C09977730 / invoice 10000

Reason: Suspect Oesophagitis - GeorgiaHistory:Sunny Lala is presenting for assessment of suspected oesophagitis.Sunny Lala previously underwent BOAS (staphylectomy and rhinoplasty) surgery and desexing with ARH surgery department.  She was also treated for a superficial corneal ulcer of OD in November 2024. Ntermittent exaggerated swallowing and stertor particularlyt at night over the lkast few weeks. Gets severe oesophagitis after vomiting bile (can be after eating or random time) every few months, given omeprazole and cerenia to resolve these issues within hours. Omeprazole and cerenia usually continued for 7d.  OR particarly congested this morning after walk.O concerned requires more BOAS.Diet: sensitive skin and stomach, dry in AM, wet in PMCurrent medications:Omeprazole PRN after vomitingCerenia PRN after vomitingPhysical Exam: T:  NT P: 144  R:  pantMM: pink   CRT: 1-2sThorax: NAD on auscultation of heart or lung fields, significant stertor heard. Palpation of oesophagus induced repeated swallowing.Abdo:LN: WNLEENT: NADIntegument: clean, shiny coat, no erythemaMSK:Neuro:Laboratory: Awaiting QML resultsAssessment: 1. Primary gastrointestinal disease with secondary airway disease2. Primary airway disease with concurrent gastrointestinal diseaseIt is possible she has chronic oesophagitis and reflux that exacerbates intermittently and resolves with PPI use, with secondary exacerbation of her BOAS CSx.Ultrasound for GI abnormalities (polyps, pyloric outflow obstruction, hitatial hernia), airway exam for BOAS, thoracic radiographs +/- GI scope under GASunny may require chronic therapy for GI disease (maropitant, metoclopramide, PPIs)Dietary modification to increase wet food content may also aid in improving gastric motility.Plan:Return next Tuesday for abdo ultrasound, thoracic rads, airway exam.Await QML Scripts written for:Metoclopramide 10mg half tablet q8-12Omeprazole 10mg 1 tab PO q8-12 prior to meal    Vital Signs