C09988605 / invoice 10000

Reason: Initial - Ref ECC - GI Issues Brought in by Hansen (O son who aacts as interpreter)Problem List:Chronic enteropathy>Hypocobalaminemia 17/02> 2 discrete regions (approx. 1cm) within the jejunum with focal partial thinning of the mucosa (suspect ulceration). Mild diffuse mucosal speckling throughout the small intestines and intermittent segments of mild blurring of the jejunal submucosa.Hepatopmegaly on AUS 18/02> normal echogenicity and textureCholecystolithRecent History:29/01 presented to rDVM for acute haematochezia and vomiting . Treated as outpatient with maropitant, pro-kolin and recommended GI low fat diet. Bloods performed were largely unremarkable adn faecal float negative for eggs. Due to ongoing diarrhoea Jio Jio developed dehydration and was referred for overnight care to emergency,30/01/26 presented to VRH for AHDS, he was quiet but stable on presentation with mild abdominal discomfort. She was admitted and treated with IVFT 5% rehydration, paracetamol 10mg/kg IV q8, pro-kolin. Discharged home as appetite improved - pro-kolin only.06/02 - rDVM recheck, normal stool for 2 days15/02 - presented to AEC for regurgitation multiple times that day after drinking water. Regurgitation/vomiting persisted despite maropitant administered PO at home. He was stable on exam with normal baseline bloods. Hospitalised for IVF and supportive care (ondansetron IV), discharged following morning as no further regurgitation but had developed diarrhoea.17/02 presented to VRH for ongoing symptoms, TXR and AUS performed (see below) with changes to SI and liver reported.Discharged home with recommendation for B12 supplementation 18/02 as diarrhoea improving and vomiting/regurgitation resolved.Since discharge has been having borborygmi every morning. Ongoing since of abdominal discomfort. Still noticing signs of nausea  a few times a week which owner quickly treats with ondansetron.Appetite - often eating grass, scavenges and getting into grass/plants. Excellent appetite/increasedDiet - RC GI low fat canned (~1/2 can twice daily), prior to this the GILF dry food, prior to this RC beagle dry food. Faeces - no diarrhoea since discharge. Prior to illness would mostly have score 2-3 faeces but score 5-7. Other than when unwell no haematochezia or melena. Vomiting - none since discharge, prior to recent illness would have intermittent nausea and grass eating every 3-5 days at least once a week. 2-3 years ago was overweight so changed to satiety, remained on this for a few years until reached 13kg and then changed back to RC beagle.Resp - no coughing, nasal discharge or changes to breathing. Good energy levelsThirst - normalUrination - normalMobility - normal.Behaviour - still been a bit flat since discharge but mostly normalRecent Diagnostics: Imaging: 18/02 AUS VRH1) Focal areas of mucosal thinning in the jejunum – Ddx: jejunal ulcers, Peyer’s patches.a. Diffuse mild mucosal speckling throughout the small intestines – Ddx: chronic enteropathy (e.g. diet-associated, dysbiosis, infectious), lymphangiectasia, lymphangitis, unlikely neoplasia (e.g. lymphoma).b. Slightly prominent jejunal and colic lymph nodes – Ddx: most likely reactive lymphadenopathy, less likely lymphadenitis or lymphoma.2) Moderate hepatomegaly – Ddx: vacuolar hepatopathy, nodular hyperplasia, EMH, hepatitis/cholangiohepatitis, round cell neoplasia (e.g. lymphoma).3) Moderate mobile echogenic biliary sludge, with occasional small adherent globules– Ddx: cholestasis, fasting, bactibilia, cholecystitis.a. Solitary cholecystolith in the gallbladder.4) Trace amount of anechoic peritoneal effusion05/02/2026: Abdominal ultrasound performed at primary vet and was reported as normal/unremarkable.TXR VRH-  Mild broncho interstitial pulmonary pattern- likely chronic bronchitis or age-related change.