C10003499 / invoice 10000

Reason: Not Eating One V+ This AMAppointment Notes: Special payment terms exist, Overdue remindersReason: Student: Clive Ng/ Kade WilliamsReviewed By: CKHistory: Recheck for recurrent vomiting d diarrhoea.  Manny is a 14yo 3mo MN Maltese X presenting to UQ SAH Urgent Care today for inappetance, progression of coughing and lethargy. He vomited once this morning at 7am - where the vomitus was the dinner he had last night at 1830. The owner gave him a Cerenia (Maropitant) tablet after this episode, then offered him food an hour later at 8am. Manny ate this however left a little portion. Owner reports that Manny is not as bright as he is used to be and not so interested in his food, which is out of the ordinary. She reports that he is not as energetic as before and has not been interested in short walks these past few days.In the past few days, Owner hadn't been able to sleep well due to Manny's excessive coughing overnight, where there would be episodes of dry retching. Owner is mainly concerned about his inappetence. Previous medical conditions:- MMVD Stage B1 with grade 4/6 apical holosystolic heart murmur. Last cardiologist check was a couple of years ago.- CKD IRIS Stage II and hydronephrosis secondary to an ectopic ureter- Urolithiasis with calcium oxalate crystals- Chronic cough associated with stress/excitement- Multiple subcutaneous masses- Mature bilateral cataracts (diagnosed by Animal Eye Services): currently managed with Acular BID OU- Pruritic skin disease- Suspected primary hyperparathyroidism - fluctuating mild hypercalcemia- Mild diffuse pancreatopathy seen on U/S 10/2/26- Hepatopathy with non-specific nodules + hepatic lymphadenopathy seen on U/S 10/2/26- Gall bladder sludge/functional stasis seen on U/S 10/2/26 Current medications:- Telmisartan 10mg/ml 0.8mL PO SID- Acular BID OU- Oclacitinib SID- Maropitant 16mg PO SID PRN- Metronidazole half 250mg tab PO BID- Pimobendan 1.25mg PO BID- Esomeprazole 0.57mg/kg ½ sachet BIDDiet: Hills I/d Appetite: Decreased - only half of his normal breakfast ingestedUrination/Defecation:Urinating and defecating normally. According to O, no changes, stool good consistency and texture. Access to toxins: nilEnvironment: Kept at homeProphylaxis:Vaccination - UTDWorm/Flea/Tick - Not UTD due to gastro issuesPhysical Examination:General appearance (demeanour, gait): BAR, mildly anxious in consult. Generalised cachexia. Normal synchronous gait. Body Weight: 4.8kgMM: Mildly pale   CRT <2:	HR:108bpm	RR: 24	 	Temp: 37.7	BCS:   3/9Ears: L ear clean, pink, dry with no discharge or inflammation observed. R ear relatively clean, pink some ceruminous discharge.Eyes:  Both eyes have cloudy appearance. Obvious vision and tear film. Normal appearance of 3rd eyelid and conjunctivaOral exam: mildly pale MM’s but well lubricated. C2/3, G0/3. Thoracic auscultation: Grade 5/6 left apical holosystolic heart murmur. Normal bronchovesicular sounds. No crackles or wheezes. Pulse synchronous with heart beats.Abdominal palpation: Abdomen is soft, slightly rounded and tense but non-painful on deep palpation with no palpable masses or organomegaly. No fluid wave or discomfort noted during the examination.Urogenital: External genitalia appear normal with no discharge, swelling, or irritation.Integument: Several subcutaneous masses (L sternum, R flank and 2 on abdomen) - soft, rubbery and mobile.  Poor hair coat with patches of alopecia on the abdomen and forelimbs. No skin inflammation or lesions.Lymph nodes: Submandibular, prescapular and popliteal lymph nodes soft, mobile and normal size.Musculoskeletal: Normal gait. Muscles symmetrical. Generalised cachexia observed with loss of coverage around spine, sternum and ribs. Full ROM of all limbs. Nervous system: Normal mentation, clear intact vision pathways, normal balance, scent and ability to swallow. Full exam not performed. Rectal: Not performedPain score: 3/24Diagnostics: TFAST - clear lungs with no fluid observed. No B lines present and normal glide sign observed bilaterally.Problem List:1. Vomiting - GIT (IBD, colitis, neoplasia) vs hepatic/gall bladder vs pancreatic vs renal2. Chronic Cough - Throaty and non producing.3. Left systolic grade 5/6 cardiac murmurMMVD - recheck with cardiologist recommended4. CKD iris stage IIAssessment: Manny has presented today for V+, inappetance and increased severity of chronic cough (mainly at night). Upon physical examination Manny appears BAR and non-painful. Cough is still non-producing and is spontaneous as well stimulated by pressure applied to the abdomen/thorax. According to O the cough has progressed to be worse at night time. Obvious 5/6 murmur auscultated with palpable thrill in consultation. No diagnostics were run to assess CKD and no thoracic radiographs performed. Previous D+ has been managed. O main concern was to get Manny back to eating and will follow up on comorbidities in internal medicine consult later in the week.Treatments:- 0.1mg/kg Butorphanol SC- 0.5mg/kg Ondansetron SCPlan: Owner to call in tomorrow if concerned or Manny is still inappetent.To continue all current medications.Manny will be seeing a cardiologist on 16/03/2026Owner communication (including estimate):Provided owner with the option of repeat blood test to assess whether his renal values have worsened. Gave them the option of keeping Manny in hospital overnight, keep him comfortable and monitor him and transfer to IM tomorrow. Owner declined this option as her main goal was to get medications that would potentially improve his appetite. Explained the medications given to owner. Owner happy to take Manny back home and monitor his progress.Advised owner to call up in the morning if Manny is still inappetant, or there are still concerns.Referral veterinarian communication:Ref Vet Communication issued: (Yes or No)    Vital Signs