1 cap) PO eod PRN2) Clindamycin 37.5mg (Clindamycin 75mg, 1/2 tab) PO bid - follow with food/water - may be off3) Marbofloxacin 12.5mg (Marbofloxacin 25mg, 1/2 tab) PO sid - may be off4) Ursodeoxycholic acid 30mg (Ursodeoxycholic acid 30mg, 1 cap chicken flavoured) PO sid - not started yetProblem list: 1) Inappropriate urination (15/8/24) - UA unremarkable - resolved with blocking visual access to other passer-by cats 2) Hx Weight loss with good appetite 3) Acute lethargy and hyporexia (15/12/25) 4) Acute vomiting (15/12/25) 5) Cholestatic hepatopathy (15/12/25) - No evidence of haemolysis - CT = Duodenal foreign body obstruction; Mild steatitis of the mesoduodenum is secondary to the foreign body - given the clinical history of hyperbilirubinemia, the steatitis surrounding the duodenum could be causing mild extrahepatic bile duct obstruction; Liver histopathology = Cholestasis, with mild multifocal vacuolar change (mild steatosis), mild portal fibrosis with septa; Liver copper - 658 ug/g dry weight; Liver C&S - No growth - Ddx Cholestasis with chronic cholangiohepatitis; secondary abnormal copper accumulation 6) Jejunal moderate neutrophilic and mild lymphoplasmacytic enteritis (23/12/25) - Ddx Chronic inflammatory enteropathy Examination: Neurological Mentation: BAR Gait: Ambulatory, no weakness or ataxia Cardiovascular HR: 180bpm MMs: Pink, moist CRT: 1.5s Pulses: Normal and synchronous Auscultation: No murmurs or arrhythmias Respiratory Rate: 20brpm Effort: Normal Pattern: Costoabdominal Auscultation: No crackles or wheezes Abdominal palpation: Comfortable Temperature: 38.2C Assessment: Nick is reporting emerging GIT signs (vomiting and diarrhoea) which are likely secondary to the currently untreated chronic inflammatory enteropathyPlan: 1) Stop Clindamycin, Marbofloxacin, and start Ursodeoxycholic acid and Prednisolone at a immunomodulatory dose of 1.5mg/kg sid - for chronic inflammatory enteropathy and unspecified chronic cholangiohepatitis 2) Start a hydrolysed protein diet 3) Repeat GREYP 1-month later, monitor CIE with FCEAI, cholangiohepatitis with ALT, ALP, and TBil 4) Consider repeat hepatic biopsies (for liver histopathology and more importantly liver copper) in 6-12 months Treatment: See SmartFlow for full treatment records Current Medications: 1) Mirtazapine 2mg (Mirtazapine 2mg, 1 cap) PO eod PRN2) Prednisolone 5mg (PredMix 5mg/mL, 1mL) PO sid3) Ursodeoxycholic acid 30mg (Ursodeoxycholic acid 30mg, 1 cap chicken flavoured) PO sid - not started yet4) Diet: Hydrolysed protein diet Other communication:1) 05/02/2026 14:10:04 ZY: Histories emailed to regular vet.    Vital Signs