C09995176 / invoice 10000

Bloated Abdomen / Not Eating / Lethargic
Paws App Details:

Booking Type: Consultation
Booking Notes: Lethargic, not eating much, Bloated Abdomen 
Pet Insurance Provider (if applicable): Pet Insurance Australia
Pet Insurance Policy # (if applicable): PI21480011

7 day hx lethargy, NQR 
Innapetant last 24 hours - very unusual for her 
O notes increasing abdominal distension 
No ratbait exposure 
PE
MM WHITE, no crt visible 
HR 160, 2/6 systolic murmur 
RR elevated, RE WNL 
SIG abdo distension, fluid wave visible 
Metatarsal pulses palpable but faint, femorals thready 

Discussed with O very concerned, rec significant workup immediately - Abdo US, tap if indicated, CBC/Chem/ PT. O happy TGA 
Abdo: Lakes of free fluid in all 4 AFAST locations. A significant amount (at least 15) hyperechoic nodules visible on spleen and throughout liver. 
Abdo tap and cytology: Significant amount of blood, on cytol ++++ lymphocytes seen - multifocal/ metted splenic lymphoma? 
PCV 15, hypochromic, normocytic, +++ retics on smear 
Mild monocytosis, eosinopeania
PT WNL 
TP 51 
Cl 108 
Lipase 4813 (acute abdo/ inflam) 
dx metastatic neoplasia, haemorraging sig amount into abdomen. Not surgically or medically fixable based on changes seen on US. 
Discussed above with O, dire prognosis, strongly rec euthanasia. O happy TGA 
PTS IV euthasol, confirmed death with lack of heartbeat, corneal reflexes. 
Paw prints made, O will let us know about cremation. 

Health Check / Vaccination
Paws App Details:

Booking Type: Vaccination
Booking Notes: Health check and vaccination

History: Moved from Perth, now living in Esperance. 
Had a severe anaphylactic reaction to bee sting when living in Perth, needed plasma, epi CRI was in hospital for some time. Then got stung again and was fine with dex Both time stinger was found. 
Also had issue with vomiting previously - diaphragmatic hernia was on Ddx list by previous vet. Vomitined resolved and no further workup done. 
Current Meds: Gives zyrtec if required for itching. Used to be on cytopoint. not now. 

Exam 
Demeanor: Friendly
Neuro: QAR 
BCS 5/9 
Ears: NAD
Eyes: Mild bilateral conjunctivitis - dispensed amacin ointment 
Nose: Brachy 
Oral: NAD 
Dental 0/4 
MM pink 
Thoracic Ausc: No murmur or arrthymias 
LN:NAD
Integ: NAD
MSK: shortend spine - previous vet diagnosed multiple kissing spine lesions. O is aware not to allow excessive jumping. 

Communication with O
Bee allergy - if gets stung while in Esperance bring straight in. If going camping and going to be extended distance from vet clinic consider getting dex inj/more antihistamines to have on hand. Discussed with Vet if vomiting recurs 

Tx C5 

Meds Amacin eye ointment BID for 3-5 days 
Bravecto and pyranquantal given in consult 

Plan 
12 months C5