C10010687 / invoice 10000

STOdoing well at homeEDU okno F since D+ on Saturday arfternoonbright at homePlan: recheck this afternoon if any regressionotherwise Tuesday

Reason: recheckHistory: seen yesterday for poss FB/GEbloods normal and no overt FB in radsdid have gas in distal and ascending colonbloods all WNLEDU ok overnightD+ orangeno haematochezia or melenano V+Examine: BAReating chicken treats with gustomm=pink CRT<2abdo soft smooth no lumps or FB feltchest NADHR =116T=39.6Assessment: bright and eating no V+pyrexic!concern low grade pancreatitis or infectious agentPlan: continue blandsadd metonidzole and probioticrecheck Monday

History:Has been off food: Didn't eat at all yesterday, still not interested this morning.Usually very food motivated.Usual diet: Grainfree kibble + Prime 100 roll.Ate small amount cheese today.Seems weak, quiet & not herself.No V+.Last stool: Unsure, 2dd ago picked up 2 poos in the garden - normal.No change in diet. Can be a known scavenger & will chew socks/undies etc. Not known to actually swallow FB's.Meds: None UTD vaccines. Drank water this morning fine.No known access to any toxins.Examine:1. Demeanour: QAR - subdued & quiet2. Vitals: HR = 126 RR = 36 MM = pink moist CRT <2s. Temp = 40.03. Body condition: Bcs 3/54. Auscultation: Normal - no audible murmur or arrhythmia. Normal bronchovesicular sounds on lung auscultation in all 4 quadrants.5. Oral cavity: Grade 1-2 dental plaque/tartar generally. Nil oral lesions or lacerations. Ptyalism +++6. Eyes: NAD7. Ears: NAD8. Skin: NAD9. Abdomen: Very tense & guarded, esp mid to caudal abdomen, turning head & looking at me with wary eyes (as if painful). No palpable thickening or palpable obstruction (but due to tenseness is difficult to perform deep palpation). No fluid wave or area of disocmfort.10. Peripheral LN's: NAD11. Perianal area: NADAssessment:1. Pyrexia of unknown origin: DDx = infectious, inflammatory, neoplastic, immune-mediated, pain, other...Anorexia, lethargy, pyrexia: Open diagnosis- Need to rule in/out obtstruction.- Other DDx = brewing GI disease, pancreatitis, systemic illness, neoplasia/immune-mediated (less likely), other...Rx admit for bloods & Xrays. est $1200.Laboratory: Bloods- Mild leukocytosis due to a mild neutrophilia & monocytosis- Mild hyperglobulinaemia 46 (25-45)- Rest WNLImaging:IVC placed L cephalic.Sedation: Methadone 0.4mL + Medetomidine 0.1mL IV.Lateral & DV views abdo performed:- SI appears healthy, no gas distension present, no obvious obstructive disease/pattern.- Ascending colon, caecum, transverse & descending colon distended with gas. Possible soft tissue opacity present in the acsending colon (looks linear, striated).- Stomach looks empty.- Otherwise appears WNL.Overall, there is not a convincing obstructive gas pattern in the SI to rule in a FB obstruction.There is the possibility that there is a partial obstruction in the ascending colon, however we would expect it to pass if it has reached this point.There is still a possibility that Marley may have pancreatitis and/or another form of systemic illness not identifiable on in-house bloods or xrays.Discussion with owner: RB called Emma & relayed all of above - gave options:1) Referral overnight on IVF, supportive care + further workup (abdo U/s etc).2) Above, but here at SV (made O aware nobody here overnight).3) Home with supportive care, recheck tomorrow.O elected option 3.Treatment:Started on IVF Hartmans 75mL/hr (5% defict replacement over first 6h).Maropitant 1.9mL IV @ 2:30pm.Methadone given IV at 1:30pm with sedation.Bup to be given at 5:30pm 0.4mL IM.T 38.7 @6:40pm prior to dischargeBARurinated in cagePlan:1. O to give Paracetamol 250mg PO BID starting this evening.2. Offer bland low fat food QID in small frequent meals from this evening.3. Recheck tomorrow with MB for temp check, abdo palpation +/- rpt Xray if concerned.