C10001240 / invoice 30000

Appointment Notes: re xrays csNurses admit for xraysstomach now empty.no obstructive pasttern but suspect now in SI.Re x ray in am.    Vital Signs    

Appointment Notes: coming for x-ray please see open consult CLHISTORYPresenting for: Elaine presented with a history of eating socksHistorical Conditions: LAM had Cerenia yesterdayV/D/C/S: Emesis was attempted to be induced by Apomorphine but was unsuccessful despite 2 doses - having Cerenia on board from yersterday's Vet visit has probably prevented emesisEXAMDiagnostics: X-rays show faeces in the descending colon and material in the stomach which could certainly be a sock. No obstructive pattern at allASSESSMENTForeign body ingestion - sock material visible on radiographs in stomach with no evidence of obstructionPLANDiet Recs:- Give 1/2 his normal dinner tonightAdditional Discussion:- Revisit in the morning with a view to follow-up x-ray and potentially attempted induction of emesis again    Vital Signs    

Reason: Ate a sock - again!!History:O rang late to say eaten sock again within hour or so. Adv come straight down. Been to AREC yesterday CT run as couldnt see stomach well on U/S and rad indicated likely FB.results CT below.O instructed to fed small meals chicken next few days.Hasnt passed motion since home as yet that O aware of but eating well and bright. Last feed 2pm.SUMMARY AREC HX: (yesterday)CONCLUSION CT RESULTS:1. Segmental small intestinal (proximal jejunum) dilation with luminal foreign material and fluid. DDx: textile/fabric (e.g. Sock, cloth), vegetative material (e.g. Phytobezoar), others (e.g. Trichobezoar). A partial vs early complete obstruction is possible. If clinically indicated, exploratory celiotomy could be considered or if clinically appropriate, repeat abdominal imaging (e.g. Radiographs) could be considered in 12 hours to monitor the progression of the luminal material.2. Mild caudal mesenteric and moderate jejunal lymphadenomegaly. DDx: normal variation (e.g. Young patient), reactive hyperplasia, much less likely lymphadenitis, unlikely neoplasia.3. Scant peritoneal effusion. DDx: transudate, modified transudate, sterile exudate, less likely septic exudate.4. Unremarkable thorax. There is no evidence of aspiration pneumonia.Examine:Taken out back with nurse to make vomit. Given Apomorphine tablet x 2! sc in 3mL both times. 2nd tablet after no effect from first 15mins later.Got very drooly and passed small nugget and then watery D+ dripping from anus +LOTS drool but no emesis still. Normal softish stools on rectal.Worried after reading AREC hx re possible sock FB yesterday, avoided Metomide and given Cerenia inj 3.2mL sc.Recovered well.Attempted lateral rad to confrim if sock or not but machine not working (OS fixed by adjusting connections after moved other day).PLAN:Went to Cardiff for rad this evening with AC to confirm if new FB in stomach or not.Also slightly worried whether still previous sock FB passing through still?    Vital Signs