C09983104 / invoice 10000

Reason: HOSP - Suspected Cholangiohepatitis (HB Case)Appointment Notes: Overdue remindersHx: - IHP for suspect colangiohepatopathy (ALT 570 26/2, ALT 337 03/03) - FIV positive (confirmed 26/2)- Hyperbilirubinemia (30 26/2, 22 03/03)- Also worsening anemia (PCV 19 26/2, 15 03/03)- 26/02 presented with vomiting and hyporexia. Hematology performed on 26/02 revealed regenerative anemia (reticulocytosis), SAT was negative- Was hospitalised on 26/02 for 2 days, sent home - Re-presented yday hyporexia and lethargic, re admitted to hospital, ALT still elevated (although improving- Edgar was admitted and treatment for bacterial cholangiohepatitis was commenced. Given his recent FIV diagnosis, AB therapy was commenced yday. An IDEXX advantage haematology panel has been sent externally to accurately characterise the anaemia, and assess a blood smear (results not back yet) TODAY: - Not eating in hospital, no urine or faeces overnight- IVFT @ 1.5 overnight- Medications: onansetron, maropitant, marbofloxacin, cefovecin, temgesic - Very difficult to examine, will not tolerate concious blood pressure Examine: - Needed alfaxalone to effect to aid examination, hissing and very difficult to examine concious- MM pale pink / pigmented- Temp 39C- Euhydrated, pulses strong and synchronous- HR 180, G 2 L parasternal systolic murmur - Painful on abdominal palpation even with alfaxalone on board Diagnostics: - PCV 13%, icteric serum - Hematology: None regenerative anemia, eosinopenia 0.04, low PLT (- In vue blood smear:  POCUS: - No FAF, no pericardial or pleural effusion - Sludge/mucus in the gall bladder- Hyperechoic urine Assessment: Problem list:1) Anorexia - persistent 2) Cranial abdominal pain - persistent 3) High-normal temperature (39.2) - Improving 39C today 4) Biochemical cholangiohepatopathy - first noted on 26/02/26 5) now non-regerative anaemia - WORSENING 12% today 6) Recent FIV diagnosis - confirmed with external IDEXX FIV PCR panelTreatment: 1) IVFT (Hartmann's) @ 1.5x maintenance 2) Buprenorphine 0.45ml (0.02mg/kg) IV q8-12h - last given @ 8:30am 3) Cerenia 0.65ml (1mg/kg) IV q24h - 1st dose @ 10pm 03/03 4) Ondansetron 4mg (0.6mg/kg) q12-24h - Last given 8:30am 5) Marbofloxacin 25mg (3.9mg/kg) PO q24h - 1st dose @10pm 03/036) Cephazolin 2.1ml (0f 100mg/ml solution --> 33mg/kg LAST  NIGHT, 22mg/kg this morning 8:30am) IV q8h slowly over 10 mins.PLAN: - Needs advanced imaging as next step, Chris not available until tomorrow - Cannot exclude IMHA, although SAT negative positive and non-regenerative - Given worsening anemia, recommend referral for ongoing care, IM referral and advanced imaging - Discussed with O likely AUS +/- CT- Estimate ICU 2-3 days with blood typing, blood transfusion, bloods, AUS +/- CT, 11-16k    Vital Signs    Weight: 6.36;       

