C09979733 / invoice 10000

Reason: lilly has blood in poo. went on ABs . 4 days off and has a lot of frank blood in poo.Assessment: Did have a vomit in the cage while in the clinic - digested food and fluid, no blood.Passed a couple of very haemorrhagic and smelly diarrhoeas.Treatment: Abdominal ultrasound performed without sedation, very good for the procedure: - Liver:  Enlarged with rounding of the edges, hyperechoic, no mass lesions found. - Gall bladder:  Volume: 14.8  (<10).  Normal wall, some sludge present, gravity-dependent.  Possible area of mineralisation towards one edge, with hyperechoic material and some shadows, almost looks a bit curled up. - Spleen:  Tucked in underneath the ribs more cranially than normal.  Hyperechoic, slightly mottled appearance.  Single hypoechoic nodule towards the tail tip, 6.9mm diameter.  Multiple other hyperechoic areas along the hilus, likely myelolipomas. - Stomach:  Normal wall layers, 2.5mm thick (<5) - Duodenum:  4.0mm (2.9-4.7).  Mucosa: 3.1 (1.6-3.5), Submucosa: 0.4 (0.3-0.8), Muscularis:  0.4  (0.2-0.8) - Jejunum:  3.5-4.6  (2.2-4.1).  Mucosa: 3.3 (1.2-2.6) - mildly thickened.  Submucosa: 0.4 (0.5-0.9).  Muscularis: 0.65 (0.2-0.7).  One area found with a hyperechoic luminal outpocketing into the mucosa but not through the full wall layer - possible ulcer, 4mm long, 2.3mm deep. - Ileum and iliocaecocolic junction not able to be examined due to gas in the area. - Colon:  Marked thickening of the colonic wall, especially throughout the descending colon. Extra layering of the wall.  Hyperechoic lining of the mucosa, with multiple hyperechoic gas bubbles also present along the wall.  Thick hyperechoic layer within the mucosa (presumed based on appearance) - this layer is 1.79mm thick, parallel to the lumen.  Wall: 4-5.3mm (1-2).  Mucosa: 2.9mm  (0.2-0.6).  Submucosa: 0.4mm (0.2-0.6).  Muscularis:  0.4  (0.2-0.7).  Hypermotile, with corrugation of the lining at times.  Lumen has areas of fluid, some small thicker hyperechoic faeces, and large gas pockets. - Pancreas:  Right limb: 4.3mm  (3.9-16). - Kidneys:  Both have good corticomedullary distinction and normal pelvis size.  LK/Ao ratio: 6.5.  RK/Ao ratio: 7.8  (5.5-9.1). - Left adrenal:  5.69mm  (<6.8) - Right adrenal:  6.32mm  (<6.8) - Bladder:  NAD - Lymph nodes:  Medial iliac lymph nodes are visible, 5.9 x 10.4mm in size, mostly just slightly hyperechoic to surrounding tissue, but 2-3 anechoic or very hypoechoic cystic pockets within the lymph node.  Can also visualise other lymph nodes in close association with the colon (colonic lymph nodes) - approx 3.7 x 7.4mm, elongated oval.Summary: - Colitis - inflammatory vs antibiotic responsive vs infectious vs neoplastic (eg lymphoma).  No strictures or discrete mass lesions, excessive wall layering rather than any loss of layers. - Local lymph nodes inflammed and activated.Discussed options with owner: - Faecal sample submitted for analysis - Sampling of the colon (colonoscopy vs laparotomy) - Long antibiotic course (8 weeks) - Steroid trial (only if not wanting to sample now or in the near future).Plan: Submit faecal sample for analysis.O opted for conservative management at present given her multiple comorbidities.Will start on antibiotics again while awaiting faecal results, then plan for long antibiotic course (8 weeks) directed by any findings on the faecal sample.Discussed with idexx to guide best next sampling:  Recommended faecal antigen panel with giardia rather than full faecal PCR (will have dysbiosis so less likely to be accurate), then also testing for Cobalamin in case supplementation required.Other recommendations:  Increased fibre (metamucil/psyllium husks), and a food trial on a hydrolysed food in case able to get more control with a hydrolysed diet.Note:  Misc Idexx fee is for FAPG faecal antigen panl with giardia testing.    Vital Signs    Weight: 10.7;