C09982993 / invoice 10000

Appointment Notes: Special payment terms existHISTORY:Presented for assessment of a single episode of blood-tinged vomit yesterday at 3:30 pm. The owner reported a small amount of pink-coloured vomit containing hair. This was preceded by a normal hairball vomit the day prior. After the vomit yesterday, Nomi hid for approximately 2 hours but seemed to improve. At 4:00 pm, exhibited unusual behaviour including hunching, crouching, piloerection, and hiding. The owner is concerned about potential discomfort or illness. Eating normally this morning. No other cats in the household are affected.Current meds: Nil.Prophylaxis: Vaccinations and deworming up to date.Pre-existing conditions:Presented on 18/01/2025 for vomiting and inappetence. Diagnosed with gastrointestinal upset of unknown cause, possibly secondary to constipation. Treated with a microlax enema, maropitant injection, and oral lactulose.Presented to a primary care veterinarian a few weeks prior to 18/01/2025 with vomiting and diarrhoea, which also affected the housemate. Prescribed probiotics and a bland diet.Re-presented to primary care veterinarian on a Thursday prior to 18/01/2025 for recurrent vomiting; ondansetron was prescribed.Triage:HR: 172RR: 60Temp: 38.2Mm: pink and moistCrt: <2Mentation: BAREXAMINATION:Body Condition Score: 5/9Pain Scale (0-4): 0/4Hydration status (%): EuhydratedCardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Mentation appropriate. Plr positive , menace positive, palpebral positive . No abnormal strabismus or nystagmus positional or otherwise noted. Normal facial sensation and motor. Normal facial symmetry. Normal gag reflex. No neck pain. CPs and withdrawals present in all limbs. Patella reflexes intact. Cutaneous trunci reflex WNL. Strongly ambulating with no observable ataxia. Normal posture. Perineal reflex WNL. Adequate anal tone. Full exam not performedMusculoskeletal: Strongly ambulating x4. Adequate range of motion in joints, no overt swelling or painGastrointestinal:Oral: mild dental diseaseAbdominal: Abdomen soft, non painful on palpation. Firm faecal balls palpated in the descending colon, but not considered clinically significant for constipation. No organomegaly or fluid wave appreciatedRectal: not performedUrinary: no significant findingsReproductive (incl ext genitalia): no significant findingsIntegument/Ears: clean and shiny haircoat. No skin masses of lesions noted. No fleas or flea dirtLymph Nodes: peripheral lymph nodes palpable < 1cmEyes: no significant findingsPROBLEM LIST:Haematemesis (single episode)History of hairballsHistory of anxious behaviour (grooming)DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Gastritis secondary to trichobezoars (hairballs)Foreign body obstruction (less likely given current clinical signs)Inflammatory bowel diseaseInfectious gastroenteritisDIAGNOSTICS:None performed today.ASSESSMENT:Nomi presented for a single episode of blood-tinged vomit. On examination, she is bright, euhydrated, and comfortable on abdominal palpation. The most likely cause is gastritis secondary to irritation from hairballs, given the history. An intestinal obstruction is a differential but seems less likely at this time as she is clinically stable. Two options were discussed with the owner: outpatient treatment versus immediate diagnostics. The owner elected for outpatient treatment.TREATMENT:Maropitant 1 mg/kg SQLactulose 2 ml PO oncePLAN:Discharge into owner's care for feeding and monitoring at home. If there is any ongoing vomiting, inappetence, or failure to improve within the next 24 hours, recommend reassessment with their primary care veterinarian or return to the animal emergency service for further diagnostics. Recommended diagnostics would include abdominal radiographs and blood work as discussed.CLIENT COMMUNICATION:Discussed that the likely cause of vomiting is gastritis secondary to hairballs. Explained the risk of hairballs causing an intestinal obstruction requiring surgery, particularly in cats with underlying conditions like inflammatory bowel disease. Discussed management strategies for hairballs including specialised diets, occasional use of lactulose, and managing anxiety-related over-grooming. The two options for today were discussed: 1) Outpatient trial therapy with anti-nausea medication and lactulose, with further diagnostics if she worsens or does not improve. 2) Proceed with diagnostics (abdominal x-rays and bloods) today. The owner elected to pursue outpatient therapy. Advised to seek veterinary attention if Nomi is not eating tomorrow morning, has further vomiting, or seems unwell. The owner was advised they can call or email for further questions.    Vital Signs