C09978300 / invoice 10000

Reason: L3 - Ate String YesterdayTime: 9am-9pmObjective:Bodyweight: 3.5 kgDemeanour: BARTPR: Temp: 39.5 C, HR: 168 = Pulses gd/sync, RR: 28 RE: Normal effort MM Colour: Pink, CRT: <2secCVS: No significant findings on auscultation. Pulses normal.Resp: No significant findings on auscultation. Normal respiratory rate and character at rest.Abdo/ALI: Mild to moderate discomfort on abdominal palpation. Catheter Site: No significant findings. Catheter patent.Hydration: No significant findings. No evidence of hypovolaemia or dehydration.Diagnostics:Nil. Assessment:The patient has remained stable and is eating well. The patient's analgesia has not been able to be de-escalated further at this stage as the patient quickly shows discomfort on gentle palpation of his abdomen, but as he is eating and appears comfortable unless palpated analgesia has been kept on the same level at this stage. His temperature is intermittently borderline pyrexic but it appears to be more pain related than of infectious nature given no further increase has been seen during the shift and the temperature is now back to normal. Treatment:See smartflow. Plan:Continue hospitalisation until the patient's symptoms can be effectively managed with oral medication.--- 28/02/2026 8:59:06 PM LD9:Blood Gas Analysis Results - source: venousFindings: mild hypercapnia, very mild hypokalaemia, marginal hyperlactataemia, marginally elevated bicarbonateInterpretation:- mild metabolic alkalosis (loss of GI fluid, fluid therapy containing bicarb precusor)- mild respiratory acidosis (most likely stress related)- marginal hyperlactataemia but stable since post-surgery Assessment: Frank is bright with a reasonably good appetite and moving around in his cage suggesting he is reasonably comfortable. He is growling slightly on abdominal palpation however also when handled, abdomen is slightly tense but mostly soft. After reducing his fentanyl CRI from 3mcg/kg/hr to 1.5mcg/kg/hr there was minimal change in his demeanour. Clients have cost constrains prohibiting continued hospitalisation, therefore discharge is planned for tonight. Client Communication: Discussed possible post-op complications associated with linear foreign bodies/enterotomies and clinical signs to monitor for at home. If breakdown of surgery sites are likely to happen then usually around day 4-5. Must book a follow up with regular vet on Tuesday morning for recheck, or represent to PVE over the weekend if any decline. Medications at discharge:1. Pregabalin (mild sedative)    HALF a tablet by mouth every 12 hours for 7 days2. Buprenorphine (pain relief)    Give contents of 1 syringe into the side of the cheek every 12 hours for 5 days3. Ondansetron (anti-nausea)    Dissolve HALF a wafer onto the tongue every 12 hours, if needed for nausea or inappetence Plan: - Strict rest for 7 days - Soft food only for 7 days- Recheck with regular vet in 48 hours    Vital Signs    Weight: 3.5;       

Reason: L3 - Ate String YesterdayTime: 0800-2000-0800Objective:Bodyweight: 3.4kgDemeanour: QARTPR: Temp: 39.7C, HR: 180 = Pulses, RR: 28 MM Colour: Pale pink, CRT: <2secCVS: No significant findings on auscultation. Pulses normal.Resp: No significant findings on auscultation. Normal respiratory rate and character at rest.Abdo/ALI: No significant findings. Comfortable on abdominal palpation.Catheter Site: No significant findings. Catheter patent.Hydration: No significant findings. No evidence of hypovolaemia or dehydration.Diagnostics:See previous note for post-op blood gasesAssessment:Frank has recovered from anaesthetic and appears to be brighter, but remains inappetant. Has also been found to be hyperthermic/pyrexic, likely an inflammatory pyrexia given recent surgery. He has been started on 1/3 RER with emeraid to help with enterocyte nutrition. Treatment:> IVFT: Hartmann's maintenance fluids > Analgesia: - Fentanyl 3mcg/kg/hr CRI - Ketamine 0.3mg/kg/hr CRI --> starting to wean down > Gastrointestinal - Maropitant 1mg/kg q24h- Ondansetron 0.35mg/kg q8h Plan:Continue IVFT, NG feeding if inappetantAim to wean off IV analgesiaMonitor respiratory rate and effort in case of pneumothorax from NG tube placement Discharge home if comfortable and eating    Vital Signs    Weight: 3.4;       