- Cholecystolith of unknown clinical significance.Laboratory:17/02 PCV/.TP 51/52cobalamin 172 pmol/L - lowVBG pH 7.326, pCO2 47.1, K 4.1, Na 145, Cl 114,  iCa 1.23, lact 1.1, HCO3 2230/01/26 in-house: qPL 39, qcort 367, crea 49 all WNL28/01/26 Hct 0.41, neut 7.2, lymph 1.3, mono 0.4, plt 225 normal morphology on smearTP 52, alb 24, glob 28, urea 3.5, crea 60, SDMA 14, Na:K 27.5, glu 6.1, ALT 96H, AST 43, ALP 53, Tbili 2chol 4.5, TT4 25. Snap cPL normalCurrent Medications:B12 1000mcg PO SIDPro-kolin enterogenic 1 sachet in morning and 1/2 in afternoon.Ondansetron 4mg given intermittently (every 3-4 days), not given since Sunday/Monay.Cytopoint monthlyPrevious Pertinent Medical History:2025 August weight loss reported 13.4kg when previously 14.5-15kg. Feeding appropriate amount of RC satiety (weight loss diet). Tx with all wormer, transition to normal diet and weight did improvelabs - hypoproteinaemia (TP 44, alb 23, glob 21), crea 40 L, urea 5, ALT 80 WNL remainder WNLUSG 1.038, no active sediment in urine2023 presented for vomiting but good appetite and otherwise well. Tx with maropitant and i/d dietlabs - mild hypoproteinaemia (TP 51, alb 26, glob 25) and mild ALT elevation 138 (16-90) otherwise WNLHistorical lip fold dermatitis, pododermatitis and anal sacculitisMeningitis as a puppy - treated with immunosuppressives (history not available and owner does not remember where was treated).Vacc: August 2025 C5Worming: Nexgard spectraTravel: noneBIOP  since puppyExamination:HR:	RR:	MM: pink/moist	CRT <2s 	Temp:Oral: no dental disease, no pain on opening mouth, no visible lesionsEars: no discharge, no erythemaEyes: no discharge no conjunctival/scleral hyperaemia, fundic exam not performedNasal: no discharge, no pain on palpation of sinuses, no evidence of deformityCVS: no murmur, normal rhythm, strong synchronous pulsesResp: normal effort, normal bronchovesicular sounds all quadrantsAbdomen: no pain on deep palpation, no palpable fluid wave, no masses palpableGenitourinary: Rectal: normal formed faeces, anal sacs palpate normally, no palpable irregularities to mucosaMSK: normal ROM, no pain on palpation, no palpable joint effusionsNeuro: appropriate mentation, normal gait and posture, no spinal pain. Brief CN exam WNLPeripheral LNs: submandibular, prescapular and popliteal nodes are symmetrical and smallBCS:   /9Weight:    kg Procedure:Sedation - Anaesthesia - Imaging:Laboratory:Problem List:Assessment:Treatment:Plan:Communication:Client - see discharge instructionsVet - Medicine referral summaryReason:History:Physical examination:Demeanour - Bright and alertVital signs - MM pink, CRT<2s, HR  bpm, RR  bpm, T  CCardiovascular - Cardiac auscultation normal, pulses strong and synchronousRespiratory - Effort normal, bronchovesicular sounds audible all quadrantsAbdomen - No abnormalities on palpationHead / neck - No abnormalities identifiedMusculoskeletal - Normal gait, no pain identifiedIntegumentary - No abnormalities identifiedGenitourinary - No abnormalities identifiedLymph nodes - Peripheral lymphadenopathy not detectedBCS  /9. Body weight  kg.Procedures:Premed - Anaesthesia - Laboratory:Haematology -Biochemistry - Urinalysis - Imaging:Assessment:Treatment:Plan:Client communication:Vet communication:    Vital Signs    Weight: 12.5;