C09988809 / invoice 10000

EASON: Chronic diarrhoeaHISTORY: - Huge has a known history of pancreatitis diagnosed about 6 months ago that presented with vomiting, inappetance and diarrhoea and required hospitalisation. It is unclear how this was diagnosed (confirmed on ultrasound vs assumed based on bloods) without his full history. He has been on royal canin gastrointestinal low fat food since.- Initially presented last week with diarrhoea and some spotting of blood. Changed to chicken and rice diet and treated with pro-kolin which provided temporary improvement mid-week but symptoms returned.- Current diarrhoea described as mucoid and yellow, accompanied with tenesmus.- No vomiting, appetite changes, lethargy or behavioural changes- Pre-existing conditions: Pancreatitis (diagnosed 6 months ago), heart murmur, multiple small skin lumps (weren't concerning)- Access to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavenged- Current medications: Pro-kolin finished last night.TRIAGE:- HR: 100 bpm- RR: 36 breaths/min- Temp: 38.5- Mm: pink moist- Crt:  1s- Mentation: BAR - Pain Scale (0-4): 0.5/4 - Hydration status (%): EuhydratedEXAMINATION:Body Condition Score: 6/9Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: Neurologically no significant findings, no cranial nerve or proprioceptive deficits/gait, full neurological exam not performedMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: NSF- Abdominal: No pain on palpation, gut sounds ++- Rectal: Extremely full anal glands bilaterally, easy to express, large volume gritty fluid. Yellow faecal material, no masses.Urinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS: Blood testing in house:CBC:- Results: unremarkable.Biochemistry: - Results: Urea 12.6, ALT 169, ALP 253.- Interpretation: Urea may be from a recent meal or gastrointestinal bleeding, less likely renal with normal creatinine. Liver changes are likely age related.PROBLEM LIST:1. Chronic diarrhoea2. Pancreatitis (known)3. Heart murmur4. Mild liver enzyme elevationsDIFFERENTIAL DIAGNOSIS: Large bowel diarrhoea: Inflammatory bowel disease, colitis, Dietary intolerance, infectious cause, metabolic disease, neoplasia.ASSESSMENT: 13-year-old with suspected history of pancreatitis presenting with chronic diarrhoea persisting despite dietary management and pro-biotic management. Initial improvement with medication followed by recurrence suggests underlying cause beyond simple dietary indiscretion. Mucoid nature of diarrhoea and accompanying tenesmus suggests large bowel involvement. No pain present on abdominal palpation, appetite or behavioural changes make a chronic pancreatitis unlikely to be a contributing factor. Bloodwork shows a mild elevation in liver parameters which are likely age associated and not immediately concerning. Given age and chronic nature, conditions such as inflammatory bowel disease should be considered. Continuing pro-biotics and adding fibre to the diet has been recommended. If failure to respond in a few days, have discussed an exclusive dietary trial with hypoallergenic food in the case of a food-responsive enteropathy, however failing that faecal sampling and cobalamin testing should be considered.TREATMENT: Continue chicken and rice dietContinue pro-kolinAdd psyllium husk fibre 2 teaspoons BIDPLAN:- Add in additional fibre and continue on pro-biotics.- Hypoallergenic diet trial if fails to improve (Royal canin, hills Z/D).- Consider faecal and cobalamin testing to further investigate chronic enteropathy.DISCHARGE INSTRUCTIONSPlease read through the following instructions to help guide your pet’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. It can also be caused from organ dysfunction.Hugo showed no signs of abdominal pain and his physical exam was normal aside from enlarged anal glands.His bloods revealed a mild elevation in his liver parameters which is not uncommon in older dogs and unlikely to be a major issue. He also had an elevation in his urea which can be from eating prior to blood testing, blood in the gut (from his previous diarrhoea) or kidney changes (unlikely).We will continue to treat with probiotics and add in fibre in the form of psyllium husks.Medications:Pro-kolin: Please continue 2 days beyond resolution of diarrhoea.Psyllium Husks (Benefibre is the easiest option as a powder): Give 2 teaspoons onto the food once or twice daily to firm up faeces.Diet:Please continue on chicken and rice for the next few days while adding in the fibre. If there is no improvement in a few days I would consider starting him on a hypoallergenic diet in case he is reacting to something in his food. Example diets include Royal Canin Hypoallergenic or Hills Z/D.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