C10000517 / invoice 10000

Reason: RecheckIntern: SNHistory:Archie is presented for a recheck following recent consultation with ECC. He was last managed by ARH Neurology for ictal episodes and the IM team for chronic gastrointestinal disease in 2024. See previous records for a comprehensive history. The owner reports that since 2024 there had stability in his GIT disease with home cooked diet. There would occasionally be episodes of hyporexia which were self limiting. His previous ictal events had also significantly improved. There has been a chronic history of dermatological disease which is managed at the RV with cytopoint.He was presented through ARH ECC on 27/2 for acute onset haemorrhagic diarrhoea (haematochezia) and inappetance. No vomiting, but burping and lip licking noted. OR chronic intermittent gastrointestinal signs characterised by diarrhoea, vomiting and hyporexia usually self resolves at home within 24- 48hrs, and the haematochezia is not usual. On PEx, he was QAR (usually reactive in hospital). O elected for outpatient management given his temperament, and anti-nausea (ondansetron, maropitant), prokolin and lectade were dispensed. OR that the GI signs observed on the 27/2/26 developed soon after the O had returned back to work after having been at home for a few weeks. Apart from this change in routine, no alterations were made to his diet. Today, OR that Archie's diarrhoea has improved - stools are no longer haemorrhagic and intermittently normal stools Prokolin administration was trialled initially but discontinued due to issues with administration and palatability. Stools and appetite did improve initially but after O returned back to work on Tuesday, Archie was distressed upon his return home and started demonstrating similar signs of unsettledness and nausea again - lip licking, pacing, 'burping'. Yesterday, he produced mustard coloured soft stools, but formed stools have been produced since. He has been flat at home, but has perked up today. Pexion was discontinued when he was inappetant, and recently recommenced at a lower dose due to ataxia observed. The ataxia has since improved. No abnormal neurological signs or seizure activity has been noted. Tehre has been no vomiting. His appetite has returned. Diet: Cooked (beef mince + pumpkin) + black hawk dog food. Treats are typically apple or dried turkey. Diavetalac milk administered twice weekly Receives greek yoghurt supplementation with meals. Current medications: Pexion 50mg in AM, 100mg in PM - O decreased dose after recommencingDiazpem PRN for ictal events Cytopoint SQ monthlyOndansetron 4mg OTM q8 PRN Maropitant 2mg/kg PO q24 - not being administeredLectade solution PRN Examination Findings:Unable to examine due to demeanour. BAR in consult, pacing and appears anxious. Ambulation appears normalOwners showed MM - appear pink and moist (trying to bite)Cardiac auscultation only brief - normal rate and no murmur detected but limited and growlingRespiratory effort normal.Unable to palpate abdomenNo temperature takenSome alopecia and scabs on left fore antebrachium. Skin erythema ventral abdomenLaboratory:None todayAssessment:Problem list (acute): - Haemorrhagic diarrhoea - resolved- Inappetance - intermittent, improvedProblem list (chronic): - chronic intermittent V+ and D+ - chronic atopy - intermittent ictal eventsThere has been clinical improvement in Archie's gastrointestinal signs since his emergency visit last week although there has not been complete resolution. Given the chronicity of his gastrointestinal issues, an underlying chronic inflammatory enteropathy is likely. Hypoadrenocorticism is considered less likely in the face of protracted signs, but an ACTH stimulation is necessary to rule it out. Endoscopic biopsies would be required for definitive diagnosis of CIE. However, diet modification should be trialled as a first step. Given Archie's historical aversion to most commercial diets, pursuing a balanced diet formulated by VNG or use of Compete Me toppers should be considered. Stress associated with owner's return to work may have exacerbated the clinical signs. The pacing behaviour, lip licking and swallowing is most consistent with nausea/ abdominal discomfort. Oesophagitis or other oesophageal disease is possible. As this current GIT episode if improving supportive care with ongoing ondansetron administration is recommended. If there is clinical deterioration then further investigation is required. Archie's current diet is not nutritionally balanced. Diet adjustment through commercial vet diet or nutritional consult is recommended. The relationship between Archie's' GIT disease and previously noted neurological events is unknown although it is plausible that these events are related and that stress/anxiety contributes. Continuing pexion is advised. The atxaia is considered secondary to Pexion use. Treatment:Commence:Fortiflora sachets BID on foodPlan:- Continue ondansetron q8 for at least 3 days until clinical signs fully resolve- Consider a commercial veterinary diet appropriate for GIT disease or trial complete me range to have a nutritionally balanced diet- Monitor episodes of suspected reflux/ nausea- Commence fortiflora probiotics- Represent if there is active vomiting, hyporexia again, progressive diarrhoea- Attempt to manage anxiety Contingency- If ongoing concerns for reflux then can trial a course of omeprazole however have warned owner this may not be effective and could cause diarrhoea. Can dispense 5 day course if required and can have a 2 day course of maropitant if stable but mild hyporexia.If not clinically improving then hospitalise and consider ultrasound and bloods. Owner does not feel warrants hospitalisation now and declined bloods. Longer term plan: Dietary modification - VNG, can consider scope and biopsies (briefly discussed today), ideally needs ACTH stim first to rule out addison's disease.    Vital Signs    Weight: 6.8;