C10007193 / invoice 10000

History:
Straining to urinate at home
O saw pink tinges urine at home

Examination:
BAR
Pink MM
CRT <2
LN wnl
tense abdomen
small bladder - confirmed on U/S as unable to get a urine sample
Bladder wall thickening

Assessment:
FLUTD non obstructed

Treatment:
Buprenorphine 0.3ml SC

TGH with bupe 0.12mg TD and gabapentin 100mg po bid

Plan:
O goes away for 1 month tomorrow
Dispensed extra gabapentin for this whilst Os partner looks after Titus
Sent home with FLUTD handout and discussed preventative care
Start urinary diet

ABDOMINAL ULTRASOUND'
- performed by AWO, supervised by SZ

- the urinary bladder is normal in shape, has a normal thin regular wall and contains anechoic fluid. No obvious signs of urolith. wall thickness = 1mm
- the spleen is normal in shape, it has a normal, regular, mildly hyperechoic soft tissue echogenciity
- the liver is normal in size and echogenicity with sharp borders and normal vascular pattern
- the gal bladder is a normal size and shape with thin, sharply echoic wall and contains anechoic  bile

- the left and right kidneys are similar in appearance with normal in size and shape with normal corticomedullary distinction and absence of renal pelvic dilation
L: 45.5mm, R: 40.2 --> cat kidneys (37-44 mm in length)
- the adrenal glands are normal in size and shape with normal hypoechoic echogenicity
- L = 0.24cm; R = 0.27cm
- the stomach is empty. There are normal rugal folds. 
- the duodenum can be traced from the pylorus caudally. It's lumen is empty, there is normal wall layering. The pancreas is not evident, there are no visable masses present in this area
duodenum:2.4mm  ; jejunum: 2.6mm; Ileum = 2.3mm
Norms for cat:  duodenum 2.0-2.4 mm, jejeunum 2.1-2.5 mm, ileum 2.5=3.2 mm

- there is no free abdominal fluid
- there is no evidence of mesenteric inflammation or lymphadenopathy
ICCJ LN = 2.2mm; jejunal LN= 3.0mm (LNs are very close together and relatively long, most likely normal finding in young cat) 

COMMENTS
- unremarkable abdomen on ultrasound
- cystocentesis performed at the end of ultrasound. clear urine aspirated 

DIAGNOSTICS
CBC, Biochem - WNL
Lytes - very slight hypokalaemia
Urinalysis
- USG 1.008
- no bacteria/ crystal noted

SUBJECTIVE: 
Presented for urinating blood. Taken to vet last few days and been on NSAId. This morning passing urine which is red and pink. Keeps going to litter box and passing less amounts of urine. Tried to get fluids into him. Feeding wet food.  On Zylkene. Generally a non anxious cat.
There are two other cats who are outdoors. Does try to go up to them to make friends.  Generally try to keep them apart.
 
Reg vet is Montmorency. Went to Eltham vet at same branch yesterday. Were given beads to collect a urine sample but have not been able to at home.. Could not collect urine sample.
OBJECTIVE: 
HR 180 MM pink CRT < 2sec
Abdomen palpation- bladder is small and soft.
ASSESSMENT: 
FLUTS unobstructed. Needs  full urinalysis, abdominal imaging and meds.
DIAGNOSTIC PLAN:
TBFP, Ultrasound and Urinalysis.
THERAPY: 
0730: Methadone 0.3 mg/kg IM.
CLIENT COMMUNICATION: 
Discussed with owner further workup will involve, abdominal imaging, full bloods and urinalysis. As bladder s empty at the moment, recommend admit to do all the above.
Owner consents to further workup and estimate.