C10001799 / invoice 10000

PRESENTED FOR:Acute vomiting

DIAGNOSTICS DONE: 
Radiographs showed dilated colon/large intestine with no obvious obstructive pattern. 

DIAGNOSIS: Suspect hemorrhagic gastroenteritis (differentials: dietary indiscretion, partial foreign body obstruction, pancreatitis, other)

TREATMENT:
Coco was treated with a antinausea injection under the skin.

MEDICATIONS AT HOME: 
Ondansetron is an anti-nausea medication we use. They come as wafers that dissolve in the mouth and are absorbed across the gums. They should be given half an hour prior to food or other medications to reduce the likelihood of vomiting. START TOMORROW 07/12/22

Maropitant (Cerenia) has been given as a strong anti-nausea medication which will last 24hours.  
If vomiting continues after 24 hours of this medication please contact us. START TOMORROW 07/12/22

Pro-kolin is a probiotic paste which accelerates the resolution of diarrhoea by correcting the intestinal microbiome. Please give as directed on the label. START TONIGHT 06/12/22

CHANGES DIET/EXERCISE/ONGOING CARE: 
We recommend feeding a bland diet for the next 5 days. When constructing a bland diet, the general rules are to avoid raw meat, unwashed vegetables, rich or high fat food. People will often used poached (boiled) chicken, with the fat trimmed off, and cooked white rice.

i/d low fat has been prescribed as a diet for your pet. i/d low fat is a highly digestible, low fat diet with prebiotic fibres to help support the growth of beneficial gut bacteria,  and ginger and omega-3 fatty acids to help calm and soothe the gastrointestinal tract;  Hill’s™ Prescription Diet™ i/d™ Low Fat, is recommended for adult  dogs suffering  from gastrointestinal disorders requiring a low fat food such as pancreatitis. Complete and balanced for long term feeding. As a low residue diet it is normal for the volume and frequency of stool production to decrease. This diet can be purchased from your regular vet clinic or pet stores. Please feed this diet exclusively with no other food unless otherwise specified. 

SHORT/LONG TERM ASPECTS TO WATCH OUT FOR: 
Please monitor for inappetance, worsening diarrhea and persistent vomiting. Please see your regular vet or return here if these clinical signs occur as dogs can dehydrate quite quickly if not eating and vomiting + having diarrhea.

Gastroenteritis can occur due to changes in diet, eating garbage/compost etc. or other underlying diseases such as inflammatory bowel disease, allergic enteritis or Addison’s disease. If your pet has another episode of bloody vomiting and diarrhoea, further tests such as blood tests for Addison’s, abdominal ultrasound or endoscopy may be warranted. In some cases, dietary therapy can be helpful. 

FOLLOW UP AT REGULAR VET:
There is not need to follow up unless the clinical signs described above continues.

DATE/TIME of CONSULTATION: 6/12/22
CLINICIAN: GW
PRESENTING COMPLAINT: Acute vomiting 

HISTORY:
-Vomited 7 times during the past 2 hrs 
-Didn't have appetite during the weekend, went to O's grandmas house this morning, ate breakie but vomited straight away
-Last time seen pooped was last Friday 2/12/22, but has a doggie door so wasn't 100% sure
-O noticed some plastic material in the poop at the time
-No other medical concern
-No rat bait around the house

CLINICAL FINDINGS:
HR 98, resp 30, clear BV sounds on bilateral lung fields, heart sound good w no murmur, BAR, MM pink, CRT <2s

DIAGNOSTIC TESTS:
- Xray
- US

DIAGNOSIS:
- primary GIT e.g.: gastroenteritis, FB 
- secondary GIT e.g.: endocrine

TREATMENT OPTIONS PROVIDED:
Opt1 - medical management with Ondansetron, maropitant, panadol
Opt2 - admit and do more work ups e.g.: diagnostic imaging 

TREATMENT PERFORMED:
- Maropitant SC
- ACP/Butorphanol SC
- Xray

PLAN: 
- Admit overnight 
- Xray
- US
+/- supportive care 

CLIENT COMMUNICATION:
-Informed O the options above
-O wanted to do outpatient xray and US, advised that we are ECC center and therefore cannot guarantee the time available(  if there is a more emergent case it will have to be prioritized), advised O they also hv the option of booking an appointment with their RV instead, O understands and decides to admit for overnight care and more work-ups

PROGNOSIS: good

******************NIGHT SHIFT UPDATE***************

CLINICIAN:NS

SUBJECTIVE:BAR

OBJECTIVE:TPR wnl (refer to smartflow). Did a huge blood tinged diarrhea in hosp.

DIAGNOSTIC TESTS:
Radiographs - gas filled colon/large intestine, unable to appreciate obvious obstruction pattern

ASSESSMENT:Suspect HGE ddx dietary indiscretion, FB, pancreatitis, other

PLAN:
Home with prokolin 3ml BID PO, maropitant 16mg SID PO and ondansetron 4ml BID PO. 
Return if not eating/drinking and diarrhea worsens

CLIENT COMMUNICATION:  
Offered to manage at home as outpatient or stay overnight and repeat radiographs in 12 hours. Owners elected first option, will do repeat xrays/further workup if no improvements and stops eating and drinking.