C10002672 / invoice 10000

Reason: Pancreatits Diagnosed Rv MY/HSDr Holly Sanders completed consultHISTORY:Leon presented for suspected urinary incontenence tonight. The owner reports that Leon defecated on Monday and Tuesday but was not eating and seemed unwell. On Thursday, he was diagnosed with pancreatitis by his primary veterinarian. He was hospitalised for the day and received intravenous fluids, pain relief, and anti-nausea  medication before being discharged. He was re-admitted for the day on Friday and Saturday for ongoing supportive care. He was sent home on Saturday with pain relief (buprenorphine) and anti-nausea (ondansetron) medication. Owner reports he seems to be slightly disorientated after dosing with buprenorphine, is regularly seen staring at the wall etc.Tonight, the owner administered his pain relief at approximately 8:30 PM. He ate some poached chicken. The owner then attempted to give his anti-nausea medication. At this time, the owner discovered that he was wet around his back end, and there was a wet patch with a small dark area on the lounge. It is unclear if the dark patch was faeces or urine. The owner also noted Leon urinated in his carrier on the way to the clinic which is highly abnormal for him.He has been hyporexic but did eat some poached chicken tonight. On Friday night, he refused poached chicken but ate tinned salmon in spring water. He is not interested in his usual cat food or tuna, which he normally has with his Osmolax. There has been no vomiting. He has been urinating normally at home, with four urinations reported the night before last. However, the owner reports that he had not urinated since getting home today until the episode of incontinence on the lounge. The owner notes that the amount of urination seen was abnormal. The wet patches on the lounge the previous night did not have an odour, but the owner could smell urine on the patient when he came out of the carrier tonight.Current meds: Steroids (for a chronic liver problem), Osmolax (for bowel movements), buprenorphine, ondansetron Prophylaxis: UTD vacc and FTW.Pre-existing conditions: A chronic liver issue for which he has been on steroids for several years. History of a severe bladder infection and two bowel blockages, during which he reportedly experienced respiratory arrest three times.Access to toxins eg. Rodenticide: none.TRIAGE:HR: 160RR: 40Temp: 38.9°CMm: pinkCrt: <2 secondsMentation: BAREXAMINATION:Body Condition Score: 4/9Pain Scale (0-4): 1/4Hydration status (%): EuhydratedCardiovascular: cardiac ausculation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, full neuro exam not performedMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain- Abdominal: mild discomfort on cranial abdominal palpation, normal gut sounds- Rectal: not performedUrinary: small, soft bladder Reproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: NSFEyes: NSFPROBLEM LIST:- Pancreatitis - Hyporexia - Lethargy- Urinary incontinence- History of chronic liver disease, bladder infection, and bowel blockagesDIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:Acute pancreatitis (diagnosed by primary veterinarian).Differentials for urinary incontinence in a 19-year-old cat would include urinary tract infection, chronic kidney disease, diabetes mellitus, cognitive dysfunction, or severe systemic illness causing debility.DIAGNOSTICS:BG analysis:pH 7.39pCO2 41pO2 35Na+ 151K+ 3.7Cl- 118Ca2++ 1.23Hct 33%Glu 5.4Lac 1.7COHb 2.7tHb 114MethHb 0.8sO2 44.8BEecf -0.2AG 12HCO3- 24.1Interpretation NSF Diagnostic Imaging: Abdominal Ultrasound   Systematic Abdominal Ultrasound was performed with the following findings: Urogenital Tract (Kidneys, Bladder, Prostate, Uterus): - Kidneys - bilaterally normal echotexture and echogenicity - Left: 46.5mm x 27.1mm, renal pelvis 2.3mm- Right: 49.8mm x 28.3mm, renal pelvis 2.2mm - Bladder - normal bladder wall with anechoic urine Hepato-Biliary System (Liver, Gallbladder): - Liver - normal echotexture and echogenicity - Gall bladder - normal anechoic bile, gall bladder wall normal - Liver hypoechoic to the spleen Gastro-Intestinal Tract (Stomach, Small Intestine, Large Intestine): - Stomach - small amount of ingesta present - Small intestine - small amount of liquid luminal contents, no obvious intestinal dilation (>8mm) - Large intestine - gas dropout Pancreas: - Pancreas - no pancreatits present Spleen: - echotexture and echogenicity normal Adrenals: - LHS: 3.1mm - RHS: not visualised Abdominal Lymph Nodes: Present, homogenous echogenicity Hypoechoic mass at right side of abdomen cranial to kidney 13mmx15mm. Query gastric LN vs right adrenal mass.Mesentary: echotexture and echogenicity normal Intra-abdominal Fluid: none present   Trans-diaphragmatic view: no pericardial effusion, no significant abnormalities Interpretation: nil pancreatitis present, hypoechoic mass cranial to right kidney - query gastric LN vs right adrenal mass. Cystocentesis performed UrinalysisCystocentesis sampleTurbidity: clear Colour: StrawUSG 1.024pH 7.0Pro 1+Blood 3+Glu negKet negBili NormManual:Wet prep: nil crystals Stained: nil bacteria, nil neutrophils/RBC ASSESSMENT:Leon is a 19-year-old cat presenting for lethargy, inappetence, and a new episode of urinary incontinence. This occurs in the context of a recent diagnosis of acute pancreatitis made by his primary veterinarian, for which he has been receiving supportive care including hospitalisation, intravenous fluids, buprenorphine, and ondansetron.On presentation today, his examination is largely unremarkable. He is bright, alert, and appears comfortable with a normal temperature (38.9°C) and stable vital signs. Mild discomfort was elicited on cranial abdominal palpation.The urinary incontinence is a new concern. Urinalysis from a cystocentesis sample showed a USG of 1.024 with no evidence of infection or crystalluria, making a urinary tract infection less likely. The incontinence is most likely a side effect of the buprenorphine, which can cause euphoria or disorientation, as anecdotally reported by the owner. Other differentials in an elderly cat such as chronic kidney disease, diabetes mellitus, or cognitive dysfunction remain possibilities if the signs persist off medication however recent bloodwork with RV was unremarkable. Abdominal ultrasound did not show evidence of pancreatitis today. However, it did reveal a hypoechoic mass (13mm x 15mm) cranial to the right kidney, with differentials including a reactive or neoplastic gastric lymph node or a right adrenal mass. This finding is considered incidental and likely unrelated to the current presenting signs.Overall, Leon is stable. The primary issues appear to be resolving pancreatitis and a new, likely medication-induced, urinary incontinence. Follow-up with his regular veterinarian is recommended to monitor the abdominal mass once he has recovered from this acute episode.TREATMENT:Outpatient: Continue medications prescribed at regular vet.PLAN:Home into owner's care.The owner will continue with the prescribed pain relief and anti-nausea medications at home.Revisit if symptoms persist or worsen. Recommend follow up with regular vet to monitor abdominal mass vs lymph node.CLIENT COMMUNICATION:Discussed the examination findings, which are stable at present. Advised the owner to continue with the current treatment plan as prescribed by their primary veterinarian. Reassured the owner that his temperature is normal. Discussed the importance of monitoring for changes in appetite, urination, and overall demeanour. Advised to seek further veterinary care if there are any signs of deterioration. The full history from the primary veterinarian will be reviewed.Urine was collected for testing in house.    Vital Signs