C10001072 / invoice 10000

Subjective
Presenting Concerns:  
Elsie, a 6-month-old female, presented for diarrhoea, vulvar swelling, and sanguineous discharge that started 5 days ago.  
  
Historical Conditions:
-   Suspected chicken allergy; previous pruritus resolved with dietary elimination.
  
Diet/Appetite:
-   Inappetence; refusing to eat, including chicken.
  
V/D/C/S:
-   Diarrhoea since Tuesday.
-   Some vomiting reported initially.
  
Drinking/Urination:
-   Decreased water intake.
-   Pollakiuria reported.
  
Additional Information:
-   A new dental treat was given prior to the onset of clinical signs.
-   Excessive licking of the vulva noted.

Objective
Mentation: Bright, alert, and responsive  
Wt: 9.1 kg  
T: 38.5¡C  
P: 96 bpm  
MM: Pink, moist. CRT < 2 sec.  
Hydration: Normal  
  
Emotional Assessment:
-   Friendly and calm during examination.
  
Cardiovascular: No murmurs or arrhythmias.  
Abdominal: Non-tender on palpation.  
Integumentary: Good fat covering.  
Urogenital: First oestrus. Marked vulvar oedema and sanguineous discharge present.  
  
Point of Care Diagnostics:
-   Abdominal Ultrasound: The bladder wall appears thickened and irritated. No sediment or masses were visualised. The uterus is enlarged, consistent with oestrus.

Assessment
First Oestrus - With associated vulvar swelling, sanguineous discharge, and pollakiuria. Bladder irritation is likely secondary to pressure from the enlarged uterus.  
Gastroenteritis - Diarrhoea is likely secondary to the ingestion of blood from self-grooming.  
Urinary Tract Infection - Ruled out based on ultrasound findings.

Plan
Medications/Treatments:
-   Paracetamol: 0.5 tablet BID for bladder inflammation.
-   Probiotic paste: 3 mL BID to help firm stools.
  
Additional Discussion:
-   Discussed management of oestrus bleeding using nappies and sanitary pads to discourage licking and maintain hygiene.
-   Advised that the most fertile period occurs in the week following the cessation of bleeding.
-   Recommended scheduling a spay procedure approximately one month after the current oestrus cycle concludes.
-   Outlined post-operative recovery, including one week of strict rest followed by short, lead-only walks.