C09992705 / invoice 10000

Reason: L4 - V+ & D+ With BloodREASON: Presented for intermittent vomiting and diarrhoea.HISTORY:- Intermittent vomiting and diarrhoea since last week.- Scavenger, occasionally eats raw bones with meat.- Was on chicken and rice which improved symptoms.- Yesterday, kibble was reintroduced, leading to worsening diarrhoea with progressive blood.- Also vomited, possibly containing blood, though owner attributes it to raw meat consumed.- Has remained bright, eating and drinking throughout.- Pre-existing conditions: Umbilical hernia.- Access to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavenged. Is a known scavenger.- Current vaccination status: Up-to-date.- Current medications: nil mentionedTRIAGE:- HR: 180 bpm- RR: 30 breaths/min- Temp: Not taken- Mm: Pink and moist- Crt: <2 seconds- Mentation: BAR- Pain Scale (0-4): 0.5- Hydration status (%): 5% dehydratedEXAMINATION:Body Condition Score: 4/9Cardiovascular: 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: Dental score 1/4- Abdominal: Comfortable, no obvious abnormalities - Rectal: not performedUrinary: NSFReproductive (incl ext genitalia): NSFIntegumentary system: NSFLymph Nodes: WNL on palpationEyes: NSFDIAGNOSTICS:Parvovirus / coronavirus / giardia SNAP test: Negative.PROBLEM LIST:1. Vomiting2. HaematocheziaDIFFERENTIAL DIAGNOSIS:Gastric and intestinal causes (eg. dietary indiscretion, foreign body, infectious, inflammatory, neoplastic, or toxic causes), abdominal disorders (eg pancreatic, hepatobillary, or renal disease or peritonitis) as well as metabolic and endocrine disease.ASSESSMENT:Bear presented cardiovascularly stable, though clinically dehydrated from ongoing gastrointestinal losses. Given the history of scavenging, dietary indiscretion is the most likely cause of the clinical signs. If a strict bland diet is maintained and no further scavenging occurs over the next few days with no improvement, further workup will be recommended. This would include blood work, imaging, and faecal testing. Further diagnostics would be recommended sooner if anorexia develops.TREATMENT:Maropitant 20mg administered subcutaneously.PLAN:- Strict diet of chicken and rice with Pro-Kolin for the next few days.- Slowly reintroduce regular kibble once clinical signs have resolved.- Recommend re-presentation for further workup, including bloods, faecal PCR and imaging, if signs do not improve within the next 5-7 days or if condition deteriorates.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 vomiting and diarrhoea of unknown cause.  He had a parvovirus/coronavirus/giardia test which thankfully was negative. Often this is the result of something unusual in the diet (which may or may not have been directly fed to the patient) that has not been well tolerated. Diet:To facilitate your pets recovery it is recommended that you feed small frequent meals of boiled chicken over the next 5-7 days. Ensure that water is available at all times.  If after this time your pet is well, then gradually transition them back to their normal diet - mix the normal diet with chicken and rice in increasing proportions over the next 3 days.Exercise:Please keep your pet rested for the next 2-5 days then gradually reintroduce normal activity over the following week.Medications at discharge: - He was given an anti-vomiting injection that will last 24h. If he vomits despite this, we advised bringing him in sooner rather than later.- Prokolin (probiotic paste): Give 5ml orally twice daily until finished, or until diarrhoea resolves. NEXT DUE: This morningRecheck:Once your pet is discharged home, we advise a reassessment with your primary care veterinarian within ~3 days to monitor your pets progress.  If your pet's condition deteriorates, they become flat or lethargic, go off their food and water, have continued vomiting or diarrhoea or if you have any concerns please contact our team or your primary care veterinarian immediately. If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital.Thank you for trusting our hospital with the care of your pet.    Vital Signs