C09983488 / invoice 10000

Reason: L4 not eating vomiting & diarrhoea hx of pancreatiREASON: Vomiting and diarrhoea.HISTORY:- Oscar is an almost 10 year, 8 month old, male neutered Cavoodle weighing 7.5 kg.- He presented for an episode of vomiting on Friday afternoon, which was after food.- He was reported to be mopey on Saturday but was still eating.- A second vomit occurred on Saturday morning, which was yellow bile with two pieces of carrot observed. There has been no vomiting since.- Yesterday, his faeces were normal. He was being fed boiled chicken to help settle his gastrointestinal upset.- He slept through last night without any issues.- This morning, he was perky and happy on his walk but refused breakfast (boiled chicken).- He has been drinking water but has had no appetite.- This afternoon, he had an episode of gooey, normal-coloured diarrhoea, followed by another small episode of red, bloody diarrhoea.- He is anecdotally a "food monster" and there is a possibility he could have scavenged something, but there is no evidence of this.- Pre-existing conditions: History of pancreatitis as a puppy and ongoing food sensitivities/sensitive gut. Has been stable for a long time on his current diet.- Access to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavenged but he does scavenge- Current vaccination status: not discussed- Current medications: Diet consists of Hill's Prescription Diet Low Fat Digestive Care (casserole cans and dry food) and Royal Canin Gastrointestinal Low Fat wet food. He also receives a kangaroo chew at night.TRIAGE:- HR: 100 bpm- RR: 28 breaths/min- Temp: 38.6°C- Mm: Pink- Crt: <2 sec- Mentation: QAR- Pain Scale (0-4): 0/4- Hydration status (%): Clinically hydratedEXAMINATION:Body Condition Score: 5/9Pain Scale (0-4):Cardiovascular: Cardiac auscultation normal, HR 100 bpm, normal rhythm, pulse pressures normal and synchronous.Respiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal discharge. Increased borborygmi auscultated over the chest.Neurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performed. Observed to be anxious but responsive.Musculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performed.Gastrointestinal:- Oral: Gums moist and pink. Mild tartar present. Had a dental procedure in April of last year.- Abdominal: Tense on palpation, making a thorough assessment difficult. Did not appear overtly painful on deep palpation. Increased borborygmi auscultated.- Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: Coat described as wiry, which is normal for him.Lymph Nodes: WNL on palpationEyes: Cataracts developing bilaterally.PROBLEM LIST:1. Haemorrhagic diarrhoea2. Vomiting (resolved)3. Inappetence4. History of pancreatitis and food sensitivityDIFFERENTIAL DIAGNOSIS:- Acute haemorrhagic diarrhoea syndrome (AHDS)/Haemorrhagic gastroenteritis (HGE)- Dietary indiscretion- Pancreatitis flare-up- Infectious enteritis- Foreign body (considered less likely given clinical signs)DIAGNOSTICS:Nil performedASSESSMENT:Oscar presented for vomiting and diarrhoea, with the main concern being an episode of haematochezia this afternoon. He has a history of pancreatitis and a sensitive gut but has been well-managed on a prescription low-fat diet. The vomiting appears to have resolved as of Saturday morning. On examination, he is bright, alert, and well-hydrated. His vital signs are all within normal limits. His abdomen is tense, likely secondary to anxiety, but does not appear to be overtly painful on palpation. Borborygmi are increased. Given the presentation of acute onset bloody diarrhoea in a small breed dog, a primary differential is AHDS. Other differentials include a flare-up of his underlying gastrointestinal sensitivities, possibly secondary to dietary indiscretion, or infectious causes. An obstructive foreign body is considered less likely as the vomiting is not ongoing and he is clinically well. During the consultation, he readily ate some boiled chicken, suggesting his inappetence may be resolving.TREATMENT:- Boiled chicken offered in-clinic, which was readily consumed.PLAN:- Discharge for monitoring at home.- Advised to return immediately if he becomes lethargic, develops profuse watery diarrhoea (i.e., "hose pipe diarrhoea"), or if vomiting recommences. One further episode of vomiting is not a major concern.- Discussed that paracetamol can be administered for mild abdominal discomfort if needed, at a dose of 15 mg/kg.- Reassurance was provided that haematochezia is common with diarrhoea in dogs.- Advised on signs of a gastrointestinal obstruction, which typically involves persistent vomiting and profound lethargy. Advised that diarrhoea is less common with a complete obstruction.DISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide Oscar’s recovery. Do not hesitate to contact us at any time if you have any concerns or questions, and please let your vet or our client care team know if you have any questions about this information before you take your pet home today. Diagnosis: GastroenteritisYour pet has been diagnosed with diarrhoea of unknown cause. Diarrhoea can be caused by something as simple as a change in diet, scavenging behaviour or infections from worms, bacteria or viral infections. Supportive treatment is often required to prevent dehydration and will include intravenous fluid therapy, pain relief, anti-nausea medications and possibly antibiotics. This is not the case with Oscar at this stageIf your pet responds well to supportive treatment no further work up will be required, however if the diarrhoea is not responding then further investigation is warranted to ensure there are no more serious underlying conditions that require specific treatment. Diet:To facilitate your pets recovery it is recommended that you feed small frequent meals of boiled chicken over the next 3-4 days. Ensure that water is available at all times.  If after this time your pet is well, then gradually transition them back to their normal diet - mix the normal diet with chicken and rice in increasing proportions over the next 3 days.Medication:Pro kolin Please give 3mls Twice daily for 4-5 days for diarrhoeaParacetamol- Please give 15mg per kg for additional pain relief when needed every 8 hoursWe use Children Xylitol free panadol which is 48mg/ml so about 2mls every 8 hoursExercise:Please keep your pet rested for the next 2-5 days then gradually reintroduce normal activity over the following week.Recheck:Once your pet is discharged home we advise a reassessment with your primary care veterinarian within 48 hours to monitor your pets progress.  If your pet's condition deteriorates, they become flat or lethargic, go off their food and water, develops vomiting, has continued diarrhoea or if you have any concerns please contact our team or your primary care veterinarian immediately. Thank you for trusting our team with the care of your pet.    Vital Signs    Weight: 7.5;