C09981401 / invoice 10000

Recheck for pancreatitis

History: 
Not eaten or drunk anything - O thinks pretty sedate. 
Poos looked solid, not too dry. Done a couple wees. V- 
Not interested in food at all. 
5 years ago HBC and got internal stitches. 


QAR, nervous HR 112 RR pant BCS 4/9 MM p& tacky CRT<2s T37.5 - rechecked in tx room 38.2
Abdo palp: mild tense - subjectively less than yesterday 
Thoracic ausc: normal brochovesicular noises 

O consented to hosp + IVFT, also wants u/s done 

Treatment: 
Temvet 0.75ml (0.03mg/kg) IV @8:30am
IVFT Hartmann's 45ml/hr 

VERY DROOLY - suspect opioid sensitivity 
Called O to transition to other medications - O approved
-paracetamol 10mg/kg (7.5ml) IV BID
-ketamine 0.1mg/kg/hr CRI IV
-ondansetron 4mg PO BID 

-prevomax 0.75ml IV @1pm 

Abdo U/S main findings:
-bladder - moderate-significant sediment
-Ileus in duodenum- appears physiologic 
-pancreas - no signs acute pancreatitis (70% sensitive), mild changes potential chronic pancreatitis 
-nil masses, obstructions

DDx: primary GI disease (inflammatory, toxin, viral) with potential secondary pancreatitis 

Next steps of diagnostics: faecal testing, pcr for viruses, UA if urinary signs, cortisol for atypical addisons, biopsy GIT
Otherwise treat as primary GI with fluids, antinausea, pain relief.

Plan: 
Manage as outpatient as seems to be quite fussy and anxious in hospital. Consider with anti-nausea and pain relief at home. Recheck if concerns, V+, D+, continues to not eat (consider mirtazapine?)