C10007098 / invoice 10000

Reason: Vomiting, LethargicHistory:- Presented for vomiting starting at approximately 02:00 this morning.- Approximately 10 vomits throughout the day.- Owner is a veterinary nurse and took him to her clinic for assessment.- Described as flat and not his normal self.- Ingestion of nappy absorbent material occurred over one week ago. He has passed nappy material and stools have been normal- Owner's primary concern is his significant lethargy and that something is not right.- Stool passed today was softer than normal with some grass present- Initial vomitus at 02:00 was active retching, subsequent episodes have been more passive regurgitation of clear, foamy saliva/bile.- No coughing or sneezing.- Diet is Hills Science Diet Mature. No recent diet changes, new foods, or new treats. The other dog in the household is well.Prior investigations:- Bloodwork and abdominal radiographs performed at primary care veterinarian today (08/03/2026).- Bloodwork was reportedly normal except for a significantly elevated amylase.- Radiographs were suspicious, showing intestinal wall thickening and gas, but no obvious foreign body was identified. The full images are not available for review.PPH:- Grade 2-3/6 left systolic heart murmur identified last year.- Echocardiogram performed with RW diagnosed mild subaortic stenosis, currently not causing clinical issues.- Owner describes him as generally having a "stomach of steel" with no previous history of gastrointestinal issues, diet change sensitivities, intermittent vomiting, or soft stools.Current Medications:- Maropitant given earlier today at primary care veterinarian.- Has not vomited since the maropitant administration but remains inappetent and is drooling.Objective:T38.2 P88 R28 Wt 41.7GEN: BARH, mm:pk/moist, crt: 1-2sEYES- cornea, anterior chamber clear OU. No ocular discharge.NOSE- no dischargeMOUTH- No masses or ulcers. PtyalismINTEG: Full hair coat.CV: II/VI LASM, no arrhythmias ausculted. Femoral pulses strong, synchronous, symmetrical.RESP: Clear lung sounds in all fields.ABD: Soft abdomen. Mild discomfort on very deep palpation, but otherwise comfortable. No masses/organomegaly noted. MS: No overt lameness, muscling symmetric and appropriateLN: Mandibular, prescapular, and popliteal lymph nodes are soft, symmetrical and normal in sizeNEURO: Appropriate mentation. Menace response and palpebral reflex intact OU. No ataxia noted.Imaging:POCUS: no abdominal or thoracic effusion noted. AFAST limited by patient size/conformation (deep chested)Assessment:Nausea, inappetence - r/o pancreatitis, foreign body (possible partial obstruction), neoplasia, otherPlan:To follow up with GP 9/3 if not betterFurther diagnostics may include cortisol, serial rads (incl esophagus), CT scan, etcCOMMUNICATIONS:Clinical update:- Currently BAR, well-hydrated, and vital signs are stable. Treatment options discussed:- Potential causes discussed include pancreatitis, gastrointestinal foreign body (partial obstruction), or more sinister causes like neoplasia. The elevated amylase is non-specific.- Option 1 (Elected by owner): Perform a point-of-care ultrasound tonight to screen for free fluid or other major abnormalities. If stable and POCUS is unremarkable, discharge with oral anti-nausea medication (Ondansetron) and analgesia (Paracetamol) for at-home monitoring. Plan to repeat bloodwork and potentially radiographs with their primary care veterinarian tomorrow.- Option 2: Hospitalisation for intravenous fluids, monitoring, and repeat imaging in the morning.- Option 3: If not improving with supportive care, a CT scan is the recommended advanced imaging modality over an abdominal ultrasound due to his size. This would ideally be performed on a weekday for immediate access to specialist interpretation and surgical intervention if required, but can be done over the weekend if necessary.Financial Update:- Discussed cost of POCUS is approximately $280.- Discussed cost of a blood gas is approximately $200. Owner declined as they plan to repeat bloods at their clinic tomorrow.- Discussed cost of overnight hospitalisation with a POCUS is approximately $2000.After POCUS, discussed findings. O happy to take home, will return tonight if deteriorates    Vital Signs