C09998106 / invoice 10000

Subjective
Presenting Concerns:  
Janos presented for acute gastrointestinal upset, characterized by flatulence and inappetence, followed by an episode of vomiting containing blood after ingesting comfrey leaves (hepatotoxicity in aimals). ate leave at 3:00 and V+ at 3:30pm 
  
Historical Conditions:
-   Janos has no history of pancreatitis.
-   When Janos has had gastrointestinal upset in the past, it has typically manifested as diarrhea with blood AHDS.
  
Diet/Appetite:
-   Due to a shortage, Janos's usual crocodile-based diet is unavailable.
-   He is currently being fed a home-cooked diet consisting of rice (basmati and brown), crocodile tail meat, and vegetables (sweet potato, carrot).
-   A veterinary nutritionist powder and psyllium husk have also been added to the food. The owner is concerned that too much psyllium husk may have been added to the last batch.
-   Janos was inappetent this morning and refused to eat.
  
Drinking/Urination:
-   The patient has been drinking normally and drank water after the vomiting episode.
  
V/D/C/S:
-   Vomiting: The owner reports one episode of vomiting containing a significant amount of bright red blood. This occurred today around 3:00-3:30 PM, shortly after he was seen ingesting Pamprey leaves.
-   Diarrhea: No diarrhea has been observed. His stool on a walk this morning was described as marginally softer than usual and contained grass.
-   Other: The owner reports that Janos woke up this morning with unusually loud, audible flatulence. He seemed unsettled, and his abdomen was audibly groaning. He appeared to be in pain when his belly was rubbed.
  
Current Medications:
-   He did not receive his scheduled medication this morning because he was not eating.

Objective
Mentation: Bright, alert, and responsive  
Wt: —  
BCS: --/9  
T: 38.7  
MM: pink/moist. CRT < 2sec.  
Hydration: Normal  
  
FAS: 3/5 frets and wants to escape. nice dog though  
  
Eyes: bilateral conreal opacity  
Ears: Clean with no discharge or erythema AU.  
Nose: Clear, moist without discharge.  
Oral: Calculus and gingivitis absent. No masses or other lesions.  
Cardiovascular: No murmurs or arrhythmias, strong synchronous pulses.  
Respiratory: Normal bronchovesicular sounds bilaterally.  
Abdominal: The patient appeared uncomfortable on abdominal palpation, gasy.  
Lymph Nodes: No peripheral lymphadenopathy.  
Integumentary: No evidence of ectoparasites, full coat with clear skin.  
Neurologic: No ataxia, normal mentation.  
Musculoskeletal: Ambulation normal, no lameness observed.  
Urogenital: Normal external anatomy.  
Rectal: A digital rectal examination was performed. No blood was noted on the glove. The feces were foul-smelling, very soft, and bright yellow in color, suggestive of impending diarrhea.

Assessment
Acute gastroenteritis with hematemesis – The clinical signs of flatulence, abdominal discomfort, soft stool, and inappetence are consistent with gastroenteritis, likely secondary to a recent, abrupt diet change. The hematemesis is a significant concern, likely caused by irritation from plant ingestion.  
  
Suspected plant toxicity – DDx: Camprey leaf ingestion. The patient vomited bright red blood after ingesting Camprey leaves. A consultation with the Animal Poisons Hotline indicated a low risk of severe liver damage but recommended monitoring of liver enzymes as a precaution.  
  
Underlying food allergies – This is a chronic condition requiring a strict novel protein diet (crocodile), which complicates management during the current food shortage.

Plan
Pending Diagnostics:
-   A comprehensive blood profile, including liver and kidney parameters, was performed today to establish a baseline.
-   A repeat blood test to recheck liver enzymes is scheduled for Monday. An appointment has been booked for 9:00 AM at the Pymble clinic. An alternative appointment is available at 3:30 PM at this clinic if preferred.
  
Medications/Treatments:
-   An injection of Cerenia was administered in the clinic for nausea and visceral pain relief.
-   Cerenia 60 mg tablets were dispensed. The owner is to administer half a tablet by mouth SID, starting tomorrow evening.
-   Losec (omeprazole) tablets were dispensed to decrease stomach acid production and protect the gastrointestinal lining.
-   A 60 mL tube of Pro-colon paste was dispensed to manage expected diarrhea. This can be given to both Janos and Illy as needed.
  
Diet & Feeding Recommendations:
-   Continue feeding a bland diet of cooked crocodile and rice.
-   Cooked sweet potato and carrot can be included for fiber, but no other new vegetables should be introduced.
-   The Pro-colon paste can be mixed with his food.
  
Additional Discussion:
-   A consultation was held with the Animal Poisons Hotline to discuss the potential toxicity of the ingested Pamprey leaves. Plan above was provided by the hotline vet
-   The total estimated cost for today's diagnostics and treatments is $617. A gap payment claim will be processed.

also off normal crocodile diet, rc

Owners mother (Maria) called said possible vomit with blood. I suggested vet check does not sound normal however unable to see him at Pymble due to capacity offered Killara today or tomorrow. O upset having to go to killara doesn't understand why we cant simply fit him in. Reiterated we are at capacity today only option is to drive to killara. O to think about. DM