C10009133 / invoice 10000

Weight (Kg):7.10
History:History:
• Presented for an end-of-life discussion.
• Chronic history of gastrointestinal disease and liver disease managed with long-term corticosteroids.
• Acute decompensation began approximately 2.5 weeks ago (c. Feb 23, 2026) with the owner noting the sudden onset of icterus.
• Multiple recent hospitalizations at an emergency centre (ARH).
• During hospitalization, the patient had a reaction to a plasma transfusion and subsequently received a blood transfusion. A liver biopsy was also performed.
• Significant recent weight loss noted by the owner.
• Inappetence for the past two days.
• Marked decrease in mobility; unable to jump onto furniture.
• Owner has observed some circling behaviour at home.

Physical Examination:

Unless otherwise stated - examination normal
Weight: 8.7 kg
MM and CRT: Icteric mucous membranes
HR and rhythm:
Abdominal palpation:
Ears/Eyes/Nose: Marked scleral icterus
Mouth/Dental:
Skin and Coat: Generalized icterus evident on the skin
Limbs/gait: Ambulatory but weak
Other: Severe generalized muscle atrophy, particularly over the back

Other Relevant Clinical Findings:
• The owner reports the patient has been on numerous oral medications (10 pills per day) which have been difficult to administer.

Pathology Testing:
• Liver biopsy (histopathology from ARH): Results consistent with granulomatous hepatitis with marked bridging fibrosis.

Assessment/Summary
:
• End-stage liver failure secondary to chronic granulomatous hepatitis and fibrosis, likely exacerbated by long-term corticosteroid use.
• Presenting with severe hyperbilirubinemia (icterus), coagulopathy, cachexia, and anorexia.
• Suspected early signs of hepatic encephalopathy (circling).
• Quality of life is considered poor with a grave prognosis.

Plan and Treatments:

• After discussion with the owners, the decision was made for humane euthanasia.
• Sedated with 0.5 mL zolazepam/tiletamine (Zolitel) administered intramuscularly.
• Euthanized with 3 mL pentobarbital administered intravenously. The process was reported as quick and peaceful.
• Owners have elected for private cremation with ashes to be returned in a scatter box.
• Paw prints are to be made for the owners.

Need for a recheck and if so, when?
• Not applicable.
DH