C10003451 / invoice 10000

swollowed hair tye - thrown up anther hair tye last night, upset stomach,
quiet not himself, still eating

History:
threw up a small coiled hair tie yesterday night. He was a little lethargic during the day prior to this. Ate his breakfast this morning and is drinking water but seems a little tired this morning. No otrher issues to note, he has otherwise been well. Alex found a few hair ties under the bed which he may. UTD with Vacc and parasite control.

Examination:
Demeanour: BAR
BCS: 4/9
MM: Pink and moist     
CRT: <2
Hydration: Euhydrated
HR: 130
RR: 24  
Temp: 38.1
Cardiac: No murmurs auscultated, normal rhythm and intensity
Lungs: Normal lung sounds bilaterally, normal respiratory effort
Eyes: Behaving visually, corneas clear,
Ears: External ear canals and pinna clean with no erythema or discharge 
Nose: Nares moist with no discharge present.
Oral:Unable to perform oral exam as he was quite resistant
Integument: Skin and coat clean and shiny, no evidence of alopecia or ectopic parasites. 
LN's: All appropriate in size/symetry
Abdomen: Soft and comfortable on palpation
MSK: Ambulating WNL x4, no appreciable lameness or ataxia 
Urogenital: External genitalia clean with no discharge or faecal staining present.
Rectal: Rectal not performed, no perianal swelling or erythema present.
Nervous system: Mentation appropriate, no cranial nerve deficits noted

Assessment:
Problem list
1. Mild lethargey
2. V+ hair tie yesterday

DDx
Dietary indiscretion, Gastritis/GE vs GI Foreign body

Cannot rule out FB without imaging but given his energy in consultation and the fact he is still eating and drinking decreases suspicion. Offered abdominal xrays but O but declined and opted to monitor him at home for net couple of days.

Treatment:
- No treatment required today

Plan:
- Monitor at home for next couple of days and advise if he goes innapetent, vomits, becomes more lethargic or stops defecating. Consider radiographs if worsens or shows these signs.