Reason: R/cAppointment Notes: Overdue remindersVerified: NoHistory:Presenting for: Edgar, a cat, presented for lethargy and inappetence following recent discharge from hospitalHistorical Conditions: FIV positive confirmed by both initial test and PCR. Previous anaemia noted on recent blood work. Fight occurred in December. Recent hospitalisation with elevated ALT and total bilirubin levels.Diet: Normal appetite Saturday and Sunday. Started not eating yesterday, has not eaten at all today.Lifestyle Risk Factors: Recently moved to new house where two cats were present, one fighting with Edgar. Not a wandering cat, described as lonely and upset about the situation.Other: Normal behaviour Saturday and Sunday. Became very lethargic yesterday. Has been lying down for the last 8 hours.Examine: Wt: 6.36 kgT: 39.2°CBehavioural: Lethargic, lying down on consult room table.EENT: eyes clear OU, ears clean and non-inflamed AU, no oculonasal discharge or facial swelling. Oral: pale pink MMs, pink/moist. CRT unable to be assessed. No oral masses/erosions/ulcerations of oral mucosa. Thorax: HR 232 bpm, strong/regular rhythm, grade 2/6 parasternal systolic murmur. Stressed and tachypnoeic in consult (RR 80 breaths/min, settled after exam). Abdominal: moderate cranial abdominal pain (growling and hissing on cranial abdominal palpation). MSK: ambultory, normal gait, no pain/lameness noted. No spinal pain. Neuro: BAR, stressed in consult but appropriate mentation. Normal CN function. Normal gait/CP in all 4 limbs. PLNs: submandibular, prescap, pops WNL. Rectal: not performed given stress in consult. No blood/faeces on thermometer. Client Communication: Diagnostics:- Manual PCV to accurately assess anaemia status- If PCV confirms anaemia, haematology panel to be sent to laboratory for accurate machine analysis- Recheck ALT and bilirubin levels to assess for progression/persistence supportive of bacterial cholangiohepatitisAdditional Discussion:- FIV is not contagious to humans and cats can live long healthy lives with optimised health management- Patient likely to require 3-4 days of hospitalisation on IV fluids pending blood test results- Results expected in 15-20 minutesLaboratory: PCV (manual): 15%TP (manual): 72 g/LChem 15 + SDMA: ALT 337, TBil 22, mild hyperglycaemia (DDx stress hyperglycaemia)**markedly icteric serum when spun down for manual PCV and in UFO following in-house analysis**Assessment: Problem list:1) Anorexia2) Cranial abdominal pain3) High-normal temperature (39.2)4) Biochemical cholangiohepatopathy - first noted on 26/02/26, persists at today's revisit. 5) Regenerative anaemia - DDx haemorrhage vs haemolysis. PCV 18.9% on 26/02 --> 15% today6) Recent FIV diagnosis - confirmed with external IDEXX FIV PCR panelEdgar Salazar is a 11y 3m MN DSH presenting for lethargy and inappetence following recent hospitalisation for vomiting, hyporexia, and weight loss. He has recently been diagnosed as FIV positive. A biochemical cholangiohepatopathy (ALT 540, TBil 30) was noted on the 26/02/26, and persists at today's recheck (ALT 337, TBil 22). His PCV has decreased, currently sitting at 15%. On clinical examination he had a high-normal rectal temperature (39.2), with moderate cranial abdominal pain. This constellation of signs is most consistent with bacterial cholangiohepatitis. Given his recent FIV diagnosis, antimicrobials and in-hospital supportive care for bacterial cholangiohepatitis have been initiated promptly. An IDEXX advantage haematology panel has been sent externally to accurately characterise the anaemia, and assess a blood smear. The owners were advised that ideally an abdominal ultrasound would be performed to diagnose bacterial cholangiohepatitis (+/- cholecystocentesis for bacterial c/s), but that this is not possible tonight. If Edgar does not improve in 24-48hrswith antibiotics and supportive care (improvement in appetite and cranial abdominal comfort), then an ultrasound with Dr Chris Greenwell (or SASH) is strongly recommended. The owners understand this and are willing to proceed with an ultrasound if necessary (they have good pet insurance cover). Plan: 1) IVFT (Hartmann's) @ 1.5x maintenance overnight 2) Buprenorphine 0.65ml (0.03mg/kg) IV q8-12h - 1st dose @ 10pm3) Cerenia 0.65ml (1mg/kg) IV q24h - 1st dose @ 10pm4) Ondansetron 4mg (0.6mg/kg) q12-24h - 1st dose @ 10pm5) Marbofloxacin 25mg (3.9mg/kg) PO q24h - 1st dose @10pm6) Cephazolin 2.1ml (0f 100mg/ml solution --> 33mg/kg) IV q8h slowly over 10 mins. Next dose due first thing tomorrow morning (when nurse arrives --> bottle of cefazolin is labelled and in big treatment room fridge). 7) Discussed performing abdominal ultrasound with Dr Chris Greenwell if no improvement in 48hrs with the above treatment regimen. 8) Await results of haematology advantage from IDEXX.    Vital Signs    Weight: 6.36;       MMColour: pale pink;       Temperature: 39.2;       HeartRate: 232;       BodyScore: 6/9;       DentalGrade: 3/4;       RespirationRate: 80;       PainScore: 10/24 (cranial abdomen);       CRT: CNG;       

Final Idexx attached    Vital Signs