C10009883 / invoice 10000

Reason: Elevated Enzymes, Enlarged LiverAppointment Notes: 3 sms sent called for hx AHS 09.03Notes: GLDRAFTHistory: Echo is presenting for elevated liver enzymes (ALT 447, ALKP 995, GGT 24) and a mildly enlarged, hyperechoic, heterogenous liver on ultrasound on 24/02/26. There was also mild bilateral medial iliac lymphadenopathy and duodenal lymphadenopathy.Today, OR PD, but has reduced to normal since RV visit in Feb.Also panting even when not hot. O unsure if PU, but reports she can hold urine all day. has always had lots of small poo, and intermittent soft stool ( O unsure if anything precludes it, perhaps after dairy)Hair has not grown back since October lumpectomyAround time of recent accident was pollakiuric while on the walk. Not licking at vulva. Appetite has increased, O unsure if because she is excited to eat cottage cheese.No head-pressing or other behavioural changes noted.Diet: raw fed; sweet potato, pumpkin, celery, cucumber, chicken mince and foot, wings. Hemp, coconut oil, msm and health powder. Occasional human food- Crataeva supplement for urinary supportProphylaxis: Fleedom naturopathic supplement.Other Hx:- trichoblastoma removed 2024- incontinence since speyed - well managed but 4wk ago had accident - uroliths - O unsure if urea or struvite, hasn't had in several years (infrequent UA to check, but most recent in October was nil)- yeast dermatits in skin - had fungus allergies, dairy, and chicken Examination Findings:T: C                 MM: Pink, moistP: bpm             CRT: 1-2sR: bpmDemeanour: BARHydration: EuhydratedWeight:  22.9kg Body condition score: /9Muscle condition score: /3. Cardiovascular: WNLRespiratory: WNLAbdomen: WNLPeripheral LNs: WNLOcular: WNLEars: WNLIntegument: large region on R flank previously clipped in October.Oral exam: P4s absentMusculoskeletal: WNLGait: WNLNeurological: Full exam not performed. Mentation appropriate. No overt dysfunction. Rectal: NPTreatment: 0.3mg/kg butorphanol IM10mcg/kg medetomidine IMUltrasound Report: Assessment: Problem List:1.2.3.Client Communication: JFT discussed differentials for hepatopathy (Cu hepatopathy, acquired PSS, reactive hepatopathy, vacuolar hepatopathy, Cushings)    Vital Signs