Reason: L3 - Ate String YesterdayHISTORY:- Caught Frank chewing on some string from sewing machine a couple of days ago- Yesterday Frank defecated stool containing string, owner assisted pulling it out, estimated approx 30-40cm piece- Now inappetent and very lethargic, no vomiting seen- Indoor only cat, otherwise healthy Current meds: nilProphylaxis: vaccinations UTDPre-existing conditions: nilAccess to toxins eg. Rodenticide: nilEXAMINATION:Body Condition Score: 4/9Pain Scale (0-4): 1-2Hydration status (%): <5% dehydrated Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findingsMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: black string anchored underneath tongue at base, dental score (1-4): 1- Abdominal: no detectable pain on abdominal palpation, minimal gut sounds- Rectal: no detectable abnormalitiesUrinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFPROBLEM LIST:Oral string foreign body Inappetent and lethargicMild pyrexia DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Foreign body obstruction DIAGNOSTICS:Blood Gas Analysis Results - source: venousFindings: mild hyperglycaemia, Na lower reference range Interpretation: stress hyperglycaemia> Baseline BloodsPCV: 45TP: 62Serum: clear> Sedation - Methadone 0.7mg IV + Medetomidine 0.02mg IV - Alfaxan IV titrated to effect > Radiology : Digital radiography was performed.Views: 3 views Abdominal:Extra-abdominal structures: No significant findings.Serosal detail: Good.Liver/spleen: No significant findings. Normal location and appearance.GIT: obvious plication of small intestine. Stomach and pylorus gas filled. Kidneys: Normal location and shape.Bladder/Prostate: No significant findings.After the initial series of radiographs attempted gentle traction on string caught under tongue base. Successful removal of 1 end without breakage however there was more resistance to traction on second end which did snap. Free end disappeared down oesophagus. Lateral radiograph repeated, mild improvement in plication severity however not resolved. ASSESSMENT: Frank presented for a string linear foreign body obstruction anchored at the tongue base. Removal of the string was attempted orally however unsuccessful. There is the possibility that the rest of the string may pass through the GIT without complication, however also a reasonable chance that obstruction is not resolved and surgery may still be indicated. CLIENT COMMUNICATION: following options were presented to the client: 1) Proceed to surgery to find and remove rest of string (recommended, gold standard); 2) monitor and supportive care in hospital and re-radiograph in 8-10 hours, proceed to surgery if indicated; 3) monitor at home and hope rest of string passes through without issue. Discussed associated costs with each option, client has cost constrains so has decided to re-radiograph later this afternoon. TREATMENT (Fluid Therapy & Medications refer to Smartflow):> IV Fluids - LRS 10ml/h ongoing> Gastrointestinal medication - Maropitant 1mg/kg IV PLAN:- Monitor in hospital this afternoon and repeat abdominal radiographs in 6-8 hours to reassess obstructive pattern--- 27/02/2026 2:34:46 PM JBG:AFAST TFAST performed - no free fluid, ongoing plicationRepeat radiographs were taken to assess the progress of the condition of concern.Location:  abdoViews: 3 viewOngoing plication.  Not as dramatic as first views, but not significantly different to first view after string was cut.  Surgery recommended.Handed back to LD for surgery.--- 27/02/2026 4:35:55 PM LD:Assessment:A blood sample was collected for a coagulation analysis.PT         16            (14-19 sec)APTT       >300          (75-105 sec)The APTT result is abnormal with normal PT - possible error vs possible haemophilia? Venepuncture sites have showed evidence of normal clotting. Anaesthetic Report. - Induced with propofol slow IV to effect. - Intubated with an appropriately sized ET tube and the cuff inflated. - Maintained on isoflurane at 1-2% - Anaesthetic monitoring of heart rate, ECG, blood pressure, core temperature, EtCO2 and SpO2 was performed.