C09978833 / invoice 10000

Reason: Hyporexia, diarrhoea and free abdominal fluid. HISTORY: Pickles  is a 1Y6M FS presented following PSS surgery performed on 29/01/2026 at VSS. Surgery involved intrahepatic PSS repair, enterotomy, colotomy and spey due to extensive pica with numerous rocks found throughout digestive tract and colon. Recovery initially progressed well with appropriate medications and hepatic diet. Two weeks post-surgery, decreased food drive developed, progressing to significant appetite reduction over past fortnight. Straining to defecate commenced 2-3 days ago with liquid diarrhoea in small amounts followed by inability to pass stool despite continued straining efforts. Abdominal distension noted Thursday 26/02/2026. Vomited small amount two nights ago and once approximately one week prior after eating half dinner portion.Specific History Questions:- Vomiting: Occasional vomiting - small amount two nights ago, vomited dinner one week prior- Mentation/Behaviour: Energy levels normal, acts totally fine despite clinical signs- Defecation: Straining to defecate past 2-3 days, liquid diarrhoea in small amounts, unable to pass normal stool- Urination: PU/PD reported, likely related to PSS - Diet & Appetite: Significant decreased appetite past two weeks, previously required slow feeding due to rapid consumption, currently struggles to eat few tablespoons- Drinking: Drinking large amounts of water- Environment: Fenced off areas with rocks post-surgery, cannot confirm 100% no access to rocks elsewhereCurrent meds:Lactulose 8ml morning and night, increased to 9-10ml recently due to constipation. Metronidazole 200mg, currently three quarters tablet. Amoxiclav 250mg morning and night. Omeprazole discontinued two weeks post-surgery due to decreased appetite.Pre-existing conditions: Intra hepatic PSS, pica with rock ingestionTriage:HR: 144 RR: 20Temp: UTO Mm: pink and moistCrt: 1-2 secondsMentation: bright alert responsiveEXAMINATION:Body Condition Score: Hydration status (%): clinically euhydratedPain score: 0/4Eyes: NSFOral: NSFLymph Nodes: WNL on palpationCardiovascular: cardiac auscultation normal, normal rhythm, pulses normal and synchronous. Cardiovascularly stable with normal peripheral pulses and warm extremities Respiratory: clear breath sounds bilaterally, respiratory effort normalNeurological: Mentation appropriate. Normal gait. Full exam not performed.Musculoskeletal: ambulating normally x4Abdomen: mild distension of abdomen,  fluid wave present, 4/4 free abdominal on AFAST Integument/Ears: NSFRectal: Not performedUrinary: nsfReproductive (incl ext genitalia): NSFAFAST: AFAST performed showing 4/4 FAF ASSESSMENTCardiovascularly stable despite 4/4 FAF, no signs of respiratory distress or discomfort on abdominal palpation. Without diagnostic abdominocentesis unable to definitively classify, high index of suspicion that FAF may be caused by portal hypertension related to PSS surgery. PROBLEM LIST: Free abdominal fluid, decreased appetite, diarrhoea with straining, history of intrahepatic PSS surgeryTREATMENT/Plan: Conservative management elected with owner to monitor for progression/worsening clinical signs CLIENT COMMUNICATION: Discussed findings of free abdominal fluid on AFAST. Explained concern for potential portal hypertension secondary to PSS surgery causing fluid accumulation, but unable to definitively say without diagnostic abdominocentesis. Provided estimate for diagnostic workup including abdominal centesis, coagulation studies, PCV/TP and biochemistry. Owner financially constrained due to pre-existing condition exclusion from insurance. Discussed options including Animal Welfare League referral, RSPCA  medical surrender, or home monitoring with against medical advice discharge. Owner elected home monitoring. Advised to continue current medications, attempt feeding with cottage cheese if tasty cheese unsuccessful, monitor for respiratory distress or lethargy. Discussed euthanasia option if quality of life deteriorates. Recommended contact with VSS for specialist follow-up. Against medical advice discharge form signed. Available 24/7 for re-evaluation if condition deteriorates.    Vital Signs