C09997098 / invoice 10000

Constipation - due to eating tape. 

History:
- Known tape ingestion - ingested builder's tape (at least 2 layers) overnight between 2am and 6-7am approximately 2.5 days ago
- History of pica - previously ingested curling ribbon prior to adoption, passed without issue
- No bowel motion for 3 days - never occurred before, regular bowel habits normally
- Two small faecal balls passed yesterday morning only
- Vomiting bile prior to anti-nausea medication, no vomiting since
- Hiding behaviour, not himself
- Reduced appetite - eating approximately one third of normal intake
- Drinking a lot
- Three doses of Osmolax given with no effect
- Previous X-ray showed faecal backup
EDDU: Reduced appetite, no bowel motion for 3 days, vomiting bile prior to anti-nausea medication
Diet: RC (controlled diet for IBS), dry food available communally, licking gravy from wet food only
Medical condition: IBD, chronic inflammation issues
Medication: Gabapentin (neurological pain), Benefiber quarter teaspoon daily, Pro Symbiotic probiotic daily, anti-nausea medication (2 doses given)
Kept: Indoor, communal household with other cat
Parasite control: none
Behavioural concerns: Pica - known to ingest tape, plastic, plastic bags; very tactile, peels tape in layers

Examine:
Weight change: stable 
Muscle condition score: a
Mentation - BAR
CRT <2 seconds
Teeth/oral cavity - G0 nothing under tongue. 
Eyes - NAD
Ears - NAD
Skin - NAD
Lymph nodes - NAD
Thyroid - NAD
Heart rate:
Heart rhythm - NAD
Chest auscultation/Lungs - NAD
Abdominal palpation - Painful on palpation - but this can be normal behaviour for him at the vet. 
Musculoskeletal - NAD
Urogenital - NAD
Pain score - 1/6

Assessment:
- Suspected foreign body obstruction vs severe constipation secondary to tape ingestion
- Previous X-ray showed faecal backup
- Differential: upper GI obstruction vs constipation vs combination

Sedation 
Methadone 0.3ml + Ketamine 0.3ml + dexdomitor 0.1ml IM --> good effect, able to take rads and place IV with no restraint, but not too sedate RR and HR stable. 

Radiographs: 3 view abdo series
Moderate amount faeces, some food in stomach, slight gas in SI but not an obstructive pattern. 

TX 
- Gave microlax per rectum 
- Connected to IVFT hartmanns 20ml/hr 
- Gave prevomax 1.0ml IV 

Defecated large amount with tape 10 min later. 

Plan 
DC this afternoon when a bit more alert. Give zofran tonight, . Continue probiotics as normal. 
Monitor appetite, nausea and defecation. 
Clinic open tomorrow, call if concerned. 

Osmolax w water in syringe PO + give zofran

Update:
Likely ate tape - 8 inches plastic green packing tape and plastic tape, 2am-7am on the 4/3 he's previously had hx of eating curling ribbon and tape, gnawing tape. Eating but not as much, drinking, mostly normal behaviour - slightly less active, urinating, no vomiting, passing faeces but very hard and tiny which is very unusual - o concerned blockage.
Doesnt have anymore laxatives at home
DK followup w CB re unwell appt or laxatives?
o called back at 11am with further update now V
No unwells left, DK booked 9:30am for tomorrow at the minimum 
DK

CB - dispense osmolax and ondansetron for today given still eating. may be constipated based on radiograph from yesterday and small faeces?
recheck tomorrow if not back to normal. may still have FB obstruction

DK called o relayed options, offered nurse consult to give Humphrey first dose of osmolax via water syringe and zofran, as o worried that although he is usually okay with meds he isn't eating and would prefer him to be seen and have it done as collecting meds anyways. Vomiting bile, hiding. 
Came in saw ES, meds given. 
Appt still in for 9:30am tomorrow as v bile, hiding, in case doesnt feel better after meds and doesnt defecate, better to have unwell just in case. 
CB aware, DK relayed all to o