C09992151 / invoice 10000

Mucous and blood-tinged diarrhoea over the weekend + new cat in the houshold + postponed vaccination 

History: (- C/O diarrhoea for 3 days, started last Saturday. Blood tinged (once off) and watery with mucus. Irritated/swollen anus from the diarrhoea (licking the anus after toileting).
- Vomiting started Saturday night - both food and liquid, no more today
- Slightly reduced appetite in the past 3 days, improving today
- New kitten introduced last Monday
- Open mouth breathing during travel and at home when stress

EDDU: Appetite slightly reduced but improving. No vomit today so far. Diarrhoea is improving as per O, however no stool passed yet. No sneezing and coughing.
 Diet: (60 g per day Trilogy Dry + chicken broth wet treat (Ciao) + Ciao creamy treats 3x a week)
 Medical condition: (chronic diarrhoea - positive for Giardia, Campylobacter, Coronavirus, Clostridia in Nov 2024)
 Medication: (no)
 Kept: (indoor)
 Parasite control: (Milbemax 3 weeks ago)
 Behavioural concerns: (Introduction of the new kitten )

Examine:
 Weight change: (- 100g )
 Muscle condition score: (a)
 Mentation - (BAR)
 Mucous membrane (pink),(moist)
 CRT (<2) seconds
 Teeth/oral cavity - (G0 )
 Eyes - (NAD)
 Ears - (NAD)
 Skin - (NAD)
 Lymph nodes - (NAD)
 Thyroid - (NAD)
 Heart rhythm - (NAD)
 Chest auscultation/Lungs - (NAD)
 Abdominal palpation - (NAD)
 Musculoskeletal - (NAD)
 Urogenital - (NAD)
 Pain score (0/6)

Assessment:
- Acute gastroenteritis -  ddx reinfection of Giardiosis vs flare up of coronavirus/campylobacter due to stress from the introduction of the new kitten.
- Chronic diarrhoea (soft stool) - ddx food allergy vs IBD. 
- Mild pyrexia - ddx Stress vs infection 
- Not fit for vaccination due to the temperature
- Open mouth breathing - ddx stress vs heart disease (no indication at the moment)

Treatment:
- Fortiflora - 1 packet daily sprinkled on food
- Cerenia injection 0.5 mL SC
- Continue Zylkene
- Keep kitten separated for longer - gradual introduction recommended (can take months)

Plan:
- Faecal PCR - collect sample tonight, bring tomorrow, store in fridge overnight if collected to night
- Monitor appetite and ensure hydration
- Monitor for more vomits
- Postpone vaccination until resolved
- Consider Hills Biome or ID diet in future food trial for the chronic diarrhoea

O comms MHR
It is a bit hard to see but there is some translucent substance on his right eye (left in the picture) 

Photo just looks like some serous discharge in the medial canthus, eye doesn't look red/sore. Just clean eye with warm water and monitor. If holding eye closed or eye looks red then come back to have it checked TC

ETA 9am blood in pee, urinating small amounts in and out of litter box for past week

History: (
- Past week been frequently using the litterbox
- Noticed more smaller clumps of urine
- Last night noticed spots of blood in the litter
- Had a vomit this morning and diarrhoea - food and hairball
- Had one visiter but was not stressed about it, was playing with them. No other change in environment that owner could think of)
 EDDU: (Appetite slightly reduced)
 Diet: (Trilogy adult barramundi dry. No wet food - doesn't really like wet food and have had diarrhoea from having wet food before)
 Medical condition: (History of diarrhoea - giardia, camplyobacter, coronavirus, clostridia)
 Medication: (No)
 Kept: (Indoors only)
 Parasite control: ()
 Behavioural concerns: (No)

Examine:
 Weight change: (+450g)
 Muscle condition score: (A)
 Mentation - (QAR)
 CRT (<2) seconds
 Teeth/oral cavity - (G1, MMs pink and moist, CRT <2s)
 Eyes - (NAD)
 Ears - (NAD)
 Skin - (NAD)
 Lymph nodes - (NAD)
 Thyroid - (NAD)
 Heart rate - (180)
 Heart rhythm - (NAD)
 Chest auscultation/Lungs - (NAD)
 Abdominal palpation - (NAD - very small bladder, not blocked)
 Musculoskeletal - (NAD)
 Urogenital - (NAD)
 Pain score - (0/6)

Urinalysis Results

Sample collected by (cystocentesis) 
Appearance of urine: (clear) 
Glucose (neg)
Bilirubin (neg)
Ketones (neg)
Blood (+++)
PH (6.5)
Protein (++)
USG (1.042)
Sediment(See imagyst)


Assessment: (FLUTD - admit to collect urine. 0.2ml buprenorphine IM when admitted

Hematuria +++ otherwise UA unremarkable - most likely FIC)

Treatment: (Continue with 0.2ml buprenorphine OTM BID. Start 50mg gabapentin PO BID and 1 capsule zylkene SID. Increase water intake, more wet food)

Plan: (Sent home with handout on FIC)

Recheck/Recall/Reminder: ()