C09985779 / invoice 10000

Reason: VomitingHISTORY:Vomiting and diarrhoea that has waxed and waned for last month; suspect Jack is vomiting more that O initially noted. Diarrhoea has relapsed again with incontinence around the house; still will have normal stools but then the next one will be watery with mucus. This morning vomited three times and had liquid stool. Seemed lethargic for the first time, reluctant to go out for a walk. No hx of GI disease up until now. Feeding combo of blackhawk and ziwi peak now, switched onto digestive care last month. Hx of pannus being managed with tacrolimus. Currently stable. EXAMINATION:Demeanour/Behaviour: QAR, nervous Body Condition Score: BCS 3/9, 3kg lost in 8m Eyes: pannus stable Integument/Ears: ears showing no discharge bilaterallyLymph Nodes: lymph nodes symmetrical and not palpably enlarged anywhere on body Oral: MM pink, mild calculus Cardiovascular: HR 80, no murmur or arrhythmias heard on auscultationRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeAbdominal: no detectable pain on abdominal palpation, no distension or organomegalyNeurological: full neurological exam not done todayMsk: mild stiffness when ambulating, full ROM not asssessed PROBLEM LIST:Chronic vomiting and diarrhoea - primary v secondary- primary: IBD v neoplasia v non-obstructive FB- secondary: pancreatitis  v metabolic v other DIAGNOSTICS:NoneTREATMENT:Cerenia 60mg PO SID as needed Pro-kolin 6ml PO BID Novel protein diet - discussed goat v crocodile v other PLAN:Novel protein diet trial (duck, rabbit, or crocodile protein options discussed)Continue Pro-Colon supplementation (6ml dosing)Monitor response over next few weeksAbdominal ultrasound estimate to be provided for consideration if symptoms persistFecal sampling may be considered though infectious causes less likely at this ageFollow-up as needed based on response to dietary management    Vital Signs    Weight: 31.6;