- MAP was maintained >70mmHg intra-op.- Smooth, uncomplicated anaesthetic recovery.Examination: Pre Anaesthetic Exam Risk Level (1-5): 2Premedication: Methadone 0.7mg IV Induction: Alfaxan 0.5ml IV titrated to effectMaintenace: Endotracheal intubation with size 3.5 ETT, 100% oxygen, isoflurane titrated to effectMonitoring: Multiparameter monitoring - Hr, RR, SPO2 and anaesthetic depth constantly monitored by a nurse. Anaesthetic was smooth throughout. IV fluids: - Crystalloid fluids - 5ml/kg IVAntibiotics: - Cephazolin 70mg IVIntra-operative analgesia: - Ketamine 0.2mg/kg/hr - Fentanyl 3mg/kg/hrSurgery: A ventral midline abdominal incision was made.  The abdomen was explored to locate the source of the problem. There were multiple areas of plication evident through the small intestine. The stomach was first exteriorized and packed off from surrounding tissues.  A stay suture was placed in the stomach fundus with 4/0 PDS to facilitate visualisation. An incision was made into the stomach fundus and stomach contents suctioned. There were no foreign bodies identified in the stomach fundus or pylorus. Single layer closure of the stomach with 4/0 PDS in a simple continuous pattern. Four separate enterotomy sites were made into the small intestine to remove string foreign body and relieve plication. Each incision into the intestine was made along the antimesenteric margin with a #15 scalpel blade, string grasped with forceps and pulled out as much as possible with gentle traction. This was done with minimal contamination. At the most distal enterotomy site the string trailing aborally was unable to be pulled free, so was cut. Each incision was closed in a single layer with 4/0 PDS in a simple interrupted pattern. There was mild inflammation around the enterotomy sites at the time of closing but no evidence of ischaemia or necrosis. The remaining bowel was healthy, and did not require excision/anastomosis.The abdomen was lavaged with 1L of sterile saline, and suctioned. An exit swab was taken. Closure of the abdomen was routine in 3 layers:Linea Alba with 3/0 PDS in simple continuous patternSubcutaneous Layer with 3/0 PDS in simple continuous patternSkin with 3/0 PDS in intradermal patternPost operatively PCV/TP were performed and the patient was transferred to ICU for recovery and ongoing monitoring.Recovery/Post-operative:- IV fluids were reduced post-operateively- Patient recovered routinely from anaesthesia- Exit swab submitted for aerobic/anaerobic C&S--- 27/02/2026 8:52:57 PM CYT:A flexible feeding tube was introduced into the ventral meatus prior to recovery from GA.  It was passed to a pre-determined length, (~35cm at last rib)  The tube was fixed in place with suture material to prevent it from being easily dislodged, and a thoracic radiograph was taken to confirm that the tube is sitting within the oesophagus, and has not passed beyond the diaphragm into the stomach.  Initial rads revealed positioning in the trachea, so then had JBG place while visualising NG tube entering oesophagus. Placement of this feeding tube will allow administration of a liquid diet, which will improve calorie intake, and maintain gastrointestinal health.Post-op blood gas: > Baseline BloodsPCV: 57 TP: 54 Serum: Clear Blood Gas Analysis Results - source: venous Findings: Resp acidosis, likely due to hypoventilation from GA. Mild hyponatraemia and mild hyperlactaemia. Small fluid bolus given.> Ultrasound was used to assess for free fluid: - Peritoneum: No free fluid was identified in any quadrant. - Pleural space: No free fluid was identified in either hemithorax. - Pericardial space: No free fluid was identified in the pericardial space.    Vital Signs    Weight: 3.4;       MMColour: Pink;       Temperature: 39.6;       HeartRate: 140;       BodyScore: 4;       DentalGrade: 1;       RespirationRate: 64;       PainScore: 1-2;       CRT: < 2 sec;