C10005804 / invoice 10000

Date insurance claim completed:
Date/s of treatment:
Have all previous vet visits been claimed (check file) Y/N:
Is this a GAP claim?:
If so, benefit amount that insurance is covering: $
Sent via: Petsure vethub

3 days V+ bile 

HISTORY - OR for the last 3 days in a row, has V+ once yellow bile with some well-digested food. Every day has been between 12-3pm. 
Otherwise no other changes, good appetite, no D+, normal drinking and urinating. 
Normal energy and BAR in herself, no lethargy. 
No recent diet changes, no indiscretion, no toxin exposure known about. 
Hx of ongoing marked chronic liver disease - no change in meds protocol 

DIET: L/d diet - unchanged, v strict minimal treats
CURRENT MEDICATIONS: Hepatoadvanced, vit K, liver diet + Keppra 62.5mg PO BID

EXAM - 
Temperament: BAR, no weight loss
BCS  5/9
MMs: pink + moist, CRT 1.5s, no skin tent, euhyrated, eyes bright 
Dentition: Grade  2/4
Lymph nodes: NAD 
Eyes: NAD
Ears: NAD
Skin: NAD
Heart/lungs ausc: HR 112 RR 28 no murmur or arrhythmia, peripheral pulses strong and synchronous 
Abdominal palpation: wnls, mildly tense throughout abdo palp but no repeatable reaction to cranial or caudal, suspect mnore behavioural. No evidence of nausea or pain, no lip-licking or arched posture 
Rectal exam: not performed
Musculoskeletal system: NAD
Temperature: 38.4

New SC mass on RF cranial shoulder - OR been there for 4-6m, not sure will want to put her through any invx. Offered FNA cytology today, O opted to monitor, will check another time

ASSESSMENT -  

- Short hx of once-daily bilious vomiting, clinically otherwise well 
--> concern re indicative of hepatic deterioration vs secondary pancreatitis vs unrelated primary GIT cause eg distary indscretion, viral, parasitic, inflamm, other 

Discussed with O - offered full bloods to reassess liver markers and check for evidence of deterioration, inflamm etc. Vs tx supportively. 
O opted with supportive tx initially, will bring back for reassessment asap if not responding. 

TREATMENT - 
- 1mg/kg maropitant given SC in scruff 
- Disp ongoing 2mg/kg maropitant PO SID for 2-4 days further
- Continue on current diet and liver meds 

PLAN - 
-- Os going away, Zoe with daughter, will bring back if ongoing V+ despite maropitant or if recurs when meds finished 
- If fails to improve - full bloods next step 
- Keppra 250mg WP completed and hard copy given to O 

PHONE CALL - GH spoke to Jode re: Zoe's seizuring monitoring reminder, wondering how essential the appt was mid-Dec
- advised it can be around 6-7m after the last one so Dec/Jan/Feb is fine - O will book after Christmas as dog doing v well