C10003460 / invoice 10000

Reason: Recheck + Recheck PCV. KKAppointment Notes: ------- Sms reply: YHistory: - Presented for ongoing diarrhoea following discharge Friday - Initially improved over weekend with formed stool, then became watery - Faecal incontinence present - no control over defecation - Blood noted in stool - Vomiting x2 overnight around 4am - Shaking/shivering overnight and this morning - Appetite maintained - still eating - Diet: Boralil with boiled chicken, small frequent meals - Currently on prednisolone weekly, psyllium, prokolin paste - Similar episode in January - Worming overdue by one weekPhysical Exam Findings: - Mentation: Bright, alert - Behaviour: Comfortable, less sore than previous visitMM: - Pink, slightly pale but not concerning - DryAbdomen: - Not too sore on palpation todayIntegument: - Mild dehydration present, tacky mmDiagnostic Results: - PCV: 28% (previously 23%) - Protein levels: stable, no significant dropAssessment: - Problem list: 1. Ongoing diarrhoea with possible pancreatic flare-up 2. Mild dehydration 3. Vomiting 4. Anaemia - stable on current PCV 5. Possible gastric irritation/ulceration secondary to prednisolonePlan: - Losec (omeprazole) 3/4 tablet PO BID, 30 min before meals if possible - Ondansetron - 3 more days supply - Increase psyllium to 1 tsp BID or 1/2 tsp QID with each meal - Continue procolon paste - Electrolyte solution - continue at home - Faecal sample container provided for parasite check - Hospitalisation for IV fluids if not eating, not drinking, or persistent vomiting despite anti-nausea medications - Recheck Saturday if stableCommunications: - Discussed concern that cyclosporin may have triggered this episode but would have expected improvement by now - Discussed possibility of pancreatic flare-up vs prednisolone-induced GI irritation/ulceration - Discussed importance of monitoring hydration status - Discussed that hospitalisation for IV fluids is the only way to reliably rehydrate if condition deteriorates - Discussed that if PCV drops or protein levels decrease, would be more concerned about internal blood loss - Discussed delaying worming until settled - Owner to monitor for appetite loss, reduced water intake, or persistent vomiting and present to for IV fluids if this occurs    Vital Signs    Weight: 7.7;       Temperature: 39.2;