C09991605 / invoice 10000

Reason: Abdo U/sAppointment Notes: Overdue remindersHistory:AHDS with hypoproteinaemia. Negative faecal PCR Protein 45 g/L --> 42 (52-82) Albumin 18 g/L --> 20 (23-40)Ultrasound:Notable:The jejunum demonstrates diffuse mucosal thickening measuring approximately 5.3 mm, with the mucosal layer containing numerous prominent hyperechoic lacteals throughout its length. These changes are most marked within the jejunum and remain evident, although less pronounced, within the ileum (2.7 mm wall thickness) and duodenum (6.0 mm wall thickness). Overall intestinal wall layering remains preserved. Within the proximal duodenum, the mucosa appears relatively less affected compared with the mid-distal small intestine. No focal masses, loss of layering, or obstructive patterns are identified within the small intestine.The gastric wall measures 3.3mm with normal wall layering. No mural masses or focal abnormalities are identified.A small, well-defined hyperechoic nodule measuring approximately 6.3 mm is present within the splenic parenchyma. The lesion is consistent with a splenic myelolipoma. There is no capsular bulging, distortion of the splenic contour, or surrounding parenchymal change. The remaining splenic parenchyma is unremarkable.Normal: Left kidney 53.5mm, right kidney 62.2mm, left adrenal 5.3mm, right adrenal 4.4mmAorta 9.9mm, Left pancreas 11.5mm, stomach 3.3mm, ICJ is clear. Gall bladder and liver are normal. CBD 1.5mm. The bladder is small. Assessment:Chronic gastroenteritis, lymphangiectasia, and hypoproteinaemia (albumin 20) most consistent with a protein losing enteropathy. Acute progression may indicate severe gastrointestinal disease, or a rapidly progressing PLE. These are best distinguished with gastric + duodenal biopsies, however distribution may indicate that endoscopic biopsy samples obtained from the proximal duodenum alone could have reduced diagnostic yield, as the most significant abnormalities are centred within the jejunum.Treatment:Hartmanns fluids at 5% dehydration rate Low fat diet only. RC gastro low fat in hospital. Plan:Await UPC ratio to rule out protein losing nephropathy. If normal then treat for PLE. Await B12 / Cobalamin to assess severity of disease. Will gauge response to treatmentResting cortisol to screen for addisons. Recommend duodenal biopsies to investigate eosinophilic (food responsive) vs pred responsive bowel disease. Would need to perform these PRIOR to pred / chlorambucil treatment. Estimate created. Switch diet to low fat highly digestibility diet white fish/rice/pasta and/or novel protein low fat diet. Recommend gastro low fat / prime 100 kangaroo / lyka goat. Owner has lyka chicken and langaroo at home - ok to feed that. If declined duodenal biopsies then change diet, recheck albumin in 1 week Recheck albumin in 1 week. If <20 then risk of Thromboembolic event, start plavixComms: --- 05/03/2026 13:32:43 LD: Spoke with Keryn., Eating a small amount at home. Not eating in hospital. Went to do diarrhoea twice last night large size uraintion. Very watery. Has not done any diarrhoea in hospital. ok for cerenia and tabs to go home with. Meds:Zenrelia - only the last 2 nights. Tried apoquel. tried cytopoint. Concerned about itchy skin. Getting itchy again. Broached allergy testing with dermatologist when she is better if she wants to definitively find out what allergic to +/- vacicnes. Otherwise mangement. Will find out if zenrelia okBooked 6:30pm discharge.Comms:--- 05/03/2026 14:40:43 LD:Spoke to Elanco representative regarding whether Zenrelia can be used with PLE AND if Zenrelia could be responsible for PLE/gastro changes. Rep said no studies to show that Zenrelia can cause PLE but recommended we stop Zenrelia while commencing treatment for PLE (on assumption we would start pred; which is contraindicated for use alongside Zenrelia). Rep said when restart Zenrelia perhaps elect lower starting dose.    Vital Signs    Weight: 20.6;       

Reason: Recheck BloodsAppointment Notes: Overdue remindersHistory:D+ 4 times today. All liquid. Faecal PCR negative. Large vomit yesterday. Still quite flat at home Eating chicken and rice okExpress glandsLaboratory:Albumin = 20 PCV: 45TP: 42Assessment:    Vital Signs    Weight: 20.7;       

Reason: NEVS Hx AttachedAHDS with hypoproteinaemia. Total Protein 45 g/L 52 82, Albumin 18 g/L 23 40Recommending recheck TP + albumin to ensure not PLE --- 03/03/2026 08:23:54 AS1:AS called - left message    Vital Signs